Lucrezia Riente

Sonographic analysis of the ankle in patients with psoriatic arthritis.

Foot involvement is very frequent in patients affected by psoriatic arthritis (PsA). However, evaluation of the painful foot can be problematic, because it is often difficult to distinguish between arthritis, tenosynovitis, and enthesopathy. Plain radiographs can show bone erosion or other features of joint involvement, but give little information about the soft tissues. We therefore studied foot involvement in 31 PsA patients using high resolution sonography, and compared the results with the findings on x-ray and clinical examination. Ultrasound revealed pathological findings in a large proportion of the patients, most of whom exhibited no clinical (pain or swelling) or radiological signs of foot involvement at the time of the study. Our data suggest that involvement of the tendons and entheses may be more frequent in PsA patients than has thus far been supposed, even in cases of not particularly aggressive disease, and that clinical evaluation tends to underestimate these manifestations.Foot involvement is very frequent in patients affected by psoriatic arthritis (PsA). However, evaluation of the painful foot can be problematic, because it is often difficult to distinguish between arthritis, tenosynovitis, and enthesopathy. Plain radiographs can show bone erosion or other features of joint involvement, but give little information about the soft tissues. We therefore studied foot involvement in 31 PsA patients using high resolution sonography, and compared the results with the findings on x-ray and clinical examination. Ultrasound revealed pathological findings in a large proportion of the patients, most of whom exhibited no clinical (pain or swelling) or radiological signs of foot involvement at the time of the study. Our data suggest that involvement of the tendons and entheses may be more frequent in PsA patients than has thus far been supposed, even in cases of not particularly aggressive disease, and that clinical evaluation tends to underestimate these manifestations.

High Prevalence of TT Virus Viremia in Italian Patients, Regardless of Age, Clinical Diagnosis, and Previous Interferon Treatment

The pathogenic potential of the newly discovered TT virus (TTV) is currently a matter of conjecture. Its presence was investigated in the serum of 660 patients, by polymerase chain reaction. TTV was detected in 50% of 221 patients with unselected pathologies, and no significant differences related to age, sex, or organ disease were noted. TTV was present at a significantly higher rate in hemophiliacs (73%) and at lower rates in patients with cirrhosis (30%) and rheumatoid arthritis (28%). Patients with other liver diseases, systemic lupus erythematosus, or psoriasis or receiving hemodialysis had rates of infection similar to those in unselected patients. TTV-positive patients treated with interferon-alpha for underlying type C hepatitis showed no appreciable changes of TTV viremia levels. Type 1b was by far the most frequent viral genotype (92%), followed by types 2c (5%) and 1a (3%).

Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases

Musculoskeletal sonography (MSUS) has played a growing role in the diagnosis and management of rheumatic diseases, enabling the imaging of synovitis, bone erosion, and cartilage damage in the early phase of arthritis. “Dynamic” evaluation of tendons and help in guiding needle positioning in interventional manoeuvres are some of the other reasons for its success. MSUS, particularly when coupled with power Doppler (PD) examination, has recently been shown to be an efficient tool for monitoring disease activity and progression in rheumatoid arthritis, spondyloarthritis, crystal-related arthropathy, and osteoarthritis, with general consensus on its interesting results. More specifically, the PD signal has proved to be a simple and promising tool for short-term monitoring of synovial vascularity changes induced by steroids or biological agents in RA patients. MSUS has some limits, because of the physical properties of US and the quality of the equipment; it is, moreover, an operator-related imaging technique, with few standardized protocols. Future goals should be standardization of the examining approach in grey scale and Doppler ultrasound (US), including use of new equipment (3D US), extensive use in other fields (i.e. connective tissue diseases and vasculitis), and possible new applications (e.g. thoracic US).

