[Chorea as a rare symptom of systemic lupus erythematosus in the elderly]

The opinion that systemic lupus erythematosus (SLE) is a young people disease translates into its rare diagnosing in subjects in their 6th decade of life and older. The variability of neuropsychiatric disorders that may be the first symptoms of the disease suggest the need for their in-depth diagnostics and treatment. Chorea is one of the rarest neuropsychiatric symptoms of SLE. It may be present in an early stage of the disease and it is one of the most common motor disorders in SLE. The presented case of diagnosing SLE in a 79-year-old male shows the importance of individual and thorough assessment of the clinical picture of every patient regardless of his/her age and gender. In the discussed case the clinical course of the disease denies common opinions about the picture of SLE in the elderly.

[Fasciitis eosinophilica: personal observations and a review of the literature]

Eosinophilic fasciitis is a rare disease that is classified by some authors to scleroderma-like syndromes. Symmetrical induration of skin and subcutaneous tissue associated by eosinophilia in peripheral blood are characteristic features of the disease. Internal organ involvement is uncommon. It is often difficult to diagnose eosinophilic fasciitis and its course may be variable. Glucocorticosteroids are most commonly used in the treatment but in many cases they are ineffective. Then other immunosuppressive therapy must be considered. Prognosis is rather favorable. The remission is not always achieved and sometimes flares of the disease are observed as evidenced by the described cases. It should be emphasized that a majority of our patients were females. In four out of five patients anti-thyreoglobulin antibodies and/or anti-thyroid peroxidase antibodies were present suggesting their involvement in the pathogenesis of eosinophilic fasciitis. Neither indicators of inflammation nor peripheral blood eosinophilia were pathognomonic. Results of glucocorticosteroid treatment were satisfactory in three patients, but two patients required combined immunosuppressive treatment.

[Ocular manifestations in patients with systemic lupus erythematosus and antiphospholipid syndrome]

INTRODUCTION

Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyes that occurr in SLE are not frequent, but can lead to severe impairment of sight including blindness.

OBJECTIVES

The aim of the work was to asses the frequency of eye changes among patients with SLE and SLE with antiphospholipid syndrome (APS). Another aim was to asses the association between antiphospholipid antibodies and ocular lesions.

PATIENTS AND METHODS

There were 75 patients enrolled with SLE, 26 of them ha APS. All of patients had a comprehensive ophthalmological and physical examination. Moreover biochemica analysis including lipid profile and glucose metabolism and serological markers of APS and SLE were performe

RESULTS

Thirty-six patients complained of ophthalmologic disturbances (48%), with "dry eyes" being the most common symptom (20 patients). The reduced visual acuity was detected in 17 patients (22.6%). Conjunctivitis was found in 8 patients (10.67%), corneal involvement in 31 (41.3%), and sclera changes in 40 patients (53.3%). Changes in retina were found in 15 (20%) of patients, the most frequent were sub-retinal edema in the region of yellow spot. Changes in yellow spot were found in 8 patients; in 2 of them it was associated with dry degenerative changes, in 6 patients exudates with or without hemorrhages were found. Vascular changes including their lumen diameter were found in 33 patients (44%). In 4 patients there were changes in optical nerve disc. Schirmer's test was pathological in 43 patients (57.3%), but in only 4 patients Sjögren's syndrome was diagnosed. In the group of SLE patients intraocular pressure was significantly higher. The presence of anticardiolipin antibodies IgG class (aCL IgG) was associated with reduced visual acuity. The presence of lupus anticoagulant and anti-beta2, glycoprotein-I antibodies (anti-beta2GPI) was associated with conjunctive involvement. The presence of aCL IgM and anti-beta2GPI was associated with less frequent symptoms of eye dryness.

CONCLUSIONS

We found the following significant factors of the occurrence of eye involvement in our series of SLE patients: high activity of disease (conjuctiva, iris, uvea, retina, spot, vessels and optical nerve disc involvement), late diagnosis of SLE (retinopathy and conjuctive involvement), arterial hypertension (reduced visual acuity, cornea involvement, vessels involvement), age (reduced visual acuity, cornea involvement, retinopathy), glucose metabolism disorders (changes in optical nerve disc) and presence of anti-double stranded DNA antibodies (retinopathy).

[Candida spondylodiscitis--review of the literature]

Infectious spondylodiscitis due to Candida species is rarely reported, not well known entity with low frequency. Most probably its frequency is underestimated, partly because of chronic course and difficulties with establishing of final diagnosis. Candida can be considered as the opportunistic pathogens. The infection proceeds as the systemic mycosis and most commonly develops in individuals with immune deficiency. In forthcoming years, the higher frequency of opportunistic infections, including mycotic spondylodiscitis, can be expected because of an increasing number of individuals treated with immunosuppressive drugs, and an increasing number of medical invasive procedures. A purpose of our paper is to describe a natural history of infectious spondylodiscitis due to Candida, usefull diagnostic methods, and recommended treatment.

[Significance of antiphospholipid syndrome and antiphospholipid antibodies in patients with systemic lupus erythematosus in estimation of risk of subclinical atherosclerosis development]

INTRODUCTION

Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations.

OBJECTIVES

Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are risk factors for subclinical atherosclerosis in patients with SLE.

PATIENTS AND METHODS

We examined 103 patients with SLE and 30 healthy volunteers, included as the control group. Coexistence of APS was confirmed in 35 patients. Evaluation of subclinical atherosclerosis was done on the basis of measurement of intima-media thickness (IMT) in B-mode ultrasound examination. We considered classical atherosclerotic risk factors and determined profile of aPL: anti-cardiolipine antibodies (aCL), anti beta2 glycoprotein-I antibodies, antiprothrombin antibodies (aPT), anti-oxidized low-density lipoprotein antibodies and lupus anticoagulant (LA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done.

RESULTS

Thickened IMT was significantly more frequent in patients with SLE than in controls (p = 0.0002). We found that coexistence of APS is a risk factor for moderate thickening of IMT (OR: 3.41; 95% CI: 1.0-11.5). We also confirmed that the presence of aPL is significantly correlated with IMT ranging from 0.66 to 0.86 mm. The highest risk was found in patients with the presence of aPT IgA (OR: 5.50; 95% CI: 1.1-30.2), aCL IgM (OR: 4.36; 95% CI: 1.1-20.7), LA (OR: 4.02; 95% CI: 1.1-19.4) and aCL IgG (OR: 2.99; 95% CI: 1.1-9.7). Moreover, we found that ischaemic heart disease, nephropathy and myocardial infarction were significantly more frequent in patients with thickened IMT.

CONCLUSIONS

Patients with SLE develop subclinical atherosclerosis significantly more frequent than the general population. Coexistence of APS and presence of aPL are risk factors for subclinical atherosclerosis development in patients with SLE. Thickened intima-media in patients with SLE is significantly associated with an increased risk of cardiovascular manifestations.

