[Gluten-sensitive enteropathy: a disease to take into consideration - a case report]

Gluten-sensitive enteropathy or celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. Although the disease may manifest itself at any age, it occurs mostly in either early childhood or in the third or fourth decade of life. Malabsorption syndrome as a typical clinical feature is commonly absent. Patients may exhibit minor gastrointestinal complaints, as well as numerous extraintestinal manifestations. We report a 43-year-old female patient with mi gratory arthralgias as the leading symptom, fatigue, sideropenic anemia and mild intermittent diarrhoea, who was diagnosed with gluten-sensitive enteropathy. Four months after introduction of gluten-free diet the patient reported no arthralgias, and complete clinical response was achieved. The aim of our case-report was to show that migratory arthralgias can be an extraintestinal manifestation of gluten-sensitive enteropathy. Unexplained articular complaints should raise clinical suspicion of celiac disease.

[Scleroderma renal crisis]

Systemic sclerosis (SSc) is a multisystem disease whose clinical manifestations result from inflammation, vascular injury and obliteration, and cutaneous and visceral fibrosis. Scleroderma renal crisis (SRC) occurs in 5% of patients with particullary diffuse form of SSc. It is characterized by malignant hypertension and oligo/ anuric acute renal failure. SRC was once a uniformly fatal complication of SSc. The prognosis of SRC has significantly improved with the introduction of angiotensin-converting enzyme inhibitors (ACEi) as treatment. The treatment of SRC relies on tight control of blood pressure and aggressive treatment with ACEi, if needed in combination with other types of antihypertensive drugs.

Cyclic adenosine 5'-monophosphate in synovial fluid of rheumatoid arthritis and osteoarthritis patients

The relationship between synovial fluid (SF) cAMP level and IL-18 and PGE2 SF levels in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, and between SF cAMP level and disease as well as inflammatory activity in RA were investigated in 17 RA and 19 OA patients. Erythrocyte sedimentation rate (ESR), serum (S) C-reactive protein (CRP) level and SF IL-18 level were higher in RA than in OA patients. SF PGE2 level was similar in both groups. SF cAMP level was higher in OA than in RA patients. In RA patients, SF cAMP level showed negative correlation with Disease Activity Score including a 28-joint count and S CRP, ESR and SF IL-18 level. The results suggest that cAMP promotes anti-inflammatory response in RA and OA patients, which is higher in the latter. Promotion of anti-inflammatory response by cAMP elevating agents might be useful in the treatment of RA.