[Quality of life in patients with systemic lupus erythematosus--preliminary survey using a short questionnaire. ].

Because the prognosis of systemic lupus erythematosus (SLE) has been much improved by recent progress in the treatment of this disease, improvement of quality of life (QOL) will be required more and more. However, QOL in SLE has not been well studied in comparison to that in rheumatoid arthritis. Fifty-four patients with systemic lupus erythematosus were asked about healthy feeling, acceptance of disease and the extent of satisfaction with their life. The percentage of patients who gave affirmative answers to healthy feeling, acceptance, and satisfaction was 64, 87, and 50, respectively. These three parameters were correlated with the following factors; 1. physical activity, especially that for daily living, 2. understanding in the family and workplace, and 3. depression and anxiety, whereas acceptance was not correlated with disease activity. Due to having a chronic disease, there are depression and anxiety derived from loss of existence in the family or workplace in their minds. In order to resolve these issues, education and explanation about the disease is needed for the family and society as well as for the patients. Although compliance of the patients in answering the questionnaire was easily obtained, the reliability and reproducibility, and the relationship between the items and the low-ranking factors should be investigated using a larger number of patients.

Role of endothelial damage in the pathogenesis of interstitial pneumonitis in patients with polymyositis and dermatomyositis.

OBJECTIVE: Polymyositis and dermatomyositis (PM/DM) are often complicated by interstitial pneumonitis (IP), which is an important cause of death. It has been reported that blood concentration of transforming growth factor-beta (TGF-beta), which is produced by a wide range of cells including endothelial cells and enhances the fibrotic changes in various tissues, is increased in PM/DM with IP. Endothelial damage is likely to exist in PM/DM. We studied the relationship between endothelial damage and IP in PM/DM. METHODS: Blood levels of sialylated carbohydrate antigen KL-6, TGF-beta, endothelin-1 (ET-1), thrombomodulin (TM), and plasminogen activator inhibitor-1 (PAI-1) were determined in 43 patients with PM or DM with or without IP, and the relationship between these measures was analyzed. RESULTS: Blood levels of KL-6 and TGF-beta were higher in the patients with IP than those without, and these measures were well correlated with each other. Levels of ET-1, TM, and PAI-1, all known to reflect the extent of endothelial damage, were also increased in patients with IP, and these measures correlated well with TGF-beta. CONCLUSION: Our data suggest that endothelial damage might play an important role through the production of fibrosis-enhancing factors such as TGF-beta or ET-1 in PM/DM.

All-trans-retinoic acid suppresses interferon-gamma and tumor necrosis factor-alpha; a possible therapeutic agent for rheumatoid arthritis.

OBJECTIVES: To study the effects of all-trans-retinoic acid (ATRA), we determined the proliferation and cytokine production by peripheral blood mononuclear cells (PBMCs) and CD4+ T cells in healthy volunteers and patients with rheumatoid arthritis (RA), and explored the possibility of using ATRA as a therapeutic agent for autoimmune diseases. METHODS: Proliferation of these cells was determined by modified MTT assay, and expression of CC chemokine receptors 4 (CCR4) and CCR5 was determined by flow cytometry. Production and expression of interferon (IFN)-gamma, interleukin (IL)-2, IL-4, and tumor necrosis factor (TNF)-alpha was determined by Enzyme-Linked Immunosorbent Assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR). The presence of STAT6 protein was determined by Western blot analysis. RESULTS: ATRA did not affect the proliferation or production of IL-2 and IL-4. We did not detect STAT6 protein, and saw no evidence of the differentiation of PBMCs to Th1 or Th2 cells. In contrast, ATRA suppressed the production of IFN-gamma and TNF-alpha significantly. There were no significant differences between the healthy volunteers and RA patients. CONCLUSIONS: ATRA was demonstrated to affect the cytokine production of IFN-gamma and TNF-alpha. ATRA might be useful in the treatment of autoimmune diseases such as RA.