[Ear involvement in Wegener's granulomatosis]

Clinical manifestation of Wegener's granulomatosis could be multiorgan. Authors present the review of literature concerning on inflammatory changes in ears that in consequence could lead to hearing impairment or deafness.

[Therapy resistance antiphosholipid syndrome in the course of systemic lupus erythematosus: case report]

Antiphospholipid syndrome (APS) is one of the most common reasons of thromboembolic complications in the course of connective tissue diseases. There is a strong relationship between presence of antiphospholipid antibodies and the risk of thrombosis. APS related thromboembolic complications range from superficial vein thrombosis up to rapidly developing, life threatening, multi-organ embolism. We present a case of a 21-year old female who presented with myocardial infarction as the first symptom of systemic lupus erythematosus and APS. Afterwards she was consequently treated with antithrombotic and anti-aggregation agents but it did not prevent her from reoccurrence of middle retinal vein. During the 10-year follow up she presented with reoccurring neurological symptoms i.e.: headache, memory deficits, concentration loss and impairment of the cognitive functions. She was found many times to be positive for IgG and IgM anticardiolipin antibodies, anti-beta2glicoprotein-I antibodies and lupus anticoagulant.

Fungal spondylodiscitis in a patient with ulcerative colitis - case report

We report a case of a 34 year old women with spondylodiscitis due to Candida albicans infection. One and a half year earlier a ulcerative colitis she was diagnosed and treated with sulfasalazine, short course of glucocorticosteroids and with azathioprine. The diagnosis of fungal spondylodiscitis was made by culture of material collected from involved part of vertebral column during the surgery. Initially the patient was treated with fluconazole intravenously for 20 days, then the treatment was continued orally for one year. During the treatment all complaints disappeared and reduction of the laboratory acute phase indices was observed. Follow-up magnetic resonance's have shown gradual improvement. To our knowledge no similar case has been reported in the Polish literature before.

[SAPHO syndrome--clinical features]

OBJECTIVE

Presentation of clinical features of the SAPHO syndrome.

MATERIALS AND METHODS

Seventeen patients (15 women and 2 men) with confirmed diagnosis of the SAPHO syndrome was presented. The culture of biopsy of pustulotic skin lesions was performed in 11 patients. ESR, C-reactive protein level and Waaler-Rose test were determined in all patients, and antinuclear antibodies and bone scintigraphy were performed in 16 patients. X-ray of the sterno-clavicular joints was performed in 15 patients.

RESULTS

The age of patients was 22-59 yr. (mean: 47.1 yr). The duration of joint symptoms was 0.1-25 yr. (mean: 4.4 years). Pustulosis was presented in 16 patients, only 1 patient had acne. All patients suffered from pain localized on the anterior chest wall. Tenderness of the peripheral joints: wrist (in 7 patients), shoulder (in 7 patients), knee (in 4 patients) was shown. In 6 patients, skin changes preceded joint symptoms, in 2 patients skin changes followed joint symptoms after 5 and 10 yr., respectively. All patients had negative the Waaler-Rose test. Active inflammatory process characterized by an increased ESR and C-reactive protein level was present in 12 patients. Abnormalities in x-ray of the sterno-clavicular joints were present in 4 patients. Characteristic alternations for the SAPHO syndrome in scintigraphic picture of the skeleton were observed in 14 patients. All patients were treated with non-steroidal anti-inflammatory drugs. In 8 patients, treatment with antibiotics, in 11 patients--with sulfasalazine, in 3 patients--with methotrexate and low doses of glucocorticosteroids, in 1 patient--with colchicines was performed.

CONCLUSIONS

Association of typical skin changes with pain of the anterior chest wall is the key for diagnosis of the SAPHO syndrome. It seems that this syndrome is more common in Poland than it has been previously estimated.

[Antiphospholipid syndrome and antiphospholipid antibodies as a risk factors of ischaemic heart disease and myocardial infarction in patients with systemic lupus erythematosus]

Ischemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodies are the risk factor for myocardial infarction and ischemic heart disease in patients with TRU. We examined 129 patients with SLE (114 women and 15 men). All the patients underwent comprehensive physical examination. ECG, ultrasound heart examinations were performed. They were followed by heart scintygraphic examination if indicated. Routine biochemical and hematological laboratory tests were performed including fasting glucose level, concentration of homocysteine, uric acid and lipids. Wide range of immunological essays were performed, testing for antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), antiphospholipid antibodies (anticardiolipin antibodies--aCL, lupus anticoagulant--LA, antiprothrombine antibodies aPT, anti-beta2glicoprotein-I antibodies), anti-dsDNA antibodies, anti-nucleosome antibodies, antihistone antibodies, antineutrophil cytoplasmic antibodies (ANCA) and antiendothelial antibodies (AECA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. Ischemic heart disease was found in 20 (15.5%) SLE patients, myocardial infarctions were diagnosed in 9 (6.97%). Ischemic heart disease and myocardial infarction were significantly related to presence of secondary antiphospholipid syndrome (SAPS), OR: 4.21, p = 0.008 and OR: 12.8; p = 0.02 respectively). They were also related to high activity of SLE, OR: 7.18; p = 0.012 and OR: 27.3; p = 0.006 respectively. Ischemic heart disease was significantly more common in older patients (52.75 years versus 42.15 years; p = 0.0008) and in patients with hypertension (p < 0.05). Impaired glucose tolerance (OR: 8.44; p = 0.03), presence of aCL IgG (OR; 2.93; p = 0.05) and p-ANCA anti-MPO (OR: 6.08; p = 0.036) were found to be risk factors of ischemic heart disease. Myocardial infarction was significantly associated with high uric acid level (OR: 5.01; p = 0.052) and impaired glucose tolerance (OR: 7.42; p = 0.047) and with presence of the following antibodies: aCL IgG and/or aCL IgM (OR: 5.61; p = 0.039), ANCA in the indirect immunofluorescence essay (OR: 5.78; p = 0.035), anti-MPO antibodies (OR: 6.58; p = 0.051) and AECA (OR: 11.10; p = 0.026). Presence of antiphospholipid antibodies and SAPS are significant risk factors of ischemic heart disease and myocardial infarction in SLE patients. The risk factors of ischemic heart disease and myocardial infarction in SLE patients significantly differ from the ones in general population.

