M. Magaro

Serum levels of interleukin-1b, tumour necrosis factor-a and interleukin-2 in rheumatoid arthritis. Correlation with disease activity

SummaryCytokines are potent immunoregulatory factors and may be directly involved in the disordered immunoregulation found in chronic rheumatic diseases. Interleukin-1b (IL-1b), Interleukin-2 (IL-2) and Tumour Necrosis Factor-a (TNF-a) have been implicated in the pathogenesis of rheumatoid arthritis (RA) as mediators of chronic inflammation. Serum levels of IL-1b and TNF-a measured by radioimmunoassay were significantly higher in patients with RA than in healthy controls of similar sex and age while serum levels of IL-2 were significantly lower in the same patients. Further IL-1b and TNF-a were significantly elevated in RA patients with active disease and IL-2 was significantly reduced when compared with patients with low active disease. Serum IL-1b and TNF-a appear to correlate with systemic inflammation, and systemic features of RA may result from dissemination of cytokines produced in the synovium. The role of IL-2 in RA remains controversial. Reduced levels of IL-2 may be an expression of a deficiency of T-cells to produce IL-2 in the active phases of RA or may be due to a possible absorption of IL-2 by lymphocyte receptors.

A study of serum androgen and cortisol levels in female patients with rheumatoid arthritis. Correlation with disease activity

SummaryAndrogen status and the role played by androgens in the pathogenesis of rheumatoid arthritis (RA) in female patients are a matter of debate. In the present study serum testosterone (T), DHEAS, sex hormone binding globulin (SHBG) and cortisol levels were determined in 55 RA women, both in pre- and post-menopausal (M) status, and in a group of healthy subjects. Patients were divided into two groups according to disease activity and a correlation analysis of hormonal levels against serum IL1β levels was performed. No significant differences were found in serum T levels between RA patients and controls, both in preM (1.38±0.4 vs 1.35±0.3 nmol/l; p=ns) and in postM status (1.21±0.2 vs 1.10±0.2 nmol/l; p=ns). Serum SHBG levels were lower in RA patients than in control subjects, both in pre and in postM status. DHEAS levels were significantly lower in preM RA patients than in controls (2.34±1.2 vs 5.93±1.6 µmol/l; p<0.001) while cortisol levels were significantly higher in preM active RA patients than in controls (466.2±30.3 vs 411±66.2 nmol/l; p=0.02). IL1β levels were significantly higher in RA patients than in controls both in pre- and postM subjects (70±33.8 vs 23.1±2.9 and 92±27.4 vs 31.9±3.1 fmol/l, p<0.001, respectively).Although androgen status could play a role in the pathogenesis of RA, at present it is not possible to exclude the influence of RA itself on sex hormone profile.

Clinically silent inflammatory gut lesions in undifferentiated spondyloarthropathies

SummaryGastrointestinal inflammation or infection can be associated with various forms of arthritis, such as, acute reactive arthritis triggered by enteritis due to gram-negative bacteria or ankylosing spondylitis and peripheral arthritis in relation to Crohns disease and ulcerative colitis. Using colonoscopy, we have found a high prevalence of clinically silent inflammatory lesions in 38 patients (24 males and 14 females) affected by undifferentiated spondyloarthropathies (SpA). Microscopic inflammatory lesions were present in all the patients. Three patterns of nonspecific chronic inflammatory alterations were observed. No difference was noted between patients taking or not taking nonsteroidal anti-inflammatory drugs. Direct immunofluorescence demonstrated the presence of IgG, IgA, IgM, C3, C4 and fibrinogen in 75% of the specimens examined. The finding of chronic inflammatory gut lesions hypothesizes that a local activation of the immune system depending on the persistence of intestinal microbial antigens or toxins, due to impaired elimination or increased exposition, may have a part in the pathogenesis of SpA.

Serum osteocalcin as an index of bone turnover in active rheumatoid arthritis and in active psoriatic arthritis

SummaryJuxtaarticular osteoporosis is a recognized clinical feature in both rheumatoid arthritis (RA) and psoriatic arthritis (PA), while generalised osteopenia seems to be characteristic of RA only. To assess differences in bone turnover in the two forms of disease, we measured serum osteocalcin levels and other parameters of bone metabolism in two groups of female, ambulant, age-matched patients suffering from active RA or active PA and never treated with steroid therapy. Serum osteocalcin levels were significantly higher in RA patients than in PA patients (13.05±1.27 ng/ml vs 4.83±0.88 ng/ml;p<0.001), with a significant positive correlation between osteocalcin and serum alkaline phosphatase in both groups. These data suggest that bone turnover is higher in active RA than in active PA. Juxtaarticular osteoporosis could be mediated by local disease mechanisms both in RA and in PA, while factors specifically related to active RA seem to determine a more generalized impairment of bone turnover.

Behçet's disease and cardiac arrhythmia

SummaryOnly few cases of cardiac conduction disturbances and arrhythmias have been reported in Behçets disease. We recently observed the case of a 16-year-old woman with Behçets disease in whom cardiac arrhythmia became the main clinical symptom. This observation and a review of the literature led us to the conclusion that arrhythmia could represent the clinical manifestation of an underlying myocarditis due to Behçets disease and can be regarded as a feature of cardiac involvement of the disease.

Thrombosis, recurrent abortions and intrauterine foetal death in a patient with lupus anticoagulant

SummaryThe authors describe a case report of a patient suffering from thrombosis and recurrent abortions. Routine coagulation screening was abnormal and investigation showed the presence of a circulating anticoagulant. High titres of anticardiolipin antibodies were demonstrated. Antinuclear antibodies were slightly positive and antinative DNA antibodies were present. Lupus anticoagulant activity and anticardiolipin antibodies seem to be strong markers of a thrombotic tendency.

Concentration of serum bile acids as an index of hepatic damage in systemic lupus erythematosus

SummaryThe aim of this work is to evaluate the concentration of serum bile acids (SBA) as an index of impaired liver function in systemic lupus erythematosus (SLE) patients versus usual laboratory tests of hepato-biliary system diseases. In patients with SLE the mean fasting SBA concentration was 9.6±1.4μmol/L; in normal subjects the concentration was 2.9±0.6μmol/L (P<0.01). In patients with SLE, mean gamma-glutamyl transpeptidase (GGTP) concentration was 31.5 ±5.9 mU/ml versus 10.05±1.1 mU/ml in controls (P<0.01).The bromsulphalein (BSP) excretion test, 45 minutes after injection, was 6.8±1% in SLE patients versus 2.8±0.4% in controls (P<0.02). No significant difference was found between these two groups of subjects with respect to leucine aminopeptidase (LAP), alkaline phosphatase (AlPh), glutamic-oxalacetic transaminase (SGOT), glutamicpyruvic transaminase (SGPT), bilirubin serum rates. SBA rate was abnormal in 50% of the SLE patients; GGTP rate and the BSP excretion test were abnormal in 38% and 27% respectively. Our findings show the presence of an actual liver impairment in SLE patients, significantly demonstrated by fasting SBA concentration, GGTP rate and BSP excretion test. Other liver function tests are less useful in evaluating hepatic damage in SLE.

Acute rheumatoid factor positive (IgM) polyarthritis associated with a klebsiella pneumonitis

SummaryThe authors report a case of a patient suffering from acute polyarthritis with a high rheumatoid factor titre, associated with a Klebsiella pneumonitis. A polyclonal B lymphocyte activation or a possible cross reaction between rheumatoid factor and an antigen related to Klebsiella may explain the elevated production of rheumatoid factor observed.