repost: arthritis and Lyme disease...schizo. and arthritis 
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 repost: arthritis and Lyme disease...schizo. and arthritis

Bantam Medical Dictionary
arthritis:  n. inflammation of one or more joints,  characterized by swelling,
warmth, redness of the overlying skin, pain and restrictions of motion.  Over
200 diseases may cause arthritis, including rheumatoid arthritis,
osteoarthritis,  gout, tuberculosis and other infections.  Diagnosis is
assisted by examination of the pattern of distribution of affected joints,
X-rays, {*filter*} tests, and examination of synovial fluid obtained by aspiration
of a swollen joint.....Any disease involviing the synovial membranes or causing
degeneration of cartilage may cause arthritis.  Treatment of arthritis depends
on the cause......"

from Tabers Medical Dictionary

rheumatoid factor:  An immunoglobulin present in the serum of 50% to 95% of the
{*filter*}s with rheumatoid arthritis.  This factor, although not specific for
rheumatoid arthritis, is helpful in diagnosing and investigating the disease.

It is a clinical diagnosis and involves Lyme disease in the differential
diagnoses.
------------------------
Title:Prehistoric juvenile rheumatoid arthritis in a precontact Louisiana
native population reconsidered.
Authors:Lewis BA
Source:Am J Phys Anthropol 1998 Jun;106(2):229-48
Organization:Department of Geography and Anthropology, Louisiana State

Abstract:
Descriptions of skeletal pathological conditions evident in the prehistoric
Tchefuncte adolescent 16ST1-14883b are clarified. The basis is reaffirmed for
assigning to the described pathological conditions a diagnostic perspective of
juvenile rheumatoid arthritis or juvenile Lyme disease--a disease that mimics
juvenile rheumatoid arthritis in its arthritic presentation--rather than of
assigning them as representative of juvenile onset ankylosing spondylitis or
other juvenile spondyloarthropathies. A hypothesis (Lewis [1994] Am. J. Phys.
Anthropol. 93:455-475) is restated that 1) the spirochete Borrelia burgdorferi
was the infectious agent responsible for prevalence of {*filter*} rheumatoid
arthritis in prehistoric southeastern Native American populations, 2) that B.
burgdorferi is a possible cause of the arthritis evident in individual
16ST1-14883b, and 3) that antibodies to B. burgdorferi provided partial
immunity to the related spirochete Treponema pallidum for the 16ST1 precontact
Tchefuncte population from Louisiana, protecting them from severe treponemal
response. Given the probable widespread existence of Ixodid tick vectors for B.
burgdorferi in prehistoric North America, coupled with the existence of
treponematosis, it follows that the transition of Native American
hunting-gathering economies to more sedentary economies would predictably be
linked to an increased incidence of treponematosis due to the loss of benefits
of the above-stated partial immunity. In other words, as prehistoric Native
American exposure to tick vectors for B. burgdorferi decreased, susceptibility
to treponematosis increased. Inferences regarding biological controls
interacting with and influencing prehistoric Native American migration patterns
are suggested from the link of B. burgdorferi to an Ixodid tick common to
northeast Asia.

Keywords:
Adolescence, {*filter*}, Anemia, Iron-Deficiency, HISTORY, PATHOLOGY, Arthritis,
Juvenile Rheumatoid, HISTORY, PATHOLOGY, Bone and Bones, PATHOLOGY, Child,
Diagnosis, Differential, Female, History of Medicine, Ancient, Human, Indians,
North American, HISTORY, Louisiana, EPIDEMIOLOGY, Lyme Disease, EPIDEMIOLOGY,
HISTORY, PATHOLOGY, Male, Paleopathology, Prevalence, Spondylitis, Ankylosing,
HISTORY, PATHOLOGY, Treponemal Infections, EPIDEMIOLOGY, HISTORY, PATHOLOGY

Language: Eng

Unique ID: 98299256

________________________________________________________

Title:[Decisive scintigraphic diagnosis in a case of Borrelia infective
sacro-iliitis]
Authors:Giovanella LC, Bestetti A, Chiti A, Castellani M, Tarolo GL
Source:Minerva Med 1993 Apr;84(4):199-201
Organization:Cattedra di Medicina Nucleare Universita degli Studi di Milano.

