A. Zoppini

Long-term follow-up of low-dose methotrexate therapy in one case of idiopathic retroperitoneal fibrosis.

SummaryIdiopathic retroperitoneal fibrosis (RPF) is characterized by the development of a fibrotic mass surrounding the abdominal aorta and its branches, of unknown aetiology. Several immunlogical mechanisms can be operative in the pathogenesis of RPF. Based on this assumption we treated a patient affected by idiopathic RPF with low-dose methotrexate (MTX) therapy. To our knowledge this is the first example of the effectiveness and safety of a long-term low-dose MTX treatment in the post-surgical management of RPF.

One year treatment with low dose methotrexate in rheumatoid arthritis: Effect on class specific rheumatoid factors

SummaryWe evaluated the effect of a one-year treatment of low dose methotrexate (MTX) on class specific rheumatoid factors in 27 patients with rheumatoid arthritis (RA). Enzyme-linked immunosorbent assay (ELISA) showed after 6 and 12 months a significant reduction of IgM-RF, IgA-RF and IgF-RF levels from the baseline values. During MTX treatment, changes of each RF isotype were not correlated with any other isotype and its corresponding immunoglobulin changes. Moreover, immunological changes were not related to the improvement of clinical parameters. Our results showed that low dose MTX can specifically affect levels of RF isotypes, which are involved in the immune pathogenesis of RA.

Avascular necrosis of the femoral head in long-term follow-up of systemic sclerosis: report of two cases

SummaryA long-term follow-up of two patients with scleroderma (SS) who developed a polyarthritis with bilateral femoral head osteonecrosis is reported. The severe parallel evolution of the small and large joint lesions and the late appearance of osteonecrotic changes in our patients suggest that avascular osteonecrosis is related to the osteoarticular progression of the longstanding SS.

Changes of glycosylation of serum proteins in psoriatic arthritis, studied by enzyme‐linked lectin assay (ELLA), using concanavalin A

Changes of glycosylation of serum proteins of patients with psoriatic arthritis were detected by lectin blotting and a new enzyme‐linked lectin assay (ELLA) using concanavalin A (Con A). A good linear correlation was found between the total Con A‐reactivity of serum and the serum levels of C‐reactive protein and interleukin‐6, which is known to regulate the glycosylation pattern of proteins upon inflammation. A good linear correlation was also observed between the immunoreactivity of α1‐antitrypsin, measured by ELISA, using a monoclonal antibody sensitive to glycosylation changes, and the erythrocyte sedimentation rate and the serum concentrations of soluble interleukin‐2 receptor, an index of lymphocyte activation which correlated with some inflammatory parameters of disease activity. These protein changes, which are described here for the first time, deserve to be studied in further detail in view of their possible clinical applications.

Soluble interleukin-2-receptor and interleukin-6 changes during low-dose methotrexate treatment in rheumatoid arthritis.

4. Flatau, E., Shneyour, A., Hada, N., et al. Determination by ELISA of anti-DNA antibodies in patients with familial Mediterranean fever. Isr J Med Sci t989, 25, 553-556. 5. Gross, W.L., Schmitt, W.H., Csernok, E ANCA and associated disease: Immunodiagnostic and pathogenic aspects. Clin Exp Immunol 1993, 91, 1-12. 6. Cambridge, G., Rampton, D.S., Stevents, T.R.J, McCarthy, D.A., Kamm, M., Leaker B. Anti-neutrophil antibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 1992, 33, 668674. 7. Ben-Chetrit, F., Levy, M. Autoantibodies in familial Mediterranean fever. Br J Rheumatol 1990, 29, 459-461.

Lupus erythematosus panniculitis: An immunohistochemical study

SummaryAn immunohistochemical study on a case of lupus erythematosus panniculitis (LEP), without discoid lupus erythematosus (DLE) or systemic lupus erythematosus (SLE) signs, showed that the cells in skin infiltrates were immunologically committed lymphocytes (OKT4, OKT8, OKT11 and HLA-DR positive cells) and elements of the monocyte-macrophage lineage (Leu M3 and Leu M5 positive). No immunophenotypically identifiable B-lymphocytes were seen. Immunofluorescent IgG, IgM, C3 and C4 deposits were found in blood vessel walls of the deep dermis. These findings, similar to that described in the skin changes of SLE and DLE, suggest that immunological mechanisms are operative in localized LEP, where the dermal lesions are the only expression of the disease.

Hyperuricemia, gout and idiopathic aseptic necrosis of bone.

Since the original report (1) of the occurrence of aseptic necrosis of the femoral head in a patient with gout, a number of Authors have reported increased incidence of gout and/or hyperuricemia in this disease (2, 3). In particular, the finding of definite clinical gout and the demonstration of urate crystals in the synovium of the hip joint in this disease suggest more than an aceidental relationship (2).

Soluble interleukin-2 receptor and interleukin-6 levels: evaluation during cyclosporin A and methotrexate treatment in psoriatic arthritis.

In patients with psoriatic arthritis (PsA) presenting different patterns of articular involvement, high levels of soluble interleukin-2 receptor (sIL-2R) [1,2] and interleukin-6 (IL-6) [1,3,4] have been reported. In PsA patients with peripheral polyarthritis, slL-2R and IL-6 levels correlated with each other and also with some disease-activity parameters [1]. IL-6 levels also correlated with the main clinical indices as well as with the erythrocyte sedimentation rate (ESR) and levels of Creactive protein (CRP); sIL-2R correlated only with the number of swollen joints, the physicians assessment and the ESR [1]. Although a 1-year prospective trial showed that low-dose cyclosporin A (CsA) and methotrexate (MTX) are both effective in the therapy of PsA [5], to our knowledge a comparison of the effects of these drugs on sIL-2R and IL-6 levels has not been reported. The aim of this study was to investigate the effect of CsA and MTX on sIL-2R and IL-6 levels and the relationship between changes of these molecules and changes of the main clinical and laboratory parameters in PsA patients with peripheral polyarthritis.

Clinical Survey of 200 Patients with Gout

A retrospective computer assisted analysis of 200 men with primary gout has been carried out. Diagnosis was based on clinical observations, X ray findings and laboratory datal.

Changes of glycosylation of serum proteins in Sjögren's syndrome: correlation with interleukin-6 and soluble interleukin-2 receptor.

A strong increase of the affinity for concanavalin A (Con A) of serum alpha2‐macroglobulin, a non‐acute‐phase protein, was observed by lectin blotting in patients with Sjogrens syndrome (SS). On the contrary, the total Con A reactivity of serum proteins, measured by enzyme‐linked lectin assay, was not augmented in SS, compared with normal donors, probably because positive changes of certain proteins were balanced by negative changes of others, as suggested by lectin blotting analysis. However, a significant increase of total Con A reactivity occurred in subjects with increased serum concentrations of soluble interleukin (IL)‐2 receptor, compared with patients with normal concentrations of this marker of disease activity. On the other hand, the same parameter did not appear to be different in patients with normal or increased serum concentrations of IL‐6, indicating that this cytokine was not probably responsible for the changes of glycosylation described here.