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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
19662539 Epigenetic histone code and autoimmunity. 2010 Aug The multiple inter-dependent post-translational modifications of histones represent fine regulators of chromatin dynamics. These covalent modifications, including phosphorylation, acetylation, ubiquitination, deimination, and methylation, affect therefore the numerous processes involving chromatin, such as replication, repair, transcription, genome stability, and cell death. Specific enzymes introducing modified residues in histones are precisely regulated, and a single amino acid residue can be subjected to a single or several, independent modifications. Disruption of histone post-translational modifications perturbs the pattern of gene expression, which may result in disease manifestations. It has become evident in recent years that apoptosis-modified histones exert a central role in the induction of autoimmunity, for example in systemic lupus erythematosus and rheumatoid arthritis. Certain histone post-translational modifications are linked to cell death (apoptotic and non-apoptotic cell death) and might be involved in lupus in the activation of normally tolerant lymphocyte subpopulations. In this review, we discuss how these modifications can affect the antigenicity and immunogenicity of histones with potential consequences in the pathogenesis of autoimmune diseases.
19560893 Patients' understanding of the concepts of health and quality of life. 2010 Jan OBJECTIVE: The aim of this study was to identify how persons' with rheumatoid arthritis (RA) understand the concepts of health and quality of life (QoL). METHODS: A phenomenograpic approach was used to gauge variations in understanding of health and QoL. Semistructured interviews were conducted with 22 persons having RA. The interviews were audiotaped, transcribed verbatim, and analyzed, resulting in a descriptive system consisting of categories and subcategories. RESULTS: Health was primarily associated with being healthy/being free from disease, being able to function normally, experiencing well-being, and having a healthy lifestyle. Two above-mentioned domains, "being healthy" and "being able to function normally" overlapped with respondents' understanding of QoL. Additional perceived domains included attitudes towards life and, social and physical environments. CONCLUSION: The results show that patients' understanding of the two concepts of health and QoL partially overlap and partially differ. PRACTICE IMPLICATIONS: Patients' understanding of the concepts is individual and diverse, which needs to be taken into account in patient-physician consultations to ensure good communication. Furthermore, the interpretation of results based on patient-reported outcomes instruments measuring health status and/or QoL needs to be further studied over time to identify possible changes in these conceptions.
19520311 Statins, ACE inhibitors and ARBs in cardiovascular disease. 2009 Jun Atherosclerotic cardiovascular disease (CVD) is the main cause of death in developed and developing countries. It is well accepted that several diseases - including hypertension, dyslipidemia and diabetes mellitus - increase CVD. More recently also chronic inflammatory diseases, such as rheumatoid arthritis, have been shown to accelerate CVD. This association further supports a responsible role for inflammatory processes in all stages of CVD pathophysiology. Clinically, CVD ranges through different acute and chronic syndromes with ischemic symptoms in distal tissues, including heart, cerebral region or peripheral arteries. Several treatments for reducing CVD are under investigation. In this review we focus on statins, angiotensin-converting-enzyme (ACE) inhibitors, and angiotensin-II receptor blockers (ARBs), updating therapeutic evidence from the last clinical trials with particular relevance to diabetic patients.
19466979 Rituximab in non-haematological disorders of adults and its mode of action. 2009 Aug Rituximab is currently licenced for the treatment of CD20 positive lymphoma and rheumatoid arthritis (RA), however, it is increasingly being used off-label in a wide variety of non-haematological conditions. Although there are limited numbers of randomised controlled trials, there is a growing body of evidence for its efficacy in rheumatology, renal disease, solid organ transplantation, neuromuscular disorders, skin and endocrine disorders. The mechanism of action of rituximab in these conditions is not always clear and is likely to be via modification of both B and T cell function. Rituximab appears to be well tolerated in most groups of patients but certain side effects may be more prominent in particular conditions. This review examines the evidence base behind the use of rituximab in non-haematological conditions in adults and any special considerations that need to be taken into account when treating particular disease groups.
