Current causes of death in systemic lupus erythematosus in Europe, 2000--2004: relation to disease activity and damage accrual

Current therapeutic and diagnostic resources have turned systemic lupus erythematosus (SLE) into a chronic disease by reducing mortality rates. The exact contribution of disease activity and disease related damage to mortality is not well studied. The aim of this study was to describe the current causes of death (COD) in a multinational European cohort of patients with SLE in relation to quantified measures of disease activity and damage. Prospective five-year observational study of case fatalities in SLE patients at 12 European centres was performed. Demographics, disease manifestations, interventions and quantified disease activity (by ECLAM and SLEDAI) and damage (by SLICC-DI) at the time of death were related to the various COD. Ninety-one case fatalities (89% females) occurred after median disease duration of 10.2 years (range 0.2-40) corresponding to a annual case fatality of one for each of the participating cohorts. Cumulative mortality correlated linearly with disease duration with nearly 10% of fatalities occurring in the first year and 40% after more than 10 years of disease. Death occurred during SLE remission in one third of cases. In the remaining cases a mixture of disease activity (median ECLAM 5.5, median SLEDAI 15) and accrued damage (median SLICC-DI 5.0) with opposing relationships to disease duration contributed to death. Infections and cardiovascular events were the most frequent COD in both early and late fatalities with no gender differences for type of COD, disease activity, damage or comorbidity. In Europe, case fatalities have become uncommon events in dedicated SLE cohorts. The bimodal mortality curve has flattened out and deaths now occur evenly throughout the disease course with infectious and cardiovascular complications as the main direct COD in both early and late fatalities. Accrued damage supplants disease activity over time as the main SLE specific contributor to death over time.

Salivary and serum interleukin 6 and basic fibroblast growth factor levels in patients with oral squamous cell carcinoma

AIM

A role of various cytokines has been implicated in the pathogenesis of many carcinomas, and albeit the role of interleukin 6 (IL-6) and basic fibroblast growth factor (bFGF) in sera has been studied in patients with oral carcinomas, data upon salivary IL-6 and bFGF are lacking. The aim of this study was to evaluate levels of IL-6 and bFGF in the saliva and serum of patients with oral squamous cell carcinoma.

METHODS

Salivary and serum IL-6 and bFGF were evaluated in a group of 33 patients (28 men, 5 women) with oral squamous cell carcinoma (OSCC), age range 40-73 years , mean 54.05 years. Control group consisted of 23 healhy participants, mean age 25 years.

RESULTS

Serum IL-6 and bFGF levels were not significantly different between patients with OSCC and healthy controls. Elevated levels of salivary IL-6 and bFGF in patients with OSCC when compared to the healthy controls were found (p<0.001).

CONCLUSIONS

The conclusion is drawn that higher levels of salivary IL-6 and bFGF in patients with OSCC might originate from the local production, probably from carcinoma cells.

[Clinical importance of laboratory tests in rheumatology]

Knowledge of mechanisms of rheumatic diseases has a continuing influence on the introduction of many laboratory tests to be used for establishing diagnosis or monitoring the activity of rheumatic disease. In the article presented are autoantibodies characteristic for distinct inflammatory rheumatic diseases, the role of serum complement activity, immune complexes, HLA-typing as well as other laboratory parameters needed for the diagnosis of rheumatic disease. The methods of synovial fluid analysis are described. Presented are laboratory investigations used by rheumatologists for the evaluation of activity of inflammatory rheumatic diseases and successful treatment together with investigations necessary for the evaluation of side-effects of treatment.

[Spondyloarthropathies]

The spondyloarthropathies are a group of inflammatory joint diseases which are classified together because they share many clinical, epidemiologic and genetic features. Criteria and terminology, role of genetic factors and infection, disease mechanisms as well as the characteristics of some disease entities in diagnostic and therapeutic approach are presented.

[Systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is a multisystemic inflammatory rheumatic disease of unknown etiology. It is understood that immune complexes have dominant role in the pathogenesis of the disease with vasculitis being the basis of many clinical manifestations. SLE is considered to be the autoimmune disease because of many autoantibodies, some of them with the known pathogenetic role. Characteristic features of the disease are skin manifestations, arthritis, serositis as well as various tissue and organ lesions, particularly that of the kidney and nervous system. On the basis of disease activity and organ involvement the decision on the institution of immunosuppressive therapy is made.

Systemic lupus erythematosus. Disease outcome in patients with a disease duration of at least 10 years: second evaluation

Data related to the disease course of patients with systemic lupus erythematosus (SLE) with special attention to the persistence of disease activity in the long term are scarce. At this moment reliable figures are only known about the survival rate as a measure of outcome. The aim of this multicenter study was to describe the outcome of SLE patients with a disease duration of greater than 10 y. Outcome parameters were two disease activity-scoring systems (SLEDAI and ECLAM), the end organ damage (SLICC/ACR damage index) and treatment. Our results are derived from 187 SLE patients followed at 10 different centres in Europe over a period of 1 y. Serious clinical signs or exacerbations, defined by the occurrence or detoriation of already existing symptoms of renal and cerebral nervous systems were observed in 2-11% of the patients, seizures and psychosis in 3%, proteinuria in 11% and an increase in serum creatinine in 5% of the patients. No change took place in the overall damage index. Yet, the disease course in most patients was characterized by periods of tiredness (42-60%), arthritis (20-25%), skin involvement such as malar rash (32-40%), migraine (15-20%), anaemia (15%) and leucopenia (17-19%). Summarizing these results it is shown that patients, still under care after such a long time of having this disease, do have a disease that is far from extinguished.

Incomplete lupus erythematosus: results of a multicentre study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT)

OBJECTIVE

Patients characterized with antinuclear antibodies (ANA) and disease symptoms related to one organ system can be described as having incomplete systemic lupus erythematosus (SLE). The aim of this multicentre study was to describe the outcome of these so-called incomplete SLE patients. Two aspects of the outcome were studied: (i) the disease course, defined by the presence or absence of clinical symptoms; and (ii) the number of patients that eventually developed full SLE.

METHODS

Outcome parameters were the ACR criteria, the SLE disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM) and the requirement for treatment. In 10 European rheumatology centres, patients who had been evaluated in the last 3 months of 1994 and had been diagnosed as having incomplete SLE on clinical grounds for at least 1 yr were included in the study. All 122 patients who were included in the study were evaluated annually during 3 yr of follow-up.

RESULTS

Our results are confined to a patient cohort defined by disease duration of at least 1 yr, being under clinical care at the different centres in Europe. These patients showed disease activity that was related mostly to symptoms of the skin and the musculoskeletal system, and leucocytopenia. During the follow-up, low doses of prednisolone were still being prescribed in 43% of the patients. On recruitment to the study, 22 of the 122 incomplete SLE patients already fulfilled the ACR criteria for the diagnosis of SLE. In the 3 yr of follow-up only three patients developed SLE.

CONCLUSIONS

A high proportion of patients in our cohort defined on clinical grounds as having incomplete SLE eventually showed disease activity defined by the SLEDAI as well as ECLAM. However, only three cases developed to SLE during the follow-up. This suggests that incomplete SLE forms a subgroup of SLE that has a good prognosis.

[Hospitalization for systemic connective tissue diseases in Croatia in 1997: examples of the use of hospital morbidity registery data bases]

By using the explanatory analysis methods, we examined a possible model for the utilization of the Croatian Hospital Morbidity Register data for decision making in the managerial process for national health system development. To build a draft informational model, data were selected on 843 cases hospitalized in 1997 for diseases M30-M36 (ICD-10) in 45 health institutions. This was used as an index of the diagnostically/therapeutically most demanding group of rheumatic autoimmune diseases. Treatment standards were established for our health system for the patients having an M30-M36 disease by classifying Croatia's health institutions into four clusters by intensity of hospitalization, and by analyzing demographic characteristics and the length of stay by disease entity. These standards could represent a good informational base for forming consensus group panels to deal with inpatient treatment problems of patients with systemic connective tissue diseases.

