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Systemic lupus erythematosus is a chronic and multisystemic autoimmune disease that can occur in members of the same family. Genetic factors are still unidentified and not all relatives with these risk factors are predestined to develop the disease, but are more likely(1). Relatives of systemic lupus erythematosus (SLE) patients appear to be at higher risk of SLE and other autoimmune diseases, but individual family risk estimates are largely unavailable or unsafe. Moreover, the relative contribution of genetic factors, shared and divided into the susceptibility of SLE, remains unclear(2,3). The presence of antinuclear antibodies (ANA) is mainly associated with connective tissue diseases. In addition, their presence can also be found in healthy people. These antibodies are more common in women and in elderly people(4,5). It is known that subjects who are in the preclinical stages of SLE are represented in the healthy population with positive ANA autoimmunity, and the early detection of these antibodies often allows a rapid diagnosis of this disease(3). [ABSTRACT FROM AUTHOR]

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Pacients with malignancies may develop a wide variety of disorders of musculo-skeletal system. Paraneoplastic arthritis can mimic a seronegative rheumatoid arthritis especially in patients with hematologic malignancies. We present a patient diagnosed 5 years ago with seropositive stage II rheumatoid arthritis, treated with methotrexate and who presents for asimetrical arthralgia, early satiety, constipation and dry mouth. We are discussing in this paper the lab tests, positive diagnoses and differential diagnoses and theraputic attitude. [ABSTRACT FROM AUTHOR]

The extensive experience with TNFα blockers in inflammatory rheumatic diseases raise the issue of long-term safety. Malignancies represent one of the most important problems regarding the anti-TNFα therapy. In some rheumatic diseases, such as rheumatoid arthritis (RA), there is a moderate risk of non-Hodgkin lymphoma and solid cancers probably connected to chronic inflammation and conventional therapy with remisive synthetic agents (DMARDs). The anti-TNFα therapy does not add an extra risk of lymphoma în patients that receive TNFα blockers. Skin cancer (non-melanoma skin cancer and malignant melanoma) present a high risk in patients with RA treated with anti-TNFα agents. [ABSTRACT FROM AUTHOR]

Uveitis is the most frecquent extraarticular manifestation in patients with ankylosing spondilitis (AS), acute anterior uveitis (AAU) HLA-B27+ being the most important form of uveitis encountered in patients with this rheumatic disease. The pathogenesis of AS is poorly understood and immune mediated mechanisms are suggested by inflammatory histology, raised serum levels of IgA and acute fase reactants, close relationship with HLA-B27 etc. TNF-α is a proinflammatory cytokine involved not only in the pathogenesis of the articular manifestations of the rheumatic disease but also in uveitis. The treatment with anti-TNF-α drugs (Infliximab, Adalimumab, Etanercept) has a favourable effect in patients with ankylosing spondylitis, deacresing the signs and symptoms, improving the functionality and increasing the quality of life patients and their productivity. The effect of anti-TNF-α therapy in patients with uveitis associated with AS is different: in contrast with Etanercept ( soluble receptors of TNFα) which may induce uveitis as a paradoxal reaction, Infliximab and Adalimumab (anti-TNFα antibodies) have favourable effects in decreasing the rate of reccurences of uveitis in patients with AS. Better understanding of the mechanisms of articular and ocular involvement in patients with AS and AAU might improve their management. [ABSTRACT FROM AUTHOR]