Abstract:
The authors describe one case of infections sacro-iliitis caused by Borrelia,
where the diagnostic procedures by conventional radiology, computerized
tomography and nuclear magnetic resonance imaging have not permitted the
localization and the assessment of joint inflammatory disease. The bone "theree
phases" scintiscan by 99m Technectium-methylene diphosphonate (99mTC-MDP) has
made it possible to localize on left sacro-iliac synchondrosis a modification
of radioactivity, due to inflammations. Next microbiological studies gave a
positive result for borrelia. The authors finish by underlying the importance
of the nuclear medicine methods in the screening of infective osteo-arthritis.

Keywords:
{*filter*}, Arthritis, Infectious, RI, Borrelia Infections, RI, Case Report, English
Abstract, Human, Male, Sacroiliac Joint, RI, Medline File

Language: Italian

___________________________________________

Title:Infectious diseases affecting the musculoskeletal system in children and
adolescents.
Authors:Dressler F
Source:Curr Opin Rheumatol 1993 Sep;5(5):651-7
Organization:Medizinische Hochschule Hannover, Germany.

Abstract:
Many infectious organisms can lead to musculoskeletal symptoms in children.
This article reviews recent studies on rheumatic fever, invasive group A
streptococcal infections, septic infections of bones and soft tissues, reactive
arthritides caused by viruses, fungi or bacteria, and Lyme disease. The search
for etiologic organisms in chronic arthritis continues. Although Koch's
postulates are not fulfilled in most cases of infectious arthropathies,
progress has been made in diagnosing and treating these diseases.

Keywords:
Adolescence, Arthritis, Infectious, Arthritis, Reactive, Bacterial Infections,
Child, Human, Lyme Disease, Musculoskeletal Diseases, MICROBIOLOGY, Mycoses,
Rheumatic Fever, Septicemia, Streptococcal Infections, Streptococcus pyogenes,
Virus Diseases

Language: Eng

Unique ID: 94001372
_____________

Antibiotic that treats acne helps arthritis  by Laura Neergaard associated
 press
Washington-  An antibiotic used to treat acne significantly improves the
 swollen, painful joints of rheumatoid arthritis if therapy begins in the
 crippling disease's early stages, scientists reported Sunday.
    Rheumatologists said the new study by the University of Nebraska provides
 enough proof of minocycline's benefit that the drug soon may be widely
 prescribed.
    "This isn't a cure," cautioned the lead researcher, Dr. James O'Dell, who
 presented his study Sunday at a meeting of the American College of
 Rheumatology.  "If the medicine is stopped, the problem comes back."
    But O'Dell said the drug appears to offer a unique arthritis protection:
 It seems to block enzymes, called metalloproteinases, that destroy
 irreplaceable cartilage inside joints.
    "By inhibiting these metalloproteinases early on, maybe we can help shut
 off the whole inflammation cascade"  that goes out of control in later stages
 of the disease, O'Dell said.
    If his theory is right, these enzymes also could have implications for
 treatment of the much more common osteoarthritis that plagues the elderly.
    Tests in osteoarthritic dogs suggest anti-enzyme compounds offer similar
 protection, prompting other scientists to begin clinical trials of a
 minocycline cousin--called doxycycline--in people with osteoarthritis.
    About 2 million Americans suffer rheumatoid arthritis, a chronic
 inflammatory disease.  Unlike the osteoarthritis that hits certain joints
 because of the wear-and-tear of aging, rheumatoid arthritis afflicts joints
 all over the body.  It often strikes women between the ages of 20 and 45.
    Antibiotic therapy has been controversial.  Doctors haven't proved, or
 disproved, theories that an infection causes rheumatoid
arthritis._________________________________________

"......A patient had chronic septic Lyme arthritis of the knee for seven years
despite multiple antibiotic trials and multiple arthroscopic and open
synovectomies...."

