Rheumatoid Nodule
Rheumatic Nodule
Arthritis, Rheumatoid
Chimerism
Rheumatoid Factor
Leprosy, Lepromatous
Association of oestrogen receptor gene polymorphisms with age at onset of rheumatoid arthritis. (1/70)
OBJECTIVE: In view of the possible role of oestrogens in the pathogenesis of rheumatoid arthritis (RA), this study investigated the association between oestrogen receptor (OR) gene polymorphisms and RA. METHODS: Pvu II and Xba I restriction fragment length polymorphisms of the OR gene were analysed in 70 male and 240 female patients with RA, and in 300 male and 350 female controls. The absence or presence of restriction sites were represented as P, p (Pvu II) or X, x (Xba I). The distribution of OR genotypes was compared between the RA and control subjects by sex. RA patients were divided into subgroups according to their OR genotypes, then the age at onset, seropositivity, and rheumatoid nodule positivity were compared between the subgroups. RESULTS: The OR genotype frequency of distribution did not have significant differences between the male RA and male controls nor between the female RA and female controls. In women with RA, there was a significant difference of age at onset between the subgroups (uncorrected p = 0.047, corrected p = 0.94). Female patients with the OR genotype PPxx (homozygote of Px) tended to have developed RA at a younger age, whereas those with PPXX and ppxx (lack of Px haplotype) developed RA at an older age. In men with RA, there was no association between the OR genotype and age at onset. In seropositivity and rheumatoid nodule positivity, there was no significant difference between subgroups for either sex. CONCLUSIONS: Some variants of the OR gene are related to the onset of RA in women in certain age periods, suggesting the role of the interaction between the OR gene and serum concentrations of oestrogen at the onset of the disease. (+info)Extra-articular features in early rheumatoid disease. (2/70)
One hundred and two patients who presented with rheumatoid disease within the first year of onset were studied prospectively every four months for a mean 4.5 years to assess the incidence of extra-articular features. The features that seemed to be common in the early stages included hand-muscle wasting, carpal tunnel syndrome, lymphadenopathy, non-specific ankle swelling, and rheumatoid nodules, and to a lesser extent hepatomegaly, being underweight, conjunctivitis, skin transparency, and a palpable thyroid gland. Those features which seldom occurred early included scleromalacia, temporal artery inolvement, salivary gland enlargement, distal-motor neuropathy, splenomegaly, digital vasculitis, and pulmonary and cardiac complications. Being underweight indicated a significantly more severe outcome. (+info)Effect of penicillamine therapy on circulating immune complexes in rheumatoid arthritis. (3/70)
The sera of 40 patients with severe progressive rheumatoid arthritis were examined for the presence of soluble immune complexes before penicillamine therapy was started, and again after treatment for a mean period of 14-4 months. The methods used were radiobioassay (macrophage uptake), C1q-binding capacity, and precipitation by 4% polyethylene glycol. Before treatment the sera of 37 patients showed significantly enhanced uptake of 125I-labelled aggregated human IgG by guinea pig macrophages. Treatment produced significant falls in mean erythrocyte sedimentation rate, differential agglutination titre, and serum IgG and IgM levels, and enhancing complexes (EC) decreased or disappeared in 20 patients. In 9 patients EC changed to inhibiting complexes, and in 8 EC levels were unchanged. In 6 of 8 patients with cutaneous vasculitis initially, both lesions and EC disappeared. The total protein and the IgG and IgM precipitated from patients' sera by 4% polyethylene glycol fell significantly on treatment. Antinuclear antibody titres were unchanged by penicillamine, and 3 patients acquired these antibodies during treatment. These findings suggest that penicillamine treatment in rheumatoid arthritis reduces the level of circulating soluble immune complexes in which IgM rheumatoid factor is a component. (+info)The forgotten nodule: complications of sacral nodules in rheumatoid arthritis. (4/70)
Nodules commonly occur in rheumatoid arthritis and occasionally give rise to complications. The sacral nodule is easily missed and may ulcerate to produce extensive sacral sores which may lead to serious and even fatal complications in patients with rheumatoid arthritis. Seven cases are reported which illustrate some of these features. (+info)Aortic valve incompetence and replacement in rheumatoid arthritis. (5/70)
