Fibromyalgic syndrome: depression and abnormal illness behavior. Multicenter investigation.

This study reports psychological symptoms assessed in 327 patients with fibromyalgia (FS) in a multicenter investigation. Two self-report scales, in their validated Italian translations, were used for screening: the CES-D (the Center of Epidemiologic Studies-Depression) developed at the NIMH for measuring depression and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. The cutoff point of 23 in the CES-D scores revealed about 49% of the fibromyalgic patients as depressed. In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial. CES-D scores showed significant correlations with illness behavior scales. These results and their implications for the treatment of fibromyalgic patients are discussed.

[Sjögren's syndrome: therapeutic trends]. / La sindrome di Sjoegren: attualità terapeutiche.

Sjögren syndrome is an autoimmune, mostly benign disorder characterized by functional impairment of exocrine glands, especially of the salivary and lacrimal glands. Symptomatic treatment with recourse to hygienic measures and topical therapy permits to attenuate secondary disorders due to hyposecretion. Among drugs used, hydrochloroquine has proved apt to bring about marked improvement in some laboratory test results although it has scarce effect on the clinical picture. Corticosteroids and immunodepressant agents are indicated in severe forms of the disease with accompanying extraglandular and systemic manifestations. Some authors have reported interesting findings concerning the usefulness of a low lipid diet which is said to reduce inflammation and lymphocyte infiltration of the glands involved; these findings deserve further research.

Personality pattern in rheumatoid arthritis and fibromyalgic syndrome. Psychological investigation.

This study reports the psychological symptomatology assessed in 50 rheumatoid arthritis patients (RA) and 50 with primary fibromyalgic syndrome (PFS). Depression and illness behavior were investigated by two self-report scales in their validated Italian translations: the Center for Epidemiologic Studies Depression (CES-D) and Illness Behavior Questionnaire developed by Pilowsky and Spence (IBQ). Our results suggest that the average RA patients were not depressed to a clinically significant level at the time of the investigation. The mean scores of CES-D by RA patients do not differ from those found in Italian patients affected by other organic diseases. On the contrary, mean score in the CES-D depression scale obtained from PFS patients was significantly higher than the cut-off point. In analyzing the pattern of illness behavior the significant difference between RA and PFS patients in scale of denial of problems is relevant. This means the RA patients have a tendency to deny life stresses and to attribute all problems to the effects of their illness. Such a result is in line with a classic psychosomatic point of view, that defines RA patients as alexitimic ones, that is, with poor capacity to recognize and express emotions. Our data support both the hypothesis that depressive symptoms are more common among PFS patients than RA patients, and that psychological factors may play a significant role in most patients with PFS.

Influence of auranofin on lymphocyte membrane fluidity in rheumatoid arthritis. A fluorescence polarization study.

Using the fluorescence polarization of 1.6-diphenyl-1, 3, 5-hexatriene, the membrane fluidity of lymphocytes obtained from rheumatoid arthritis patients was measured during 12 months of auranofin treatment. Significant differences in fluorescence polarization values were observed following auranofin treatment. The correlations shown between fluorescence polarization values and the indices of rheumatoid arthritis activity, such as erythrocyte sedimentation rate, alpha 2-globulins, plasma fibrinogen levels and platelet count suggest that changes in lymphocyte membrane fluidity could be used to monitor the effects of auranofin therapy.

Effect of antirheumatic drugs on lymphocyte membrane fluidity in rheumatoid arthritis: a fluorescence polarization study.

We have demonstrated significant differences in 1,6-diphenyl-1,3,5-hexatriene fluorescence polarization values between lymphocyte membranes of untreated rheumatoid arthritis patients and lymphocyte membranes of patients treated with antirheumatic drugs, such as hydroxychloroquine and auranofin. No difference has been detected in rheumatoid arthritis patients treated with auranofin associated with 6-methylprednisolone. The results indicate that some drugs used in the treatment of rheumatoid arthritis induce changes of lymphocyte membrane fluidity. The positive correlations between fluorescence polarization values and objective indices of the disease activity, as erythrocyte sedimentation rate, C-reactive protein, fibrinogen level, and alpha 2-globulin, suggested that fluorescence polarization could be used in the study of the pharmacological action of antirheumatic drugs and in monitoring antirheumatic therapy.

