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Objectives: To determine whether malignant thymoma is associated with high rates of concomitantly occurring autoimmune diseases. Methods: Sheba Medical Center computer records from 1966 to 1995 werereviewed to identify patients with malignant thymoma, either type I (invasive thymoma) or type II (thymic carcinoma). All patients who had malignant thymoma and autoimmune phenomena were analyzed. The diagnosis of thymic neoplasm was confirmed by two independent pathologists. The diagnosis of autoimmune diseases was based on both clinical and serological findings. Results: Six of 22 (27%) cases of malignant thymoma had an autoimmunedisease. Five patients had type I malignant thymoma and either myasthenia gravis (four patients) or Graves' disease (one patient). Only one patient had type II malignant thymoma with Sjbgren's syndrome. The diagnosis of autoimmune disease preceded the diagnosis of thymic neoplasm in four cases, and was diagnosed simultaneously in two. Conclusions: Malignant thymomas are highly associated with autoimmunediseases, as are benign thymomas. To our knowledge, we report the first documented cases of a patient with thymic carcinoma and Sjogren's syndrome, and another with invasive thymoma and Graves' disease.

Objectives The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties. The aim of this systematic review was to present critically the level of evidence for the claims of therapeutic effects of Dead Sea treatments in several rheumatologic diseases and psoriasis as well as to review these treatments' safety. Methods All articles cited in MEDLINE under the query, "Dead Sea," were reviewed. Results We found bona fide evidence that Dead Sea treatments are especially effective in psoriasis due to both the special characteristics of solar ultraviolet radiation in the Dead Sea and the Dead Sea water balneotherapy. Dead Sea mud and Dead Sea balneotherapy have been found to be beneficial in rheumatologic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and knee osteoarthritis. In the safety analysis, we found no evidence for an increase in skin neoplasia, although skin actinic damage seems to be increased in patients treated in the Dead Sea. Dead Sea treatments do not lead to worsening of blood pressure. Substantial ingestion of Dead Sea water (generally in unusual near-drowning cases) is toxic and can result in cardiac rhythm disturbances because of electrolyte concentration abnormalities. Laboratory analysis of Dead Sea mud did not reveal mineral concentrations that could represent a health concern for their intended use. Conclusions Dead Sea treatments are beneficial in several rheumatologic diseases and psoriasis and have a good safety profile.

OBJECTIVE Description of the various autoantibodies that can be detected in patients with systemic lupus erythematosus (SLE). METHODS A literature review, using the terms “autoantibody” and “systemic lupus erythematosus”, was conducted to search for articles on autoantibodies in SLE, their target antigens, association with disease activity, or other clinical associations. RESULTS One hundred sixteen autoantibodies were described in SLE patients. These include autoantibodies that target nuclear antigens, cytoplasmic antigens, cell membrane antigens, phospholipid-associated antigens, blood cells, endothelial cells, and nervous system antigens, plasma proteins, matrix proteins, and miscellaneous antigens. The target of autoantibody, the autoantigen properties, autoantibody frequencies in SLE, as well as clinical associations, and correlation with disease activity are described for all 116 autoantibodies. CONCLUSIONS SLE is the autoimmune disease with the largest number of detectable autoantibodies. Their production could be antigen-driven, the result of polyclonal B cell activation, impaired apoptotic pathways, or the outcome of idiotypic network dysregulation. Semin Arthritis Rheum 34:501-537 © 2004 Elsevier Inc. All rights reserved.

Objective: To evaluate the clinical response of treatment-resistant membranousand membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg). Methods: Seven lupus nephritis patients who failed to respond to at leastprednisone and cyclophosphamide were studied. A kidney biopsy showing either membranous or membranoproliferative glomerulonephritis was available in six patients. They were treated with six courses (patients 1 and 2) or 1 or 2 courses (patients 3 through 7) of high-dose IVIg. For patients 3 through 7, the plasma levels of albumin, total cholesterol, urea, creatinine; dsDNA antibody titers, and daily proteinuria were measured just before the IVIg therapy, immediately on completion, and 6 months later. Results: All seven patients had a beneficial response to IVIg. In patient 1, decrease in proteinuria was evident 2 weeks after IVIg was started, nephrotic syndrome gradually disappeared, and she had no proteinuria in 3 years' follow-up. Decline in proteinuria was evident in patient 2 after the 4th IVIg course, but proteinuria reached the pretreatment level 4 months after the therapy ended. In patients 3 through 7, the mean daily proteinuria before IVIg (5.3 ± 2.1 g) decreased after 1 or 2 IVIg courses (3.3 ± 1.4 g), and further decreased when measured 6 months later (2.1 ± 1.3 g). Similarly, the plasma, cholesterol level decreased while the plasma albumin level increased after IVIg. Conclusions: IVIg might be effective in treatment-resistant membranous ormembranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.