Five cases of aortic incompetence and nodular seropositive rheumatoid arthritis are presented. Four cases underwent aortic valve replacement. Two of these had granulomatous involvement of the aortic cusps similar to subcutaneous rheumatoid nodules, and another showed a nonspecific fibrosis. One case had definite coincidental rheumatic aortic and mitral heart disease. Two patients had undergone pericardectomy previously for constrictive pericarditis. Good results were obtained in all four operated cases and cardiac surgery enabled continuation of rehabilitation for the rheumatoid arthritis, including major orthopaedic procedures. A review of 22 cases from the literature with rheumatoid granulomata within the aortic valve shows that they are associated with mitral valve granulomata in 63-6%. Congestive cardiac failure was found in 75%. Macroscopical evidence of aortic incompetence was seen in 36-8% and of aortic stenosis in 15-8%. Associated pericarditis occurred in 59-1%, which was severe or complicated in 13.6%. The associated arthritis was severe in 77-8% with subcutaneous nodules (71-5%), rheumatoid factor (83-6%), and episcleritis (66-6%). From these cases and a review of the literature the following points are emphasized. (1) Both the granulomatous and nonspecific aortic valvulitis of rheumatoid arthritis may result in significant haemodynamic abnormality. (2) The valve lesions found are often clinically and macroscopically indistinguishable from rheumatic valve lesions. (3) Granulomata, when present, are usually found in the valve cusp or ring and only occasionally in the aortic wall. (4) Associated joint disease, although usually severe, may be mild. (5) The valve lesion may be accompanied by a severe pericardial involvement--either tamponade or constriction. (6) Aortic valve replacement for aortic incompetence in rheumatoid arthritis is both feasible and worthwile, despite severe joint disease. (+info)Cell death by apoptosis is a feature of the rheumatoid nodule. (6/70)
OBJECTIVE: To examine the site and extent of apoptosis in the rheumatoid nodule and to determine whether this process make a significant contribution to the control of inflammation in the rheumatoid nodule as in other granulomas. METHODS: Nine nodules and seven synovial membranes were examined by terminal deoxynucleotidyl transferase-mediated nick end labelling (TUNEL) in situ and a subset was further examined by DNA electrophoresis. The phenotype of apoptotic cells was identified using monoclonal antibodies and immunohistology. RESULTS: Apoptosis occurred in all zones of the nodule and, except in one case, was not focused adjacent to the necrotic centre. Apoptosis occurred in 3.5 (4.5)% (mean (SD)) of cells in the nodule and 3.6 (3.1)% of cells in synovial membranes. Apoptosis was more common in nodule T cells (4.1 (2.9)%) than fibroblasts (1.0 (1.4)%), p = 0.01. Among macrophages 3.2 (4.7)% were apoptotic. Banding of DNA consistent with apoptosis was seen in two of three nodules examined. CONCLUSION: Apoptosis occurs at a low level in the nodule, similar to the synovial membrane. The results suggest that two modes of cell death occur in the nodule: apoptosis, which occurs throughout the nodule; and necrosis, which is concentrated near the necrotic centre. Apoptosis was more common in infiltrating inflammatory cells than in resident fibroblasts. These results are consistent with the proposal that apoptosis of infiltrating inflammatory cells is important in controlling accumulation of cells in the rheumatoid nodule as has been established in experimental granulomas. (+info)Cytokine profile of the rheumatoid nodule suggests that it is a Th1 granuloma. (7/70)
OBJECTIVE: To define the cytokine profile within rheumatoid subcutaneous nodules, and to determine whether the destructive inflammatory process in this lesion displays features of a lymphocyte-driven Th1 or Th2 granuloma. METHODS: Subcutaneous nodules excised from 10 patients with rheumatoid arthritis were examined. Transcripts for interleukin 1beta (IL-1beta) IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, IL-15, IL-18, and for tumor necrosis factor alpha (TNFalpha) and interferon-gamma (IFNgamma) were detected by reverse transcription-polymerase chain reaction of extracted RNA. RESULTS: Nine of 10 nodules contained transcripts for IFNgamma. We observed no evidence for the expression of IL-2, IL-4, or IL-5 among the lymphokine genes analyzed. Transcripts for TNFalpha, IL-1beta, IL-10, IL-15, and IL-18 were present