19365783 Pharmacokinetics of intramuscular microparticle depot of valdecoxib in an experimental mod 2009 Sep AIM: We did a prospective study to investigate pharmacokinetics of a single intramuscularly (i.m.) administered Valdecoxib (VC) polymeric microparticles in New Zealand white rabbits. METHOD: Poly[lac(glc-leu)] microparticles encapsulating a potent cyclooxygenase-2- selective inhibitor, VC, were prepared by emulsion and solvent evaporation technique and administered i.m. to rabbits for pharmacokinetic study. RESULTS: A single i.m. dose of drug-loaded poly[lac(glc-leu)] microparticles resulted in sustained therapeutic drug levels in the plasma for 49 days. The relative bioavailability was increased severalfold as compared with unencapsulated drug. CONCLUSIONS: Injectable poly[lac(glc-leu)] microparticles hold promise for increasing drug bioavailability and reducing dosing frequency for better management of rheumatoid arthritis.
19269107 Crohn's disease: the hot hypothesis. 2009 Jul The peculiar geographic distribution of inflammatory bowel disease is a puzzle for researchers. A low vitamin D status has now been linked to several Th1-mediated autoimmune diseases, including multiple sclerosis, type 1 diabetes and rheumatoid arthritis, with the strongest evidence for the vitamin's protective role in multiple sclerosis. Sunlight and vitamin D may be potent immunomodulatory agents by down-regulating Th1-driven immune responses and inducing the synthesis of antimicrobial peptides considered as natural antibiotics of the immune system. Similarly to multiple sclerosis, we propose in CD the so-called north-south gradient may be partly explained by variations in the degree of sun exposure, with vitamin D being a "seasonal stimulus". These observations may yield a better understanding of the pathophysiology of Crohn's disease and pave the way for developing new therapeutic approaches for an incurable disease. Whether a low vitamin D status is associated with an increased risk of Crohn's disease in the general population and whether vitamin D and heliotherapy may be effective in treating Crohn's disease will require additional investigations.
19208172 Identifying disease associations via genome-wide association studies. 2009 Jan 30 BACKGROUND: Genome-wide association studies prove to be a powerful approach to identify the genetic basis of different human diseases. We studied the relationship between seven diseases characterized in a previous genome-wide association study by the Wellcome Trust Case Control Consortium. Instead of doing a horizontal association of SNPs to diseases, we did a vertical analysis of disease associations by comparing the genetic similarities of diseases. Our analysis was carried out at four levels - the nucleotide level (SNPs), the gene level, the protein level (through protein-protein interaction network), and the phenotype level. RESULTS: Our results show that Crohn's disease, rheumatoid arthritis, and type 1 diabetes share evidence of genetic associations at all levels of analysis, offering strong molecular support for the current grouping of the diseases. On the other hand, coronary artery disease, hypertension, and type 2 diabetes, despite being considered as a natural group with potential aetiological overlap, do not show any evidence of shared genetic basis at all levels. CONCLUSION: Our study is a first attempt on mining of GWA data to examine genetic associations between different diseases. The positive result is apparently not a coincidence and hence demonstrates the promising use of our approach.
21125513 [Secondary aorto-enteral fistula as a cause of acute recurrent gastrointestinal bleeding, 2010 Dec Aorto-enteral fistulas (AEF) are a rare but life-threatening cause of acute gastrointestinal bleeding. Clinically, they can appear through massive haematochezia and haematemesis or as intermittent occult intestinal bleeding. The diagnostic procedure using endoscopy is often difficult but can contribute to making the correct diagnosis. We report on a patient who developed a secondary aorto-enteral fistula twenty years after a living kidney donation. The vascular surgery in combination with a chronic inflammatory reaction had resulted in the formation of a fistula between the renal artery stump and the duodenum. The inflammatory response was maintained by continuous treatment with methotrexate because of rheumatoid arthritis. Despite several total enteroscopies and diagnostic laparotomies, the fistula was seen on several occasions but was overlooked and misinterpreted in the absence of bleeding at first. The suspected fistula was finally marked with two endoclips and confirmed subsequently by radiological imaging by means of an abdominal CT scan.
21106455 Diamino-1,2,4-triazole derivatives are selective inhibitors of TYK2 and JAK1 over JAK2 and 2010 Dec 15 Tyrosine kinase 2 (TYK2) is required for signaling of interleukin-23 (IL-23), which plays a key role in rheumatoid arthritis. Presented is the design and synthesis of 1,2,4-triazoles, and the evaluation of their inhibitory activity against the Janus associated kinases TYK2 and JAKs 1-3.
