National registry of patients with juvenile idiopathic inflammatory myopathies in Hungary—Clinical characteristics and disease course of 44 patients with juvenile dermatomyositis

Idiopathic inflammatory myopathies (IIMs) are systemic autoimmune diseases characterized by chronic muscle inflammation resulting in progressive weakness and frequent involvement of internal organs, mainly the pulmonary, gastrointestinal and cardiac systems which considerably contribute to the morbidity and mortality of the IIMs. Aim of this study was to present clinical characteristics, disease course, frequency of relapses and survival in patients with juvenile dermatomyositis (DM). A national registry of patients with juvenile IIMs was elaborated by the authors in Hungary. We have summarized data of the register according to signs and symptoms, disease course, frequency of relapses and survival of patients with juvenile IIM. Analysis was performed using data of 44 patients with juvenile DM diagnosed between 1976 and 2004 according to Bohan and Peter's criteria. Survival probability was calculated by Kaplan-Meier method. Data of patients with juvenile DM were compared with data of 66 patients with adult DM. The most frequent cutaneous features were facial erythema and heliotrope rash. Extramuscular and extraskeletal manifestations of the disease were more frequent in adult patients. The most common extramuscular feature was arthralgia in both groups of patients with juvenile or adult DM. Cardiac manifestation of the disease was not observed in juvenile patients. Respiratory muscle involvement and interstitial lung disease (ILD) were more frequent among adult DM patients than cardiac manifestation of the myositis. In view of the disease course, the authors found that frequency of polycyclic and monophasic subtypes of the disease were mainly similar. The hazard of relapse was found higher during the first year after the remission. None of the juvenile patients died. Among adult patients four disease-specific deaths occurred. There was no correlation between relapse free survival and initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed up for at least 2 years. Although we found favourable survival probability, further investigations are needed to assess functional outcome.

Role of HLA-DRB1 and PTPN22 genes in susceptibility to juvenile idiopathic arthritis in Hungarian patients

OBJECTIVE

Juvenile idiopathic arthritis (JIA) is a complex immune-mediated disease characterized by environmental influences along with several predisposing genes in the pathogenesis. The present study was undertaken to investigate the association of polymorphisms in two candidate genes for autoimmunity, human leukocyte antigen (HLA) DRB1 and protein tyrosine phosphatase N22 (PTPN22) with JIA in Hungarian patients.

METHODS

A case-control study including 150 Hungarian JIA patients and 200 sex and ethnically matched healthy controls was conducted. Genotyping for HLA-DRB1 and PTPN22 C1858T single nucleotide polymorphism (SNP) (rs2476601) was carried out by group-specific PCR amplification and by real-time PCR allelic discrimination, respectively.

RESULTS

In Hungarian patients JIA was associated with HLA-DRB1*01, DRB1*08, DRB1*13 (p=0.048, p=0.002, p=0.019, respectively) with marked differences between the disease subtypes classified according to the ILAR criteria. There was no association of the PTPN22 C1858T SNP with JIA (p=0.66). No correlation was found between the presence of this PTPN22 SNP and HLA-DRB1 alleles.

CONCLUSIONS

Our results confirm that certain HLA-DRB1 alleles reported previously as susceptibility factors are strongly associated with JIA in a Hungarian population. However, C1858T polymorphism of PTPN22, another candidate gene of autoimmunity seems to be independent of JIA in Hungarian patients. Our data taken together with various findings in different populations suggest that associations related to PTPN22 seem to be more ethnicity-specific in contrast to the general and less population-dependent role of HLA-DRB1 in JIA.

[Various clinical patterns of relapsing polychondritis in six cases]

Relapsing polychondritis is a relatively rare disease characterized by episodic inflammation and progressive destruction of cartilage involving ears, nasal and laryngotracheal cartilage, cardiovascular system and the eyes. The increasing awareness of its clinically distinct has resulted in recognition of at least 550 reported cases. Six cases are reported to demonstrate the wide variety of clinical pattern. The most common features of the disease are auricular and nasal cartilage inflammation and nondeforming arthritis. Ocular symptoms and vasculitis is relatively rare. Two cases of relapsing polychondritis with laryngotracheobronchial manifestations illustrate the severe clinical features of the disease. Relapsing polychondritis may associate with diverse forms of connective tissue disease, such as rheumatoid arthritis. It seems interesting to note the onset in childhood. Treatment has been primarily symptomatic. In situations of mild symptoms, initial treatment is with nonsteroidal antiinflammatory drugs. For cases with serious manifestation, corticosteroids and immunosuppressants are indicated.