Antibodies to inner ear antigens in Meniere's disease

Menieres disease (MD) is an idiopathic inner ear disorder characterized by fluctuating hearing loss, episodic vertigo and tinnitus. Its aetiology is unknown, although there is growing evidence that autoimmunity may be involved in its development. Using the Western blot immunoassay, we examined the reactivity to bovine inner ear antigens of sera from a series of MD patients who had previously been extensively studied for the presence of antibodies to collagens and membrane proteins. Reactivity to inner ear antigens of molecular weight 44 and 53 kD was found in 11/25 (44%) and 10/25 (40%) of the patients, respectively; both antigens were absent in the sera of healthy donors. It is still unclear whether the antibodies to 44 and 53 kD proteins play a role in the pathogenesis of MD or if they instead represent the result of inflammation and tissue destruction. Even if the latter is true, they may contribute to the perpetuation of the disease or play a role as a cofactor in association with other mechanisms.

Is GRP78/BiP a potential salivary biomarker in patients with rheumatoid arthritis?

Purpose: In the last few years, serum and joint synovial fluid have been extensively analyzed for the proteomic research of rheumatoid arthritis (RA) biomarkers. Nonetheless, to date, there have been no studies investigating salivary biomarkers in this condition. Therefore, aim of this study is to investigate the presence of potential biomarkers of RA in human whole saliva.

Psoriatic arthritis with spinal involvement in a patient receiving alpha-interferon for chronic hepatitis C

A 26-year-old male patient being treated with alpha-interferon for chronic hepatitis C developed psoriasis, seronegative oligoarthritis and sacroiliitis after four months. The close temporal relationship between the alpha-interferon therapy and the onset of skin and articular lesions strongly suggests that the drug played a role in the induction of the disease despite the absence of HLA antigens related to psoriatic arthritis. We cannot exclude the possibility that immunological alterations associated with HCV infection could have constituted a predisposing factor in the onset of the disease.

High values of alpha (CXCL10) and beta (CCL2) circulating chemokines in patients with psoriatic arthritis, in presence or absence of autoimmune thyroiditis.

The possible role of circulating alpha and beta chemokines in psoriatic arthritis is not extensively studied. The aim of the study is to evaluate serum levels of CXCL10, CXCL9 (alpha) and CCL2 (beta) chemokines in a large series of psoriatic arthritis patients, with or without autoimmune thyroid (AT) disorders, and to relate chemokines levels to the clinical phenotype of these patients. Serum levels of CXCL10 and CCL2 were measured in 37 patients with psoriatic arthritis without AT (PsA) and 28 with AT (PsA+AT), and in gender- and age-matched (1:1) controls without (control 1) or with AT (control 2). Serum CXCL10 levels were significantly higher in control 2 than in control 1 (p < 0.001) and in PsA than control 1 or 2 (p < 0.0001). PsA+AT patients have CXCL10 higher than controls 1 and 2 (p < 0.0001, for both) and than PsA (p < 0.001). By defining a high CXCL10 level as a value at least 2 SD above the mean value of the control group (>192 pg/ml), 5% of control 1, 19% of control 2, 42% of PsA and 63% of PsA+AT, had high CXCL10 (p < 0.0001; χ2). Serum CCL2 levels were similar in controls 1 and 2. PsA or PsA+AT patients have serum CCL2 levels significantly (p < 0.01, for both) higher than controls 1 and 2. Serum CXCL9 was not significantly different in the study groups. In conclusion, our study demonstrates higher serum levels of CXCL10 and CCL2 chemokines in patients with PsA than in controls. Serum CXCL10 (alpha chemokine) levels in psoriatic arthritis patients are significantly higher in presence of AT.

Uric acid metabolism in normal subjects and in gouty patients by chromatographic measurement of 14C-uric acid in plasma and urine.

