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ID PMID Title PublicationDate abstract
12757620 Soluble FcgammaRIIa inhibits rheumatoid factor binding to immune complexes. 2003 Jun Soluble low-affinity receptors for IgG are known to inhibit immune complex (IC)-mediated inflammation, and expression by leukocytes is elevated in several inflammatory diseases. Immunoglobulin M (IgM) rheumatoid factors (RF), anti-Fc autoantibodies, are found in autoimmune diseases, such as rheumatoid arthritis (RA), as well as in normal immune responses. This study demonstrated that soluble FcgammaRIIa inhibits the interaction of rheumatoid factors with ICs. The recombinant soluble low-affinity FcgammaR, rsFcgammaRIIa, partially inhibited (30-70%) the rate of precipitation of soluble ICs by RF-positive RA sera. This required the normal interaction of FcgammaRIIa with Fc as the effect could be abrogated with the Fab fragment of the blocking mAb IV-3. Furthermore, rsFcgammaRIIa partially inhibited (40%) the binding of a monoclonal IgM RF (RF-AN) to an IC formed by IgG2 antibody binding to an antigen-coated biosensor chip. Since RF-AN has been characterized by crystallography to bind to the CH2/CH3 interface of the IgG-Fc, and leukocyte FcgammaRIIa binds to a distinct site centred on the lower hinge, this inhibition is uncompetitive. Some inhibition (15%) of staphylococcal protein A binding to IC was also observed. As soluble FcgammaRIIa disrupts Fc:Fc interactions in IgG-ICs, we propose that this alteration of the IC also reduces the accessibility of Fc portions in the IC, resulting in the partial inhibition of ligands, particularly IgM RF, which bind Fc. We propose that the high concentrations of soluble FcgammaR found during inflammation can affect the properties of ICs and their interaction with the immune system.
12673897 Increased type I collagen degradation correlates with disease activity in reactive arthrit 2003 Jan OBJECTIVE: The assay for the cross-linked carboxyterminal telopeptide of type I collagen (ICTP) has been shown to reflect increased type I collagen degradation in patients with rheumatoid arthritis. To look for increased collagen degradation in other inflammatory rheumatic diseases, we studied plasma ICTP in patients with reactive arthritis (ReA). METHODS: ICTP was determined by radioimmunoassay from 69 ReA patients. ICTP data on 56 patients aged > or = 20 years were compared with normal ICTP values available for that age group. RESULTS: The median (range) plasma ICTP concentration of the patients > or = 20 years of age was 3.9 (2.1-9.6) micrograms/l, and in 13 (23%) of them the value was elevated if compared with the normal upper reference limit (mean + 2SD), 5.2 micrograms/l, given by the manufacturer. The mean (SD) duration of joint symptoms was 76 (61) days in patients with ReA. Modest albeit statistically significant correlations were noted between the plasma ICTP and the erythrocyte sedimentation rate, C-reactive protein and the Lansbury articular index (Spearman's r 0.39, 0.37 and 0.29, respectively). The median values for all of the above mentioned parametres were at least twice as high in the group of patients with elevated ICTP compared with those in patients with normal values (p < 0.05). No statistically significant correlation was detected between the plasma ICTP and the duration of joint symptoms. CONCLUSION: Increased type I collagen degradation can take place in ReA, and this process seems to correlate with the extent and activity of the joint disease.