Antibodies to Tamm-Horsfall protein in endemic nephropathy

BACKGROUND

The aim of the study was to investigate the possible role of antibodies to Tamm-Horsfall protein (anti-THP) in the early diagnosis of endemic nephropathy (EN).

METHODS

Anti-THP (IgA, IgM, IgG classes) antibodies were determined by direct ELISA in a random sample of 159 subjects from the endemic village of Kaniza who were divided into four groups according to the WHO criteria, i.e., 'diseased', 'suspect', 'at risk', and 'others'. These groups were compared to subjects from the non-endemic village of Klakar and healthy subjects from Zagreb.

RESULTS

No differences for all the classes of antibody were observed among the groups of subjects from the endemic village of Kaniza (P>0.05) or between these subjects and those from the non-endemic village of Klakar (P>0.05). The values of IgM anti-THP antibodies exceeded those of the IgA and IgG classes in all groups of subjects (P<0.05). The values for all three classes of antibodies were higher in the rural than the urban population (P<0. 05).

CONCLUSION

Determination of anti-THP antibodies was not found to be useful in the early diagnosis of endemic nephropathy. The results suggest that most of the anti-THP antibodies are 'natural' and/or cross reactive. The highest values observed in the rural population could probably be explained by exposure to some ubiquitous antigen or more likely they are consequences of fever.

Systemic lupus erythematosus: clinical features in patients with a disease duration of over 10 years, first evaluation

OBJECTIVE

Most information available about the disease course of patients with systemic lupus erythematosus (SLE) is restricted to the first 5 yr after disease onset. Data about the disease course 10 yr after disease onset are rare. The aim of this multicentre study was to describe the outcome of SLE patients with a disease duration of >10 yr.

METHODS

Outcome parameters were the SLE Disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM), the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR), a global damage index (DI) and required treatment. In 10 different European rheumatology centres, all SLE patients who were evaluated in the last 3 months of 1994, and who had been diagnosed with SLE at least 10 yr ago, were included in the study.

RESULTS

It should be stressed that our results are confined to a patient cohort, defined by a disease duration of at least 10 yr, and who are still under clinical care at the different centres in Europe. These SLE patients still showed some disease activity, related to symptoms of the skin and musculoskeletal systems, next to the presence of renal involvement. A total of 72% of the patients needed treatment with prednisolone (</=7.5 mg). The cumulative damage was overall related to clinical features of the central nervous system (14%) and renal involvement (14%), next to deforming arthritis (14%), osteoporosis (15%) and hypertension (40%). The prevalences of obesity, Cushing appearance and diabetes are highly suggestive that the ongoing treatment and that in the past might have had an impact on the total sum of end-organ damage.

CONCLUSIONS

After 10 yr, a high proportion of patients in our cohort continued to show evidence of active disease, defined by the SLEDAI as well as ECLAM. The DI was related to the involvement of the central nervous system, renal involvement and the presence of hypertension.

[Intermittent intravenous cyclophosphamide application in patients with systemic lupus erythematosus]

The aim of this paper is retrospective analysis of data from patients in whom the indication for cyclophosphamide (CF) pulse therapy was established in our department. Indications for CF pulse treatment were lupus nephritis (LN) alone or associated with central nervous system lupus. CF was administred in the dose of 500-1000 mg/m2 intravenously once monthly for the 6 months and once every 3 months thereafter. Patients were treated with adequate dose of glucocorticoids and other symptomatic therapy. The effect of applied therapy has been analysed by monitoring proteinuria, serum creatinine concentration, creatinine clearance, ESR, ANF titer and total complement hemolytic activity. Initial therapeutic procedure has been completed in 25/30 patients. The reasons for discontinuation in 5/30 patients were as follows: end-stage renal failure in spite of therapy (1), psychosis and lost of compliance (1), recurrent pancytopenia and subsequent sepsis (1), death non related to SLE (1) and failure to show at follow-up (1). Significant improvement of all control parameters was observed in the majority of patients in whom the therapy was completely conducted. 16/25 patients continued therapy for the next 18 months and in only 1/16 patients therapy was discontinued because of end-stage renal failure. In other 15/16 patients further improvement of control parameters was observed, although not so expressed as in the first 6 months. The most frequent complications were infections (16 infections were microbiologically proved and there were probably more infections). Alopecia (2), haematuria (1) and amenorrhoea (1) were also observed. Relatively low incidence of complications may be explained by careful patient monitoring. Considering that therapeutic success is defined not only by the improvement of renal function, but by stopping of further progression of renal failure, it can be concluded that intermittent CF pulse therapy showed good effect on LN in patients with clear indication.