The turnover kinetics of uric acid were determined in a group of 25 subjects, including 6 controls, 17 gouty patients, and 2 subjects with asymptomatic hyperuricemia. According to their daily urate excretion while on a purine-free diet, the gouty patients (none of whom had evidence of tophi at the time of the study) were classified as follows: five overexcretor patients (“metabolic” gout), six normo-excretor patients (“renal” gout), and six borderline patients. Uric acid-2-14C was used as the tracer, and the uric acid radioactivity in plasma and urine samples was measured after column chromatography through a polyacrylamide gel that specifically adsorbs uric acid. The experimental data of plasma disappearance curves and urine radioactivities of 14C-uric acid (followed up to 3 days after injection) were analyzed by the noncompartmental approach and by the urine/plasma ratio method, in order to calculate the total removal rate of uric acid, its distribution volumes, and the removal rate of uric acid through the renal route. The monocompartmental approach and the urine specific radioactivity methods were also employed to compute the uric acid turnover data, and the results were compared with those of noncompartmental analysis. The overexcretor patients were found to have normal metabolic clearance rate and fractional catabolic rate values, but significantly higher-than-normal total turnover rate values (p < 0.005), whereas the normo-excretors had normal total turnover rate values but significantly lower metabolic clearance rate and fractional catabolic rate values compared to the controls (p < 0.001). Uric acid excretion through the kidneys was found to be about two-thirds of the total removal both in the control subjects and in the gouty patients. The results obtained allowed the exclusion of any significant delay in the excretion of uric acid through the kidneys. The use of monocompartmental analysis led to a significant overestimation of both the total turnover rate (p < 0.005) and the total pool of uric acid (p < 0.001), and the urine specific radioactivity approach implied a significant overestimation of the total turnover rate (p < 0.001). The gouty patients as a whole had a significantly larger-than-normal (p < 0.001) total pool of uric acid, however determined. On the basis of the results obtained, a metabolic differentiation was made possible for the two pathophysiologic types of gout. In fact, the metabolic gout patients were all characterized by normal metabolic clearance rate values and increased total pool values, whereas the renal gout patients were all characterized by reduced metabolic clearance rate values and increased total pool values.

The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus

OBJECTIVE To assess the prevalence of joint involvement in consecutive patients with systemic lupus erythematosus (SLE) by means of clinical assessment, joint US and MRI and to evaluate the sensitivity and specificity of physician evaluation of joint involvement. METHODS At enrollment, patients underwent a complete physical examination including a 44-joint count, and hand deformities were scored. On the day of enrollment, each patient underwent a non-dominant hand-wrist ultrasound (US) examination and a non-dominant hand-wrist MRI study without contrast injection. RESULTS One hundred and two patients (F 95, M 7) were enrolled. By physician examination hand or wrist involvement was diagnosed in 23.5%. At least one pathological finding was revealed by US examination at wrist and/or hand joints in 55%. We found a low sensitivity (46.5%) with high specificity (93.2%) of the physician assessment for the evaluation of joint involvement. The MRI imaging showed at least one erosion in 47.3% patients at the hand and in 98.9% at the wrist; in healthy subjects erosions were found in 19.6% and 97.8% at the hand and wrist, respectively. CONCLUSIONS In conclusion, (i) physicians tend to underestimate the severity of joint involvement in SLE; (ii) US assessment shows a high prevalence of joint and tendon involvement; and (iii) the MRI evaluation shows a high prevalence of damage, suggesting that joint involvement in SLE could be more severe than expected.

Anti-collagen antibodies in systemic sclerosis and in primary Raynaud's phenomenon

The frequency and specificity of antibodies to native and denatured collagens were evaluated in systemic sclerosis (SSc) and in primary Raynauds phenomenon (PRP) by direct and competitive ELISA. Antibodies reactive with denatured collagen type I (CI) were found in 43% of the SSc sera, and anti‐CIV and anti‐CV in 31%. In PRP, anti‐CI, anti‐CIV and anti‐CV antibodies were detected in 8% of patient sera. Anti‐CI, anti‐CIV and anti‐CV antibodies reacted with determinants expressed on the native as well as on the denatured molecule. Anti‐CI and anti‐CIV were cross‐reactive; a reactivity with CII and a lower one with CV were detected. Anti‐CV antibodies also reacted with CI and CII and, in a smaller proportion of cases, with CIV. Anti‐collagen antibodies, affinity‐purified from blotted collagen IV and V and cyanogen bromide (CBr)‐digested CI, displayed the cross‐reactivities shown by inhibition studies on sera. Moreover, antibodies eluted from a CBr fragment of CI reacted with the other CBr fragments as well. These data show that one‐third of SSc sera contain antibodies that react with epitopes expressed on native as well as on heat‐denatured CI, CII, CIV and CV, and therefore have the potential to bind collagens in vivo.