Search

The authors outline a simple, progressive protocol for differential diagnosis of chronic wrist pain, followed by a similarly progressive set of treatment procedures. Between taking of medical history with care and the use of diagnostic technology such as scintigriphy, the protocols described might improve physicians' ability to treat the disorder.

Dexamethasone produces a sustained increase in interleukin 10 levels in patients with rheumatoid arthritis (RA). Researchers measured changes in immune factors induced by corticosteroid therapy for the autoimmune, inflammatory joint disease. In conjunction with a decrease in disease symptoms, dexamethasone caused interleukin 10 production to increase and interferon gamma levels to fall. Interleukin 4 levels fell slightly. These changes indicate an immune suppression.

Rheumatoid arthritis (RA) and hay fever may represent opposite extremes of T- cell activity, and modulation of immune responses may have a place in RA treatment strategies. Researchers performed immunological tests on 643 clinic patients, 12 of whom had hay fever. The rate of hay fever was 4% among RA patients and 8% among those without RA. RA patients with hay fever had less severe arthritis symptoms and increased T2 cell activity, indicating a potentially protective immunological state.

An imbalance in type 1 (T1) and type 2 (T2) T cell activities in the blood of patients with rheumatoid arthritis (RA) may be related to the severity of joint destruction resulting from the disease. Blood samples from 66 patients with RA, 19 patients with osteoarthritis, and 15 healthy individuals were assessed for T cell products associated with the two types of cells. Significantly higher amounts of T2 cell products and less T1 cell products were found in the patients with RA. The abnormal levels were connected to the amount of joint destruction observed.

The effect of sodium fluoride (NaF) on the bone mineral density (BMD) of the lumbar spine when added to etidronate seems superior to etidronate alone in some patients with osteoporosis. Forty patients with osteoporosis who were being treated with corticosteroids were given etidronate with NaF added or etidronate alone. After 2 years, the 20 patients taking the etidronate with NaF had a 9.3% increase in the BMD of the lumbar spine while the other 20 had only a 0.3% increase, a difference of 8.9%.

Interleukin-4 (IL-4), an immune response protein, may play a role in reducing inflammation and repairing cartilage damage possibly initiated by T helper-1 (Th1) cells in patients with rheumatoid arthritis (RA). Levels of proteoglycans, which are protein and sugar compounds in cartilage, are indicators of cartilage health. Researchers isolated synovial fluid mononuclear cells (SFMNC) from the knees of 15 patients with RA and knee cartilage samples from 8 cadavers. They studied the response of SFMNC to bacterial and IL-4 stimulation and measured the rates of proteoglycan production in the cartilage samples responding to IL-4 and SFMNC stimulation. In response to SFMNC stimulated by bacteria, proteoglycan production decreased by an average of 42% in 7 of the 10 cartilage samples. After adding IL-4 to these 7 samples, proteoglycan production increased up to 82%. These 7 samples also had elevated levels of Th1 indicators. There was no effect on proteoglycan production in samples mixed with unstimulated SFMNC.

Several guidelines have been suggested for determining the need for additional treatment with hormone replacement therapy or biphosphonates to prevent osteoporosis among patients treated with glucocorticoids. Baseline bone mineral density (BMD) measurements can be used to identify an immediate need for supplemental treatment and to track treatment progress. Patients most likely to need supplemental treatment include those with rheumatoid arthritis or asthma, who are at risk for falling, who take increased levels of glucocorticoids, or who have low BMDs. Healthy lifestyle choices should also be encouraged in treated patients.