12723984 Efficacy of treatment with glycosaminoglycans on experimental collagen-induced arthritis i 2003 To evaluate the antioxidant activity of the glycosaminoglycans hyaluronic acid (HYA) and chondroitin-4-sulphate (C4S), we used a rat model of collagen-induced arthritis (CIA). Arthritis was induced in Lewis rats by multiple intradermal injections of 250 microl of emulsion containing bovine type II collagen in complete Freund's adjuvant at the base of the tail and into three to five other sites on the back. Rats were challenged again with the same antigen preparation 7 days later. Disease developed about 11 days after the second immunization. The effects of treatment in the rats were monitored by biochemical parameters and by macroscopic and histological evaluations in blood, synovial tissue and articular cartilage. Arthritis produced the following symptoms: severe periarticular erythema, edema and inflammation in the hindpaws; membrane peroxidation in the cartilage of the joints; endogenous antioxidant wasting; high tumour necrosis factor-alpha (TNF-alpha) plasma levels; and synovial neutrophil accumulation. Treatment with HYA and C4S, starting at the onset of arthritis for 10 days, limited the erosive action of the disease in the articular joints of knee and paw, reduced lipid peroxidation, restored the endogenous antioxidants reduced glutathione (GSH) and superoxide dismutase, decreased plasma TNF-alpha levels, and limited synovial neutrophil infiltration. These data confirm that erosive destruction of the joint cartilage in CIA is due at least in part to free radicals released by activated neutrophils and produced by other biochemical pathways. The beneficial effects obtained with the treatment suggest that HYA and C4S could be considered natural endogenous macromolecules to limit erosive damage in CIA or as a useful tool with which to study the involvement of free radicals in rheumatoid arthritis.
12718751 Advanced glycation end-product (AGE)-damaged IgG and IgM autoantibodies to IgG-AGE in pati 2003 Advanced glycation end-product (AGE)-damaged IgG occurs as a result of hyperglycemia and/or oxidative stress. Autoantibodies to IgG-AGE were previously demonstrated in patients with severe, longstanding rheumatoid arthritis (RA). We investigated whether IgG-AGE and anti-IgG-AGE antibodies were present early in the course of RA and other inflammatory arthropathies. We prospectively followed a cohort of 238 patients with inflammatory arthritis of duration less than 1 year. Patients were evaluated clinically and serologically, and radiographs were obtained at initial and 1-year visits. Sera were assayed for IgG-AGE and anti-IgG-AGE antibodies by enzyme-linked immunosorbent assay (ELISA). Rheumatoid factor (RF) was determined by nephelometry and ELISA. Of all patients, 29% had RF-positive RA, 15% had RF-negative RA, 18% had spondyloarthropathy, and 38% had undifferentiated arthritis. IgG-AGE was present in 19% of patients, and was similar in amount and frequency in all groups. Patients with elevated IgG-AGE levels had significantly higher levels of the inflammatory markers C-reactive protein and erythrocyte sedimentation rate, but there was no correlation with blood glucose levels. Overall, 27% of the patients had IgM anti-IgG-AGE antibodies. These antibodies were highly significantly associated with RFs (P < 0.0001) and with swollen joint count (P < 0.01). In early onset arthritis, IgG damaged by AGE was detected in all patient groups. The ability to make IgM anti-IgG-AGE antibodies, however, was restricted to a subset of RF-positive RA patients with more active disease. The persistence of the anti-IgG-AGE response was more specific to RA, and was transient in the patients with spondyloarthropathy and with undifferentiated arthritis who were initially found to be positive for anti-IgG-AGE antibodies.
16329559 Ultrastructural characteristics of synovial effusion cells in some arthropathies. 2004 Dec OBJECTIVE: To evaluate the range of activation changes of polymorphonuclear leukocytes (PMN) and the ratio of apoptosis and necrosis in synovial effusions of patients with various arthropathies, and to reveal possible correlations with clinical variants of joint inflammation. METHODS: Synovial effusions were aspirated from the knee joints of patients with rheumatoid arthritis (RA, 28 cases), and seronegative spondyloarthritides (SSA): Reiter's disease (RD, 9 cases), peripheral form of the ankylosing spondyloarthritis (6 cases) and psoriatic arthritis (6 cases); and primary osteoarthritis (OA, 9 cases). Cytospin preparations were processed for transmission electron microscopy and assessed for the incidence of apoptosis, necrosis, and cytophagocytic cells (CPC) in the synovial fluid (SF). The range of activation changes of the neutrophil granulocytes, the dominating cell population in the arthritic SF, was evaluated. RESULTS: In all arthropathies under investigation most of the synovial effusion cells had intact ultrastructure with a certain amount of apoptotic cells dominating over the cells with signs of necrosis, and a few CPC. The highest rate of apoptosis was discovered in the synovial effusions of patients with RA, the lowest in those with OA, while the rate of CPC among the inflammatory joint diseases was the lowest in RA. In RA the current disease activity correlated with the incidence of apoptotic cells and CPC, while the clinical stage was related only to the CPC rate. These data suggest that in RA, despite exposure to the anti-apoptotic signals, apoptosis of the synovial effusion PMN is maintained at a significantly higher level than in non-rheumatoid arthropathies, both inflammatory (SSA) and degenerative (OA), providing elimination of the neutrophils accumulating in the joint cavity and thus stimulating resolution of the joint inflammation.