[Severe neurological and obstetrical complications in a patient with antiphospholipid syndrome]

Antiphospholipd syndrome (APS) is a disease characterised by venous and arterial thrombosis or recurrent foetal loss, which are associated with antiphospholipid antibodies or/and lupus anticoagulant. Clinical symptoms ofAPS are assocciated with presence of noninflammatory thrombosis ocluding arteries or venes. Symptoms of APS are often very dramatic what can be illustrated by the presented case of 40 year patient. At the age of 25 after a miscarriage the patient developed tetraparesis and motor aphasia in the course of thrombosis in central nervous system vessels. In physical examination besides neurological symptoms reticular livedo was found on the trunk and limbs. Serological tests have revealed presence of high titre of IgG and IgM anticardiolipin antibodies and lupus anticoagulant (LA). CT examination revealed hypodensic foci in left parietal lobe, and abnormal EEG findings were observed in fronto-temporal leads of left hemisphera of brain. At that point the patient did not meet the criteria of connective tissue diseases, including lupus. The diagnosis of primary APS was suggested. The patient received anti-aggregation treatment and also immunosuppressive drugs (azathioprine and prednison) due to progression of neurological manifestations. 3 years later, the second pregnancy ended in the 27th week with intrauterine fetal death. During the 3rd pregnancy, 2 years afterwards, the patient was treated with heparin, aspirin and intravenous immunoglobulin. The pregnancy finished with a successful delivery at term, the newborn was in good condition. During the following pregnancy the symptoms of preeclampsia occurred at 36/37th week but the newborn was delivered in a good condition after a caesarean section. At the age of 36 patient developed ischemic brain stroke with left-side hemiparesis inspite of anti-aggregation and immunosupressive (prednison and azathioprine) treatment. At that time homogenic type antinuclear antibodies (ANA) 1:2560, anti-beta2-glycoprotein antibodies (beta2-GPI), aCL antibodies in medium titer and thrombocytopenia were found. The patient was treated with heparin, cyclophosphamide and methyloprednisolon intravenously. During rehabilitation process gradual improvement of cognitive functions, speech and motorical functions was observed. Recently high titre of ANA and recurent thrombocytopenia < 100,000/mm3 were present. Maybe during the further follow-up, 14 years after the first symptoms of APS, the patient will develop full blown symptoms of SLE.

[Cardiovascular abnormalities in systemic lupus erythematosus patients in echocardiographic assessment]

Cardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLE patients with a regard to clinical, serological and environmental risk factors.

MATERIAL AND METHODS

103 patients were included into the study, 91 women and 12 men, aged 16-74 yrs, the control group included 25 subjects. Physical examination, two-dimensional guided M-mode and Doppler echocardiographic recordings were performed. The tests for the presence of ANA, ENA, antiphospholipid antibodies (aCL, LA, anti-beta2GPI and antiprothrombin antibodies), ANCA (anti-neutrophil cytoplasm antibodies), AECA (anti endothelial cell antibodies) were carried out.

RESULTS

The following pathologies were significantly more common in the SLE patients: pericardial involvement (58%), organic changes of the mitral valve cusps (54%), organic changes of the aortic valve cusps (36%), widening of the aortal lumen (35%), enlargement of the left atrium (18%), hypokinesis of the left ventricle myocardial muscle (15%). Ultrasound cardiac pathologies were associated with presence of antiphospholipid antibodies, ANCA, anti-hitone antibodies and AECA. High activity of SLE increased risk of pericarditis and ascending aortic wall thickening. Cardiovascular manifestations occurred most frequently in patients with short time duration of SLE.

CONCLUSION

Cardiac involvement is a frequent and early systemic complication of SLE and it is the most commonly related to pericardium and valvular apparatus. Cardiovascular manifestations in SLE patients are the most frequently related to the presence of serological risk factors, mainly antiphospholipid antibodies. It suggests their major role in the pathogenesis of the cardiovascular involvement in SLE. Pericarditis are markers of high activity of SLE.

[Activity of the disease and selected echocardiographic abnormalities in ankylosing spondylitis]

Cardiovascular involvement in the course of ankylosing spondylitis (AS) is a very important problem. The aim was to assess the influence of the activity of the disease on echocardiographic abnormalities in ankylosing spondylitis.

MATERIAL AND METHODS

We studied 38 AS patients. Activity of the disease was assessed according to the ESR and following indexes: BASMI, BASFI, BASDAI, BASG-t, BASG-6. Using 2-dimensional echo Doppler (Acuson 128XP) the heart dimensions were determined according to the American Society of Echocardiography guidelines.

RESULTS

Patients with mitral valve prolapse compared with the group of the AS patients without this abnormality had significant higher (p = 0.05) activity of the disease assessed by ESR. Patients with aortic incompetence compared with the group of the AS patients without this abnormality, had significant (p = 0.04) lower disease activity assessed by BASG-6. We found significant negative correlation between EF and disease duration, and significant lower disease activity assessed by BA SG-6. Patients with pericardial effusion compared with group without this had significant shorter (p = 0.05) disease duration.

CONCLUSION

There was no significant influence of the following indexes: BASMI, BASFI, BASDAI, BASG-t, BASG-6 of the activity of the disease on echocardiographic abnormalities in ankylosing spondylitis.

[A review of paraneoplastic rheumatic syndromes]

Malignant neoplasms are sometimes associated with a variety of paraneoplastic rheumatic syndromes. The most frequently diagnosed ones include hypertrophic osteoarthropathy, polyarthritis, dermatomyositis/polymyositis, and paraneoplastic vasculitis. Fasciitis, panniculitis, erythema nodosum, lupus-like syndrome, and Raynaud's syndrome are rare. Rheumatic manifestations of cancer are sometimes indistinguishable from idiopathic rheumatic disease. Hence, the neoplasm is not discovered because it is masked by another disease implicating improper therapeutic decisions and worsening the prognosis. The aim of this work was to review the literature on paraneoplastic rheumatic syndromes.

[Coexistence of hypothyroidism with polymyositis or dermatomyositis]

INTRODUCTION

Muscle weakness with elevation of muscle enzymes may be a predominant manifestation of many diseases, among them myositis and hypothyroidism.

MATERIAL AND METHODS

Between 1997 and 2005, polymyositis (PM) or dermatomyositis (DM) was diagnosed in 28 patients (7 males, 21 females) referred to our Department of Rheumatology. Coexistence of hypothyroidism and poly/dermatomyositis was established in seven patients (25%), all of them women. Five of them fulfilled the diagnostic criteria for PM, two for DM. The mean age at the time of diagnosis was 46.1 years (40-54 years). Four patients were diagnosed with chronic autoimmune thyroiditis, in two patients the autoimmune etiology was probable, whereas one patient was diagnosed with hypothyroidism secondary to strumectomy for follicular adenoma. We present and compare signs and symptoms characteristic for hypothyroidism and poly/dermatomyositis. Hypothyroidism may be masked by symptoms of poly/ dermatomyositis especially when the course of myositis is rapid.

RESULTS

Every patient suspected of poly/dermatomyositis should be tested for thyroid hormone levels to exclude hypothyroidism with muscle weakness arising from the polymyositis-like syndrome or alternatively to confirm the coexistence of hypothyroidism and poly/dermatomyositis.

[Hemochromatosis--disease of concern of rheumatologist]

Hemochromatosis is an congenital metabolic disorder depending on increase in intestinal iron absorbtion. That result in many systemic disorders and organ failure including arthralgia, occuring usually between 30 and 50 year of life. These symptoms precede liver cirrhosis with few years. We are describing the case of 40 years man with seronegative arthritis diagnosed for hemochromatosis proven in further diagnostics.

