M. Ben Ahmed

Functional defects of peripheral regulatory T lymphocytes in patients with progressive vitiligo.

Auto‐reactive cytotoxic T lymphocytes play a key role in the progressive loss or destruction of melanocytes in vitiligo but the mechanism underlying the loss of self‐tolerance is unknown. A deregulation of regulatory T‐cell biology has recently been suggested. The analysis of the suppressive effects of peripheral T regulatory cells in vitiligo patients revealed a functional defect in seven of 15 cases. This defect was strongly correlated with disease activity. The evaluation of the percentage of peripheral regulatory T lymphocytes did not reveal any intrinsic quantitative defect. Yet, a decrease in the percentage of such cells was noted in patients with progressive forms, suggesting a recruitment of regulatory T cells from the peripheral blood to the site of injury. This was further corroborated by the significant increase of Forkhead box P3 expression in the vitiliginous skin of patients. Our data support the involvement of a functional defect of peripheral regulatory T cells in the pathogenesis of vitiligo and open new possibilities to advance therapeutic approaches.

MICA Transmembrane Region Polymorphism and HLA B51 in Tunisian Behçeťs Disease Patients

None of MICA microsatellite alleles was significantly increased in Tunisian BD patients. Only HLA-B51 was primarily associated to BD in this population. These data, similar to those found in other ethnics6,9, further support the hypothesis that the amino-acids, common to all HLA-B51 encoding alleles and absent in other HLA-B antigens, probably confer high affinity binding for peptides that may contribute to BD development. However, the possibility that HLA-B contributes to the pathogenesis as an additional or complementary risk factor cannot be excluded.

Vascularite urticarienne hypocomplémentémique de McDuffie associée à un syndrome de Gougerot Sjögren

We report a patient with Sjögrens syndrome who presented with urticarial hypocomplementemic vasculitis. A 46-year-old female was admitted for assessment of ascitis. Clinical examination and computed tomographic scan disclosed evidence of multiple peripheral and intra abdominal lymph nodes. During her admission, she developed several bouts of acute angioedema and urticarial skin lesions. Minor salivary gland biopsy showed focal sialadenitis, stage IV of Chisholm. Schirmers test was positive. Laboratory examination found low levels of C1q and high levels of C1q antibodies. Therapy with prednisone and hydroxychloroquine was initiated. Six months later, the patient presented with lower limb oedema. Urinalysis showed proteinuria (1g/day) and renal biopsy revealed membranous nephropathy with favorable outcome with corticosteroids.

Expression colique de l’interféron-γ et de l’interleukine-10 au cours de la maladie de Crohn et de la rectocolite ulcéro-hémorragique

Resume Objectif Le but de ce travail etait d’explorer l’expression colique de l’INF-γ et de l’IL-10 chez des patients atteints de maladie de Crohn (MC) ou de rectocolite ulcero-hemorragique (RCH). Methodes Quatorze patients atteints de MC et 11 atteints de RCH ont ete inclus, ainsi que 7 sujets temoins. L’etude de l’expression colique de l’INF-γ et de l’IL-10 a ete realisee sur des biopsies de colon sain et malade, en utilisant la technique de transcription inverse et d’amplification genique (RT-PCR) en temps reel (Taqman). Les resultats ont ete exprimes sous forme de rapport entre la quantite d’ARN messager (ARNm) de la cytokine et celle d’une molecule de reference, l’ARN ribosomal 18S, puis multiplie par 10 8 . Resultats En cas de maladie de Crohn, le colon exprimait plus d’INF-γ et d’IL-10 par rapport aux temoins (medianes respectives : 23,03 vs 1,87, p = 0,042 et 20,61 vs 2,13, p = 0,08). Une puissante correlation positive a ete trouvee entre l’expression colique de l’IL-10 et celle de l’INF-γ au cours de la MC (r = 0,9, p Au niveau des sites lesionnels de RCH, l’expression de l’INF-γ ainsi que celle de l’IL-10 etaient comparables a celles observees chez les temoins (7,18 vs 2,18, p = 0,36 et 3,66 vs 1,87, p = 0,44). Conclusion Au cours de la maladie de Crohn, l’expression de l’IL-10 et celle de l’INF-γ etaient plus elevees que chez les temoins et etroitement correlees.

