Arthritis and Celiac Medline Abstracts (downloaded 22-May-1995) TI- Glutathione and glutathione-metabolizing enzymes in the erythrocytes of healthy children and in children with insulin-dependent diabetes mellitus, juvenile rheumatoid arthritis, coeliac disease and acute lymphoblastic leukaemia. AU- Stahlberg MR; Hietanen E CS- Department of Pediatrics, University of Turku, Finland. JN- Scand J Clin Lab Invest; 51 (2) p125-30 CP- ENGLAND PY- Apr 1991 AB- Oxidative biotransformation of xenobiotics and endogenous substances involves glutathione in reduced form as an integral component through two mechanisms: glutathione peroxidase catalysing the reduction of hydrogen peroxide and organic hydroperoxides, and glutathione-S-transferases catalysing the conjugation of oxygenated derivatives with glutathione. We studied glutathione and glutathione-related enzyme activities in haemolysed venous blood samples from 49 healthy children and from 11 children with diabetes mellitus, 10 children with rheumatoid arthritis, seven children with active coeliac disease, and seven children with acute lymphoblastic leukaemia. Among the healthy children glutathione content and the activities of glutathione reductase, glutathione peroxidase, and glutathione-S-transferase were unrelated to sex; age-dependent differences were also minor. The patients with diabetes mellitus had decreased activity of glutathione reductase. The patients with acute lymphoblastic leukaemia had increased activity of both glutathione peroxidase and glutathione-S-transferase, possibly reflecting an adaptive response to free-radicals. The patients with active coeliac disease had control levels of all measured parameters of glutathione-related reactions indicating, since we earlier found decreased activities of glutathione peroxidase in intestinal mucosa of celiacs, that blood may not always reflect tissue-specific changes. TI- HLA antigens in IgA deficient paediatric patients. AU- Klemola T; Savilahti E; Koskimies S; Pelkonen P CS- Children's Hospital, University of Helsinki, Finland. JN- Tissue Antigens; 32 (4) p218-23 CP- DENMARK PY- Oct 1988 AB- HLA antigens (A, B, C and DR loci) were studied in 62 IgA-deficient (IgAd) paediatric patients: 17 with coeliac disease (CD), 13 with juvenile arthritis (JA), 27 with frequent respiratory tract infections (RTI) and five with other diseases. The frequencies of HLA antigens in IgAd patients were compared with those in healthy blood donors, and in CD and JA patients with normal serum IgA levels. The IgA deficiency in the patients showed significant associations with HLA A1, B8, B13, Cw6, DR3 and DR7 (P less than 0.0005, P corr less than 0.02 vs controls) and decreased frequencies of DR2 (P less than 0.0005, P corr less than 0.02 vs controls). The HLA associations typical of coeliac disease, increased frequencies of HLA-B8 and DR3, were evident among the IgAd coeliacs; in contrast to the coeliacs with normal IgA levels, the IgAd coeliacs showed a significant increase of the HLA-Cw6 allele (P less than 0.0005, P corr less than 0.02 vs control coeliacs). Increased frequencies of HLA-A1, B8, B13, Cw6, DR3 and DR7 were noted in the patients with RTI, which can be explained by the frequent occurrence of the haplotypes A1, B8, DR3 and B13, DR7, the latter haplotype often also having the Cw6 allele. Among the IgAd JA patients, the antigen frequencies were similar to those in the JA patients with normal serum immunoglobulins. TI- Antibodies to Proteus in rheumatoid arthritis. AU- Rogers P; Hassan J; Bresnihan B; Feighery C; Whelan A JN- Br J Rheumatol; 27 Suppl 2 p90-4 CP- ENGLAND PY- 1988 AB- Increased levels of Proteus antibodies were found in patients with rheumatoid arthritis and coeliac disease, when compared to normal controls or patients with SLE and sarcoidosis. TI- Serum IgG subclass levels in paediatric clinic patients with variable degrees of IgA deficiency. AU- Klemola T; Seppala I; Savilahti E CS- Children's Hospital, University of Helsinki, Finland. JN- J Clin Lab Immunol; 25 (1) p29-34 CP- ITALY PY- Jan 1988 AB- We measured IgG subclass levels by radial immunodiffusion with polyclonal antisera in 60 patients with IgA deficiency. The low