14564352 Association study of the IL13 variant Arg110Gln in atopic diseases and juvenile idiopathic 2003 Oct BACKGROUND: It has previously been shown that various inflammatory diseases, such as diabetes mellitus, bronchial asthma, chronic inflammatory bowel diseases, and rheumatoid arthritis, are in some circumstances genetically linked to the same chromosomal regions. Consequently, common genes underlying the pathogenetics of these diseases have been proposed. Chronic inflammatory disorders can be subdivided by their predominant immune response, either TH1 or TH2. For example, juvenile idiopathic arthritis (JIA) is a TH1 disease, and bronchial asthma is a TH2 disease. OBJECTIVES: The present study investigated the polymorphism Arg110Gln within the IL13 gene, a strong TH2 cytokine. We attempted to determine whether it is associated with these 2 diseases and whether this would reflect the TH1/TH2 paradigm. METHODS: Arg110Gln was typed in 4 different populations: asthmatic children, atopic children, children with JIA, and a control population. Statistical analysis was performed by using logistic and linear regression analysis of serum IgE levels and the Armitage trend test. RESULTS: The variant Gln110 was shown to be associated with increased total serum IgE levels in our atopic population (P =.006) and was weakly associated with bronchial asthma (P =.04). There was no association of the variant with JIA when compared with the control population. However, the variant Gln110 was significantly less frequent in children with JIA compared with its presence in children with bronchial asthma (P =.007). CONCLUSION: This is the first study to compare the same gene variant in TH1 and TH2 chronic inflammatory diseases. The results suggest that the same gene variant might protect from one disease and make an individual susceptible to the other.
15556682 CD25+ regulatory cells from HLA-DQ8 transgenic mice are capable of modulating collagen-ind 2004 Nov In the last decade, CD4+CD25+ T regulatory cells have been implicated in the protection against autoimmune diseases. The human DQ8 major histocompatibility complex (MHC) class II molecule is associated with rheumatoid arthritis (RA) and various other autoimmune diseases in humans. The human leukocyte antigen (HLA)-DQ8 transgenic mouse, containing the human DQ8 MHC class II molecule, is predisposed toward collagen-induced arthritis. However, the biologic pathways responsible for DQ8-associated autoimmunity have yet to be defined, including possible defects in the CD4+CD25+ T regulatory cell compartment. To explore this concept, we examined the suppressive capacity of CD4+CD25+ T regulatory cells from DQ8 transgenic mice in vitro and, using CD25-specific depleting antibodies, investigated their influence on collagen-induced arthritis in vivo. CD4+CD25+ T regulatory cells isolated from DQ8 transgenic mice were found to be sufficient suppressors of splenocyte proliferation and interferon (INF)-gamma production. Furthermore, depletion of these cells before immunization led to significant increases in arthritis severity, collagen-specific antibodies, and INF-gamma production. These results indicate that HLA-DQ8 mice contain naturally occurring CD25+ regulatory cells that modulate collagen-induced arthritis and imply that DQ8 expression does not hinder the development of CD25+ T regulatory cells.