Introduction. Rituximab (RTX), an anti-CD20 monoclonal antibody, tested in randomised placebo-controlled trials and approved for clinical practice, has demonstrated its efficacy in rheumatoid arthritis (RA) in patients with TNFa inhibitor failure. Objectives. The present study aims to monitor the evolution of a group of RA patients, undergoing RTX treatment over a 12 month period. The main objective was to assess the parameters of disease activity throughout RTX treatment at 6, respectively 12 months. The secondary objectives were to evaluate the therapeutic response to RTX contingent on the classic disease modifying drug associated and the body mass index. Materials and method. The present article is a descriptive retrospective case-series study, which included a group of 30 patients with RA treated with RTX. Treatment efficacy was evaluated with the aid of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), VAS (visual analog scale), SJC (swollen joint count), TJC (tender joint count) and the composite score DAS28 at three different time points: treatment initiation, 6 months and 12 months. For data analysis, the present study used Microsoft Excel 2010 and SPSS Statistics 20. The statistical tests employed for the analysis were: the paired t-test, the independent t-test and the Chi-squared test. Results. In the study group the mean DAS28 decreases from 5,62 at treatment initiation to 3,96 at 6 months, reaching 3,09 at the end of the study period. These values display a decrease in linear time trend (R2 = 0,9157) and their differences are statistically significant when taking the obtained p-values into account. The individual components of DAS28 display the same trend. At 12 months, the RTX-leflunomide (LEF) patient subgroup displayed statistically significant lower means for DAS28 and ESR in comparison to the association RTX-methotrexate (2,67 vs. 3,28, p = 0,038); (16,22 mm/h vs. 28,04 mm/h, p = 0,011); moreover, a higher proportion of the first group reached LDA at 6 months (44,4% vs 0%, p = 0,001) and at 12 months (55,6% vs 9,5%, p = 0,006). At the end of the study period, the patient subgroup with a normal BMI exhibited lower ESR values (20,13mm/h vs 28,86mm/h, p = 0,045), DAS28 scores (2,82 vs 3,37, p = 0,042), more marked improvement in the DAS28 score from baseline (3,02 vs 2, p = 0,022) and a higher proportion of remission (40% vs 0%, p = 0,006) in comparison to overweight patients. Conclusions. For the study group it has been shown that all the parameters of disease activity decrease from baseline at 6 months and, respectively, 12 months. It has also been shown that the RTX-LEF association is superior to the RTX-methotrexate one and that patients with a normal BMI have better treatment response rates. [ABSTRACT FROM AUTHOR]

We present the case of a 31 years old genetically predisposed (HLA B51) male with Behçet's disease and parenchymatous neurological manifestations, being treated at present with azathioprine and oral glucocorticoids. The first clinical signs were oral and genital aphthous ulcerations, accompanied by pseudofoliculitis and intense headache. Concomitantly, the patient was diagnosed with ocular toxoplasmosis, for which he received oral glucocorticoids. Subsequently, he received more glucorticoids for the MRI-suspected inoperable tumor of the hindbrain, treatment which partially concealed the clinical signs of Behçet's disease, delaying the proper diagnosis and the adequate immunosuppressive treatment. [ABSTRACT FROM AUTHOR]

Background. Pulmonary arterial hypertension is a frequent complication of systemic sclerosis (SSc) with high morbidity and mortality. Objectives. Evaluation of clinical features and follow-up of pulmonary hipertension in agroup of csleroderma patients. Matherial. 62 scleroderma patients were evaluated during January 208 - January 2013 in Internal Medicine and Rheumatology Department of Sf. Maria Hospital, Bucharest, Romania. We performed a complete evaluation of all patients following: MEDS evaluation sheets (cutaneous, musculoarticular, gastrointestinal, cardiac, pulmonary or renal involvement; inflammatory markers, autoantibodies, complement, capilaroscopy), disease activity was evaluated with the Disease Activity Score (DAS) according to the European Scleroderma Study Group guidelines, HAQ (Health assessment questionnaires) have been also completed. A follow-up of systolic pulmonary arterial pressure was done after 3 years and 5 years. Results. 28 patients (45.16%) were diffuse forms and 34 (54.74%) limited. Medium age at scleroderma diagnosis was 56,92 (12,33) years, medium disease duration was 12.22 (3,06) years. Prevalence of PAH at first evaluation was 22.5%, at 3 years 32.25%, and at 5 years was 33.87%. Medium disease duration until PAH diagnosis was 2.75 (4.9) years. Medium initial sPAP was 31.82 (10,86) mmHg, 46.63 (11,48 )mmHg at 3 years, 55.67 (16.59) mmHg at 5 years, having the most rapid progression between years 3-5. In most patients PAH developed after 5 years of scleroderma evolution (57.15%), prevalence at 5 years was 66.66% for diffuse forms and 55.55% for limited forms. PAH is independent of sex, age, disease duration, subset, autoantibodies, visceral involvement. Differences between SSc patients with PAH and those without PAH were dyspneea class (p = 0.002), dyastolic disfunction (p = 0.001), arythmias (p = 0.003), DLCO (p = 0.001) and capillaroscopy pattern (p = 0.001). Mortality for patients with PAH was higher than for others (14.28% versus 4.58%). Medium survival duration since the diagnosis of PAH was 47.53 month. Rodnan score was a predictor for PAH appearence and also for higher mortality. Conclusions. PAH is a frequent complication of systemic sclerosis no matter of sex, age, subtype, disease duration, visceral involvement, markers of activity and imunologic features. It is also an independent predictor of mortality. Annual screening for PAH should be implemented for all patients. [ABSTRACT FROM AUTHOR]