[Adult-onset Still's disease]

INTRODUCTION

The authors present the course and manifestations of adult-onset Still's disease on the basis of five cases diagnosed at the Department of Rheumatology, Pomeranian Medical University in Szczecin.

MATERIAL AND METHODS

The usefulness of two most popular sets of diagnostic criteria of adult-onset Still's disease (Yamaguchi and Cush) was analyzed. At onset of the disease, two out of five patients met both sets of the diagnostic criteria, two others met criteria of Yamaguchi and one of Cush. During follow-up, criteria of Yamaguchi were met in all cases.

RESULTS

The authors suggest to use the Cushs criteria of adult-onset Still's disease when the patient does not meet the criteria of Yamaguchi and other causes of fever are excluded.

[Quality of life and activity of disease in patients with rheumatoid arthritis]

PURPOSE

The aim of this study was to evaluate the quality of life in patients with rheumatoid arthritis (RA) considering their age, activity of the disease, its duration and radiological stage.

MATERIAL AND METHODS

The study group consisted of 151 women (mean age 55.0 years, mean duration of RA 9.4 years) and 45 men (mean age 55.0 years, mean duration of RA 9.4 years). All subjects were treated at the Department of Rheumatology and at the SPSK-1 rheumatology outpatient clinic in Szczecin. Diagnosis of RA was established according to ARA criteria of 1987. The radiological stage of the disease was established according to Steinbrocker's criteria. The patient's quality of life was evaluated with the Health Assessment Questionnaire. The activity of RA was determined with the Disease Activity Score DAS 28.

RESULTS

Significant correlation between HAQ score and DAS 28 was found (correlation coefficient--R = 0.38; p < 0.001). Age (R = 0.31, p < 0.001) and radiological stage of RA (R = 0.26, p < 0.001) were also found to affect the quality of life.

CONCLUSIONS

The quality of life of patients with rheumatoid arthritis is significantly influenced by their age, activity of the disease, and radiological stage of RA.

[Antiendothelial cell antibodies as a risk factor of atherosclerosis in systemic lupus erythematosus]

PURPOSE

It was confirmed experimentally that antiendothelial cell antibodies (AECA) react directly with the vascular endothelium and are involved in the pathogenesis of vasculitis. There is evidence for a role of AECA in atherosclerosis. To search for correlations between intima-media thickness (IMT) and high titer of AECA in patients with systemic lupus erythematosus (SLE).

MATERIAL AND METHODS

IMT of carotid arteries was measured with B-mode ultrasound in 103 SLE patients and 30 healthy subjects (control group). The presence of AECA was determined with indirect immunofluorescence using human umbilical vein endothelial cells as target. Statistical analysis was performed with chi2 Yates, chi2 Pearson, R Spearman rank test, and logistic multivariate regression analysis.

RESULTS

Normal IMT (< or = 0.65 mm) was found in 34 patients. In 52 patients, IMT was 0.66-0.86 mm and in 17 it exceeded 0.86 mm. The difference in comparison with the control group was significant (p = 0.0002). High titers of AECA were significantly more frequent in patients with SLE than in controls (p = 0.0001). In SLE patients, high titers of AECA correlated with IMT greater than 0.86 mm (OR = 6.61; 95% CI: 1.6-28.3).

CONCLUSIONS

The presence of antiendothelial cell antibodies is a risk factor for premature, subclinical atherosclerosis in patients with SLE.

[Retrospective analysis of the risk factors in patients with ischaemic heart disease hospitalized in the years 1983-1992]

PURPOSE

The aim of this study was to perform a retrospective analysis of selected risk factors and their variability in a 10 years period of observation in patients with ischemic heart disease (IHD).

MATERIAL AND METHODS

We reviewed 5219 questionares of patients hospitalized at internal wards of the Internal Medicine Institute of the Pomeranian Medical University in Szczecin. Among the participants 1709 were females with mean age 56.3 +/- 7.1 and 3510 males with mean age 54.46 +/- 7.96. Multivariate logistic regression analysis of the relationship between the: analysed risk factors and the hospitalization year, age and sex of patients was used.

RESULTS

Among all risk factors, cigarette smoking appeared most frequently (43.93% of patients) followed by arterial hypertension (32.90%), lipid disturbances (25.78%), obesity (16.26%), type 2 diabetes (13.79%), family history of IHD (8.46%), impaired glucose tolerance (5.8%), hyperuricaemia (3.62%) and type 1 diabetes (1.1%). Cigarette smoking and hyperuricaemia appeared markedly more often in men in comparison to women (p < 0.0002) in whom arterial hypertension and obesity significantly dominated (p < 0.0001).

CONCLUSIONS

During the 10-years period of observation a significant raise of arterial hypertension, dyslipidemia, hyperuricaemia, type 2 diabetes mellitus and impaired glucose tolerance was found. Hovever, some positive changes such as a decrease in number of cigarette smokers and obesity among women were detected. In conclusion, the results of our study show that between 1983 and 1992 there was a domination of negative changes among the IHD risk factors. This was more pronounced in the studied group of females in comparison to males.

[Fenofibrate--induced myopathy in a patient with undiagnosed hypothyroidism--case report and a review of the literature]

Hypothyroidism is one of the common causes of the secondary hypercholesterolemia. The prevalence of hypothyroidism in the general population is estimated to be as high as about 1.5%. Frequency of the hypothyroidism in patients with hyperlipidemia is high, and can be observed in 4.2-10% in different populations. Most commonly, there is no need to treat the hypothyroid patients with the hypolipidemic drugs. Substitution treatment with the thyroid hormones usually results in either normalization or significant decreasing of the lipid levels. Hypothyroidism with symptoms of involvement of skeletal muscles is referred as to hypothyroid myopathy in English literature, and can be present in 30-80% patients with deficiency of the thyroid hormones. Hypothyroidism is a risk factor of developing of toxic injury of muscles, what is thought to be related to hypolipidemic drug intake. We report a case of a patient with undiagnosed hypothyroidism with muscle involvement manifestation, who was treated with fenofibrate due to accidentally diagnosed hypercholesterolemia. Hypolipidemic management resulted in rapid exacerbation of previously moderate myopathy. High concentrations of muscle enzymes and moderate increasing of creatinine concentration were detected. Improvement was observed after discontinuation of fenofibrate administration, but muscle symptoms and elevation of muscle enzymes and creatinine persisted. After administration of levothyroxin, muscle weakness and laboratory abnormalities were observed no longer. After several months of follow-up we believe that treatment with fenofibrate in our patient was complicated with muscle tissue damage and exacerbated symptoms of myopathy originally related to decompensated hypothyroidism.

[Spastic tetraparesis and heart thrombus in a male patient as first symptoms of the antiphospholipid syndrome]

PURPOSE

The antiphospholipid syndrome (APS) manifests itself with circulating anticardiolipid antibodies (aCL) and/or lupus anticoagulant (LA) associated with thrombi and emboli or with recurrent complications of pregnancy.