15197999 [Arthritis following intravesical instillation of BCG for urothelial cancers]. 2004 May BACKGROUND: Intravesical instillation of bacillus Calmette-Guerin (BCG) is efficient for prophylaxis of superficial bladder cancer and treatment for carcinoma in situ (CIS) of the upper urethelial cancer. However, the incidence of adverse effects is relatively high, and those include reactive arthritis. We retrospectively evaluated the incidence and the outcome of reactive arthritis following intravesical BCG therapy for urothelial cancers. PATIENTS AND METHODS: Intravesical instillations of BCC were performed in 192 cases (218 courses) between January 1998 and January 2002. BCG was instilled for prophylaxis of superficial bladder cancer recurrence in 170 (195 courses), treatment for CIS in 7 (8 course), and treatment for CIS in 7 (8 courses), and treatment for CIS in upper urinary tract in 15 (15 courses). RESULTS: Arthritis was recognized in 8 cases (3.7%, 8/218 courses), and 7 of them were identical to reactive arthritis following BCG therapy. Remaining 1 patient was diagnosed as rheumatoid arthritis (RA), and the relation between arthritis and intravesical BCG instillation was unclear. Mean number of BCG instillation was 5.6 (3-8 times). All reactive arthritis were occurred within 4 weeks after the last BCG instillation, i.e., BCG induced urinary tract infection, and 6 of them were polyarthritis. Concurrence of conjunctivitis was seen in one patient. HLA-B27 was negative in 4 examined patients. A nonsteroidal anti-inflammatory drug (NSAID) was used in all 8 patients, anti-tuberculous agents were used in 3, and prednisolone was added in 3, Arthritis was improved within 2 months in patients received prednisolone, however, it persisted longer than 3 months in patients without prednisolone. CONCLUSION: Arthritis was recognized in higher incidence than previous reports following intravesical instillation of BCG. All cases except one, diagnosed as RA, were diagnosed as reactive arthritis (Reiter's syndrome). However, correlation between HLA-B27 and arthritis was not clear in this study. Administration of steroidal drug was thought to improve arthritis in shorter duration.
14655981 Uveitis in childhood. 2003 Nov PURPOSE: To review the etiologic factors and complications of uveitis in patients younger than 16 years. PATIENTS AND METHODS: Between January 1989 and December 1999 in the Department of Ophthalmology of Hacettepe University School of Medicine, 219 patients were diagnosed or observed as having pediatric uveitis. After complete ocular and physical examinations, routine and specific laboratory and radiologic investigations were performed. Medical or surgical treatment was employed when necessary. RESULTS: Of the 219 patients, 112 were girls, with a mean age of 7.4 +/- 4.2 years, and 107 were boys, with a mean age of 8.3 +/- 3.4 years. In 24.2% of the cases, no etiologic factor could be ascertained; these cases comprised the idiopathic group. Among the remaining cases, the most common etiologies were toxoplasmosis, juvenile rheumatoid arthritis (JRA), pars planitis, Behçet's disease, and Fuchs' heterochromic iridocyclitis. Anatomically, anterior uveitis was the most common form. The mean follow-up time was 37 +/- 6.2 months. Complications for which surgical treatment was employed were identified in 71 eyes (20.9%), most of which were due to JRA, pars planitis, or Behçet's disease. CONCLUSION: Uveitis in childhood may be idiopathic or most commonly due to toxoplasmosis, JRA, and pars planitis. Due to inflammation itself or to prolonged therapy especially with corticosteroids, pediatric uveitis entities (mostly JRA, pars planitis, or Behçet's disease) may result in complications necessitating a surgical approach.