Background: rheumatoid arthritis (RA) is a systemic inflammatory disease with an unknown etiology and an autoimmune pathogenesis characterized by a deforming and destructive arthritis, but with multiple systemic manifestations. Nowadays, there is a trend in treating earlier and more aggressive RA taken into account the highly intense and erosive forms of disease. Aims: to assess the efficacy and safety of Rituximab (RTX) associated with Methotrexate (MTX) in patients with active RA that had an inadequate response to one or more anti TNFα therapy. Material and method: this study included 57 patients aged between 23 and 77 years old, diagnosed with RA according to the ACR 1987 criteria, admitted in a rheumatology service clinic from Bucharest from April 2008 to August 2011. Results: selected patients have a mean age of 54.5±12.9 years, 49 women, with a mean disease duration of 12.07±6.2 years, 85.9% had positive rheumatoid factor and 57.9% were positive for anti CCP antibodies. The response to the treatment with RTX, evaluated periodically after initiation through DAS28 score, is not influenced by the prior TNFα inhibitor, nor by the number of prior TNFα agents used. Conclusion: choosing the treatment with RTX as an alternative to patients with RA that have had an inadequate response to anti TNFα therapy represents one of the most appropriate method of optimizing the treatment of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Tumor necrosis factor (TNF alpha) is a proinflammatory cytokine with important role in the inflammatory immune response in ankylosing spondylitis (AS). There is multiple evidence establishing the immuno-pathogenic role of TNF-alpha in AS: high titres of TNF-alpha in synovial fluid of affected joints, increased expression of TNF alpha in sacro-iliac joints biopsies, disease patterns very similar to SA in transgenic mice for TNF alpha. SA is a chronic progressive disease that mainly affects vertebral joints and sacro-iliac joints, ascending to vertebral ankylosis. Forms of active disease with inadequate response to conventional therapy (non steroidal anti-inflammatory drugs in axial form, sulphasalazine in peripheral form) benefit from therapy with agents known to neutralize the biological action of TNF-alpha. The main biological agents against TNF-alpha synthesized by genetic engineering and currently approved for the treatment of SA are: infliximab (IFX), etanercept (ETA) and adalimumab (ADA). IFX and ADA are anti TNF alpha monoclonal antibodies and ETA is a solubile TNF receptor. Objectives: The efficacy of anti TNF alfa treatment for patients with AS over 1 and 2 years, side effects of anti TNF alfa treatment, the dynamic of clinical response to various anti-TNF medications used in clinical practice. Patients and methods: We performed a retrospective analysis of patients diagnosed with AS and treated with IFX, ADA and ETA within the Departament of Internal Medicine and Rheumatolohy at "Sf. Maria" Clinical Hospital during 2006 - 2010. The lot included 109 patients diagnosed with AS according to modified New York criteria, who fulfiled the Romanian criteria for biological therapy issued by the Speciality Comission of Minister of Health and approved by the National Health Insurance House (CNAS) forfull refund: of all patients treated with anti TNF alpha agents 37 patients received treatment with IFX, 33 patients received ADA and 39 patients received ETA. From this lot, 9 patients were excluded from the study due to side effects or because they were considered non-responsive. The final lot included 100 patients with the average of 39 years, with an average disease duration of 8.5 years, 82 (75.2%) men, 88 (80.73%) expressed the HLA-B27 genotype, 13 (11.9%) with episodes of iridocyclitis prior to the initiation of biological therapy. The clinical response was evaluated using: Bath Ankylosing Spondylitis Activity Index (BASDAI); the paraclinical evolution was evaluated measuring inflammatory syndrome reactants: erythrocyte sedimentation rate (ESR), fibrinogen (FBR) and C-reactive protein (CRP). Results: At 2 years all patients had BASDAI score <4, indicating a clinically controlled disease. Mean value of ESR, CRP and FBR decreased in the first 3 months of treatment, with the constant maintenance of these values throughout the follow-up period. Fast efficacy of the treatments was proven by the decrease of BASDAI with 50% (BASDAI 50) in the first 3 months of treatment for the patients in all 3 groups. The treatment was well received, 3 patients manifested side effects. Conclusions: 1. Anti TNF alpha therapy with IFX, ADA and ETA is effective in patients with AS by decreasing the disease activity score (BASDAI) and nonspecific inflammatory syndrome reactants 2. BASDAI 50 response at 3 months is similar for all anti TNF alpha agents 3. The optimal BASDAI at 2 years is similar for all anti TNF alpha agents 4. Patients treated with IFX were younger and had lower disease duration than those treated with ADA and ETA 5. Clinical response at 2 years to IFX is faster than the response to ADA and ETN 6. Anti-TNF alpha drugs are safe over 2 years of follow-up with minimal. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) of the knee has been proven better than clinical examination in fluid and synovitis detection (1). Nowadays, all rheumatologists are interested in objective evaluation of disease activity and response to treatment in Rheumatoid Arthritis (RA). DAS28 and ACR scores are used on that purpose, but they depend on subjective appreciation of pain by the patient (VAS scale). US measurement of fluid and synovitis could be a more objective tool on that matter, if proven correlated with pain, quantified by VAS. In a previous study, US fluid level was not correlated with pain (VAS) in osteoarthritis (2). Objectives: To assess the US fluid and the level of pain in RA knee. Methods: 52 RA patients (11 males) with knee swelling (not recently punctioned or infiltrated with corticosteroids) were included. Mean age was 58.5 (SD 13.7) and mean disease duration 93.3 (SD 83.7). Patients (fulfilling ARA criteria for RA) were selected to have active disease according to DAS28. All patients underwent knee ultrasonography, by the same sonographer. Separately, and blinded to US findings, a clinician assessed pain (quantified by patient VAS, and at pressure points), immediately after US examination. Pain at pressure has been assessed on the lateral, medial and median side of both knees. For pain in each of these locations, we gave one point, with a total maximal knee score of 3. Results: Rheumatologist's evaluation of pain (0 to 3 point scale) and patient's assessment (on VAS) correlated very well (Pearson index: 0.699 -- right and 0.681 left p <0.001). Pain (on VAS) was highly correlated with US level of sinovial fluid in the respective joint (Pearson index 0,468 -- right , 0,680 -- left knee, p<0.05). Conclusion: In RA the level of pain seems to be a definite indicator for the US (re)examination. In addition, it might be speculated that joint RA pain is highly dependent on the level of sinovial fluid, probably due to its inflammatory contents, comparative to osteoarthritis. [ABSTRACT FROM AUTHOR]