MATERIAL AND METHODS

We present a case of a 50-year-old man who was diagnosed with the antiphospholipid syndrome on the basis of serologic findings and results of diagnostic imaging. Neurological symptoms in the form of memory deficits, disorders of orientation, and pyramidal-type bilateral hemiparesis more evident on the left side were reported by the patient over a period of two years. Magnetic resonance imaging (MRI) of the head revealed numerous vascular foci located in the cortical-subcortical areas of the brain. Ultrasound (USG) disclosed a large, irregular thrombus adhering to the margins of the mitral valve with signs of inflammation. aCL (high titers in both classes), LA, and anti-beta2-glycoprotein I antibodies (a-beta2GPI) were found in serum. a-beta2GPI and anti-nDNA antibodies were disclosed in the cerebrospinal fluid.

RESULTS

Combined anticoagulant and anti-aggregation therapy was unsuccessful. It was then decided to use immunosuppression with intravenous cyclophosphamide and methylprednisone pulses every 4 weeks (7 cycles). USG at follow-up showed marked regression of the mitral thrombus with swollen margins of the mitral valve. MRI of the brain confirmed progression of the lesions described previously.

CONCLUSION

The diagnosis of secondary antiphospholipid syndrome associated most probably with systemic lupus erythematosus (SLE) was made. It should be remembered, however, that diagnostic criteria for APL and SLE partially overlap.

[Primary hypertrophic osteoarthropathy as a rare cause of joint pain]

Primary hypertrophic osteoarthropathy (HOA) is a rare cause ofjoint pain. The diagnosis is often delayed, due to mild complaints. However, finger clubbing combined with joint pain should suggest considering HOA in the diagnosis. The progression of toes and fingertips widening is slow and can be overlooked by a patient. It is common that patient seeks physician's aid only when the joint pain occurs. The presented case is an example of delayed diagnosis. Due to the fact that secondary HOA coexists with some diseases associated with serious prognosis it is recommended to exclude other possible causes before diagnosing primary HOA. Some clues, like the age of disease onset or positive family history allow the diagnosis of primary HOA with high probability. This case report contains clinical symptoms and new diagnostic criteria, differential diagnosis, and possible complications.

Association between early-onset breast and laryngeal cancers

Recent studies suggest that there are groups of genes that predispose simultaneously to both early-onset breast and laryngeal cancer. Studies were performed on a large series of unselected patients with laryngeal cancer diagnosed in Szczecin, Poland. Pedigrees of 683 laryngeal cancer patients were analysed for the frequency of early-onset and late-onset breast cancer among first degree relatives. The observed frequencies of breast cancer in these families were compared to those expected. In addition, common mutations/variants in the 3 genes BRCA1, NOD2 and CYP1B1, known to be associated with early-onset breast cancer, were assessed to determine their frequency in 348 unselected laryngeal cancers. The average age at diagnosis of LC among patients, who had relatives affected by BC diagnosed under the age of 50 years was 57.62. In comparison LC patients reporting a first degree relative affected by BC diagnosed above 50 years of age, had an average age of diagnosis of 66.00 years, which was significantly different (p=0.0064). Similarly, the average age of diagnosis of BC among patients with LC diagnosed under age of 50 years was 46.7 years and whereas LC patients with tumors diagnosed above 50 years had relatives diagnosed with breast cancer at an average age of 53.37 years, which was significantly different (p=0.02). From the 348 consecutive ascertained laryngeal cancer patients who had molecular studies undertaken, breast cancers among first degree relatives were found in 18 families including 8 with breast cancers diagnosed less than 50 years of age. A molecular basis was identified (the CYP1B1 355T/T genotype) in only 2 of the 8 early cases suggestive of there being additional, as yet unknown genes that are associated with an early-onset laryngeal-breast cancer phenotype.

Nuclear Pedigree Criteria for the Identification of Individuals Suspected to be at Risk of an Inherited Predisposition to Renal Cancer

Renal clear cell carcinomas represent about 3% of all visceral cancers and account for approximately 85% of renal cancers in adults. Environmental and genetic factors are involved in the development of renal cancer. Although to date there are 19 hereditary syndromes described in which renal cell cancer may occur, only four syndromes with an unequivocal genetic predisposition to renal cell carcinoma have been identified: VHL syndrome (mutations in the VHL gene), hereditary clear cell carcinoma (translocations t(3:8), t(2:3)), hereditary papillary carcinoma (mutations in the MET protooncogene) and tuberous sclerosis (mutations in the TSC1 and TSC2 genes). Little is known genetically about the other forms of familial renal cell cancer. Since there is a growing awareness about the necessity of early intervention, clinical criteria have been developed that aid in the identification of hereditary forms of renal cancer. The aim of the current study was to identify minimal inclusion criteria so that nuclear pedigree families can be ascertained for risk assessment and/or kidney tumour screening. The results reveal that inclusion features described herein, such as (a) renal clear cell cancer diagnosed before 55 years of age, and (b) renal clear cell cancer and gastric cancer or lung cancer among first degree relatives, are useful in identifying suspected hereditary clear cell renal cancer patients.

[Acceptance of screening colonoscopy in the prevention of colorectal cancer in relation to some demographic factors]

Colorectal cancer is a quite common neoplasm. Screening colonoscopies and polypectomies can decrease the incidence of that neoplasm by 75%. Discovering the most frequent reasons and most convincing sources of information about the examinations is important for success of screening programme.

OBJECTIVES

The aim of this study was to find the connection between some demographic factors, the source of information about the examination and the consent for colonoscopy.

MATERIAL AND METHODS

Two groups of subjects, aged 40-65, were included: 1000 subjects, who gave their consent for colonoscopy and 200 subjects, who refused the examination. The sources of information were two kinds of questionnaires: fulfilled before colonoscopy and in case of lack of consent for the examination, which included demographic data, the reason of undergoing or refusal of colonoscopy and the source of information about the examination.

RESULTS

The higher educated were the subjects, the more often they agreed for the examination; among subjects after university 87%, and among subjects with elementary education 71% gave their consent for colonoscopy. The most convincing sources of information were the medial sources; 100% of subjects, who found out about the examination from television and radio, gave their consent for colonoscopy. The most frequent reason of undergoing the examination was prophylaxis (54.6%), and the most frequent reasons of refusal was fear of pain (33.5%).

CONCLUSIONS

Educational level and the source of information about the examination are the factors that have an important influence on undergoing screening colonoscopy. Identifying the influence of some demographic factors on the consent for colonoscopy and the efficacy of each source of information seems to be very important for the success of screening colonoscopy programme and therefore for discovering adenomatous polyps and colorectal cancer.

Efficacy and tolerability of lumiracoxib 100 mg once daily in knee osteoarthritis: a 13-week, randomized, double-blind study vs. placebo and celecoxib

OBJECTIVE

To determine the efficacy and safety of lumiracoxib for knee osteoarthritis (OA).