12919221 Patient education: perspective of adolescents with a chronic disease. 2003 Sep The purpose of this study was to describe patient education from the perspective of adolescents. Data were collected by interviewing adolescents who had asthma, epilepsy, juvenile rheumatoid arthritis, and insulin-dependent diabetes mellitus. The sample consisted of 40 Finnish adolescents aged between 13 and 17 years. The interview data were analysed with methods of content analysis. From the perspective of adolescents with a chronic disease, patient education can be divided into the following categories: routine programmes, problematic planning issues, atmosphere of patient education session and written patient education material. Some features of ideal patient education also emerged. In a routine programme, patient education was based on the professional knowledge of the physicians and nurses rather than the needs of the adolescents. It was provided at a time that was good for the nurses or physicians. The level of education was not compatible with each developmental level of the adolescent. Problematic planning issues included a poorly outlined plan of education and a lack of systematic and continuous education. Educational communication consisted of dialogue between the adolescent and the educator. An encouraging atmosphere developed when the educators motivated the adolescents, respected them and their opinions and encouraged them to express their feelings, to ask questions and to relate experiences. Also, it was important that the adolescents' opinions were respected. In ideal patient education, the sessions had been planned well beforehand based on the adolescents' needs and written patient education material. Ideal patient education helped adolescents to acquire skills to take care of themselves and provided information on how to adjust to different situations and problems. The results provided useful insight into patient education and served to raise awareness of the problems and difficulties experienced by adolescents with a chronic disease.
14975369 A human dual-color enzyme-linked immunospot assay for simultaneous detection of interleuki 2004 Jan The enzyme-linked immunospot (ELISPOT) assay is an efficient technique for the enumeration of single cells secreting antibodies and cytokines. For simultaneous differentiation of individual cells producing interleukin-2 (IL-2) and interleukin-4 (IL-4) at a single cell level in human peripheral blood mononuclear cells (PBMCs), a human dual-color ELISPOT assay has been optimized. In the present system, the red spots corresponding to IL-2-secreting cells (T helper type 1, Th1, cells) were developed with horseradish peroxidase and the amino ethyl carbazole (AEC)/H2O2. The blue spots corresponding to IL-4-secreting cells (T helper type 2, Th2, cells) were developed with an alkaline phosphatase and the Vector blue. The usefulness of the assay method was tested. With this system, we could detect the IL-2- and IL-4-secreting cells simultaneously in human PBMCs of a juvenile rheumatoid arthritis (JRA) patient. This procedure provides useful information on clinical immune disorders.
12653923 Newly available treatments for psoriatic arthritis and their impact on skin psoriasis. 2003 Mar Far from being a "benign" arthropathy, as it was initially characterized, psoriatic arthritis (PsA) affects approximately 0.2% of the US population and can be associated with considerable joint damage, symptomatology, and quality of life impairment. PsA shares many characteristics with rheumatoid arthritis (RA), and new, rationally designed drugs that are effective in RA also are proving active in PsA. Two such drugs, etanercept and infliximab, target tumor necrosis factor (TNF), a key component of the inflammatory response. This review discusses the rationale for and experience with the use of these agents in PsA. Etanercept is a dimeric fusion protein that binds specifically to TNF, blocking its interaction with cell surface TNF receptors. Infliximab is a chimeric (murine/human) monoclonal antibody that binds to TNF and inhibits its binding to its receptor. A randomized placebo-controlled trial of etanercept in PsA found statistically significant benefits for this agent in measures of arthritic activity and psoriatic severity. There have been anecdotal reports of the efficacy of infliximab in PsA, but results from controlled clinical trials of this agent in PsA have not been reported. TNF inhibitors represent new therapeutic options for patients with PsA. The potential advantages of treatment with etanercept and infliximab early in the disease course are discussed.
12180746 Gynecomastia and sexual impotence associated with methotrexate treatment. 2002 Aug Methotrexate (MTX) is the disease modifying antirheumatic drug most frequently used for rheumatoid and psoriatic arthritis (PsA). Several reports associate sexual dysfunction to MTX use. We describe 2 cases of sexual impotence and gynecomastia in patients with PsA treated with MTX. Although the mechanism underlying MTX induced sexual dysfunction is unknown, the potential consequences should be taken in account in view of the steady increase in the number of patients.
14975430 Hypokalemic paralysis revealing Sjögren's syndrome. 2004 Apr A rare case of a lady with acute hypokalemic quadriparesis and underlying distal renal tubular acidosis manifesting as a presentation of Sjögren's syndrome is described. The case highlights the concept that acute hypokalemia due to unrecognized renal tubular acidosis may unmask Sjögren's syndrome in patients without sicca symptoms and it may be a marker of more severe renal disease. Acute paralysis is a life threatening consequence of hypokalemia and when due to potassium wasting secondary to renal tubular acidosis may be easily prevented. Underlying Sjögren's syndrome should be considered in all patients of either sex and at any age presenting with hypokalemic paralysis.