Low back pain is a frequent health problem that could affect every person during the lifetime. About 90% of the patients are complete cured at two weeks after the onset. It also has a deep impact on duration and quality of the work done during the acute and recovery phases. Objectives: To evaluate the loss of productivity (absenteeism and presenteeism) for patients with low back pain with respect of the non-medical treatment: hospitalization or early return to work. Methods: 126 volunteers selected from two regional sites have been included in one of the two treatment groups (hospitalization or early return to work). Quality of life (by using EQ5D scale) and loss of productivity (by using WPAI questionnaire) have been assessed twice: at day 0 and day 14. Results: Total loss of productivity and the proportion of lost working time have been found correlated with day 0 quality of live level. Total loss due to presenteeism has been situated between 58% and 84.4% from the total loss of productivity. Conclusions: This study supports the effort of optimization of the sick leave duration. [ABSTRACT FROM AUTHOR]

Infliximab (IFX) is an IgG1k anti TNFa chimerical monoclonal antibody. Presuming that TNFa is a key-element implied in the autoimmune reaction in ankylosing spondylitis (AS), several clinical studies have shown a rapid effect, sustained efficacy, the stop of the radiological progression, improvement of mobility and life quality in case of early administration of IFX in SA. IFX is capable of reaching remission and maintain it after stopping the biological therapy and of the others remissive drugs (Disease Modifying Anti-Rheumatic Drugs, DMARDs). Objective: Efficacy at 1 respectively 2 years of the IFX treatment at AS patients. Side effects of IFX treatment. Patients and methods: We made a retrospective analysis of patients treated with IFX in our clinical section between 2006-2010. Conclusions: IFX treatment at AS patients produces: fast and sustained reduction of the inflammation, rapid improvement of activity and functionality scores (BASDAI, BASFI), the lowering with 50% of BASDAI at 3 months. The drug is secure on long term (12, 24 months). [ABSTRACT FROM AUTHOR]

Adalimumab is an anti-TNF totally humanized monoclonal antibody acting against a cytokine involved in articular inflammation and destruction which are currently seen in most of the chronic inflammatory disease such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA). Clinical studies with adalimumab have shown not only the decrease in signs and symptoms of diseases, but also an important reduction in the rate of bone damage as well as a significant improvement of the patients' quality of life. Objectives: This is a retrospective study of effectiveness and tolerability for 3, 6 and 12 months of treatment with adalimumab in patients with RA, AS and AP). Patients and methods: The study included patients hospitalized in the rheumatology department of “St. Mary" Clinical Hospital 2006-2009. From the group of 50 patients underwent treatment 21 (57%) were women and 29 (43%) men. The final evaluation has been done on 37 (74%) patients: 22 (68%) with PR, 10 (27%) with SA and 5 (14%) with AP. Adalimumab was administered in combination with MTX in 14 patients suffering from PR or associated to other DMARDs in 8. All the 5 patients with AP were treated with adalimumab and MTX, while all the others received adalimumab and SSZ. Mention should be made that 4 patients had been previously treated with one or two other anti-TNFα agents. The treatment with glucocorticoids, non-steroidal anti-inflammatory drugs or analgesics had also been continued. Results: In RA patients the mean value of CRP significantly decreased from 20.1mg/l to 2.5 mg/l, fibrinogen from 523 mg/dl to 272 mg/dl, mean value of DAS 3v decreased from 5.9 to2.6 , HAQ from 2.38 to 1.06. în patients with AS the mean value of CRP decreased from 42.54 mg/l to 1.49 mg/l, ESR from 26.3 mm/h to 11 mm/h, fibrinogen from 461.5 mg/dl to 188.43 mg/dl. The mean value of clinical scores în those patients decreased as follows: BASDAI from 7.6 to 1.3 and BASFI from 6.77 to 1.35. în patients with PA the mean value of ESR decreased from 36.5 mm/h to 12 mm/h, the one of CRP from 18.5 mg/l to 17 mg/l, the mean value of HAQ decreased from 2.89 to1.5 and PASI from 12.8 to 6.8. Conclusions: In rheumatic inflammatory diseases treatment with adalimumab was effective on short, medium and long term as well. The drug significantly decrease the values of inflammation markers and the disease scores in patients with SA rather than in those suffering from PR. [ABSTRACT FROM AUTHOR]

