RESUMEN
The aim of this study was to determine whether the levels of serum cytokines IL-6 and TNFalpha and of the soluble receptors p55 srTNFalpha, p75 srTNFalpha and srIL-2ac are valuable markers of disease activity in patients with systemic lupus erythematosus (SLE) compared with the established parameters of anti-dsDNA, C3, C4 and CH50. Forty patients with SLE, 19 ambulatory and 21 hospitalised, were included in this study. On the day of blood sampling a clinical examination was performed and SLEDAI and ECLAM disease activity scores were used to assess disease activity. Nineteen patients had inactive disease and 21 patients had active disease. Thirteen patients from the second group developed nephritis. In these patients the blood sampling and disease activity assessment were performed twice (at presentation and 6 months after treatment). Serum levels of cytokines and soluble receptors were measured by ELISA. Serum levels of cytokines and soluble receptors of patients with active disease were significantly higher than in patients with inactive disease (IL-6 p = 0.0004, TNFalpha p = 0.0015, srIL-2c p<0.0001, p55 srTNFalpha p<0.0001, p75 srTNFalpha p<0.0001). Serum soluble receptor levels of patients with inactive disease were higher than those of healthy controls (p55 srTNFalpha p<0.0001, p75 srTNFalpha p = 0.0002, srIL-2alpha p = 0.0012). No significant difference was found for TNFalpha and IL-6 (TNFalpha p=0.015, IL-6 p=0.019). Serum TNFalpha levels and especially srIL-2alpha, p55 srTNFalpha( and p75 srTNFalpha levels correlated strongly with SLEDAI and ECLAM disease activity scores, anti-dsDNA, C3, C4 and CH50 (p<0.0001). Serum soluble receptor (srIL-2alphac, p55 srTNFa, p75 srTNFalpha) levels were higher in patients with nephritis before treatment and decreased significantly 6 months after treatment (p=0.005). The same trend was noticed with SLEDAI and ECLAM disease activity scores (p = 0.005) and anti-dsDNA (p = 0.008). In contrast, no significant differences were observed for C3 and C4 levels before and after treatment, which suggests that soluble receptors of cytokines are more sensitive markers of disease activity than C3 or C4 in predicting improvement. Serum levels of srIL-2alpha, p55 srTNFalpha and p75 srTNFalpha could provide useful information about disease activity in SLE patients, especially in cases where the other markers do not.
Asunto(s)
Antígenos CD/sangre , Interleucina-6/sangre , Lupus Eritematoso Sistémico/sangre , Receptores de Interleucina-2/sangre , Receptores del Factor de Necrosis Tumoral/sangre , Factor de Necrosis Tumoral alfa/metabolismo , Adolescente , Adulto , Biomarcadores/sangre , Progresión de la Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Receptores Tipo I de Factores de Necrosis Tumoral , Receptores Tipo II del Factor de Necrosis Tumoral , Índice de Severidad de la EnfermedadRESUMEN
We describe a case of an 82-year-old woman with giant cell arteritis, who developed unilateral pitting oedema of the dorsum of the right hand, foot and distal part of the right forearm as well as tenosynovitis of the right wrist extensors, mild synovitis of the right wrist, metacarpophalangeal and metatarsophalangeal joints, during relapse of giant cell arteritis. Increase of corticosteroids resolved the giant cell arteritis, pitting oedema and tenosynovitis.
Asunto(s)
Edema , Arteritis de Células Gigantes/diagnóstico , Anciano , Anciano de 80 o más Años , Biopsia , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Angiografía Cerebral , Femenino , Estudios de Seguimiento , Pie , Antebrazo , Arteritis de Células Gigantes/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Prednisolona/uso terapéutico , Arterias Temporales/patología , Tomografía Computarizada por Rayos X , MuñecaRESUMEN
The association of certain HLA-DRB1 alleles in Green rheumatoid arthritis (RA) patients with several features of the disease, the gender of the patient and the age at onset was investigated. This case control study includes 86 Greek RA patients and 130 healthy controls unrelated to the patients. HLA typing was performed by polymerase chain reaction (PCR) and hybridization with sequence-specific oligonucleotide (SSO) probes. HLA-DR4 was significantly increased in RA patients. The alleles *0101, *0401, *0405 and *1001 were associated with a higher risk of RA. The *0408 allele was absent from our patients. Sixty-five per cent of RA patients carried the 'sharp epitope' (SE) compared with 31.5% of controls. The risk for RA in individuals carrying a single allele positive for SE was 2.85 times higher, and for those carrying two alleles positive for SE 8.57 times higher, than in SE-negative individuals. The risk was higher in those carrying the *0401 allele, followed by *0405 and *0101, while the genotype *0401/*0404 was absent. Alleles positive for SE comprise a predisposing factor for RA at an early age, particularly in men, and are associated with positive rheumatoid factor, nodules and erosions.
Asunto(s)
Artritis Reumatoide/genética , Frecuencia de los Genes , Genes MHC Clase II/genética , Antígenos HLA-DR/genética , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/inmunología , Estudios de Casos y Controles , Epítopos , Femenino , Grecia , Cadenas HLA-DRB1 , Prueba de Histocompatibilidad , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Factores de RiesgoAsunto(s)
Artritis Reumatoide/epidemiología , Artritis Reumatoide/genética , Antígenos HLA-DR/genética , Adulto , Distribución por Edad , Edad de Inicio , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/inmunología , Femenino , Genotipo , Grecia/epidemiología , Cadenas HLA-DRB1 , Humanos , Masculino , Persona de Mediana Edad , Distribución por SexoRESUMEN
One hundred and eighteen unrelated Greek patients with classic rheumatoid arthritis (RA) were tissue-typed for HLA-A, -B, -DR antigens and the frequency was compared to that of healthy controls. Greek RA patients regardless of sex, anatomical severity, seropositivity and age at disease onset are not associated with any of the HLA alloantigens tested. Only an increased prevalence, not statistically significant, was observed of the HLA-DR5 antigen in the Ro (SSA) positive RA group.