METHODS

This was a 13-week, multicentre, randomized, double-blind, double-dummy, placebo-controlled study. Males or females aged >/= 18 years with primary knee OA received lumiracoxib 100 mg od, lumiracoxib 100 mg od with a loading dose of 200 mg od for the first two weeks, celecoxib 200 mg od, or placebo.

MAIN OUTCOME MEASURES

Co-primary variables, assessed at week 13, were OA pain intensity in the target knee, patient's global assessment of disease activity and the WOMAC total score. Other variables included OMERACT-OARSI responder rates and WOMAC subscale scores. Safety and tolerability were evaluated.

RESULTS

All active treatments were superior to placebo for all co-primary variables. No significant differences were observed between any active treatments. Mean reductions from baseline to week 13 for lumiracoxib 100mg od, 100mg od with loading dose, celecoxib and placebo, respectively, were: OA pain intensity in the target knee: 26.8, 26.2, 26.6 and 21.4mm (all p < 0.01 vs. placebo); patient's global assessment of disease activity: 25.1, 21.9, 22.9 and 18.9 mm (all p < 0.05 vs. placebo); WOMAC total score: 15.2, 14.8, 14.7 and 11.3 (all p < 0.01 vs. placebo). Lumiracoxib was superior to placebo and similar to celecoxib for OMERACT-OARSI response and WOMAC subscale scores. Lumiracoxib was well tolerated. The incidence of adverse events was similar across groups.

CONCLUSIONS

Lumiracoxib 100 mg od provided effective relief from the pain of knee OA, with efficacy similar to celecoxib 200 mg od, and was well tolerated.

[Churg-Strauss syndrome--report of four cases]

Four subsequent cases of Churg-Strauss syndrome were presented. The patients fulfilled criteria of the syndrome developed by American College of Rheumatology. They were treated with combination of systemic corticosteroids and cyclophosphamide, one patient was additionally treated with plasmapheresis. In all four cases complete remission of the disease was achieved.

TNF-alpha -308 promoter polymorphism in patients with rheumatoid arthritis

OBJECTIVES

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which tumour necrosis factor-alpha (TNF-alpha) plays an important role. There are, however, controversial reports that TNF-alpha promoter polymorphism may be an independent marker of susceptibility and severity of RA. The aim of the present study was to examine the TNF-alpha -308 promoter polymorphism in patients with RA.

METHODS

We examined 91 patients with RA diagnosed according to the criteria of the American College of Rheumatology. Polymerase chain reaction (PCR) amplification was used for analysis of the polymorphism at position -308 in promoter of TNF-alpha gene.

RESULTS

Distribution of TNF-alpha genotypes in RA patients did not differ from that in control subjects. Moreover, there was no association between TNF-alpha genotypes and age at disease diagnosis, disease activity in global physician's assessment, and joint and extra-articular involvement. There was also no correlation between TNF-alpha polymorphism and disease activity measures, including erythrocyte sedimentation rate (ESR), CRP, number of swollen and tender joints, and morning stiffness duration.

CONCLUSIONS

We suggest that TNF-alpha -308 promoter polymorphism is not a genetic risk factor for RA susceptibility and severity.

Normal profile of sex hormones in women with primary fibromyalgia

PURPOSE

One of the prevailing hypotheses on the pathogenesis of fibromyalgia (FM) emphasizes the role of the hypothalamic-pituitary-gonadal axis in this condition. Aberrant function of the axis was inferred from decreased concentrations of growth hormone and serotonin and reduced urinary excretion of corticosteroid metabolites observed in FM patients. Studies in a very limited number of FM patients suggest that disturbances in the hypothalamic-pituitary-gonadal axis may also lead to changes in the synthesis of sex hormones.

MATERIAL AND METHODS

This study was performed in 19 women aged 23 to 46 years in whom FM was diagnosed according to ACR criteria. The control group consisted of 18 healthy women aged 21 to 41 years. Pain intensity and sleep quality was assessed with the Visual Analogue Scale (VAS). The number of points reported as painful ("tender points") was measured by dolorimetry. Hormones or contraceptives were not administered to the women during the pre-study period. Blood was collected on day 8 or 9 of the menstrual cycle and serum was prepared for measurements of estradiol and progesterone with Microparticle Enzyme Immunoassay (MEIA) and AxSYM reagents from Abbott (USA).

RESULTS

The study and control groups differed as to pain intensity and sleep quality, as well as number of tender points reported. However, groups did not differ as to mean concentration of estradiol or progesterone.

CONCLUSIONS

A deficit of sex hormones does not appear to be part of the manifestations of FM.

[Recurrent polychondritis. Presentation of two cases and a review of the literature]

Relapsing polychondritis is a rare, chronic disease that can involve all types of cartilage in different sites. The most common symptoms of relapsing polychondritis are features of auricular, nasal and tracheal cartilage inflammation. The authors presented two cases of relapsing polychondritis and related diagnostic and therapeutic difficulties.

[The influence of FcgammaRIIa polymorphism on rheumatoid arthritis]

The FcgammaRIIa receptor is most widely distributed of the Fcgamma receptors and is expressed on the most types of immunocomponent cells. Polymorphism of the FcgammaRIIa receptors may modulate immune complex mediated inflammation, particularly when immune complex contains IgG. The aim of the study was to evaluate the influence the FcgammaRIIa polymorphism on disease parameters activity in patients with rheumatoid arthritis (RA). The study included 75 patients with RA diagnosed according to the American College of Rheumatology criteria. In each patient the following parameters of disease activity were evaluated during one-year period: number of swollen and tender joints, morning stiffness duration, CRP, ESR as well as the disease activity in global physical assessment. There was no correlation between disease activity parameters and FcgammaRIIa polymorphism. Our results suggest, that FcgammaRIIa polymorphism does not represent an important genetic risk factor for RA activity.

Value of high resistance index - HRI calculated from Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE)

BACKGROUND

HRI is a new Doppler index calculated as a ratio between S -maximal systolic flow and D -maximal early diastolic reversed flow -HRI=D/S. The aim of the study is to evaluate the diagnostic significance of HRI calculated from the Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE) with and without secondary antiphospholipid syndrome (SAPS) compared with healthy controls.

MATERIAL/METHODS

During 9-month period (May 2003 -January 2004), 93 patients (81 women and 12 men) with SLE (including 24 patients with SAPS) and 30 healthy controls (24 women and 6 men) underwent bilateral duplex Doppler examinations of lower limb arteries. The examinations were performed using HDI 3500 (ATL) with 5 -12 MHz linear transducer under standardized conditions: correct insonation angle and sample volume size, with the patient in a supine position, after 10 minutes rest.

RESULTS

Mean HRI value obtained in the control group was 0.415 (range 0.305 -0.555; median 0.402). In the group of SLE patients without SAPS, mean HRI value was decreased to 0.320 (range 0 -0.584; median 0.334) and even lower -0.283 in SLE patients with SAPS (range 0.106 -0.545; median 0.291).