We present the case of 25-year old young women with pulmonary arterial hypertension. The exhaustive investigations lead us, in the presence of systemic inflammatory syndrome, to the diagnostic of systemic lupus erythematosus. The treatment with pulmonary vasodilators (i.e. bosentan) and corticosteroids was started with a favorable evolution of clinical, laboratory and echocardiographic parameters. This case highlights the need for an accurate diagnostic of pulmonary hypertension, the efficacy of treatment with bosentan and the modern tools for the evaluation of patients with pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) is more common and premature in association with rheumatoid arthritis (RA). Excessive release of cytokines and growth factors due to inflammation associated with the effect of antirheumatic therapy (mainly corticosteroids) and immobilization significantly influence total bone mass. Purpose: To evaluate the bone mineral density (BMD) and some of the risk factors for osteoporosis in RA. Material and methods: BMD was measured using calcanean quantitative ultrasound in 153 patients (pts) with RA and the correlation between BMD and some risk factors (e.g. disease duration and activity - DAS28, functional status, menopausal status, treatment (corticosteroids and methotrexate - MTX) has been evaluated. For statistical analysis we used Statisti XL, Statcrunch R 2.0.1., T-test and Pearson's product moment correlation. Results: Eighty five per cent of the pts had a decrease in BMD (T score < -1.5), and 63% had a T score < -2.5. Statistical analysis revealed a significant correlation between the decrease in BMD and the disease duration, functional status, menopause, corticosteroid and MTX treatment. We could not find any correlation with the disease activity, rheumatoid factors concentration or menopause duration. Conclusion: RA pts have an increase incidence of OP, because they associate several risk factors. OP is a major source of both disability and costs in these pts. Therefore an appropriate therapy must be associated. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis (SSc) is a complex disease, skin thicness being the most obvious involvement. The "gold standard" method for the evaluation of dermal thickness is the modified Rodnan skin (mRSS). Many authors have reported correlations of this score with visceral involvement and prognosis. Objectives: To evaluate the correlation between mRSS and organ involvement in the two subset of SSc. Methods: Data from 55 SSc patients were collected during one year: demographics, visceral involvement according to MEDS evaluation sheet, lab tests. The mRSS was performed by 2 independent trained examiners. Statistical analysis was done with EpiInfo and SPSS 17.0 b Results: In the diffuse cutaneous group mean disease duration was 7. 8 years, mean mRSS was 17.5. We found a significant correlation of the mRSS with pulmonary fibrosis (p=0, 04), diastolic dysfunction (p=0, 03) and renal crisis (p=0, 00001). In the limited cutaneous group mean disease duration was 7. 23 years, mean mRSS was 8.2.. We found a signification correlation between mRSS and arrhythmias (p=0, 04). Conclusions: Although it is known that Rodnan skin score is a prognostic tool useful in the first 3 years of the disease we still found a significant correlation with pulmonary fibrosis, diastolic dysfunction and renal crisis in the diffuse SSc group and with arrhythmias in the limited SSc group even after several years of disease. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is an inflammatory joint disorder associated with psoriasis, which belongs to the group of seronegative spondylarthropaties. We present a case of a young patient with erosive arthritis and invalidant bilateral coxitis nonresponsive to disease modifying antirheumaic drugs (DMARDs) successfully treated etanercept. The patient presented almost all negative prognostic known factors (young age, HLA-B27, polyarticular involvement etc.). Over expression of tumor necrosis factor a (TNFa) in synovial biopsy removed in the course of the surgical treatment is a reliable indicator for a good response to biological treatment anti-TNFα. The strict monitoring of the side effects during etanercept treatment is mandatory in daily clinical practice. [ABSTRACT FROM AUTHOR]