in all 10 nodules. Transcripts for IL-12 were present in all but one nodule. Expression of IL-13 messenger RNA was observed in only 5 nodules. CONCLUSION: The cytokine profile within the rheumatoid nodule (i.e., presence of IFNgamma but not IL-2, and prominent expression of IL-1beta and TNFalpha together with IL-12, IL-18, IL-15, and IL-10) is similar to the profile of cytokines in the synovial lesion of rheumatoid arthritis, which is generally accepted as being attributable to a Th1-mediated inflammatory mechanism. Our results suggest that damage to affected synovial membrane or subcutaneous tissue is caused by the same inflammatory mechanisms, and that the nodule is a Th1 granuloma. (+info)Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. (8/70)
OBJECTIVE: To investigate the trends in incidence of extra-articular rheumatoid arthritis (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine possible predictors of ExRA occurrence. METHODS: Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 609 cases of RA in Olmsted County, MN, diagnosed during 1955-94. These cases had been previously classified using the ACR 1987 criteria for RA. Patients were followed up from 1955 to 2000 (median follow up 11.8 years; range 0.1-42.8), and incident ExRA manifestations were recorded according to predefined criteria. Time to first presentation of ExRA was compared in patients with RA by decade of diagnosis. Possible ExRA risk factors were identified in case record reviews. RESULTS: ExRA occurred in 247 patients (40.6%). A subgroup of 78 patients (12.8%) had ExRA manifestations considered to be severe in a previous study from Malmo, Sweden. The incidence of severe ExRA did not change significantly over the decades (p=0.165). In a multivariate analysis the main predictors of severe ExRA were smoking at RA diagnosis (risk ratio (RR)=2.94; 95% confidence interval (95% CI) 1.68 to 5.13) and early disability (Steinbrocker class III-IV at diagnosis) (RR=2.45; 95% CI 1.51 to 4.00). The effect of smoking overwhelmed the weaker effect of rheumatoid factor seropositivity. CONCLUSION: There was no decrease in the incidence of extra-articular manifestations in patients with RA diagnosed up to 1995. Smoking and early disability are independent risk factors for extra-articular RA. (+info)A Rheumatoid nodule is defined as a type of non-suppurative inflammatory lesion that occurs in the subcutaneous tissue, commonly associated with rheumatoid arthritis (RA). These nodules are firm, round to oval shaped, and usually range from 0.5 to 5 cm in size. They are typically found over bony prominences such as the elbow, heel, or fingers, but can occur in various locations throughout the body.
Histologically, rheumatoid nodules are characterized by a central area of fibrinoid necrosis surrounded by palisading histiocytes and fibroblasts, with an outer layer of chronic inflammatory cells, including lymphocytes and plasma cells. Rheumatoid nodules can be asymptomatic or cause pain and discomfort, depending on their size and location. They are more common in patients with severe RA and are associated with a poorer prognosis.
A rheumatic nodule is not a specific medical definition, but rather a descriptive term for a type of nodule that can be found in certain medical conditions. These nodules are typically associated with rheumatoid arthritis (RA), although they can also occur in other diseases such as systemic lupus erythematosus (SLE) and dermatomyositis.
Rheumatic nodules are small, firm, round or oval-shaped lumps that develop under the skin or in certain organs such as the lungs. They can vary in size from a few millimeters to several centimeters in diameter. In RA, these nodules usually appear on the forearms, elbows, fingers, knees, and ankles, although they can occur in other areas of the body as well.
Histologically, rheumatic nodules are characterized by a central area of fibrinoid necrosis surrounded by palisading histiocytes and fibroblasts. They may also contain lymphocytes, plasma cells, and eosinophils. The presence of these nodules is thought to be related to the immune system's response to the underlying disease process, although their exact cause and significance are not fully understood.
It is important to note that rheumatic nodules can also occur in individuals without any known medical condition, and their presence does not necessarily indicate the presence of a specific disease. However, if you notice any new or unusual lumps or bumps on your body, it is always a good idea to consult with a healthcare professional for further evaluation and diagnosis.