[Paraneoplastic autoimmune neurologic syndromes]

Paraneoplastic neurologic syndromes are group of distant nonmetastatic neurologic manifestations of malignant diseases. In last few decades a major advance in understanding their etiology and pathogenesis has been achieved. Larger series of patients have been reported allowing more detailed clinical research of particular syndromes. To practicing physician they can be a first clinical sign in diagnosing a neoplasm. In these conditions immunologists can test new theories in tumor immunology and autoimmunity. To the oncologists they can serve as a model in development of new modalities of treating malignant tumors. Neurologic syndromes that can be explained as autoimmune reactions initiated by the development of malignancy are presented in this paper.

[Clinical importance of antinuclear antibodies]

Determination of antinuclear antibodies in the sera of patients with multisystem connective tissue disease has a long clinical application. In the review article authors report on their clinical significance and describe the types of antinuclear antibodies; anti-DNA antibodies, antihistone antibodies, anti-RNA-protein complexes and other antinuclear antibodies. The methods of laboratory determination of antibody types are discussed as well as their application in the diagnosis of autoimmune and multisystem-rheumatic diseases.

Antibodies to Tamm-Horsfall protein in patients treated with extracorporeal shock wave lithotripsy (ESWL)

The aim of this study was to determine antibodies to Tamm-Horsfall protein in patients with nephrolithiasis treated with extracorporeal shock wave lithotripsy (ESWL). The values of antibodies to Tamm-Horsfall protein were determined by direct enzyme immunoassay. No statistically significant differences (P > 0.05) were observed for the IgG and IgM classes of antibodies between the groups of healthy subjects and patients with nephrolithiasis before, and 30 and 60 days after ESWL. The values of IgA class determined 30 days after treatment were significantly higher (P < 0.05) in patients, which could be due to the stimulation of the immune system. The highest values of antibodies to Tamm-Horsfall protein were obtained in both groups in the test with secondary antibodies directed toward IgM class, implicated at the presence of cross-reactive antibodies. Determination of antibodies to THP subunits isolated form urine of patients with nephrolithiasis should be performed.

Binding of anti-double stranded (ds) DNA-positive sera to denatured (d) DNA and synthetic poly[dA-dT] x poly[dA-dT] double stranded copolymer in an ELISA format

Using an ELISA assay anti-nuclear antibody-positive sera from 300 patients with various immune-related diseases and 64 anti-nuclear antibody-negative sera were analysed for binding to S1-nuclease-treated double stranded (ds) DNA. In addition, the pattern of reactivity of 50 selected anti-dsDNA-positive sera was established using denatured (d) DNA and poly[dA-dT] X poly[dA-dT] double-stranded alternating copolymer (dAT) as additional DNA antigens. None of the 64 anti-nuclear antibody-negative sera and 76 of the 300 anti-nuclear antibody-positive sera (25%) were anti-dsDNA-positive. Of the anti-nuclear antibody-positive and anti-dsDNA-positive sera, 48 (63%) were from systemic lupus erythematosus patients, and 7 (9%) from rheumatoid arthritis patients, whereas 21 patients (27.6%) suffered from various immune and non-immune related diseases. Anti-dsDNA-positive reactivity was highly correlated with dDNA and dAT reactivity (r = 0.906, p < 0.0001 and r = 0.93, p < 0.0001, respectively). Although the majority of the 50 selected (37 systemic lupus erythematosus and 13 non-systemic lupus erythematosus) anti-dsDNA-positive sera concomitantly bound to both additional antigens, 7 of these (14%) did not bind to dAT, and 2 (4%) did not bind to dDNA. Anti-dsDNA-positive sera (n = 37) showed a similar pattern, in which 8.1% and 2.7% of sera did not bind to dAT and to dDNA, respectively. In contrast, anti-dsDNA-negative sera from various immune-related diseases bound either ssDNA (12.5%) or dDNA and dAT (12.5%). These data suggest that dsDNA and dAT-based assays detect similar but not identical specificities in the sera of patients suffering from systemic lupus erythematosus and in a proportion of non-systemic lupus erythematosus patients.