Aims: The evaluation of the leflunomide (LF) and methotrexate (MTX) treatment on certain biochemical, hematological and inflammation markers. Another aim was to evaluate the influence of LF and MTX on the membrane fluidity of peripheric blood mononuclear cells (PBMC) isolated from rheumatoid poliartritis (RA) patients via in vitro toxicological studies. As a comparison, a lot of healthy volunteers were used. Materials and methods. The study included 28 (71% female and 29% male) RA patients diagnosed according to the 1987 revised criteria of the American College of Rheumatology. All patients received immunosupressive therapy (LF or MTX), neither received corticosteroids or TNF-α antagonists. The biochemical, hematological, inflammation markers as well as the PBMC membrane fluidity was evaluated on blood samples collected à jeun from the participants to the study. The PBMC membrane fluidity was spectrofluorimetrically evaluated in polarized light using 1-(4-trimethylammoniumphenyl)-6-phenyl-1,3,5-hexatriene p-toluenesulfonate (TMA-DPH) as a fluorescent probe; the basic membrane fluidity and following in vitro stimulation of the cells with MTX and dexamethasone (D) was evaluated. Discussion. The presented results are preliminary and the final ones will be correlated with the pathology associated. Results. The obtained results indicate a lower activity of seric transaminases in patients treated with LF compared to those trated with MTX. The creatinine, uric acid and C reactive protein (CRP) levels were lower as well in LF-treated patients as compared to MTX-treated patients, whereas erythrocythes sedimentation rate (ESR) and fibrinogen level were higher. The in vitro stimulation with MTX and D of the PBMC's resulted in an increased membrane fluidity in controls, but had no influence in the groups treated with LF or MTX. Conclusions. The obtained results for the biochemical, hematological and inflammation markers suggest a lower toxicity of LF treatment, provided that the antinflammatory activity of the drugs is almost the same. The in vitro studies regarding the membrane fluidity of PBMC suggests that MTX and D stimulation result in an increased fluidity in controls, but has no influence on the fluidity of the cells prelevated from RA patients treated with LF or MTX, in the conditions of in vitro overstimulation. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in pediatric population, with uveitis as the most common and severe extra-articular manifestation. Eye damage (bilateral in 70-80% of cases) is usually anterior, chronic and asymptomatic. Young age, female gender, oligoarticular form and ANA positivity are risk factors for chronic anterior uveitis (CAU). Acute anterior uveitis (AAU) frequently occurs in HLA-B27 positive boys with enthesitis-related arthritis. The onset is on average 1.8 years after the onset of JIA, but it may also precede the articular manifestations. Ophthalmological screening for JIA is recommended every 3 or 6-12 months depending on the combination of risk factors for associated uveitis. The major purpose of the treatment is to minimize the loss of visual acuity. The treatment is topical (corticosteroids, cycloplegics) and systemic (short-term glucocorticoids, methotreexate, biological drugs). Biological therapy (indicated if previous treatments are ineffective) is using anti-TNF drugs as first choice (most studies are indicating sup erior efficiency for Adalimumab). Usually AAU is treated promptly and no systemic treatment is needed. In some cases the evolution of CAU can lead to severe complications (synechiaes, cataract, glaucoma, even blindness). Interdisciplinary approach involving the pediatric rheumatologist and ophthalmologist is essential for correct monitoring of this disease.