A neuroma is not a specific type of tumor, but rather refers to a benign (non-cancerous) growth or swelling of nerve tissue. The most common type of neuroma is called a Morton's neuroma, which typically occurs between the third and fourth toes in the foot. It develops as a result of chronic irritation, compression, or trauma to the nerves leading to the toes, causing them to thicken and enlarge.
Morton's neuroma can cause symptoms such as pain, numbness, tingling, or burning sensations in the affected area. Treatment options for Morton's neuroma may include rest, ice, orthotics, physical therapy, medication, or in some cases, surgery. It is essential to consult a healthcare professional if you suspect you have a neuroma or are experiencing related symptoms.
Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the joints. It is characterized by persistent inflammation, synovial hyperplasia, and subsequent damage to the articular cartilage and bone. The immune system mistakenly attacks the body's own tissues, specifically targeting the synovial membrane lining the joint capsule. This results in swelling, pain, warmth, and stiffness in affected joints, often most severely in the hands and feet.
RA can also have extra-articular manifestations, affecting other organs such as the lungs, heart, skin, eyes, and blood vessels. The exact cause of RA remains unknown, but it is believed to involve a complex interplay between genetic susceptibility and environmental triggers. Early diagnosis and treatment are crucial in managing rheumatoid arthritis to prevent joint damage, disability, and systemic complications.
Chimerism is a medical term that refers to the presence of genetically distinct cell populations within an individual. This phenomenon can occur naturally or as a result of a medical procedure such as a stem cell transplant. In natural chimerism, an individual may have cells with different genetic compositions due to events that occurred during embryonic development, such as the fusion of two fertilized eggs (also known as "twinning") or the exchange of cells between twins in utero.
In the context of a stem cell transplant, chimerism can occur when a donor's stem cells engraft and begin to produce new blood cells in the recipient's body. This can result in the presence of both the recipient's own cells and the donor's cells in the recipient's body. The degree of chimerism can vary, with some individuals showing complete chimerism (where all blood cells are derived from the donor) or mixed chimerism (where both the recipient's and donor's cells coexist).
Monitoring chimerism levels is important in stem cell transplantation to assess the success of the procedure and to detect any potential signs of graft rejection or relapse of the original disease.
Rheumatoid factor (RF) is an autoantibody, specifically an immunoglobulin M (IgM) antibody, that can be detected in the blood serum of some people with rheumatoid arthritis (RA), other inflammatory conditions, and infectious diseases. RF targets the Fc portion of IgG, leading to immune complex formation and subsequent inflammation, which contributes to the pathogenesis of RA. However, not all patients with RA test positive for RF, and its presence does not necessarily confirm a diagnosis of RA. Other conditions can also lead to elevated RF levels, such as infections, liver diseases, and certain malignancies. Therefore, the interpretation of RF results should be considered alongside other clinical, laboratory, and imaging findings for an accurate diagnosis and appropriate management.
Lepromatous leprosy is a type of leprosy, a chronic infectious disease caused by the bacterium Mycobacterium leprae. In this form of the disease, there is a widespread and diffuse involvement of the skin, mucous membranes, and peripheral nerves. The bacteria multiply slowly and spread to the skin, upper respiratory tract, and peripheral nerves.
In lepromatous leprosy, the immune response is weak, allowing for extensive bacterial multiplication and widespread tissue damage. The skin lesions are typically numerous, pale, and have a smooth surface. Nerve involvement can lead to loss of sensation, muscle weakness, and deformities, particularly in the hands and feet.
Lepromatous leprosy is a more severe form of the disease compared to tuberculoid leprosy, which has a stronger immune response and localized skin lesions. Both forms of the disease are treatable with multidrug therapy (MDT), recommended by the World Health Organization (WHO) for all leprosy patients. Early diagnosis and treatment can prevent disability and reduce transmission.
The elbow is a joint formed by the articulation between the humerus bone of the upper arm and the radius and ulna bones of the forearm. It allows for flexion, extension, and rotation of the forearm. The medical definition of "elbow" refers to this specific anatomical structure and its associated functions in human anatomy.
Rheumatoid nodule - Wikipedia
A combined immunohistological and histochemical analysis of lymphocyte and macrophage subpopulations in the rheumatoid nodule
Multiple cutaneous nodules in a patient with rheumatoid arthritis - Indian Journal of Dermatology, Venereology and Leprology
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