Title: Chronic septic arthritis caused by Borrelia burgdorferi.
Authors: Battafarano DF, Combs JA, Enzenauer RJ, Fitzpatrick JE
Source: Clin Orthop 1993 Dec;(297):238-41
Organization: Department of Medicine, Fitzsimons Army Medical Center, Aurora,
Colorado 80045-5001.

Abstract:
Chronic arthritis occurs in 10% of Lyme disease patients. A patient had chronic
septic Lyme arthritis of the knee for seven years despite multiple antibiotic
trials and multiple arthroscopic and open synovectomies. Spirochetes were
documented in synovium and synovial fluid (SF). Polymerase chain reaction (PCR)
analysis of the SF was consistent with Borrelia infection. Persistent infection
should be excluded with silver stains and cultures in any patient with chronic
monoarticular arthritis and a history of Lyme disease.

Keywords:
{*filter*}, Antibiotics, Combined, THERAPEUTIC USE, Arthritis, Infectious,
MICROBIOLOGY, THERAPY, Borrelia burgdorferi, ISOLATION & PURIF, Case Report,
Chronic Disease, Female, Human, Knee Joint, Lyme Disease, DIAGNOSIS, DRUG
THERAPY, Synovial Fluid, MICROBIOLOGY, Synovial Membrane, SURGERY, Synovitis,
MICROBIOLOGY

Language: Eng

Unique ID: 94062207

__________________

".......Diagnosis of Lyme arthritis may be difficult; exposure in an endemic
area and clinical findings may help distinguish it from septic arthritis..."

Title: Emergency department presentations of Lyme disease in children.
Authors: Bachman DT, Srivastava G
Source: Pediatr Emerg Care 1998 Oct;14(5):356-61
Organization: Pediatric Emergency Services, Maine Medical Center, Portland,
USA.

Abstract:
OBJECTIVE: To review the clinical characteristics and diagnostic evaluation of
children with Lyme disease evaluated in an emergency department (ED) in an
endemic area. DESIGN: A retrospective review of the demographic, historical,
clinical, and laboratory data of pediatric patients with a final diagnosis of
Lyme disease. SETTING: The pediatric ED of an urban university hospital.
PARTICIPANTS: Children with Lyme disease evaluated during the three-year period
from 1992 to 1994. RESULTS: Twenty-nine children ranging in age from three to
19 years who were diagnosed with Lyme disease subsequent to a visit to a
pediatric ED were identified. Four patients had early localized disease with
erythema migrans and varying degrees of systemic symptoms. Ten had early
disseminated Lyme disease, with multiple erythema migrans, neurologic
involvement (including three patients with pseudotumor cerebri), or carditis.
Fif{*filter*} cases of late Lyme disease with arthritis were identified. Recognition
of Lyme arthritis proved particularly difficult; seven children were initially
diagnosed as having septic arthritis, six of whom underwent arthrotomy. Marked
elevations of the erythrocyte sedimentation rate and synovial fluid white {*filter*}
cell counts were observed in these patients, making it difficult to distinguish
Lyme disease from septic arthritis on the basis of laboratory findings.
CONCLUSION: Lyme disease is an infrequent, often difficult, diagnosis in
children who present to an ED. Early disseminated and late disease predominate;
classic erythema migrans is uncommon in the ED in comparison with other
ambulatory venues. Diagnosis of Lyme arthritis may be difficult; exposure in an
endemic area and clinical findings may help distinguish it from septic
arthritis. Overall, underdiagnosis of Lyme disease may actually be more of a
problem than overdiagnosis in the ED setting. Recognition of Lyme disease by
emergency medicine practitioners requires familiarity with its epidemiology and
its multiple manifestations.

Keywords:
Adolescence, {*filter*}, Child, Child, Preschool, Emergency Service, Hospital,
STATISTICS & NUMER DATA, Endemic Diseases, Female, Hospitals, University,
Hospitals, Urban, Human, Lyme Disease, COMPLICATIONS, DIAGNOSIS, DRUG THERAPY,
EPIDEMIOLOGY, Maine, EPIDEMIOLOGY, Male, Retrospective Studies

Language: Eng

Unique ID: 99029544
_______________

".....Whenever a distinction between Lyme arthritis and septic arthritis is
difficult to make, treatment should be directed at septic arthritis while
serological tests for Lyme disease are pending..."

