Rheumatoid Arthritis: Schwarz-Eywill M

Simon S, Schwarz-Eywill M, Bausewein C. · Institute of Palliative Care, Oldenburg, Germany. · J Palliat Care. · Pubmed #19227019 No free full text.

Abstract: Currently, the main goal in rheumatic research is to achieve remission, even in highly active stages of the disease. However, there is a lack of understanding of how to manage patients when some rheumatic diseases such as vasculitis, connective tissue disease, or rheumatoid arthritis develop fulminant, progressive, and complicated courses. There is a clear role for palliative care to enhance patients' quality of life, but hardly any data exist regarding the prevalence and management of symptoms, and the special needs of these patients and their relatives. Rheumatologists, and palliative and primary care physicians should become more aware of this patient group so as to offer them the care they need. Further research is necessary in this field.

Rinaldi N, Schwarz-Eywill M. · Abt. Infektiologie und Klinische Immunologie, III. Medizinische Klinik, Ulm. · Z Rheumatol. · Pubmed #10663939 No free full text.

Abstract: The original structure of the synovial membrane is completely destroyed in the rheumatoid synovium and is characterized by mononuclear cell infiltration, synoviocyte proliferation, neo-vascularization, and deposition of extracellular matrix proteins. Adhesion molecules play an important role in the development of these pathologic changes. In this review we discuss the role of the adhesion receptors of the selectin, integrin and immunoglobulin families and of the CD44 molecule in the cell-cell and cell-matrix interaction in the pathogenesis of the inflammatory changes in rheumatoid arthritis.

Schwarz-Eywill M. · Medizinische Klinik, Krankenhaus Dresden-Friedrichstadt. · Z Arztl Fortbild Qualitatssich. · Pubmed #10355057 No free full text.

Abstract: Autoimmune diseases play an increasing role in daily practise. Advanced understanding of the pathogenesis and pathophysiology enables an outcome orientated therapy leading to a far better prognosis. Immunosuppressive drugs are essential for the treatment. The therapeutical concepts are adopted to the individual character and stage of the disease. In the meantime, therapeutical regimes combine certain drugs. Although it is not possible to cure these autoimmune diseases, a remission can be achieved in most cases. Further developments will concentrate on more selective strategies and the potentials of gene therapy.

Schwarz-Eywill M, Friedberg R, Stösslein F, Unger L, Nüsslein H. · I. Medizinische Klinik, Schwerpunkt Rheumatologie/Klinische Immunologie, Klinikum Dresden-Friedrichstadt, Dresden. · Dtsch Med Wochenschr. · Pubmed #16118728 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The involvement of the cervical spine in rheumatoid arthritis can be essential regarding prognosis and mortality. The cervical myelopathy due to pannus formation and/or subluxation can be fatal. Aim of this study was to demonstrate the possible changes seen by MRI, and to establish a risk-profile for the individual patient. PATIENTS AND METHOD: Within a period of 24 months 214 patients with active RA were included. Clinical and laboratory data were obtained and plain radiographs of the cervical spine were taken. In patients with pathological findings on X-ray an MRI was performed (36 patients). RESULTS: Within the group of 214 patients 36 were identified to get an cervical spine MRI. In all cases the MRI showed significant changes: in 7 (19.5 %) pannus surrounded the dens, with additional erosions in one patient (2.7 %). In 25 (69.5 %) atlanto-axial-subluxation was present, 7 (19.5 %) showed a spondylodiscitis below C2. In 10 (27.8 %) a cervical myelopathy due to pannus or subluxation was present. There was no correlation of the MRI-results with symptoms and findings by examination. The patients with cervical spine disease were in all stages of RA. The majority was rheumatoid-factor positive. 5 out of 10 patients with cervical myelopathy showed neurological deficits: 3 patients died in consequence of neural compression, 2 patients underwent surgery successfully. CONCLUSION: The early detection of a cervical spine involvement in RA is essential to avoid possibly fatal complications. The only reliable method to achieve this goal has to include radiographic diagnostic including MRI of the cervical spine. Only this approach can answer the question of the right time-point for surgery. In daily clinical practice the cervical-spine involvement in RA is still underestimated.

Rinaldi N, Willhauck M, Weis D, Brado B, Kern P, Lukoschek M, Schwarz-Eywill M, Barth TF. · Abteilung Innere Medizin III, Ulm, Germany. · Virchows Arch. · Pubmed #11764389 No free full text.

Abstract: Collagen type IV is a structural matrix protein which contributes to the structural organization of the synovia. In order to characterize the distribution of this protein in synovia with chronic synovitis, collagen type IV was detected by immunochemistry in normal synovia and in synovia from patients with osteoarthritis (OA) and rheumatoid arthritis (RA). A decrease of collagen type IV was observed in synovial layers of rheumatoid synovia, which statistically correlated with the grade of inflammation and with the thickness of the synovial layer. In vitro, we found no differences in the gene expression of collagen type IV in cultures of fibroblast-like synoviocytes (FLS) derived from OA and RA using a reverse-transcriptase polymerase chain reaction. Nevertheless, we observed a downregulating effect of tumor necrosis factor-alpha and interleukin (IL)-1beta on the gene expression of collagen type IV only in FLS isolated from patients with RA. The effect of IL-1beta was dose dependent. In summary, we observed an inflammation-associated decrease of collagen type IV in the synovial layer of rheumatoid synovia. Inflammatory cytokines may play a role in regulating the synthesis of collagen type IV in the rheumatoid process in vivo.