Suliman R. Alballa

Cytokine profile in systemic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases

We investigated serum levels of interleukin-6 (IL-6), interferon-gamma (IFN-γ), and tumor necrosis factor alpha (TNFα) from patients with systemic lupus erythematosus (SLE) and its various clinical manifestations of disease and from patients with rheumatoid arthritis (RA) and other rheumatic diseases. The serum levels of IL-6 and IFN-γ were highly elevated from patients with SLE associated with lymphadenopathy (LN) or nephrotic syndrome (NS). On the contrary, the serum levels of TNFα were elevated from most patients with SLE associated with thrombocytopenia (TP). However, serum levels of TNFα were in the normal range from patients with SLE associated with NS, LN, or central nervous system disease. Of interest, patients with SLE associated with humoral immunodeficiency disorder, hypogammaglobulinemia, had highly elevated levels of serum IL-6. The concanavalin A-stimulated mononuclear cells (MNC) of patients with SLE associated with TP secreted highly elevated levels of TNFα compared to other patient groups. We suggest that abnormal production of various cytokines in SLE is an intrinsic defect of MNC and the immune system that may be the key element for a variety of clinical manifestations of this disease.

Interleukin-10 (IL-10) secretion in systemic lupus erythematosus and rheumatoid arthritis: IL-10-dependent CD4+CD45RO+ T cell-B cell antibody synthesis

Interleukin-10 (IL-10) is a major immunoregulatory cytokine and has a multitude of immunomodulatory effects in the immune system. In this study, we have examined the secretion andin vitro function of IL-10 in B cell hyperactivity in antibody production in two common autoimmune diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). IL-10 was detectable in serum of all active SLE and serum and synovial fluid samples of all RA patients but in none of the normal controls. B cells and CD4+CD45RO+ “memory” T cells secreted highly enhanced levels of IL-10 in SLE and RA versus normals. Increased IgM and IgG production by B cells-CD4+CD45RO+ T cells in SLE and RA was IL-10 dependent, since neutralization of IL-10 cytokine by anti-IL-10 antibody drastically reduced Ig synthesis in these coculture experiments. B cell hyperactivity in autoantibody production in SLE and RA may be a function of IL-10-dependent CD4+CD45RO+ Th2 cell activation. Therefore, IL-10 may play an important role in highly disturbed immune system and B cell-T cell function in these immune disorders.

Eosinophilic fasciitis (Shulman's syndrome): case reports and review of the literature.

In 1974, Shulman et al. reported two patients with scleroderma-like skin changes, peripheral eosinophilia and hypergammaglobulinemia.1 This disorder was initially distinguished from progressive sys...

Effect of phonophoretic application of diclofenac gel on localized musculoskeletal disorders

Abstract The objective of this study was to assess the efficacy and tolerability of the phonophoretic application of diclofenac gel TM in patients with localized musculoskeletal disorders. Sixty-seven consenting patients were randomly assigned to receive ultrasound treatment using either Aquasonic ® 100 (32 patients) or diclofenac gel (35 patients) as the ultrasound coupling agent. Each group received ultrasound treatments of 1.5 W/cm 2 for 15 minutes three times per week for 3 weeks. Both groups showed significant improvement in all the criteria evaluated. Twenty-four (68.6%) patients in the diclofenac gel group and 16 (50%) patients in the Aquasonic 100 group discontinued treatment early. Of these patients, 14 (58.3%) in the diclofenac gel group and 6 (37.5%) in the Aquasonic 100 group discontinued treatment early because they were considered cured. This occurred earlier in the diclofenac gel group (5.3 ± 1.8 vs 6.7 ± 1.4 sessions; P = 0.054) and resulted in 52 fewer sessions in the diclofenac gel group and 14 fewer in the Aquasonic 100 group. The treatment was well tolerated, with only minor local side effects. These results suggest that phonophoretic application of diclofenac gel is well tolerated and results in an early cure in a substantial proportion of patients with localized musculoskeletal disorders.

Pulmonary Involvement in Behcet's Disease

Among-51 patients with Behcets disease diagnosed at our centers between 1979 and May 1989, nine had major pulmonary involvement (18%). All were males with a mean age of 30 years. Four presented wi...