Re: both overnight and slow onsets are common in RA

October 19, 2005

> Just like CFS. I was interested to read this in a textbook, and

would

> be interested to know whether it is true of any of the other

diseases.

THis one may be of interest in this connection, but beware the animal

model part:

Arthritis Rheum. 1998 Aug;41(8):1481-8. Related Articles, Links

Asymptomatic synovitis precedes clinically manifest arthritis.

Kraan MC, Versendaal H, Jonker M, Bresnihan B, Post WJ, t Hart BA,

Breedveld FC, Tak PP.

Leiden University Medical Center, The Netherlands.

OBJECTIVE: It has been hypothesized that asymptomatic synovitis may

precede clinical manifestations of arthritis in the earliest phase of

rheumatoid arthritis (RA). To obtain more insight into this disease

phase, we investigated the immunohistologic features of synovial

tissue (ST) from the knee joints of rhesus monkeys with induced

arthritis and from RA patients with both clinically involved and

clinically uninvolved knee joints. METHODS: Serial ST biopsy

specimens from the knee joints of 4 rhesus monkeys that had been

immunized with type II collagen and ST from 10 RA patients were

investigated. Eight patients without inflammatory joint disease

served as controls. RESULTS: In ST from immunized monkeys, an influx

of macrophages was observed well before the occurrence of arthritis.

Signs of inflammation were also demonstrated in ST from clinically

uninvolved knee joints of all RA patients evaluated. The ST was

characterized in particular by infiltration with macrophages and by

the expression of macrophage-derived cytokines. CONCLUSION: The

findings support the view that asymptomatic synovitis precedes

clinically manifest arthritis in both early and established RA. This

implies that the debut of RA already represents a chronic phase of

the disease.

PMID: 9704648 [PubMed - indexed for MEDLINE]

October 19, 2005

Well - all conditions have to meet some critical criteria before they

become symptomatic.

The meaning of subclinical is that there's a condition brewing that

hasn't reached the symptomatic stage yet..

So maybe their point is that just that it's not an acute onset -

Although- rRA is documentation of an infection PRECEEDING RA

symptoms - so in that case you have an acute infection.... then later

the person gets RA symptoms..

Barb

Article said in part :

QUOTE

The

findings support the view that asymptomatic synovitis precedes

clinically manifest arthritis in both early and established RA. This

implies that the debut of RA already represents a chronic phase of

the disease.

END QUOTE

>

> > Just like CFS. I was interested to read this in a textbook, and

> would

> > be interested to know whether it is true of any of the other

> diseases.

>

> THis one may be of interest in this connection, but beware the

animal

> model part:

>

> Arthritis Rheum. 1998 Aug;41(8):1481-8. Related Articles, Links

>

> Asymptomatic synovitis precedes clinically manifest arthritis.

>

> Kraan MC, Versendaal H, Jonker M, Bresnihan B, Post WJ, t Hart BA,

> Breedveld FC, Tak PP.

>

> Leiden University Medical Center, The Netherlands.

>

> OBJECTIVE: It has been hypothesized that asymptomatic synovitis may

> precede clinical manifestations of arthritis in the earliest phase

of

> rheumatoid arthritis (RA). To obtain more insight into this disease

> phase, we investigated the immunohistologic features of synovial

> tissue (ST) from the knee joints of rhesus monkeys with induced

> arthritis and from RA patients with both clinically involved and

> clinically uninvolved knee joints. METHODS: Serial ST biopsy

> specimens from the knee joints of 4 rhesus monkeys that had been

> immunized with type II collagen and ST from 10 RA patients were

> investigated. Eight patients without inflammatory joint disease

> served as controls. RESULTS: In ST from immunized monkeys, an

influx

> of macrophages was observed well before the occurrence of

arthritis.

> Signs of inflammation were also demonstrated in ST from clinically

> uninvolved knee joints of all RA patients evaluated. The ST was

> characterized in particular by infiltration with macrophages and by

> the expression of macrophage-derived cytokines. CONCLUSION: The

> findings support the view that asymptomatic synovitis precedes

> clinically manifest arthritis in both early and established RA.

This

> implies that the debut of RA already represents a chronic phase of

> the disease.

>

> PMID: 9704648 [PubMed - indexed for MEDLINE]

>

October 19, 2005

Well, they are talking about histology - lab determinations, not

clinical determinations - histologic abnormalities in joints which

are clinically asymptomatic.

However, if I read right, they arent saying they found this stuff in

well people who soon got RA. Rather, they were looking at histologic

abnormalities in asymptomatic joints of people who had RA in other

joints.

This is no huge surprise, as I think there are abnormalities in the

RA lung about half the time, and I think these are usually

asymptomatic.