15841813 Resting and stimulated whole salivary flow rates in Sjögren's syndrome patients over time 2004 Oct The aim of the present study was to evaluate Swedish and Norwegian criteria currently applied in the assessment of eligibility for subsidized dental care of Sjogren's syndrome (SS) patients. These criteria are partly based on a single salivary test showing a resting whole salivary secretion rate of < or =0.1 mL/min. Thirty secondary Sjogren (SSS) patients (29 F and 1 M) participated for the duration of the study, in which resting (RWS) and stimulated (SWS) whole salivary flow rates were collected in the morning and afternoon, over 3 consecutive weeks, once per week, as well as at different times over a 5-year period. Twenty patients presented levels of RWS flow rates of < or =0.1 mL/min on one or more occasions over a 3-week period, while 8 of these also exceeded, on one or more occasions, the cut-off level of 0.1 mL/min, indicating that salivary flow rates varied over time. Six patients showed consistently low secretion rates of RWS as well as of SWS, estimated as < or =0.1 mL/min and <0.7 mL/min, respectively. Based on the results, salivary tests that are to be used as a diagnostic aid for SS diagnosis, and thus as a basis for inclusion within the subsidy net for dental care, must be taken on several occasions in order to more accurately give information about salivary gland function. In line with this, current regulations governing the eligibility of SS patients within subsidized dental care programs should be reviewed.
15069784 [Secondary bronchiolitis obliterans organizing pneumonia with primary Sjögren's syndrome, 2004 Mar A 71-year-old female who was taking 10 mg/day of prednisolone for Sjögren's syndrome was admitted because of fever and dyspnea with multiple infiltrative shadows on chest radiography and computed tomography (CT), although she had been discharged only 4 days before. On the 1st and 2nd admissions, a BOOP pattern had been suspected, and she was treated by tapering the prednisolone dose from 40 mg/day to 10 mg/day, which resulted in the disappearance of the infiltrative lung shadows. This time we confirmed the BOOP pattern with Sjögren's syndrome, because bronchoalveolar lavage showed an increase of total cells, with a high lymphocyte fraction, and a transbronchial lung biopsy revealed loose fibroblastic plugs in some alveolar ducts and alveoli. Also, there were intra-alveolar accumulations of foamy macrophages. Furthermore, we noticed migration of pulmonary opacity. Although the clinical symptoms of the patient improved, the response to the prednisolone therapy appeared to be poor. At 35 mg of prednisolone (which had been initiated at 40 mg/day), the disease became rapidly exacerbated by a common cold, and developed into ARDS on the 30th hospital day. In spite of intensive care, the patient died. Here we report a rare case in which the BOOP pattern based on Sjögren's syndrome resulted in ARDS. In general, prednisolone is effective against the BOOP pattern, but we need to be aware of the possibility of a poor response to this BOOP pattern in Sjögren's syndrome.