IgA levels were measured by a sensitive and specific enzymoimmunometric method. None of the patients had complete deficiency of IgG2, but 4 patients had serum levels of IgG2 and 4 of IgG3 below the range for controls. Elevated levels of IgG1 were found in patients with juvenile rheumatoid arthritis and coeliac disease. None of the patients with coeliac disease or juvenile rheumatoid arthritis had low IgG2 or IgG3 levels. The levels of IgG4 were highly variable but patients with coeliac disease had particularly high values. The severity of IgA deficiency did not correlate with the level of serum IgG2. TI- Gluten-sensitive enteropathy in childhood. AU- Auricchio S; Greco L; Troncone R CS- Department of Pediatrics, University of Naples, Italy. JN- Pediatr Clin North Am; 35 (1) p157-87 CP- UNITED STATES PY- Feb 1988 AB- Genetic and environmental factors (breast feeding, probably viral infections) play a role in the expression of the disease. Prevalence of GSE in childhood did not substantially decrease in the last 15 years in all European countries, where GSE is still more common in infantile age and presents frequently gastrointestinal symptoms. A decrease has been reported in childhood in several United Kingdom areas and in Finland, where the clinical presentation is changing, shifting upward with age and coming closer to the adult type of the disease. The following clinical problems have been reported in the recent literature: enamel hypoplasia; monosymptomatic short stature; arthritis and other immunologic diseases; association with diabetes, atopy, Iga deficiency, and probably Down's syndrome. Delay in puberty and other peculiar problems of the disease have been described in adolescents. Tests assessing the permeability of the small intestine and the blood levels of antigliadin antibodies have recently gained success as noninvasive tools for the diagnosis of the GSE. The gluten should be withdrawn from the diet and the challenge with gluten should be performed not before 12 months of gluten-free diet with an accurate timing of the biopsy on the basis of the antigliadin and antireticulin antibodies, to avoid clinical and growth damage. Celiac children do require a permanent gluten-free (and not poor) diet. In reality, too many celiac adolescents are off-diet. TI- Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients. AU- Jessurun J; Yardley JH; Giardiello FM; Hamilton SR; Bayless TM JN- Hum Pathol; 18 (8) p839-48 CP- UNITED STATES PY- Aug 1987 AB- The histopathologic features of collagenous colitis were studied in 14 women and one man. All but one patient presented with chronic watery diarrhea: 10 had a history of thyroid disease or unspecified arthritis. All 15 patients showed characteristic thickening of the subepithelial collagen layer (SCL) in colorectal biopsy specimens, but in the distal colorectum the thickening was sometimes absent or borderline. Patchy or diffuse injury to the surface epithelium was seen in all cases and was independent of SCL thickening. The injured surface epithelium was infiltrated by lymphocytes and variably by eosinophils and neutrophils, causing it to resemble the surface epithelial injury seen in the small intestine in celiac disease. Crypts were commonly infiltrated by lymphocytes but without associated epithelial injury. The lamina propria in all patients was expanded by lymphocytes, plasma cells, and eosinophils. Neutrophilic cryptitis was seen in seven patients but was usually sparse. Watery diarrhea abated in eight patients treated with corticosteroids or sulfasalazine and was often paralleled by restoration of surface epithelium, reduction in surface epithelial lymphocytes, diminished SCL thickening, and reduced lamina propria eosinophils. Therapy did not consistently alter other inflammatory changes. The possible role of autoimmunity in collagenous colitis should be investigated because of the following circumstantial evidence: the overwhelming female predominance; the frequent presence of possible immunologically mediated disorders such as thyroid and joint disease; the resemblance of surface epithelial changes to those in celiac disease; and the response to corticosteroids. TI- Autoimmunity