CONCLUSIONS

Small arteries, arterioles and capillaries are the main affected vessels in SLE. This chronic process stimulates circulation through lower resistance collaterals, decreasing HRI value. The Doppler HRI calculation can be valuable in early diagnosis and monitoring of lower extremity vascular changes in patients suffering from SLE with and without SAPS.

The urinary excretion of pyridinoline and deoxypyridinoline during rheumatoid arthritis therapy with infliximab

Rheumatoid arthritis is a systemic disease that causes inflammation and joint destruction. As a result of pathological destruction in bone and cartilage, crosslinks in collagen are resorbed more rapidly. This causes a rise in circulating collagen crosslink levels and their urinary excretion. In RA, apart from the crosslink resorption at the site of inflamed joints, there may be increased resorption due to general bone loss associated with disease activity. The aim of this study was to evaluate the influence of therapy with infliximab on urinary excretion of pyridinoline (PYD) and deoxypyridinoline (DPYR) as a markers of collagen degradation and its correlation with clinical and biochemical parameters of disease activity. Seventeen patients with active rheumatoid arthritis treated with infliximab were recruited into the study. The therapy resulted in the reduction in the symptoms of RA and urinary excretion of PYD and DPYR. The urinary excretion of PYD correlated with a number of swollen joints, morning stiffness, CRP and ESR. The urinary excretion of DPYR correlated during infliximab therapy with the number of swollen and tender joints and morning stiffness. The measurement of urinary excretion of PYR and DPYR may give insight into bone metabolism and help us to better understand the actual changes in bone and cartilage caused by RA and its treatment.

The influence of N-acetyltransferase 2 polymorphism on rheumatoid arthritis activity

OBJECTIVE

The N-acetyltransferase polymorphism is involved in the metabolism of many xenobiotics, as well as in susceptibility to some diseases such as rheumatoid arthritis (RA). The aim of this study was to investigate the influence of NAT 2 polymorphism on disease activity in RA patients.

METHODS

70 with RA were enrolled in the study. As a measure of disease activity, the number of swollen and tender joints, the duration of morning stiffness, ESR and CRP as well as disease activity based on a global physician's assessment were evaluated. The NAT2 polymorphism was determined by a polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP).

RESULTS

The mean number of swollen and tender joints, as well as the ESR and CRP values, did not differ significantly with the acetylation genotype. Erosive RA was diagnosed in 74.5% of the slow and 40% of the fast acetylators. The risk for the development of erosive RA was 4.39 time greater in slow acetylators than in fast acetylators.

CONCLUSION

NAT2 polymorphism may be a genetic risk factor for joint destruction.

Ovarian cystadenoma as a characteristic feature of families with hereditary ovarian cancers unassociated with BRCA1 and BRCA2 mutations

The study aimed to determine whether hereditary ovarian cancers that are not caused by BRCA1/BRCA2 constitutional mutations are associated with a predisposition to cystadenoma. The study consisted of two parts. Part one concerned the incidence of ovarian cystadenoma in females from families with hereditary ovarian cancer unassociated with BRCA1 mutations. The study group included 62 female patients from 29 families, without any previously diagnosed malignancy, with no proven constitutional mutation of the BRCA1 gene. The first control group was composed of 62 female patients from 53 families, without any previously diagnosed malignancy, with an identified constitutional mutation of the BRCA1 gene. The second control group comprised 124 female patients for whom the only reason for the examination was a prophylactic check-up. All studied women were subjected to intravaginal ultra- sonographic investigations. In 8 patients with benign and/or borderline ovarian cystadenoma, a complete sequencing of coding fragments of the BRCA2 gene from the peripheral blood DNA was performed. Part two of this study concerned the incidence and pattern of malignant tumors in the families of female patients with ovarian cystadenoma. The final study group included 117 patients who had 726 I0 relatives (359 females and 367 males). We concluded that cystadenoma is likely to be a characteristic feature of the subgroup of families with hereditary ovarian cancers unassociated with BRCA1/BRCA2 constitutional mutations.

Clinical features of familial ovarian cancer lacking mutations in BRCA1 or BRCA2

PURPOSE OF INVESTIGATION

The purpose of the present study was to identify the clinical and pathologic features of ovarian cancers in patients who have a family history of breast or ovarian cancer but who do not have a mutation in the BRCA1 or BRCA2 gene.

METHODS

303 patients with ovarian cancer were reviewed for clinical features and for cancer family histories. After the exclusion of 51 patients known to carry BRCA1 or BRCA2 mutations, 24 patients with familial cancer were compared with 228 patients with non-familial cancer.

RESULTS

Patients with familial cancer were more likely to have grade 2 tumors, Stage II disease and to present between ages 51 and 60 than were non-familial controls. Ten of 24 patients in the familial group presented between ages 51 and 60 with a grade 2 tumor compared to 3.0 expected (p = 0.001).

CONCLUSIONS

Families of women who present with grade 2 ovarian cancer between the ages of 51 and 60 may have an unidentified ovarian cancer susceptibility gene.

Nuclear Pedigree Criteria of Suspected HNPCC

The criteria for the diagnosis of HNPCC established by the ICG-HNPCC are very restrictive as they do not allow for the diagnosis of a large number of "suspected HNPCC" cases - these are families which do no fulfill the strict diagnostic "Amsterdam criteria", but do present with several pedigree and clinical features characteristic for HNPCC. Several series of families suspected of harboring germline mutations in DNA mismatch repair genes have been studied for germline changes in DNA mismatch repair genes and a mutation rate of somewhere between 8-60% was found. Therefore a subgroup of members of the ICG-HNPCC has been working on pedigree/clinical diagnostic criteria for suspected HNPCC.

Materials and methods

Results

The combination of features - i.e. the occurrence of an HNPCC associated cancer (CRC or cancer of the endometrium, small bowel or urinary tract) in a 1st degree relative of a CRC patient; at least one of the patients being diagnosed under age of 50 - appeared to be strongly associated to HNPCC with an OR - 161. Constitutional mutations were identified in 18 (10 MLH1 and 8 MSH2 mutations) of 52 (34%) cases matching the above features.

Conclusions

The results of our studies strongly suggest that it is possible to diagnose HNPCC with a high degree of accuracy on the basis of nuclear pedigree data and clinical features.

Therapy with infliximab decreases the CD4+CD28? T cell compartment in peripheral blood in patients with rheumatoid arthritis

Chronic inflammatory syndromes such as rheumatoid arthritis (RA) are associated with high frequencies of CD4+CD28- T cells. The number of these cells is genetically determined and may also be a consequence of chronic exposure to tumor necrosis factor-alpha (TNFalpha). The aim of this study was to examine whether the reported efficacy of anti-TNFalpha therapy in RA involves a resurgence of T cell populations that re-express CD28. After 36-week therapy with infliximab, a significant decrease in CD4+CD28- T cells in RA patients was observed in comparison with baseline. The results suggest that TNFalpha-neutralizing therapy may restore T cell homeostasis and reduce expansion of the CD28- T cells, which are cytotoxic and may contribute to organ manifestations in RA.

