M. Magaró

Serum zinc and copper in active rheumatoid arthritis: correlation with interleukin 1 beta and tumour necrosis factor alpha

Serum zinc and copper levels and serum interleukin 1β (IL1β) and tumour necrosis factor α (TNFα) levels were evaluated in 57 female patients with active rheumatoid arthritis (RA) to investigate a possible role of IL1β and TNFα on zinc and copper homeostasis in RA. Serum zinc levels were significantly lower and serum copper levels significantly higher in RA patients when compared with osteoarthritis or asymmetrical psoriatic oligoarthritis patients and with normal controls. No differences were observed in serum IgM rheumatoid factor positive and serum IgM rheumatoid factor negative patients as regards serum zinc and copper concentration. In RA patients the erythrocyte sedimentation rate and acute-phase proteins correlated negatively with serum zinc and positively with serum copper. IL1β and TNFα were found to correlate negatively with zinc and positively with copper in RA patients. Lower levels of zinc may be due to an accumulation of zinc-containing proteins in the liver and in the inflamed joints in RA. Elevated serum copper levels seem to be linked to the increased synthesis of ceruloplasmin by the liver.

ACTH, Cortisol and Prolactin in Active Rheumatoid Arthritis

Abstract Prolactin (PRL) and glucocorticoids are hormones involved in the regulation of the immune system. Rheumatoid arthritis (RA) is an inflammatory condition that presents a diurnal rhythm of disease activity. ACTH, PRL, cortisol, IL-1β and TNF-α circadian rhythms have been studied in active RA (aRA) to evaluate a possible relationship between the neuroendocrine system and immunological activity in rheumatoid patients. ACTH, PRL, cortisol, PRL/cortisol ratio and IL-1β and TNF-α levels were determined in aRA patients and in control subjects at 6.00, 10.00, 14.00, 18.00, 22.00 and 02.00 h. In aRA patients we observed lower ACTH and cortisol levels at 22.00 h and 2.00 h, respectively and higher PRL and PRL/cortisol ratio at 2.00 h when compared to controls. IL-1β and TNF-α reached their highest serum levels in aRA patients at 2.00 and 6.00 h. This study provides evidence that in aRA there could be a temporary and probably causal relationship between diurnal disease activity, hormonal disequilibrium and cytokine secretion. An imbalance in favour of proinflammatory hormones (PRL and cytokines) as opposed to levels of anti-inflammatory hormones could be responsible for the diurnal rhythm of activity disease observed in aRA patients.

Lack of correlation between anticardiolipin antibodies and peripheral autonomic nerve involvement in systemic lupus erythematosus.

SummaryThe presence of anticardiolipin antibodies has recently been related to a clinical complex in which both central and peripheral neurologic damage is included. A series of 27 female patients affected by systemic lupus erythematosus (SLE) was tested for the presence of peripheral autonomic neuropathy and serum anticardiolipin antibody (ACA) levels were determined in each patient by ELISA. Peripheral autonomic impairment was detected in 40.7% of SLE patients and a large number (77.7%) of patients had elevated levels of ACA. No relationship was found between presence of ACA (both for IgG and IgM classes) and the autonomic neuropathy.

Relapsing polychondritis with severe aortic insufficiency

SummaryRelapsing polychondritis (RP) is a rare disease characterized by auricular, nasal and respiratory tract chondritis, ocular inflammation, inflammatory polyarthritis and cardiovascular abnormalities. Here we describe a patient with a five-year history of mild nasal and auricular chondritis, which suddenly developed into a severe aortic insufficiency with rest dyspnea. The pathogenesis and the management of this rare connective tissue disease are discussed.

Chronic active hepatitis and Behçet's syndrome

SummaryIn a patient with Behçets syndrome the finding of five times the normal level of serum transaminase accompanied by weakness may be correlated to the syndrome itself. We performed needle biopsy of the liver in our patient which showed piecemeal necrosis and portal lympho-monocytic infiltration extending into the lobule. It is interesting that HLA B5 and B27 antigens were present. Simultaneous occurrence of chronic active hepatitis and Behçets syndrome may imply the same autoimmune pathogenesis, as we suggest in this work.

Neurobehavioural and psychiatric manifestations in a case of ANA-negative SLE with antiphospholipid antibodies

Antiphospholipid antibody syndrome has become a wellestablished clinical entity and numerous recent reviews have summarised the clinical manifestations of this syndrome, which include arterial and venous thrombosis, thrombocytopenia, fetal loss, cardiac and neuropsychiatric manifestations and livedo reticularis [1]. Antiphospholipid antibodies (aPL) are often present in patients with systemic lupus erythematosus (SLE) and may occur without other evidence of collagen vascular disease in the primary antiphospholipid antibody syndrome (PAPS). Various thrombotic and non-thrombotic neurological manifestations have been reported in patients with aPL-like stroke, migraine, seizures and confusional state, but aPL as aetiological or contributing factors in neurobehavioural and psychiatric syndromes have not been emphasised. Neuropsychiatric manifestations have been described in SLE patients, and were related to the presence of vasculitis cerebral lesions [2]. Cases of antinuclearantibody (ANA)-negative lupus have been reported rarely in the literature [3], but psychiatric manifestations have never been associated. We described the case of a patient with ANA-negative lupus and aPL who presented clear symptoms of psychiatric disease.

Cerebral blood flow abnormalities detected by SPECT in Behçet's-syndrome-related psychiatric disorders.

Behqets disease is recognised as a vasculitis of small vessels involving virtually any organ system. Central nervous system (CNS) involvement is thought to occur in 15-25% of patients suffering from Behqets disease [1]. Although a meningoencephalic syndrome, focal neurological deficits and acute and subacute brain stem syndromes are the most common events, a diffuse presentation clinically expressing as a psychiatric disorder has also been described [2,3]. We wish to draw attention to the possible usefulness of non-invasive brain functional imaging, such as single-photon emission computed tomography (SPECT), in detecting cerebral abnormalities in psychiatric manifestations of Beh~ets disease, a condition in which anatomical brain imaging can often prove non-diagnostic.