in gastrointestinal diseases. AU- Shiner M JN- Arq Gastroenterol; 23 (2) p99-103 CP- BRAZIL PY- Apr-Jun 1986 AB- This article is an update on the importance of some gastrointestinal diseases such ulcerative colitis, coeliac disease and some types of diarrhoea, in preceding an autoimmune response. A correlation with autoimmune disease without digestive symptoms, is made (rheumatoid arthritis, Hashimoto's thyroiditis, ankylosing spondylitis, and so on). Recognising such interrelations should be followed by search of extradigestive symptoms of autoimmune gastrointestinal diseases, allowing a better understanding of the immunologic phenomena involved. TI- Overlap syndromes with sarcoidosis. AU- James DG; Sharma OP JN- Sarcoidosis; 2 (2) p116-21 CP- ITALY PY- Sep 1985 AB- It is hoped that readers of this article will make a note of any other disorders which occur in their patients with sarcoidosis. We shall welcome this list and the frequency with which other disorders coincide with sarcoidosis. TI- Circulating HLA-DR bearing T cells: correlation with genetic rather than clinical variables. AU- Clegg DO; Pincus SH; Zone JJ; Ward JR JN- J Rheumatol; 13 (5) p870-4 CP- CANADA PY- Oct 1986 AB- Elevated levels of circulating HLA-DR bearing (activated) T cells have been reported in a variety of conditions. The role played by these cells in the pathogenesis of disease is not established. We found elevated levels of activated T lymphocytes in patients with rheumatoid arthritis (RA), dermatitis herpetiformis, gluten sensitive enteropathy, as well as presumed healthy persons with HLA-B8 antigen. We could not show any change in the concentration of these cells with disease activity, therapy, or in a case of dermatitis herpetiformis, challenge with the presumed antigen, gluten. Our studies do not suggest an apparent causal relationship between activated T lymphocytes and the above disorders. TI- Studies of intestinal permeability in inflammatory diseases using polyethylene glycol 400. AU- Jenkins RT; Goodacre RL; Rooney PJ; Bienenstock J; Sivakumaran T; Walker WH JN- Clin Biochem; 19 (5) p298-302 CP- CANADA PY- Oct 1986 AB- It has been proposed that increased bowel permeability might play a role in the pathogenesis of inflammatory disease. Intestinal permeation was investigated by measuring the 6-hour urinary excretion of polyethylene glycol (PEG) 400 in 40 adult volunteer controls and in patients with inflammatory disease. Of the patients, 15 had Crohn's disease; 7, ulcerative colitis; 2, celiac disease; and 7, rheumatoid arthritis. No significant difference in total urinary excretion over a 6-hour period was found between controls and patients with ulcerative colitis. Patients with Crohn's disease, celiac disease, or with rheumatoid arthritis were found to have significantly decreased urinary excretion of PEG 400. The results of this study indicate that there is no identifiable increase in intestinal permeation as measured by PEG 400 excretion during periods of active inflammatory disease. TI- [A model and 3 examples for understanding HLA and diseases: cis and trans complementation of MHC class II in juvenile insulin-dependent diabetes, juvenile rheumatoid arthritis and celiac disease] TI- Un modele et trois exemples pour comprendre HLA et maladies: Cis et Trans associations moleculaires de classe II du CMH dans le diabete juvenile insulino-dependant, l'arthrite rhumatoide de l'enfant et la maladie coeliaque. AU- Charron D JN- Pathol Biol (Paris); 34 (6) p795-800 CP- FRANCE PY- Jun 1986 AB- The heterozygous effect observed for the HLA and disease association in insulin dependent diabetes, juvenile rheumatoid arthritis and coeliac disease is interpreted in the view of recent cellular and molecular data of MHC class II molecules demonstrating the existence of hybrid HLA DQ molecules and conformational determinants created by Trans (or Cis) complementation. It is postulated that unique determinants created de novo by such mechanisms represent the structural basis for the altered immune response leading to the pathogenesis of these auto-immune diseases. TI- Arthritis associated with gluten-sensitive enteropathy. AU- Pinals RS JN- J Rheumatol; 13 (1) p201-4 CP- CANADA PY- Feb 1986 AB- A 15-year-old girl, with synovitis of the knees and ankles for 3 years before a diagnosis of gluten-sensitive enteropathy, is described. The enteropathy was confirmed histologically and on the basis of a clinical response to a gluten-free diet. The arthritis also resolved promptly, suggesting that it was associated with the bowel disorder. TI- Arthritis and coeliac disease. AU- Bourne JT; Kumar P; Huskisson EC; Mageed R; Unsworth DJ; Wojtulewski JA JN- Ann Rheum Dis; 44 (9) p592-8 CP- ENGLAND PY- Sep 1985 AB- We report six patients with coeliac disease in whom arthritis was prominent at diagnosis and who improved with dietary therapy. Joint pain preceded diagnosis by up to three years in five patients and 15 years in one patient. Joints most commonly involved were lumbar spine, hips, and knees (four cases). In three cases there were no bowel symptoms. All were seronegative. X-rays were abnormal in two cases. HLA-type A1, B8, DR3 was present in five and B27 in two patients. Circulating immune complexes showed no consistent pattern before or after treatment. Coeliac disease was diagnosed in all patients by jejunal biopsy, and joint symptoms in all responded to a gluten-free diet. Gluten challenge (for up to three weeks) failed to provoke arthritis in three patients tested. In a separate study of 160 treated coeliac patients attending regular follow up no arthritis attributable to coeliac disease and no ankylosing spondylitis was identified, though in a control group of 100 patients with Crohn's disease the expected incidence of seronegative polyarthritis (23%) and ankylosing spondylitis (5%) was found (p less than 0.01). Arthritis appears to be a rare manifestation of coeliac disease. This relationship may provide important clues to the role of gastrointestinal antigens in rheumatic diseases. TI- Persistent and transient IgA deficiency in juvenile rheumatoid arthritis. AU- Pelkonen P; Savilahti E; Makela AL JN- Scand J Rheumatol; 12 (3) p273-9 CP- SWEDEN PY- 1983 AB- Twenty-five children with serum IgA levels of less than 0.1 g/l (below the 2.5% confidence limit at 2 years of age) were found among approximately 350 cases of juvenile rheumatoid arthritis (JRA). During follow-up, 10 of them proved to have persistent IgA deficiency, 13 were classified as having transient IgA deficiency, and 2 had consistently low serum IgA. Transient IgA deficiency occurred during treatment, in 9 cases with gold and in 2 with antimalarials. The gold-induced IgA deficiency usually developed abruptly soon after institution of gold therapy, and its duration varied from a few months (4 cases) to several years (3 cases). In 6 cases a low IgA level has returned to normal despite continuing gold therapy. In half the patients with persistent IgA deficiency the course has been mild and oligoarticular, and after a mean duration of 8.8 years only one has active disease. In contrast, in the patients with transient IgA deficiency the disease was characterized by early onset (mean age 3.0 years), a polyarticular course (10/13) and prolonged activity (7/13, mean duration 9.6 years). Coeliac disease was diagnosed in 2 patients, both with persistent IgA deficiency. TI- The affected sib method. II. The intermediate model. AU- Louis EJ; Thomson G; Payami H JN- Ann Hum Genet; 47 (Pt 3) p225-43 CP- ENGLAND PY- Jul 1983 AB- An iteration procedure is outlined which uses HLA haplotype sharing data from sib pairs in which both sibs have the disease of interest. The procedure allows estimation of the degree of dominance of the HLA linked 'disease' allele, and its frequency in the population, for intermediate models where it is assumed that individuals who do not have at least one copy of the 'disease' allele do not contract the disease. Parameter estimates from sib-pair data on multiple sclerosis, insulin dependent diabetes mellitus, haemochromatosis, coeliac disease juvenile rheumatoid arthritis, and Graves' and Hashimoto's diseases are given. TI- Male gonadal function in coeliac disease: 2. Sex hormones. AU- Farthing MJ; Rees LH; Edwards CR; Dawson AM JN- Gut; 24 (2) p127-35 CP- ENGLAND PY- Feb 1983 AB- Hypogonadism, infertility, and sexual