20815988 Mindfulness-based stress reduction for people with chronic diseases. 2010 Mindfulness-based stress reduction (MBSR) is a structured group program that uses mindfulness meditation to improve well-being and alleviate suffering. This article reviews the impact of MBSR for people with chronic diseases. The review includes original research that was published in English and peer-reviewed and reported outcomes for adults with chronic diseases who had participated in an MBSR program. Fifteen studies were identified. Outcomes related to mental and physical health, well-being, and quality of life. The studies included different research designs, and used self-report and physiological outcome measures. Participants' clinical diagnoses included fibromyalgia, chronic pain, rheumatoid arthritis, type 2 diabetes, chronic fatigue syndrome, multiple chemical sensitivity, and cardiovascular diagnoses. All 15 studies found that participation in an MBSR program resulted in improvements. No negative change was reported between baseline and follow up. Outcomes in regard to specific variables were difficult to compare and equivocal. Overall, positive change predominated. Chronic diseases are associated with a range of unwelcome psychological and physical consequences. Participation in an MBSR program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes. As an adjunct to standard care, MBSR has potential for much wider application in Australian primary care settings.
20739880 Clinical relevance of microparticles from platelets and megakaryocytes. 2010 Nov PURPOSE OF REVIEW: Platelet microparticles were identified more than 40 years ago and are the most abundant circulating microparticle subtype. Yet fundamental questions about their formation and role in human disease are just beginning to be understood at the cellular and molecular level. This review will address mechanisms of platelet microparticle generation and evaluate our current understanding of their clinical relevance. RECENT FINDINGS: New evidence indicates that the majority of CD41 microparticles circulating in healthy individuals derive directly from megakaryocytes. CD41 microparticles also form from activated platelets upon loss of cytoskeleton-membrane adhesion, which occurs in a multitude of disease states characterized by elevated platelet microparticle levels. More recent studies have demonstrated that platelet microparticles function as a transport and delivery system for bioactive molecules, participating in hemostasis and thrombosis, inflammation, malignancy infection transfer, angiogenesis, and immunity. The mechanism of platelet microparticle participation in specific disease entities such as rheumatoid arthritis has been elucidated. SUMMARY: Continued research into how platelet microparticles are generated and function as a transcellular delivery system will advance our basic understanding of microparticle physiology and may enable new strategies for treatment of select disease entities.
20559203 U S. Medical Eligibility Criteria for Contraceptive Use, 2010. 2010 Jun 18 CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
19192880 [An analysis of operation-correlated complications of total knee arthroplasty]. 2009 Jan OBJECTIVE: To summarize and analyze the operation-correlated complications of total knee arthroplasty (TKA) with posterior stabilized prosthesis (PS). METHODS: From October 2000 to October 2007, 707 cases (816 knees) underwent TKA. All the TKA knees were divided equally into former and latter groups according to the operation time (408 knees for each group). In the former group (October 2000 to January 2005, n=350), there were 63 males (84 knees) and 287 females (324 knees), aging (63.5 +/- 7.8) years. A total of 198 left knees affected and 210 right knees affected; 292 single knees affected and 58 both knees affected. There were 304 knees of osteoarthritis, 84 knees of rheumatoid arthritis and 20 knees of other disease. The disease course was (9.3 +/- 5.6) years. The knee range of motion (ROM) was (97.2 +/- 8.7) degrees, the HSS score was 47.4 +/- 12.2. In the latter group (January 2005 to October 2007, n=357), there were 77 males (92 knees) and 280 females (316 knees), aging (62.7 +/- 6.3) years. A total of 221 left knees affected and 187 right knees affected; 306 single knees affected and 51 both knees affected. There were 278 knees of osteoarthritis, 109 knees of rheumatoid arthritis and 21 knees of other disease. The disease course was (8.6 +/- 5.1) years. The knee ROM was (101.1 +/- 10.3) degrees, the HSS score was 49.3 +/- 11.2. We modified the method of lateral patellar retinaculum release and used a new femoral rotational alignment technique in the latter group. The intraoperative and postoperative complications were divided into mild, moderate and severe. The HSS score, ROM and complications of the knee were compared and analyzed statistically during the follow-up. RESULTS: The former group was followed up 5.3 years (1 to 7 years), complications occurred in 278 knees (68.1%), including mild in 136 knees (33.3%), moderate in 135 knees (33.1%) and severe in 7 knees (1.7%). The latter group was followed up 2.1 years (0.5 to 3.5 years), complications occurred in 159 knees (39.0%), including mild in 111 knees (27.2%), moderate in 47 knees (11.5%) and severe in 1 knee (0.2%), and there was significant difference between them (P < 0.001). There was significant difference in increased ROM between the former group (6.0 +/- 3.7) degrees and the latter group (14.4 +/- 4.2) degrees after operation (P < 0.05). There was significant difference in increased HSS score between the former group (36.9 +/- 3.7) and the latter group (44.0 +/- 4.2) after operation (P < 0.05). CONCLUSION: The TKA is a complex operation with innumerable potential complications. To accumulate operative experience and improve surgical skills are the key points to reduce the operation-correlated complications.