Title: Orthopaedic complications of Lyme disease in children.
Authors: Davidson RS
Source: Biomed Pharmacother 1989;43(6):405-8
Organization: Department of Orthoapedic Surgery, Childrens' Hospital
Philadelphia, PA 19104.

Abstract:
Lyme disease is transmitted by the tick Ixodes dammini ("deer tick") or a
related ixodid tick. Early diagnosis of children with Lyme disease is difficult
because the bite of the ixodid tick often goes unnoticed. Furthermore, erythema
chronicum migrans, the characteristic rash of the disease, occurs in less than
50% of cases. However, an awareness of orthopaedic complications of Lyme
disease may facilitate an early diagnosis of this disease. Orthopaedic
complications of Lyme disease include those which are oligoarticular in nature.
Brief intermittent attacks of swelling and pain in one or more
joints--primarily large ones--is the pattern of disease most frequently
presented. The knee is the joint most commonly affected. In most cases, pain is
not severe enough to debilitate the patient or prevent weight-bearing activity.
An elevated sedimentation rate is the only consistently abnormal routine
laboratory finding in Lyme disease. The only radiographic abnormalities noted
in children are effusion and osteopenia. However, the radiograph of a patient
known to have Lyme disease may not show any abnormalities at all. Lyme disease
shares symptoms in common with septic arthritis and juvenile rheumatoid
arthritis. Whenever a distinction between Lyme arthritis and septic arthritis
is difficult to make, treatment should be directed at septic arthritis while
serological tests for Lyme disease are pending. The physician should consider
Lyme disease to be a possible diagnosis of any patient with arthritis and a
history of rash or fever, idiopathic neurological disease, or a cardiac
conduction defect--especially if there is a history of possible exposure to the
carrier tick.(ABSTRACT TRUNCATED AT 250 WORDS)

Keywords:
Acute Disease, Adolescence, Arthritis, Infectious, DIAGNOSIS, Arthritis,
Juvenile Rheumatoid, DIAGNOSIS, Child, Child, Preschool, Diagnosis,
Differential, Human, Joint Diseases, ETIOLOGY, Knee Joint, Lyme Disease,
COMPLICATIONS, DIAGNOSIS, Pain, ETIOLOGY

Language: Eng

Unique ID: 90074693
___________________________
"..... diagnosis of Lyme disease remains clinical. Knowledge of the orthopaedic
manifestations of Lyme disease may aid in early diagnosis and help
differentiate from possible cases of juvenile rheumatoid arthritis and septic
arthritis..."

Title: Orthopaedic manifestations of Lyme disease.
Authors: Jouben LM, Steele RJ, Bono JV
Source: Orthop Rev 1994 May;23(5):395-400
Organization: Albert Einstein Medical Center, Philadelphia, Pennsylvania.

Abstract:
Lyme disease is caused by the spirochete Borrelia burgdorferi and is
transmitted by the Ixodes tick. Early diagnosis is difficult because the tick
bite may go unnoticed and the distinguishing rash, erythema chronicum migrans,
often does not occur. Serologic tests are both sensitive and specific in the
later stages of the disease but not in stage 1. Thus diagnosis of Lyme disease
remains clinical. Knowledge of the orthopaedic manifestations of Lyme disease
may aid in early diagnosis and help differentiate from possible cases of
juvenile rheumatoid arthritis and septic arthritis. If septic arthritis is
suspected, appropriate antibiotic therapy should be initiated while awaiting
serology for Lyme disease. ..... Lyme disease should be considered in any
patient with arthritis and a history of rash, fever, or neurologic or cardiac
abnormality.

Language: Eng

Unique ID: 94316439
__________________

Title: [Localized scleroderma (morphea) and septic arthritis. Clinical
manifestations of Lyme borreliosis seen in El Ferrol]
Authors: Maestre JR, Almagro M, Mart:inez P, de Casas R, Quesada R, Egido J
Source: Enferm Infecc Microbiol Clin 1991 Aug-Sep;9(7):394-8
Organization: Servicio de Microbiolog:ia Cl:inica, Hospital Naval de El Ferrol.