dysfunction occur in some men with coeliac disease. We have measured plasma testosterone, dihydrotestosterone, sex-hormone binding globulin, oestradiol, and serum luteinising hormone in 41 men with coeliac disease and have related these findings to jejunal morphology, fertility, semen quality, and sexual function. To determine the specificity of these observations in coeliacs we also studied 19 nutritionally-matched men with Crohn's disease, and men with chronic ill-health due to rheumatoid arthritis and Hodgkin's disease. The most striking endocrine findings in untreated coeliacs were increased plasma testosterone and free testosterone index, reduced dihydrotestosterone (testosterone's potent peripheral metabolite), and raised serum luteinising hormone, a pattern of abnormalities indicative of androgen resistance. As jejunal morphology improved hormone levels appeared to return to normal. This specific combination of abnormalities was not present in any of the disease control groups and, to our knowledge, androgen resistance has not been described previously in any other non-endocrine disorder. Plasma oestradiol concentration was modestly raised in 10% of coeliacs and 11% of patients with Crohn's disease. Unlike plasma androgens and serum luteinising hormone in coeliacs, plasma oestradiol was not clearly related to jejunal morphology. Androgen resistance and associated hypothalamic-pituitary dysfunction appear to be relatively specific to coeliac disease and cannot be explained merely in terms of malnutrition or chronic ill-health. In addition, our findings suggest that this endocrine disturbance may be related to sexual dysfunction in coeliac disease but its relationship to disordered spermatogenesis in this condition has not been clearly established. TI- Investigation of the mode of inheritance of the HLA associated diseases by the method of antigen genotype frequencies among diseased individuals. AU- Thomson G JN- Tissue Antigens; 21 (2) p81-104 CP- DENMARK PY- Feb 1983 AB- Statistical features of the method of antigen genotype frequencies among the diseased, for single and multiple disease associations at a locus, will be presented. A methodology to determine when a true intermediate mode of inheritance can be distinguished from strict recessive or additive inheritance will be developed. The effect of sporadics and ascertainment bias on the observed antigen genotype frequencies will be investigated. Data on ankylosing spondylitis, multiple sclerosis and dermatitis herpetiformis are very close to expectations for an additive (or dominant) mode of inheritance for the HLA-linked disease-predisposing gene, and data on hemochromatosis, insulin dependent diabetes mellitus and celiac disease are close to recessive expectations. If an intermediate model does apply in any of these cases, it must be an intermediate model that is fairly close to a strict recessive or dominant model; as appropriate. DR data for insulin dependent diabetes mellitus (IDDM) strongly indicate that there are two separate "disease" alleles, which exhibit negative complementation, predisposing individuals to IDDM, where the mode of inheritance of the "disease" alleles considered separately is close to recessive. In general, this method cannot rule out the existence of sporadics or a second disease-predisposing gene, when the penetrance values over the two disease-predisposing genes are strictly additive, for diseases showing agreement with additive (or dominant) modes of inheritance. TI- [Celiac disease: association with rheumatoid arthritis and diabetes mellitus. Apropos of a clinical case] TI- Morbo celiaco: associazione con artrite reumatoide e diabete mellito. A proposito di un caso clinico. AU- Mingrone G; Negrini AP; Principi E; De Cunto F; Vecchio FM; Altomonte L ; Magaro M JN- Minerva Med; 71 (30) p2109-13 CP- ITALY PY- Aug 25 1980 AB- A case of coeliac disease accompanied by serum-negative rheumatoid arthritis and (subsequently) by diabetes mellitus is described. The appearance of a similar clinical and sympatomatological enteric and articular picture in one of the patient's brothers is seen as evidence that the link between the components of the three-fold