19776374 Autoimmune disease and risk for Parkinson disease: a population-based case-control study. 2009 Nov 3 OBJECTIVE: Inflammatory mediators are increased in autoimmune diseases and may activate microglia and might cause an inflammatory state and degeneration of dopaminergic neurons in the brain. Thus, we evaluated whether having an autoimmune disease increases the risk for developing Parkinson disease (PD). METHODS: A population based case-control study was conducted in Denmark of 13,695 patients with a primary diagnosis of PD recorded in the Danish National Hospital Register during the period 1986-2006. Each case was matched on year of birth and sex to 5 population controls selected at random from among inhabitants of Denmark who were alive at the date of the patient's diagnosis. The main exposure measure was a hospital diagnosis of 1 of 32 selected autoimmune diseases recorded 5 or more years before the index date in the files of the Danish Hospital Register. RESULTS: We observed no overall association between a diagnosis of autoimmune disease and risk for subsequent PD (odds ratio 0.96, 95% confidence interval 0.85-1.08). In a subgroup of patients with autoimmune diseases with systemic involvement, primarily rheumatoid arthritis, we saw a decrease in risk for PD of 30%. CONCLUSIONS: Our results do not support the hypothesis that autoimmune diseases increase the risk for Parkinson disease. The decreased risk observed among patients with rheumatoid arthritis might be explained by underdiagnosis of movement disorders such as Parkinson disease in this patient group or by a protective effect of the treatment with anti-inflammatory drugs over prolonged periods.
20369524 [Comparison of short-term result between high-flex and conventional posterior-stabilized p 2010 Mar OBJECTIVE: To compare the short-term result between the high-flex (HF) and conventional posterior-stabilized (PS) prosthesis in total knee arthroplasty (TKA). METHODS: From April 2005 to October 2007, 23 cases (27 knees) underwent TKA by HF prosthesis (HF group), and 35 cases (41 knees) underwent TKA by PS prosthesis (PS group). In HF group, there were 2 males (3 knees) and 21 females (24 knees) aged (64.3 +/- 5.6) years, including 20 cases (23 knees) of osteoarthritis and 3 cases (4 knees) of rheumatoid arthritis; body mass index (BMI) was 27.3 +/- 3.9; the course of disease was (5.3 +/- 5.6) years; the Hospital for Special Surgery Scoring System (HSS) score was 58.4 +/- 7.9; the Western Ontario and McMaster universities osteoarthritis index (WOMAC) score was 49.4 +/- 6.9; the maximum knee flex degree was (107.6 +/- 8.3) degrees; and the range of knee motion was (103.5 +/- 7.7) degrees. In PS group, there were 3 males (3 knees) and 32 females (38 knees) aged (65.1 +/- 5.9) years, including 33 cases (39 knees) of osteoarthritis and 2 cases (2 knees) of rheumatoid arthritis; BMI was 27.1 +/- 4.1; the course of disease was (5.1 +/- 4.9) years; HSS score was 60.1 +/- 10.4; WOMAC score was 47.9 +/- 7.2; the maximum knee flex degree was (108.4 +/- 9.7) degrees; and the range of knee motion was (105.9 +/- 11.4) degrees. There were no significant differences in general data between two groups (P > 0.05). RESULTS: All incisions achieved healing by first intention. No complication of ankylosis, blood vessel and nerve injuries, and prosthesis loosening occurred. All patients were followed up for 24-54 months (average 32.8 months). There were no significant differences in the HSS score, WOMAC score, the maximum knee flex degrees, and the range of knee motion at 3, 12, and 24 months after operation between two groups (P > 0.05), but there were significant differences between pre- and post-operation (P < 0.05). Anterior knee pain occurred in 1 case of HF group and 4 cases of PS group after 24 months, the incidence rates were 3.70% in HF group and 9.76% in PS group, showing significant difference (P < 0.05). The X-ray films showed that no lucent zone around prosthesis and no patella baja were observed, and the force line was excellent. CONCLUSION: There is no significant difference in the range of knee motion and clinical scores between the HF prosthesis and the PS prosthesis, but the former's incidence rate of anterior knee pain is lower.