AB0023 Peripheral th17 cells in rheumatoid arthritis: correlation with the activity parameters of rheumatoid arthritis

Background Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disease regulated by T lymphocyte subsets. Th17 lymphocytes reportedly play significant roles in the development of this disease. Objectives We investigated the correlation of circulating Th17 cells with the clinical and biological activity parameters in patients with RA. Methods This is a prospective study including patients with RA (1987 ACR criteria). Disease activity was evaluated by global pain intensity visual analog scale (VASP), visual analog scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP) and Disease Activity Score (DAS28). Peripheral blood Th17 cell frequency (LTh CD4+ IL-17+ IFNγ-) was determined with flow cytometry. Clinical examination and blood samples were performed on the same day. The significance level for Pearson correlation was set at p <0.05. Results Thirty-eight patients were included, 35 women and 3 men, with a mean age of 52.4 ± 10.3 years and a mean disease duration of 124 ± 98 months (7-456 months). The mean VASP arose to 57 mm [0-100], the mean VASOA to 58 mm [0-100] and the mean duration of morning stiffness to 37.76 minutes [0-240]. The mean TJCs and SJCs were 7 and 6, respectively. A biological inflammatory syndrome was noted in 33 patients with a mean ESR of 46 ± VS 25 mm [15-110] and a mean CRP of 16.8 ± 15 mg / l [5-59]. The mean DAS28 was 5.2. Distribution according to the activity level of the disease showed a high activity for 20 patients according to the DAS28. There was no significant correlation between the percentage of peripheral LTh17 and the various parameters of clinical and biological activity studied. Conclusions Even though Th17 cells involvement in the pathogenesis of RA is now well established, our study shows that the peripheral percentage of Th17 cells is not correlated with the disease activity. Their frequency in rheumatoid synovial fluid might show a better activity index. References Gullick NJ, Evans HG, Church LD, Jayaraj DM, Filer A, et al. (2010) Linking Power Doppler Ultrasound to the Presence of Th17 Cells in the Rheumatoid Arthritis Joint. PLoS ONE 5(9): e12516. doi:10.1371/journal.pone.0012516 Disclosure of Interest None Declared

AB0044 Correlation of peripheral il17 cytokine with activity parameters and ultrasound scores in rheumatoid arthritis

Background It is now recognized that some pro-inflammatory cytokines, such as IL-17, contribute to synovial neoangiogenesis and osteocartilaginous destruction in rheumatoid arthritis (RA). The serum concentration of this cytokine has also been associated with the disease activity. Objectives The present study sought to determine the relationship between IL-17 plasma concentration and clinical, biological and ultrasound activity parameters in patients with RA. Methods This is a prospective study including patients with RA (1987 ACR criteria). Disease activity was evaluated by global pain intensity visual analog scale (VASP), visual analog scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP) and Disease Activity Score (DAS28). The patients underwent blinded power Doppler ultrasonography (PDUS) and grey-scale ultrasonography (GSUS) examination of 22 joints (10 metacarpophalangeal, 10 proximal interphalangeal and wrists), within the 2 hours of clinical assessment, using a handheld 13-18 MHz transducer. In GSUS, the grade ranged from 0 (no synovial thickening, no articular effusion) to 3 (marked synovial thickening). Similarly, in PDUS, the grade ranged from 0 (absence of signal) to 3 (confluent vessel signals in more than 50% of the synovial area). PDUS and GSUS semi-quantitative scores were established, ranging from 0 to 66 and corresponding to the sum of the different grades for each joint. The plasma concentration of IL-17 was determined by enzyme-linked immunosorbent assay (ELISA) kits. The significance level for Pearson correlation was set at p <0.05. Results A total of 38 patients with RA were evaluated, 5 were male. Their ages ranged from 30 to 70 years (mean: 52.4 ± 10.3 years). Their histories of RA ranged from 7 to 456 months (mean: 124 ± 98 months). The mean VASP arose to 57 mm [0-100], the mean VASOA to 58 mm [0-100] and the mean duration of morning stiffness to 37.76 minutes [0-240]. The mean TJCs, SJCs, ESR, CRP and DAS28 were 7, 6, 46, 16.8 and 5.2, respectively. The score average value in GSUS was 17 ± 14 [0-51] and that in the PDUS 14 ± 14 [0-53]. The mean plasma concentration of IL-17 was 7.8 IU [5.81-22.49]. The CRP value was significantly and positively correlated with the plasma concentration of IL-17 (p=0.025, r=0.374). The GSUS and PDUS score was significantly and strongly correlated with the concentration of IL 17 (p=0.007 and p=0.000). Conclusions Our study shows that the plasma concentration of IL-17 may serve as a quantitative index of the disease activity in RA. References Leipe J, Grunke M, Dechant C, Reindl C, Kerzendorf U, Schulze-Koops H, Skapenko A. Role of Th17 Cells in Human Autoimmune Arthritis. Arthritis Rheum 2010;62:2876–85. Disclosure of Interest None Declared