12661106 [A case of Sjögren's syndrome with subacute transverse myelitis as the initial manifestat 2002 Jul We report a case of subacute transverse myelitis associated with Sjögren's syndrome free of xerosis. A 62-year-old man was admitted due to dysesthesia of both lower extremities and the left trunk, weakness of the left leg, and urinary disturbance. Neurological examination showed myelopathy at the Th7 level. CSF had increased protein (82 mg/dl) and IgG (23.4 mg/dl) and IgG index (1.03) but an almost normal cell count (7/mm3). T2-weighted MRI showed a high signal intensity lesion at the sixth and seventh thoracic levels. Although he was free of xerosis, typical sialographic findings, as well as the presence of anti-SSA antibody, are consistent with the diagnostic criteria for Sjögren's syndrome decided by the Japanese research group on Sjögren's syndrome. The patient was treated with prednisolone, 60 mg/day, which completely cured his muscle weakness and difficulty in walking, and sensory disturbance was gradually alleviated. Spinal MRI detected a marked reduction in the size of T2-weighted high signal intensity lesion during prednisolone treatment. In Western countries, central nervous system complications are reported in up to 20% of Sjögren's syndrome patients, but myelopathy is a very rare condition. Only 12 cases, including ours, have been reported. The clinical manifestations of myelopathy in Sjögren's syndrome include acute or subacute transverse myelitis (6 cases, including ours), chronic progressive myelopathies (2 cases.), relapsing and remitting cord syndromes (4 cases) and Brown-Séquard syndrome (none). Ten patients were women. In 9 of 12 cases there were sicca symptoms. The level of the myelopathies in 6 of 10 cases was between the third to eighth thoracic level, consistent with the region vulnerable to ischemia. Eight patients were treated successfully with steroids. We speculate that ischemia due to vasculitis is important in the genesis of myelopathy associated with Sjögren's syndrome. In the case of myelopathy, especially in the thoracic cord, it is necessary to look for evidence of Sjögren's syndrome even when xerosis is unremarkable.
12436232 Laparoscopic approach to fever of unknown origin. 2003 Mar BACKGROUND: Fever of unknown origin (FUO) is difficult to diagnose. Laparotomy is needed to establish the etiologic diagnosis in some patients. The aim of this study was to analyze the feasibility, safety, and success rate of a protocolized laparoscopy in patients with FUO. METHODS: An extensive clinical evaluation was performed before surgery. Laparoscopy included inspection of the abdominal cavity, wedge and tru-cut liver biopsies, lymph node biopsy, splenectomy, and bone marrow biopsy. Histologic analysis, permanent section analysis, and cultures were obtained. RESULTS: The study involved 15 patients with a mean age of 43.6 +/- 14.5 years. The mean operative time was 122 +/- 60 min. Minor complications occurred in 9% of the patients. One patient bled after surgery and underwent reoperation. There was no operative mortality. An etiologic diagnosis was made in 66% of the patients, and laparoscopy helped to rule out intraabdominal pathology in four additional patients, giving a total success rate of 93%. CONCLUSION: Protocolized laparoscopy in patients with FUO is safe, feasible, and accurate.
15176660 Antiphospholipid antibodies in primary Sjögren's syndrome: prevalence and clinical signif 2004 The aim of this study is to determine prevalence, clinical significance of antiphospholipid antibodies (aPL) including anticardiolipin antibodies (aCL), anti-beta2GP1 and lupus anticoagulant (LA) in a cohort of 74 patients with primary Sjögren's syndrome (pSS) according to revised European criteria. aPL were found in 25 (34%) patients; IgG in 23 (12 had low titres, six moderate titres and five high titres) and IgM in five (three and two had respectively moderate and high titres). Eight (11%) patients were found to have LA; anti-beta2GP1 antibodies were detected only in three (4%) patients. Only two patients with LA, aPL and beta2GP1 had recurrent venous thrombosis. One patient with moderate titres of aPL exhibited recurrent spontaneous foetal losses. Peripheral neuropathies without cryoglobulinemia were more frequent in the aPL group. Other systemic involvements of pSS were the same in both groups with or without aPL. Patients with aPL have more concurrent immunological diseases such as thyroiditis and primary biliary cirrhosis and a higher prevalence of hypergammaglobulinemia (P < 0.05). Even if aPL prevalence reached 30% in pSS, titres were usually low, with a close correlation with hypergammaglobulinemia but not with antiphospholipid syndrome, which is related to positivity of both LA and aPL.
14680280 Respiratory paralysis in Sjogren syndrome with normal renal function. 2003 Sep We report a 28-year-old woman who presented with quadriparesis and respiratory failure, and had severe hypokalaemia and distal renal tubular acidosis. She recovered completely on potassium and alkali supplementation. Biopsy and scintigraphy of the minor salivary glands confirmed the presence of Sjogren syndrome. A 6-month course of prednisolone did not correct the distal renal tubular acidosis.