Dendritic cells were isolated from peripheral blood, synovial fluid, and synovial tissue of patients with rheumatoid arthritis and from peripheral blood of healthy blood donors on the basis of semiadherence to plastic surfaces. The cells were compared with autologous peripheral blood monocytes with respect to their stimulating capacities in allogeneic and autologous mixed leukocyte reactions (MLR). Dendritic cells from the various compartments stimulated allogeneic T cells 6-14 times more than monocytes did. Dendritic cells also stimulated autologous T cells 10-24 times more than monocytes did. Evidence in favour of the dendritic cell as the major stimulating cell type in MLR was also found in mixed experiments in which various ratios of dendritic cells and monocytes were used as stimulator cells. Furthermore, the activating structures on the dendritic cells seem to be major histocompatibility complex class II antigens, since anti-HLA-DR antibodies inhibited the responses. The results, especially from the autologous MLR, indicate that dendritic cells are important accessory cells for the various immune responses in rheumatoid inflammation.

RA with neck involvement is a progressive and serious condition with reduced lifetime expectancy. Hence, our interpretation is that operative intervention improves local symptoms and most likely changes the condition from worse to better by increasing lifetime expectancy in high risk patients. Since the per- and postoperative complications are few, a changed attitude toward more liberal indications for earlier surgery may reduce the symptoms and the mortality rate even more.

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Synovectomy for haemophilic arthropathy is safe and efficacious in reducing recurrent haemarthroses and joint pain. Synovectomy should not be performed to improve joint mobility. The progression of the arthropathy is not arrested, and subsequently many patients will be candidates for arthroplasty or arthrodesis.

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Objective. To evaluate pre-and postoperative nutritional status in patients with rheumatoid arthritis (RA) and osteoarthritis (OA).Methods. Preoperative dietary intake was assessed by a food frequency questionnaire, and postoperative dietary intake by food records. Anthropometric and laboratory measurements were assessed 1 day before and 10 days after surgery. Disease activity and acute response to surgery were assessed by erythrocyte sedimentation rate and C-reactive protein.Results. The dietary intake was similar in the two groups preoperatively. Energy, protein, and fluid intake was significantly higher in the RA group postoperatively. There was a significant reduction in the concentration of hemoglobin, albumin, total protein, and ferritin in the OA group after surgery, whereas only hemoglobin concentration was reduced in the RA group.Conclusion. Preoperative nutritional status in the RA group was reduced as compared with preoperative nutritional status in the OA group. However, nutritional status in the RA group was less affected after joint replacement surgery compared with nutritional status in the OA group.

Induction of CCR5 expression on Th2 clones was associated with secretion of some IFN-g. Moreover, the Th2-associated chemokine receptor CCR3 could be expressed on both Th1-dominant cell lines, and clones of Th1 and Th0 type after culture conditions with IL-4. This expression of CCR3 was associated with a reduced IFN-g production, but no IL-4 production could be induced. The IL-4-treated Th1 clones had a reduced migratory capacity against chemokines produced by ST cells compared to nonmanipulated T-cell clones. In contrast, the same IL-12-treated Th1 clones showed an increased migratory potential. Induction of the Th2-associated marker CCR3 on memory Th1 cells demonstrates that a change in chemokine receptor phenotype related to the Th2 type can be induced on terminally differentiated Th1 cells, without a change in the cytokine profile.

A 61-year-old man suffered a rheumatoid destruction of the dens of the C-2 vertebra with subsequent backward dislocation of the atlas resulting in tetraparesis. The clinical picture was consistent with a central spinal cord syndrome with motor impairment more of the upper than of the lower extremities. Reduction of the dislocation with skull traction followed by a posterior fixation from the occiput to C-3 resulted in a marked neurological restitution.