Abstract:
Two cases of Lyme's disease seen at El Ferrol (Spain) were described. One of
them developed a recurrent knee arthritis and the other had a localized
sclerodermia (morphea) syndrome. Diagnosis was established by means of clinical
picture and serologic tests (enzyme-linked analysis and/or indirect
immunofluorescence tests). Joint involvement has often been described in
patients diagnosed of having Lyme's disease in Spain, however, the relationship
between morphea and borreliosis is still a matter of controversy. We believe
that patients with localized sclerodermia and high significant titers of
specific antibodies against B. burgdorferi should be treated with antimicrobial
agents.

Language: Spa

Unique ID: 92190314

_________________

ABSTRACT
Current Opinion in Rheumatology
Vol. 8, No. 3, May 1996
------------------------------------------------------------------------
Potential infectious agents in the induction of arthritides [Review article]
Andreas Krause MD, Thomas Kamradt MD, Gerd R. Burmester MD
Current Opinion in Rheumatology 1996, 8:203-209.

Abstract: In the multifactorial etiology of rheumatic diseases, infectious
agents are regarded as the major environmental factors that may cause
inflammatory arthritides in genetically susceptible hosts. Two not mutually
exclusive pathogenetic pathways are hypothesized to explain the initiation and
perpetuation of chronic arthritides by infectious agents: persistent infection
and induction of immunopathology. In this review we focus on the role of
infections in the etiopathogenesis of rheumatoid arthritis. Retroviruses and
enteropathogenic bacteria continue to be the most intensively discussed
candidates as possible etiologic factors of rheumatoid arthritis. Although
there is ample indirect evidence for the involvement of infections in the
pathogenesis of autoimmune disease,  DIRECT PROOF IS STILL MISSING . There may
be No single infectious trigger for rheumatoid arthritis, but multiple
infectious agents that share antigenic motifs.
_________

"......Reactive arthritis is so named because it is felt that the arthritis and
other inflammatory manifestations are an immune reaction to a distant
infection....."

Volume 4 NO. 3
July - September
Emerging Infectious Diseases

Classification of Reactive Arthritides

To the Editor: We read with interest J.A. Lindsay's article on sequelae of
foodborne disease (1). However, we believe that there are errors in the
classification of the reactive arthritides. Lindsay states that ankylosing
spondylitis (AS) is a "rheumatoid inflammation of synovial joints and entheses
within and distal to the spine." Although not the primary focus of the article,
the classification and etiopathogeneses of rheumatoid arthritis (RA) and the
seronegative spondyloarthropathies, including AS, should be clarified. The term
spondylitis, from the Greek spondylos, for vertebra, means inflammation of the
vertebrae. The term rheumatoid is generally taken to apply to rheumatoid
arthritis, while rheumatic is a more general term applying to all connective
tissue diseases.

AS is a chronic, systemic, inflammatory disorder primarily affecting the axial
skeleton, with sacroiliac joint involvement as its hallmark. Back pain is the
first clinical manifestation in approximately 75% of the patients (2). The
backache is usually insidious in onset, dull, and difficult to localize. After
several months, it generally becomes bilateral and persistent. The ache is
often worse in the morning or after periods of inactivity and improves with
movement. The course is highly variable. Involvement of peripheral joints other
than hips and shoulders is uncommon.

AS is strongly associated with human leukocyte antigen (HLA) B27, a major
histocompatibility complex (MHC) class I allele, and may show familial
aggregation. More than 90% of patients with AS have the HLA-B27 allele (3).
HLA-B27 is believed to be directly involved in disease pathogenesis. Transgenic
rats expressing human HLA-B27 develop a broad spectrum of disease closely
resembling human disease. These rats have peripheral and axial arthritis,
gastrointestinal inflammation, and diarrhea. Psoriatic-like skin changes and
inflammation of the heart and male {*filter*}ia are also seen. Histologically, the
joint, gut, skin, and heart lesions resemble those seen in HLA-B27-related
disease in humans (4).