Antibodies to Tamm-Horsfall protein subunits prepared in vitro, in patients with acute pyelonephritis

The aim of this study was to determine antibodies to Tamm-Horsfall protein subunits in patients with acute pyelonephritis. The protein subunits used in this determination were prepared by chemical treatment of Tamm-Horsfall protein isolated from the urine of healthy individuals. Values for IgG and IgA were significantly higher (p < 0.05 and p < 0.01 respectively) in patients than in healthy persons, while IgM class antibodies were significantly higher only in the test performed with subunits obtained with 8.3 mol/l acetic acid (THP-A) (p < 0.05). Values for all three classes determined in the test with THP-A were significantly higher in patients with vesicoureteral reflux than in patients with normal radiological findings (p < 0.05). Antibodies to Tamm-Horsfall protein subunits isolated from the urine of patients with acute pyelonephritis should also be determined.

Peripheral blood CD5+ B cell subset in the remission phase of systemic connective tissue diseases

OBJECTIVE

To get a better insight into the level of circulating CD5+ B cells as related to the systemic connective tissue disease activity.

METHODS

Peripheral blood CD5+CD19+ cells of patients in the remission phase of systemic lupus erythematosus (SLE) (n = 28), Sjögren's syndrome (SS) (n = 20), rheumatoid arthritis (RA) (n = 26), and 19 control healthy subjects were analyzed by 2-color flow cytometry.

RESULTS

In comparison to control group, the patients with SLE had a significant increase in the relative CD19+CD5+ blood cell count (p < 0.0005); this count was also different from the finding in both RA (p < 0.005) and patients with SS (p < 0.05). In contrast, the proportion of B cells expressing CD5 (within an individual B cell population) was significantly increased in all the 3 diseases compared to healthy subjects (SLE, p < 0.0001; SS, p < 0.05; and RA, p < 0.01). In the multivariate discriminant analysis, a discriminant function defined by the CD19+CD5+ subset strongly discriminated SLE, SS and RA from the control, but also SLE from both SS and RA.

CONCLUSION

Our findings demonstrated that, in relation to healthy control subjects, the blood CD5+ B subset tended to be elevated in the patients in the remission phase of systemic connective tissue diseases, particularly in SLE.

Antibodies to Tamm-Horsfall protein in patients with acute pyelonephritis

The role of antibodies to Tamm-Horsfall protein in the diagnosis of acute pyelonephritis was studied. Antibodies to Tamm-Horsfall protein were also determined in a group of normal subjects. Patients with acute pyelonephritis were divided into subgroups according to the concurrent presence of vesicoureteral reflux or nephrolithiasis. No statistically significant differences (p > 0.05) were observed for any class of antibodies (IgG, IgA and IgM) between the groups of healthy subjects and patients with acute pyelonephritis, regardless of the presence or absence of vesicoureteral reflux or nephrolithiasis. Values for different antibody classes showed that IgM antibodies were the most abundant in all the groups examined. A difference in the values of IgM relative to IgA and IgG antibodies was found to be statistically significant in the patient group only (p < 0.05). In patients with vesicoureteral reflux, there was no statistically significant difference (p > 0.05) between the values of IgM and of other antibody classes. In these patients, however, the highest values of all the three antibody classes were obtained, although these differences were also not statistically significant (p > 0.05). The results pointed to the need of further studies of the role of antibodies to Tamm-Horsfall protein in the diagnosis and pathogenesis of tubulointerstitial nephritis.