syndrome is to be found in common genetic factors, with an onset in the form of a cellular and biohumoral immunological disorder. TI- Chronic disease and short stature. AU- Hill DE; Fiser RH JN- Postgrad Med; 62 (6) p103-11 CP- UNITED STATES PY- Dec 1977 AB- Careful graphing of the anthropometric measurements of children with chronic disease and short stature should be done to determine height and weight growth velocities. In addition, a detailed history can provide information helpful in determining the expected growth curve. If the chronic disease can be effectively treated (eg, malnutrition, emotional deprivation, celiac disease, asthma, rheumatoid arthritis), a period of rapid "catch-up" growth can be anticipated. The prognosis with regard to adult stature depends on the timing, duration, and severity of the growth-inhibiting influence. TI- Agammaglobulinemia with arthritis and celiac disease developing after infectious mononucleosis. Follow-up study of a case. AU- Lanning M; Kouvalainen K; Simila S; Raunio V JN- Scand J Infect Dis; 9 (2) p144-8 CP- SWEDEN PY- 1977 AB- A previously healthy 2 1/2-year-old boy from a healthy family developed agammaglobulinemia with arthritis 3 months after infectious mononucleosis (IM). The response of serum immunoglobulins at the initial stage of IM was typical, with greatly elevated IgM and a positive IM-specific heterophil antibody test. A secondary celiac disease was diagnosed one year after IM. Considering the serum immunoglobulin levels and the normal half-lives of IgM and IgG, it seems very probable that the synthesis of immunoglobulins ceased about one month after the onset of IM. The role of suppresor T-cells in the development of acquired secondary agammaglobulinemia is discussed. TI- [Arthropathies in intestinal diseases] TI- Arthropathien bei enteralen Erkrankungen. AU- Tanner E; Bosseckert H; Seidel K JN- Z Gesamte Inn Med; 32 (7) p160-3 CP- GERMANY, EAST PY- Apr 1 1977 AB- Together with gastroenterologists rheumatologists describe diagnostically significant disturbances of the supporting apparatus and the locomotor system which frequently occur in ulcerous colitis, enterocolitis regionalis Crohn, Whipple's disease and non-tropical sprue. Important conclusion for the diagnostic approach supplement the description. TI- Serum folates in man. AU- Thien KR; Blair JA; Leeming RJ; Cooke WT; Melikian V JN- J Clin Pathol; 30 (5) p438-48 CP- ENGLAND PY- May 1977 AB- In an aseptic microbiological assay of folate compounds and their breakdown compounds, using Lactobacillus casei, Streptococcus faecalis, and Pediococcus cerevisiae, 4a-hydroxy-5methyl-4,5,6,7-tetrahydrofolate and 5-methyl-5,8-dihydrofolate were inactive under all conditions to all three organisms and 5-methyl-5,6-dihydrofolate was inactive unless ascorbate was present in the incubation medium, and then only to L. casei. 5-Methyltetrahydrofolate was active only for L. casei, and activity in purified samples to S. faecalis was due to trace amounts of folic acid. Analysis of S. faecalis values in the serum in normal subjects and in patients with various disorders showed that levels of 10-formyltetrahydrofolate are raised in coeliac disease, leukaemia, rheumatoid arthritis, and schizophrenia. 5-Methyltetrahydrofolate is readily absorbed by normal human subjects and by patients with pernicious anaemia but poorly absorbed by patients with coeliac disease or leukaemia. 5-Methyl-5,6-dihydrofolate was quickly absorbed by normal human subjects, being reflected by a considerably raised level of 5-methyltetrahydrofolate in serum when sodium bicarbonate was given by mouth before the 5-methyl-5,6-dihydrofolate. These higher levels were comparable to those in patients with pernicious anaemia after oral administration of 5-methyl-5,6-dihydrofolate. Oral 5-methyl-5,8-dihydrofolate and 4a-hydroxy-5-methyl-tetrahydrofolate did not appear as microbiologically active folates in the serum. The findings of this study suggest that the availability for biological utilisation of the major dietary folate compounds will depend on the amount of gastric acidity and of ascorbate in the intestinal chyme. Many may be unavailable for metabolic utilization in the body.