And then theres the rhesus monkey part of the investigation, where

the monkey joints were histologically abnormal before they developed

overt arthritis - but thats AI experimental arthritis, and I'm sure

neither of us considers that to be as relevant to RA as these workers

probably consider it to be. I essentially ignore that part.

Apparantly there is some sort of arcane charecteristic of the RA T-

cell population (other than self-reactivity) that some think

indicates AI. I havent sorted that out yet. However, I dont think its

very solid, as there are rheumatologists on the " sterile " side who

suggest the T-cells arent even the ongoing driving force; rather they

suggest that the synovial fibroblasts could just go renegade without

necessarily having ongoing stimulation from the adaptive immune

system.

> >

> > > Just like CFS. I was interested to read this in a textbook, and

> > would

> > > be interested to know whether it is true of any of the other

> > diseases.

> >

> > THis one may be of interest in this connection, but beware the

> animal

> > model part:

> >

> > Arthritis Rheum. 1998 Aug;41(8):1481-8. Related Articles, Links

> >

> > Asymptomatic synovitis precedes clinically manifest arthritis.

> >

> > Kraan MC, Versendaal H, Jonker M, Bresnihan B, Post WJ, t Hart

BA,

> > Breedveld FC, Tak PP.

> >

> > Leiden University Medical Center, The Netherlands.

> >

> > OBJECTIVE: It has been hypothesized that asymptomatic synovitis

may

> > precede clinical manifestations of arthritis in the earliest

phase

> of

> > rheumatoid arthritis (RA). To obtain more insight into this

disease

> > phase, we investigated the immunohistologic features of synovial

> > tissue (ST) from the knee joints of rhesus monkeys with induced

> > arthritis and from RA patients with both clinically involved and

> > clinically uninvolved knee joints. METHODS: Serial ST biopsy

> > specimens from the knee joints of 4 rhesus monkeys that had been

> > immunized with type II collagen and ST from 10 RA patients were

> > investigated. Eight patients without inflammatory joint disease

> > served as controls. RESULTS: In ST from immunized monkeys, an

> influx

> > of macrophages was observed well before the occurrence of

> arthritis.

> > Signs of inflammation were also demonstrated in ST from

clinically

> > uninvolved knee joints of all RA patients evaluated. The ST was

> > characterized in particular by infiltration with macrophages and

by

> > the expression of macrophage-derived cytokines. CONCLUSION: The

> > findings support the view that asymptomatic synovitis precedes

> > clinically manifest arthritis in both early and established RA.

> This

> > implies that the debut of RA already represents a chronic phase

of

> > the disease.

> >

> > PMID: 9704648 [PubMed - indexed for MEDLINE]

> >

>

October 24, 2005

I wonder how many organisms are subclinical. How long they are

brewing before they can not longer exist just under the radar. I read

an excellent but old paper by a doctor who was referring to the

diabetic process, so it was long ago, but it spoke very clearly how

the disease process begins long before anyone knows anything is going

on. It said that that process occurs in all disease, so the trick is

to develop the patterns that different disease have in their pre-

recognition stages so that medicine can provide much better solutions

by the time the patient is really hurting. (my interpretation( It was

sad though,in a way, I felt it completely represented another time

when medicine was about cures " and helping the patient. Not about the

business of medicine. I would like to have a mass mailing to all

doctors of the world.

After I became ill I was really stunned at the nonchalant attitude

that some doctors had about not being able to help some of their

patients. They almost took on an attitude of win some, lose some. One

duc came within a hairs breath of admitting that he may try, but he

knows that if he can't help me, he will just turn around and help the

next hang nail patient in line. I felt this eerry kind of feeling as

if he declared that doctor's are untouchable, because they will

always be able to help at least the minor patients and redeem

themselves.

The article drew me in because of all this talk about calcium, except

I'm trying to keep the calcium in me and I can't. But probably the

littele I have is in my knees.They are hurting me so bad today, I

cannot even use my hands. Go figure? I was kidding, but was referring

to the problem of distraction when the pain is like this.

I'm sorry to hear that your pain is on the upswing. Wouldn't it be

nice if there were controlled studies into the disease process of

what we face.

Where we could be told that according to studies, the next dilemma

would be " XXX " , but not to worry because they already were taking

care of its path and destruction by giving us " XXX " solutions.

I guess I'd be running true to form if I admitted that in my naive

life, I still believe that is the way it is supposed to be.

Did the doctor's long ago know that if they took care of the immunity

and its response to the disease process of diabetes, that it would

be a good representation of all disease? Did they maybe have a hint

that many questions could be answered. But the everyone sold out when

there wasn't any money in those solutions?

I have no answers, just questions.

Peg