We report two cases of neuromyelitis optica (NMO) associated with primary Sjögren's syndrome (pSS), comparing the clinical and laboratory features of these predominant neurological patients and reporting their different outcome. NMO - a severe demyelinating disorder of the central nervous system - primarily affects the spinal cord and optic nerves, resulting in longitudinally extensive transverse myelitis and/or optic neuritis. Our patients had a late pSS diagnosis, due to the absence of sicca syndrome and specific Sjögren serology in the early stages of their diseases, when the neurological symptoms prevailed. Many NMO patients have an accompanying autoimmune disease, most commonly Sjögren syndrome and systemic lupus erythematosus or a related profile of non-organ-specific autoantibodies. Neurologic involvement occurs in approximately 20% of patients with pSS, usually preceding the diagnosis (in 75-80% of the cases) [1,2]. The frequency of both neurologic manifestations (revealing pSS) and negative autoimmune serology, especially in the event of CNS involvement, could explain why underlying pSS is misdiagnosed [3,4]. Screening for pSS should be systematically performed in cases of acute or chronic myelopathy and/or cranial nerve involvement, mainly because these patients have a severe outcome. The presence of the anti-aquaporin4 antibodies, besides anti-Ro and anti-La, in both reported cases, is intriguing and raises the question of whether we are facing two distinct diseases or the NMO is just complicating an unusually less expressive Sjögren's syndrome subtype.

Unlabelled: BACKGROUND; Previous studies reported the increased prevalence of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) compared to the general population. However, the predictors for the development of CVD in patients with RA were not clearly established, and the role of thrombosis mechanisms was inconsistently characterized in these patients. The aim of this study was to evaluate the platelet histogram indices, as markers of platelet activation, in patients with RA with or without CVD., Material and Methods: In 64 pts with RA (mean age: 58.0 +/- 12.7 yrs) we performed the standard clinical evaluation and biochemical workup with platelet histogram, including mean platelet volume (MPV) and platelet distribution width (PDW) as markers of platelet activation. We divided the study population into two groups: A - 41 patients with RA without CVD and B - 23 patients with RA and CVD (ischemic heart disease, peripheral artery disease or cerebrovascular disease). The values of MPV and PDW were also analyzed in an age- and sex-mached control group of 20 subjects without RA and CVD and in a group of 62 patients with CVD without RA (stable angina)., Results: The platelets number was similar in both groups, but the platelet histogram showed higher values for MPV (9.6 vs. 8.6 fL, p < 0.01) and PDW (16.1 vs. 14.0, p < 0.01) in patients with RA and CVD, reflecting greater platelet activation in these patients. MPV values were lower in patients with RA, but the values of PDW were higher in these patients comparing to control. Patients with RA with CVD have higher values of PDW than patients with CVD, but without RA, showing an increased platelet activation in RA. The PDW values correlate with fibrinogen (0.63; p = 0.003) but not with CRP or ESR, while the MPV was not correlated with the inflammatory markers in patients with RA., Conclusions: The pathogensis of CVD in patients with RA may be linked to an increased prothrombotic activity which might be evaluated by platelet histogram indices.