[Usefulness of ultrasonographic and MR imaging in diagnosis of shoulder impairment]

The aim of our study is to determine the value of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnostics of shoulders pain and dysfunction. 25 patients were examined both with US and MRI. The group consisted of 16 females, ranged 33-74 yr. (mean 57) and 9 males, ranged 32-65 yr. (mean 53). The mean complaint duration was 2 years and 7 months (1 month-16 yr). US detected RCT in 12 patients, what was confirmed with MRI in all cases. In 13 patient (52%) US detected no abnormality, but MRI revealed changes in four patients. The overall sensitivity of USG in diagnosing rotator cuff tears was 80%. USG and MR imaging has been shown to be accurate in diagnosing of rotator cuff tear to a high and comparable degree. Because of high accuracy and ability to dynamic assessment, US should be a method of choice in evaluation of painful shoulder.

The expansion of CD4+CD28- T cells in patients with rheumatoid arthritis

Clonal expansion of CD4+CD28- T cells is a characteristic finding in patients with rheumatoid arthritis (RA). Expanded CD4+ clonotypes are present in the peripheral blood, infiltrate into the joints, and persist for years. CD4+CD28- T cells are oligoclonal lymphocytes that are rare in healthy individuals but are found in high percentages in patients with chronic inflammatory diseases. The size of the peripheral blood CD4+CD28- T-cell compartment was determined in 42 patients with RA and 24 healthy subjects by two-color FACS analysis. The frequency of CD4+CD28- T cells was significantly higher in RA patients than in healthy subjects. Additionally, the number of these cells was significantly higher in patients with extra-articular manifestations and advanced joint destruction than in patients with limited joint manifestations. The results suggest that the frequency of CD4+CD28- T cells may be a marker correlating with extra-articular manifestations and joint involvement.

[Characteristics of selected features of hereditary ovarian cancer in carriers of constitutional BRCA1 gene mutation]

BACKGROUND

Hereditary ovarian cancer in BRCA1 constitutional mutation carriers shows a characteristic clinical pattern.

AIM OF THE STUDY

Evaluation of the type of mutation, age of onset, clinical stage (FIGO) and morphological grade (G) of ovarian cancers in BRCA1 mutation carriers.

MATERIAL AND METHOD

We analyzed 16 cases of hereditary ovarian cancers from 14 families. The cases were included into studied group as a result of evaluation of pedigree criteria and molecular-genetic analyses detecting constitutional mutation--5382insC, C61G, 4153delA--founder mutations dominating the Polish population. The following features were compared between studied and control group: C1--age of onset of ovarian cancer in 5-year intervals (below 35, 40, 45, 50 and 55 years of age); C2--clinical staging (FIGO) I/II or III/IV: C3--grading (G1-G3). The data were analyzed statistically.

RESULTS

Age of onset < 50, OR--2.52 is highly characteristic for BRCA1 mutation carries. Similarly the staging III/IV is more often observed in studied group--OR 2.71. The most characteristic of studied group is high morphological grading--OR 12.38.

CONCLUSIONS

1. Features of HOC in studied material and in other populations are similar 2. High morphological grading is the most characteristic for HOC in BRCA1 carriers.

FC gamma RIIa polymorphism in patients with rheumatoid arthritis

OBJECTIVE

Polymorphism of phagocyte IgG receptor Fc gamma RIIa may modulate immune complex mediated inflammation, particularly when immune complex contain IgG2.

METHODS

Fc gamma RIIa genotyping in 82 patients with rheumatoid arthritis (RA) and 148 healthy subjects was performed using the polymerase chain reaction technique with allele specific primers.

RESULTS

No significant relation between Fc gamma RIIa genotypes and susceptibility to RA was observed, but extraarticular complications with high frequency were revealed in patients with R/R131 genotype.

CONCLUSION

The results suggest that the Fc gamma RIIa polymorphism is not a risk factor for RA.

Increased genotype frequency of N-acetyltransferase 2 slow acetylation in patients with rheumatoid arthritis

OBJECTIVES

Acetylation polymorphism can alter therapeutic responses and toxicity to certain xenobiotics and may also be a factor that influences a patient's susceptibility to certain diseases. We investigated whether patients with rheumatoid arthritis (RA) differed from healthy individuals with regard to genotype of the polymorphic enzyme N-acetyltransferase 2 (NAT2).

METHODS

NAT2 polymorphism was compared in 118 healthy subjects and 82 patients with RA. NAT2 alleles (*4, *5, *6, and *7) were determined by polymerase chain reaction-restriction fragment length polymorphism methods with deoxyribonucleic acid extracted from peripheral blood.

RESULTS

A statistically significant increase in the proportion of homozygous slow acetylators with 2 mutated alleles (84.1%) was found among patients with RA in comparison with healthy subjects (52.5%; P <.0001). The risk of development of RA was almost 5-fold greater in slow acetylators than in fast acetylators (odds ratio, 4.79; 95% confidence interval, 2.28-10.21). There was no correlation between NAT2 polymorphism and presence of rheumatoid factor, extra-articular manifestations, and age at first occurrence of disease symptoms.

CONCLUSIONS

NAT2 slow acetylation genotype may be a risk factor of individual susceptibility to RA.

Clinical characteristics of hereditary ovarian cancer (HOC) in Poland

BACKGROUND

Hereditary ovarian cancer (HOC), as any genetic disease, may display clinical characteristics that depends on population.

AIM OF THE STUDY

The aim of the study was to describe clinical characteristics of HOC in Polish population basing on analysis of the following features: age at onset, clinical staging, morphological grading and prevalence of serous adenocarcinoma.

MATERIAL AND METHOD

The cases were selected basing on analysis of pedigree/clinical features and molecular studies of founder mutations of BRCA1 gene in Poland.

RESULTS

The patient's age at diagnosis was ca 49-52 and was similar in all groups. The exception was the subgroup without mutations in group II (breast and ovarian cancers found in families) with mean age at diagnosis ca 46 years (n = 9). In patients with HOC without mutation of BRCA1 gene, lower FIGO stage and lower morphological grade were detected more frequently. The majority of HOC showed histopathological pattern of serous adenocarcinoma.

CONCLUSIONS

Clinical features of HOC in Poland and in other countries are similar. 2. Introduction of DNA tests to the clinical and pedigree diagnostic criteria allows detection of subgroups of HOC with different clinical features.

[Skeletal changes during the course of pustulosis palmoplantaris--report of two cases]

We report two cases of coincidence palmoplantar pustulosis and joint changes. Two patients fulfilled criteria for arthroosteitis pustulosa: pustular eruptions of the palms and soles and pain of sterno-clavicular joint. They also fulfills criteria for SAPHO syndrome: osteoarticular manifestations of palmoplantar pustulosis. Clinical examination and scintigraphy confirmed the diagnoses. Treatment was started with antibiotics and nonsteroid anti-inflammatory drugs. Oral corticosteroids therapy with methotrexate was given to one patient.