19880688 Lupus-like syndrome attributable to anti-tumor necrosis factor alpha therapy in 14 patient 2009 Nov OBJECTIVE: To examine clinical characteristics, laboratory features, and outcomes of patients with lupus-like syndrome attributable to anti-tumor necrosis factor alpha (TNF-alpha) therapy. PATIENTS AND METHODS: We performed a retrospective review of patients with lupus-like syndrome attributable to anti-TNF-alpha therapy at Mayo Clinic's site in Rochester, MN, between July 1, 2000, and June 30, 2008. RESULTS: Of 14 patients (mean age at disease onset, 46.2 years), 12 (86%) were female. Ten patients (71%) had Crohn disease, and 4 (29%) had rheumatoid arthritis. Thirteen patients (93%) originally were treated with infliximab, and 1 (7%) was treated with adalimumab. A lupus-ike syndrome occurred after a mean treatment duration of 16.2 months. Features of lupus included presence of antinuclear antibodies (14 patients [100%]), arthritis (13 patients [93%]), anti-double-stranded-DNA antibodies (10 patients [71%]), cutaneous findings (malar rash, discoid rash, or photosensitivity, 4 patients [29%]), serositis (4 patients [29%]), hematologic abnormalities (4 patients [29%]), oral ulcers (4 patients [29%]), and lupus anticoagulant (1 patient [7%]). No patient had renal or neurologic abnormalities. All patients improved after stopping anti-TNF-alpha therapy (mean time to improvement, 2.9 months). Four (80%) of 5 patients tolerated an alternative TNF-alpha inhibitor (adalimumab, 3 patients; etanercept, 1 patient) without recurrence of lupus-like syndrome. CONCLUSION: Compared with previous studies, cutaneous findings were less frequent and arthritis was more frequent in our cohort of patients. Some patients were able to tolerate an alternative TNF-alpha inhibitor without recurrence of lupus-like syndrome.
19016697 Outcomes of methotrexate therapy for psoriasis and relationship to genetic polymorphisms. 2009 Feb BACKGROUND: The use of methotrexate is limited by interindividual variability in response. Previous studies in patients with either rheumatoid arthritis or psoriasis suggest that genetic variation across the methotrexate metabolic pathway might enable prediction of both efficacy and toxicity of the drug. OBJECTIVES: To assess if single nucleotide polymorphisms (SNPs) across four genes that are relevant to methotrexate metabolism [folypolyglutamate synthase (FPGS), gamma-glutamyl hydrolase (GGH), methylenetetrahydrofolate reductase (MTHFR) and 5-aminoimidazole-4-carboxamide ribonucleotide transformylase (ATIC)] are related to treatment outcomes in patients with psoriasis. METHODS: DNA was collected from 374 patients with psoriasis who had been treated with methotrexate. Data were available on individual outcomes to therapy, namely efficacy and toxicity. Haplotype-tagging SNPs (r(2) > 0.8) for the four genes with a minor allele frequency of > 5% were selected from the HAPMAP phase II data. Genotyping was undertaken using the MassARRAY spectrometric method (Sequenom). RESULTS: There were no significant associations detected between clinical outcomes in patients with psoriasis treated with methotrexate and SNPs in the four genes investigated. CONCLUSIONS: Genetic variation in four key genes relevant to the intracellular metabolism of methotrexate does not appear to predict response to methotrexate therapy in patients with psoriasis.