Immunologic abnormalities observed in Systemic Sclerosis (SSc) patients consist of chronic mononuclear cell infiltration of affected tissues, dysregulation of lymphokine and growth factor production, and autoantibodies production. Expansion of CD4+T cells within the tissue seems to involve their activation that precedes this process. Therefore, CD4+T cells activation, as an early immune event, appears to be an important process in the development and maintaining of SSc. In SSc the disturbance of peripheral tolerance mechanisms could be also responsible for CD4+T cells activation. Consequently, we reevaluated CD4+T cells positive for CD25, GITR, CTLA-4, CD45RO, or Foxp3 in SSc patients, by comparison with healthy donors (HDs), and in correlation with clinical features of the disease. Our results reargued for activation of peripheral blood CD4+T cells in SSc patients. Thus, increased percentages of CD25+ and GITR+ CD4+T cells were found in SSc patients by comparison with HDs. Direct correlation between the percentage of GITR+CD4+T cells and disease activity recommended these cells as a good candidate for disease progression. In SSc patients, the negative regulators of T cells activation are also affected. Thus, CTLA-4+ and Foxp3+ CD4+T cell percentages were significantly reduced in SSc patients when compared to HDs. Indirect correlation between the percentage of CD152+CD4+T cells and autoantibodies (aScl70) presence or disease type highlighted the role of these cells in the disturbance of peripheral tolerance. The absence of the direct correlation between CD152+CD4+T cells and CD45RO+CD4+T cells, correlation observed only in HDs, raised the hypothesis that in SSc patients, memory T cells can be easily activated, and by consequence, they can enter within affected tissues. These data reconfirm the activation state of SSc CD4+T cells and point out some abnormalities in peripheral tolerance mechanisms that can contribute to SSc pathogeny.

Sjögren's Syndrome (SS) is one of the most frequent autoimmune disorders, which affects approximately 1% of the population. It occurs in patients of all ages, but especially females during the fourth and fifth decades of life with a female/male ratio of 9:1. The main target of this disease are the exocrine glands that are infiltrated progressively by lymphocytes and finally destroyed, leading to decreased exocrine secretion. Thus primary SS is usually defined as xerophtalmia (dry eye) and xerostomia (dry mouth) accompanied in 60% of cases by parotid swelling [1]. The most serious complication of Sjögren's Syndrome is the high risk of the occurrence of non-Hodgkin's Lymphoma.

Background: Dendritic cells (DCs) are potent antigen-presenting cells (APC) that are deeply implicated in the initiation and exacerbation of rheumatoid arthritis (RA). Active RA is associated with an activated DCs population as demonstrated by high expression of adhesion and co-stimulatory molecules., Purpose: To compare the expression of adhesion and co-stimulatory molecules on DCs from synovial tissue (ST) in patients (pts) with RA and the clinical status before and after treatment with disease modifying antirheumatic drugs (DMARDs)., Methods: Samples of ST were obtained from RA patients at the time of hip or knee replacement or arthroscopy. Clinical status (assessed by the American College of Rheumatology - ACR - core set and the DAS28) and co-stimulatory and adhesion molecules on DCs were evaluated before and after treatment. Immunophenotype of DCs was analyzed by two-color immunofluorescence microscopy., Results: In patients with active RA we found a highly differentiated subpopulation of DCs that expressed an activated phenotype. After treatment, the expression of adhesion and co-stimulatory molecules on ST DCs was correlated with the ACR and DAS28 clinical response., Conclusion: Clinical outcome and the immunophenotypical presentation of ST DCs after DMARDs treatment are closely correlated in pts with RA. The co-stimulatory activity in the synovium is important in determining the course of the disease and provide new therapeutic targets for immune intervention.