Evaluation of criteria contributions for the classification of systemic lupus erythematosus

The American Rheumatism Association (ACR) preliminary and revised criteria for classification of systemic lupus erythematosus (SLE) were evaluated for sensitivity and specificity in a population of 100 patients with SLE and 100 patients with other rheumatic diseases. Bayes' theorem was applied for evaluation of ARA criteria for the classification of SLE and a scoring system was developed which allows simple determination of the probability of SLE. The evaluation revealed considerable differences in values of the ARA criteria. The serologic tests and discoid lupus appeared to be the most distinctive criteria, while Raynaud's phenomenon, oral and nasal ulcers and arthritis were of little value. Comparison of SLE and control patients presenting the same number of criteria revealed that patients with SLE exhibit more distinctive criteria. This finding emphasizes the need for a quantitative evaluation of classification criteria.

[Tuberculosis in systemic connective tissue diseases]

Six female patients who developed tuberculosis during the treatment of connective tissue diseases are presented. Underlying disease--systemic lupus erythematosus, rheumatoid arthritis, and polymyositis--with its numerous immunopathologic processes essentially decreases resistance of the organism to infections. Tuberculosis usually accompanies chronic, exhausting diseases and tends to involve patients with the decreased immunity. The use of glucocorticoids and immunosuppressive agents has been shown to have a significant influence on the suppression of the immune system. Thus, tuberculosis is a dangerous, very often fatal complication in the course and treatment of connective tissue diseases.

[Analysis of the flow of medical information from Croatia into the world]

It is commonly thought that an article published in a renown international journal gives its authors better chances for visibility. The present paper aims at answering three questions: (a) does an article published in a top international journal guarantee that its authors will be visible, (b) is an article published in a domestic journal (not covered by ISI) completely inaccessible to the international public, and (c) which are the information flows and how far does the medical information from Croatia reach. Selected was a corpus of 60 authors, who simultaneously publish in foreign journals and in Lijecnicki vjesnik (LV). The corpus consists of 1053 articles published in the 1961-1986 period. Out of these, 369 articles were published in LV and 684 in foreign journals; 177 among them are covered by the Science Citation Index. A total of 4481 citations were collected for the entire corpus of 1053 articles. The citations pertain to 506 articles, i.e. 48% of articles were cited. There are 190 cited and 83 uncited journals. The citations were distributed among 890 journals. Although the studied authors published their papers in renown international journals, a number of examples proves that this does not guarantee their visibility. An article published in LV need not necessarily remain inaccessible to the world--this depends on the article itself. The present analysis provides a compendious insight into the transfer of information from Croatia into the world. The data from citation analysis enable the deduction of "average number of citations per paper". With an appropriate interpretation it can be used as an indicator of information transfer.

Natural killer cell number and activity in remission phase of systemic connective tissue diseases

The proportions and numbers of peripheral blood mononuclear cell markers and peripheral blood NK cell activity were analyzed and correlated in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS) patients in the remission phase of the diseases. In comparison to the control data, the number of CD56+ cells was significantly increased in RA patients only; the same held true for double-positive cells, i.e., the alterations did not distinguish various subpopulations of NK cells. NK cell activity was significantly decreased in all the three groups of patients, with the complete lack of correlation between the NK cell number and their activity. It is possible that a significantly diminished NK cell activity in these diseases provokes a compensatory production of nonfunctional NK cells.