The inflammatory process in AS involves the synovial and cartilaginous joints,
as well as the osseous attachments of tendons and ligaments (entheses). Much of
the skeletal pathology of AS can be explained by the changes that take place at
the entheses. After an initial inflammatory, erosive process involving the
entheses, there is healing in which new bone is formed. The final outcome of
this process is an irregular bony prominence with sclerosis of the adjacent
cancellous bone (5). This can be contrasted with the pathology of RA, in which
there is a greater tendency to affect cartilaginous joints such as the
intervertebral discs and symphysis pubis. The process in RA is one of bony
erosion rather than new bone formation.

The term ankylosing spondylitis, derived from the Greek for "bent spinal
vertebrae," by definition requires exclusion of the other
spondyloarthropathies, such as Reiter syndrome and reactive arthritides due to
enteric (or uro{*filter*}) organisms. Spondylitis may occur in reactive arthritis,
psoriatic arthritis, or the arthropathy associated with inflammatory bowel
disease, but is less common in these diseases (approximately 50% in reactive
arthritis, 20% in enteric arthritis or psoriatic arthritis). All of these
diseases can be viewed as seronegative spondyloarthropathies in that, by
definition, rheumatoid factor is not present.

RA is a systemic autoimmune disorder of unknown etiology. It is a chronic
symmetric arthropathy of peripheral joints, associated with erosive synovitis.
Enthesopathy is generally not found. The majority of patients have elevated
titers of serum rheumatoid factor, as opposed to the seronegative
spondyloarthropathies. Spinal involvement in RA is seen but most often involves
the cervical spine. The pathogenesis of the spinal disease is that of synovitis
of the odontoid-atlas joints. The major HLA association is with HLA-DR4, an MHC
class II allele.

Reactive arthritis is so named because it is felt that the arthritis and other
inflammatory manifestations are an immune reaction to a distant infection.
There is an association with HLA-B27 but less so than that found in AS (60% to
80%, compared with more than 90% in AS). While bacterial antigens can be found
within the joint, the offending infectious process most often subsides before
the onset of arthritis, and no living organisms are found in the joint (2). In
many cases, no infectious trigger can be identified. Persistence of microbial
antigens has been demonstrated and is likely to play a prominent role in the
pathogenesis of acute and chronic inflammation. Antigens to several
gastrointestinal pathogens have been isolated from the synovial fluid in
patients with reactive arthritis. Salmonella, Shigella, Yersinia,
Campylobacter, and Borrelia are the most common pathogens capable of initiating
reactive arthritis (2). The arthritis is generally an asymmetric oligoarthritis
pre{*filter*}ly affecting the lower extremities and typically develops 6 to 14
days after a bout of diarrhea. However, onset can occur up to 3 months later.
Diarrhea can also be absent, and there is no relationship between the severity
of the arthritis and the severity of the diarrhea.

Reiter syndrome is in fact a reactive arthritis. In 1916, Hans Reiter described
a triad of arthritis, urethritis, and conjunctivitis in a soldier with
dysentery. However, the disease was actually first described by Sir Benjamin
Brodie in the early 1800s (6). The complete triad is actually seen in only a
minority of patients. Arthritis develops 1 to 3 weeks after the diarrhea or
urethritis. It is generally asymmetric, involving large joints, especially in
the lower extremities. The term Reiter syndrome actually refers only to the
triad of arthritis, urethritis, and conjunctivitis. Reiter syndrome is both
clinically and historically more accurately termed reactive arthritis.
Nevertheless, the term reactive arthritis does not reflect the systemic nature
of the disease.

In summary, while both reactive arthritis and ankylosing spondylitis are
seronegative spondyloarthropathies, they are separate entities. Both are
distinct from rheumatoid arthritis.