[Disseminated histiocytosis X in an adult patient]

Patient was a 69 year old white female who presented with diffuse brownish-reddish and normal skin colored nodules of a diameter ranging from 0.5-4 cm. Histologic examination showed histiocytosis X. Despite the retinoid-PUVA, and combination of glucocorticoid and chemotherapy the disease progressed and in 8 months after the appearance of the skin lesions the patient expired. The authors briefly summarise the clinical, histological features of histiocytosis X and the therapeutic possibilities.

[Laparoscopic cholecystectomy during the 25th week of pregnancy]

The authors made a laparoscopic cholecystectomy on a woman in the 25th week of pregnancy in tocolytic defence at the surgical department of St. Imre Hospital, Budapest. The patient was emitted from hospital without any changes in obstetric status and without complaints after an obstetric status and without complaints after an undisturbed operation and postoperative period. The applied method was already published in Hungary.

Wegener's granulomatosis exhibiting the clinical features of Goodpasture's syndrome

A case is reported here, the clinical features of which raised the suspicion of Goodpasture's syndrome which was, however, at variance with the absence of antiglomerular basement membrane antibodies. Renal failure improved on immunosuppressive treatment and peritoneal dialysis, but the patient died of gastric haemorrhage from a peptic ulcer related to steroid treatment. Necropsy and microscopic study revealed abnormalities of liver and spleen, consistent with Wegener's granulomatosis. Immunohistologic studies of the kidney confirmed the presence of granular-type IgG deposits in the glomeruli. There were extensive fibrin deposits in the kidney. The ways and means for the differentiation of Wegener's granulomatosis from Goodpasture's syndrome, the potential pathogenetic role of immunocomplexes and fibrin deposits, and the therapeutic possibilities are discussed.

Effects of apomorphine combined with chlorpromazine and pimozide on the estrous cycle in rats

Chlorpromazine (CPZ) a neuroleptic which has both antiadrenergic and antidopaminergic activity when administered in doses of 5 to 25 mg/kg s.c. inhibited ovulation and induced pseudopregnancy. Pimozide which possesses only an antidopaminergic action induced only pseudopregnancy (in doses between 0.05-10 mg/kg s.c.). Apomorphine (APO), a dopaminergic agonist, prevented the pseudopregnant effect of both neuroleptics, especially of CPZ, but failed to counteract the ovulation-blocking action of CPZ. APO itself had an antiovulatory action, but only in large doses (above 5 mg/kg s.c.), and only in a few animals. Our data plead for the importance of dopaminergic mechanisms in the inhibition of prolactin secretion (by means of PIF) and for the stimulatory role of adrenergic transmission in the ovulation process (by means of LRF). These results fail to support the proposed stimulatory role of dopamine on the LRF secretion. On the contrary, they do not exclude the possibility of its inhibitory action.

Magnesium and gastric acid secretion

This study examined the modifications of acid gastric secretion caused by magnesium oxide, peroxide, silicate and sulphate in 805 patients with duodenal ulcers; The calcium-magnesium antagonism on the one hand and the acetazolamide - magnesium synergia on the other, were also investigated. Our results show that administration of magnesium, either oral or parenteral, does not significantly modify gastric acid secretion, either basal or stimulated by maximal histamine. Administration of un infusion of calcium gluconate 15 mg/kg body weight, significantly increases gastric acid secretion as compared to basal secretion. Addition of a dose of magnesium sulphate to the infusion antagonises the effect of gastric acid secretion caused by calcium. Administration of 1.5 gr magnesium oxide along with 25 mg acetazolamide per kg/body weight, strengthens the inhibitory effect of acetazolamide upon gastric acid secretion, increasing the proportion of significant inhibitory effects up to 98% of the cases under investigation. Addition of magnesium to the classical therapy antagonises the noxious effects of calcium compounds; the presence of magnesium in the composition of antacid powders proves necessary.

The different influence of predominantly antiadrenergic and antidopaminergic neuroleptics on the estrous cycle in rats

In experiments performed on rats, single subcutaneous doses of predominantly antidopaminergic neuroleptics (fluspirilene, pimozide, and thioproperazine in large doses) elicited persistent diestrus, i.e. pseudopregnancy. Neuroleptics with predominantly antiadrenergic action (levomepromazine, thioridazine, chlorpromazine) as well as phenoxybenzamine injected intraventricularly induced mainly prolonged estrus, i.e. blocking of ovulation. Since pseudopregnancy implies a rise of prolactin secretion, our results indirectly indicate that PIF secretion is stimulated by dopamine. The antiovulatory effect of the antiadrenergic agents, which involves an inhibition of the proestral LH surge, suggests that the discharge of LRF is mediated by an adrenergic mechanism.