T cell subset composition in remission phase of systemic connective tissue diseases

The proportions and numbers of peripheral blood mononuclear cells bearing T-cell markers (CD3/HLA-DR, CD4/CD29, CD4/CD45, CD8/CD56) were analyzed using two-color flow cytometric analysis in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS) in the remission phase of the diseases. The number of T cells (CD3+) in the blood was significantly decreased in SLE patients only; in these patients, but also in RA patients, an increased number of activated T cells (CD3+ HLA-DR+) was found. The number and proportion of helper T cells (CD4+) were decreased in SLE and SS, and normal in RA patients. In contrast, helper-inducer (CD4+ CD29+) and suppression-inducer (CD4+ CD45+) cells were both significantly increased in RA patients, decreased in SLE (only CD4+ CD45+ significantly) and unchanged in SS patients. Interestingly, however, the proportions of helper-inducer cells relative to total helper (CD4+) cell pool were significantly increased in all three groups of patients, whereas the proportion of suppression-inducer (CD4+ CD45+) cells was significantly decreased, but in SLE patients only. It is thus possible that this parameter is most pertinent to the disease status in the model studied. The population of CD8+ cells appeared more abundant in SLE patients, and the pool of CD8+ CD56+ cell was significantly enlarged in RA patients. It appears that the remission phase of disease in RA, SLE and SS patients still contains a substantial activation of the immune system, but the respective mechanisms are quite different in RA patients on one side, and SLE and SS patients on the other side.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cellular immunity and the autoantibody system in polymyositis and dermatomyositis]

Polymyositis and dermatomyositis are clinical forms of inflammatory muscle diseases of unknown etiology. Cellular immunity seems to have great importance in pathogenesis of the idiopathic inflammatory myopathy. It is well known that specifically sensitised lymphocytes from the peripheral blood of patients with polymyositis and dermatomyositis may secrete various mediators (e. g. lymphokines) and be cytotoxic to muscle cell tissue culture as well. In recent years, a variety of anti-muscle antibodies and antibodies to nuclear and cytoplasmic antigens have been identified in the serum of patients with idiopathic inflammatory muscle disease, but their role in this clinical syndrome is still unknown. In this review article authors bring out some of the current state of knowledge about polymyositis and dermatomyositis related autoantibody systems, including biochemical characteristics of the target antigens, epidemiological and clinical significance, and possible role of these autoantibodies in the development of the disease.

[The mastocytosis syndrome]

A female patient with the history and clinical signs suggesting cutaneous and systemic mastocytosis is reported. The diagnosis of cutaneous mastocytosis was confirmed by the Darier's sign as well as by histologic analysis of the skin. An X-ray film of the bones showed an infiltration of the mast cells into the skeletal system what was also cytologically and histologically proven. The patient was treated only symptomatically because of the benign course of the disease. A current literature data on mastocytosis syndrome are discussed.

Striational autoantibodies: quantitative detection by enzyme immunoassay in myasthenia gravis, thymoma, and recipients of D-penicillamine or allogeneic bone marrow

Striational autoantibodies (StrAb) are a useful serologic marker of thymoma in patients with myasthenia gravis (MG). We compared a standard immunofluorescence method with a new enzyme immunoassay (EIA) for detection of StrAb. Retrospective testing of 264 stored sera by the two methods yielded well-correlated results (58 sera were positive by both assays; r = 0.8). For 104 patients with spontaneously acquired MG or thymoma, results were 100% concordant, of which 53% were positive. For 34 recipients of D-penicillamine, StrAb were found in 15% by EIA and in 6% by immunofluorescence. StrAb were detected in two of four bone marrow recipients by EIA and in one by immunofluorescence. Prospective testing of 434 fresh sera (of which 49 were positive by the two methods) yielded discordant results in only 4. Serial EIA quantitation of StrAb in two patients with MG and thymoma proved useful in monitoring immunosuppressant therapy and in a third patient predicted recurrence of the tumor. A high prevalence of StrAb was detected by both assays in elderly patients with spontaneous MG, but StrAb were more readily quantifiable by EIA. The EIA method proved to be highly sensitive and specific for detecting StrAb in patients with thymoma with and without MG, in patients treated with D-penicillamine, and in those with graft-versus-host disease after bone marrow transplantation.