20802008 TNF-α antagonists beyond approved indications: stories of success and prospects for the f 2010 Dec Tumour necrosis factor alpha (TNF-α) is a key molecule of the inflammatory response and data derived from studies in experimental animal models and humans suggest that TNF-α may be implicated in the pathogenesis of various autoimmune and non-infectious inflammatory conditions. Over the past decade pharmaceutical agents directed against TNF-α (infliximab, adalimumab and etanercept) have been widely and successfully employed for the management of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis, psoriatic arthritis, juvenile idiopathic arthritis and inflammatory bowel disease, whereas two novel anti-TNF-α agents, golimumab and certolimumab pegol, recently entered the market for the treatment of RA, AS, Crohn's disease and psoriasis. Encouraged by the positive results obtained from the use of TNF-α antagonists in terms of efficacy and safety and due to the increasingly accumulating evidence regarding the implication of TNF-α in the pathogenesis of numerous disorders, anti-TNF-α agents have been considered for the management of diseases other than the ones they were initially approved for. Although in the case of multiple sclerosis and chronic heart failure the outcome from the administration of TNF-α blockers had been less than favourable, in other cases of non-infectious inflammatory conditions the response to TNF-α inhibition had been fairly beneficial. More specifically, according to well-documented clinical trials, anti-TNF-α agents exhibited favourable results in Behçet's disease, non-infectious ocular inflammation, pyoderma gangrenosum and hidradenitis suppurativa. In this review we discuss the successful outcomes as well as the prospects for the future from the off-label use of TNF-α antagonists.
20112373 Tumor necrosis factor alpha blockade exacerbates murine psoriasis-like disease by enhancin 2010 Feb OBJECTIVE: Patients with psoriasis and psoriatic arthritis respond well to tumor necrosis factor alpha (TNFalpha) blockers in general; however, there is now mounting evidence that a small cohort of patients with rheumatoid arthritis who receive TNFalpha blockers develop psoriasis. This study was undertaken to explore the mechanisms underlying TNFalpha blockade-induced exacerbation of skin inflammation in murine psoriasis-like skin disease. METHODS: Skin inflammation was induced in BALB/c scid/scid mice after they received CD4+CD45RB(high)CD25- (naive CD4) T cells from donor mice. These mice were treated with either anti-interleukin-12 (anti-IL-12)/23p40 antibody or murine TNFRII-Fc fusion protein and were examined for signs of disease, including histologic features, various cytokine levels in the serum, and cytokine or FoxP3 transcripts in the affected skin and draining lymph node (LN) cells. In a separate study, naive CD4+ T cells were differentiated into Th1 or Th17 lineages with anti-CD3/28 magnetic beads and appropriate cytokines in the presence or absence of TNFalpha. Cytokine gene expression from these differentiated cells was also determined. RESULTS: Neutralization of TNFalpha exacerbated skin inflammation and markedly enhanced the expression of the proinflammatory cytokines IL-1beta, IL-6, IL-17, IL-21, and IL-22 but suppressed FoxP3 expression in the skin and reduced the number of FoxP3-positive Treg cells in the draining LNs. TNFalpha also demonstrated a divergent role during priming and reactivation of naive T cells. CONCLUSION: These results reveal a novel immunoregulatory role of TNFalpha on Th17 and Treg cells in some individuals, which may account for the exacerbation of skin inflammation in some patients who receive anti-TNF treatments.
19590446 Cryoglobulin crystal arthropathy in a patient with multiple myeloma. 2009 Aug Joint involvement is unusual in patients with monoclonal gammopathies. It has been characteristically described as a rheumatoid-like seronegative polyarticular erosive arthropathy, which also has been related to crystal deposition of cryoglobulins in the synovium and several other tissues. This report describes the case of a 57-year-old African American woman with a seronegative polyarthritis associated with deposition of nonbirefringent or weakly positive birefringent rhomboid-shaped crystals in the synovial fluid. The patient, who was subsequently diagnosed with multiple myeloma, showed good clinical response to oral and intra-articular corticosteroids. Type II cryoglobulins were identified in the serum as well as in the synovial fluid. It is important to consider this association as part of the differential diagnosis of a patient with multiple myeloma and arthritis.