[Anterior uveitis in ankylosing spondylitis. A retrospective study]. / L'uvéite antérieure dans la spondylarthrite ankylosante. Enquête rétrospective.

In ankylosing spondylarthritis (AS), there is sometimes an anterior uveitis (AUV) or a previous history of AUV. The authors have reviewed the medical files of 338 hospitalised AS and 30 AS seen in consultation. They found an AUV in 28 hospitalised AS, or 8.3 p. cent of all cases (7.7 p. cent in men and 14.8 p. cent in women). In 3 cases (0.9 p. cent), the AUV was the first manifestation of the disease, preceding joint involvement. AUV was never found in patients seen in consultation. The findings of this investigation agree, but only partially, with those from the literature which, usually, acknowledge a greater frequency of AUV. Comparison with other previous investigations conducted in Italy enables to confirm that among Italian AS, AUV is less frequent than in other European and out of Europe series. It is possible that in a certain number of cases the AUV is not diagnosed clinically. However, it seems that the reduced incidence of the AUV discovered by a few Italian authors is not fortuitous (genetic factors?).

Changes of lymphocyte membrane fluidity in rheumatoid arthritis: a fluorescence polarisation study.

Fluorescence polarisation of 1,6-diphenyl-1,3,5-hexatriene was used to study the lymphocyte membrane in rheumatoid arthritis. The increase of polarisation value in the patients (n = 27) compared with healthy controls (n = 32) suggests a decrease of membrane fluidity. Moreover, erythrocyte sedimentation rate (ESR) and plasma fibrinogen concentrations were positively correlated with lymphocyte fluorescence polarisation values (r = 0.66 and r = 0.76 respectively). The results suggest that the changes in lymphocyte membrane fluidity could be involved in the pathogenetic mechanism of rheumatoid arthritis.

Stimulated chemiluminescence of polymorphonuclear leukocytes in rheumatoid arthritis: in vivo enhancement by auranofin.

The aim of the study was to investigate the interaction of opsonized zymosan with polymorphonuclear leukocytes (PMNLs) from 26 rheumatoid arthritis patients (six males and 20 females; mean age, 51.88 +/- 11.15 years; range, 33-72 years) and 11 control subjects (two males and nine females; mean age, 56.54 +/- 12.1 years; range, 33-75 years) using a luminol-amplified chemiluminescence (CL). The data obtained suggest that the opsonized zymosan stimulated CL is decreased in untreated rheumatoid patients compared with control subjects. The decreased stimulated CL may be the result of a physico-chemical alteration of the membrane (including decreased membrane fluidity and translocation of receptor sites) induced by free radicals of oxygen and/or by multiple exposures to chemotaxins. Auranofin enhances stimulated CL although the mechanism is not clear. Auranofin could interact with membrane lipids, induce changes in membrane surface charges and increase membrane fluidity. Our results are difficult to compare with those of previous studies, since different assays, and chemoattractants were applied. In addition, the disease activity and medication were also different.

[Chemiluminescence of oxygen radicals. A computerized method for its evaluation]. / La chemiluminescenza dei radicali dell'ossigeno. Un metodo computerizzato per la sua valutazione.

The measurement of oxygen free radicals (O2-) production after polymorphonuclear leukocytes (PMNLs) stimulation may be useful to elucidate the pathogenesis of rheumatic disorders and to assess the efficacy of anti-inflammatory and anti-rheumatoid drugs. The Authors describe a computerized method (with original specific analogic/digital converter and software) which allows a rapid and accurate determination of O2- production and a prompt storage of the data. The Authors, in disagreement with the current opinion, believe that PMNLs activity is more truly expressed by the total amount of emitted energy in a defined interval time than by the peak of emitted energy.