Darren R. Blumberg and Victor S. Sloan

Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

References

1.Lindsay JA. Chronic sequelae of foodborne disease. Emerg Infect Dis
1997;3:443-52.
2.Veys EM, Mielants H. Enteropathic arthropathies. In: Klippel JH, Dieppe PA,
editors. Rheumatology. St. Louis: 1994; 3.35.
3.Khan MA. Seronegative spondyloarthropathies. In: Schumache HR, editor. Primer
on rheumatic diseases. Atlanta (GA): Arthritis Foundation; 1993.
4.Hammer RE, Maika SD, Richardson JA, Tang J-P, Taurog JD. Spontaneous
inflammatory disease in transgenic rats expressing HLA-B27 and human a2m: an
animal model of HLA-B27-associated human disorders. Cell 1990;63:1099-112.
5.El-Khoury GY, Kathol MH, Brandser EA. Seronegative spondyloarthropathies.
Radiol Clin North Am 1996;34:343-57.
___________________


Newsgroups: sci.med.diseases.lyme
Date: 2001-01-17 10:08:50 PST

Schizophr Res 1997 Jun 20;25(3):177-81

Schizophrenia, rheumatoid arthritis and natural resistance genes.

Rubinstein G

Department of Psychiatry, University of Melbourne, Austin and
Repatriation Medical Centre, Heidelberg, Victoria, Australia.

The strong negative correlation between schizophrenia and
rheumatoid arthritis might provide clues as to the aetiology
of these two diseases. An immunological explanation has been
sought in the HLA sector of the major histocompatibility complex,
which has been shown to have a role in the development of
rheumatoid arthritis. The search for an association between
schizophrenia and HLA haplotypes, however, has yielded only
controversial results. Nevertheless, an autoimmune aetiology
is still suspected. ***The recent demonstration of geographical
co-occurrence of high rates of schizophrenia and flavivirus
infection suggests, for the first time, that a natural
resistance gene (NRG) might be involved in the aetiology of
schizophrenia.*** Such a NRG is carried by the C3H/RV mouse,
providing protection against lethal infection by flavivirus,
but not by the histocompatible C3H/He mouse. Furthermore,
the C3H/He mouse has proved to be a good model for the
development of Lyme arthritis, resulting from infection by
Borrelia burgdorferi. It is suggested that there is a
possibility that the C3H/RV mouse, which is known to be
resistant to both flavivirus and rickettsia, may also be
resistant to borrelia, since the Ixodid tick vector of
flavivirus is the vector for all three of these organisms.
If so, then the C3H/RV mouse would resist infection by borrelia,
and could not develop Lyme arthritis. It is hypothesised,
therefore, that despite the histocompatibility of these two
strains, while the C3H/He mouse is vulnerable to Lyme arthritis,
the C3H/RV mouse may be resistant. As a consequence, NRGs may
play a part in triggering autoimmune disease, with HLA antigens
responsible for its further development. This would indicate
that the negative association of schizophrenia and rheumatoid
arthritis could result from resistance or vulnerability to
certain infections.

TITLE:  At issue: schizophrenia and rheumatoid arthritis:
the negative association revisited.

 AUTHORS:   Oken RJ; Schulzer M
 AUTHOR AFFILIATION:
New York State Institute for Basic Research in Developmental
Disabilities, Staten Island, USA.
 SOURCE:  Schizophr Bull 1999;25(4):625-38
 CITATION IDS: PMID: 10667736 UI: 20129198
 ABSTRACT: A strong negative association between schizophrenia
and rheumatoid arthritis (RA), implying low comorbidity, has
been found in 12 of 14 previous studies, which we review.
To this literature we add two recently acquired data sets
encompassing 28,953 schizophrenia patients, only 31 of whom
had comorbid RA. Integrating our new data into those of the
previous nine studies, which stratified their populations
according to psychiatric diagnosis, we obtain a median frequency
of RA in schizophrenia populations of 0.09 percent and a mean
frequency of 0.66 percent, well below the expected range of 1
percent. ***These data robustly support prior studies.*** We also
present a meta-analysis evaluating the association between
the two diseases by integrating information derived
from nine data sets, each furnishing an estimate of the relative
risk of RA in schizophrenia patients versus that in other
psychiatric patients. We find that the estimated rate of
RA among schizophrenia patients is only 29 percent of the
corresponding rate in other psychiatric patients. Further,
the rel



Tue, 31 Jan 2006 07:55:36 GMT
 
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