Association of anti-triosephosphate isomerase antibody and MRL/MpJ-Faslpr mouse.

The association between anti-triosephosphate isomerase (TPI) antibodies and MRL/MpJ-Fas(lpr) (MRL/lpr) mice was examined. We found that serum anti-TPI antibody levels in MRL/lpr mice, measured by enzyme-linked immunosorbent assay, were significantly higher than that of age-matched Balb/c mice and NZB/WF1 mice. Anti-TPI antibodies were detected in serum and cerebrospinal fluid in MRL/lpr mice by Western blotting. Inoculation of anti-TPI monoclonal antibody-producing hybridoma into the brain of Balb/c mice resulted in immunoglobulin deposition in the regions near the ventricles, hippocampus, and choroid plexus. Anti-TPI antibodies may play a role in the etiology of brain damage and behavioral deficits in MRL/lpr mice.

A case of emphysematous pyelonephritis in a patient with rheumatoid arthritis taking corticosteroid and low-dose methotrexate.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that is characterized by chronic synovial inflammation. Patients with RA have increased risk of infection; this is related to RA itself or the adverse effects of medication. In this report, we describe a case of emphysematous pyelonephritis in a patient with RA associated with AA amyloidosis and steroid-induced diabetes mellitus who was taking corticosteroid and low-dose methotrexate.

Thrombin-cleaved osteopontin is increased in urine of patients with rheumatoid arthritis.

OBJECTIVE: To measure concentrations of the thrombin-cleaved isoform of osteopontin (OPN) in urine and plasma of patients with rheumatoid arthritis (RA), and to assess whether levels of thrombin-cleaved OPN are associated with measures of RA. METHODS: Subjects comprised 70 patients with RA, 20 patients with osteoarthritis (OA), and 46 healthy controls. RA disease activity was evaluated by tender joint count, swollen joint count, patient's global assessment of disease activity, erythrocyte sedimentation rate (ESR), and levels of C-reactive protein (CRP), matrix metalloproteinase-3 (MMP-3), and rheumatoid factor (RF), as well as 28-joint count Disease Activity Score (DAS28). OPN levels in plasma and urine were measured by ELISA. RESULTS: Median levels of thrombin-cleaved OPN in urine (U-half) were significantly higher in RA patients (143.5 pmol/mmol Cr) than in healthy controls (67.9 pmol/mmol Cr) or OA patients (69.8 pmol/mmol Cr). Thrombin-cleaved OPN was not detected in plasma. U-half levels correlated significantly with levels of CRP (r = 0.26, p = 0.03), ESR (r = 0.26, p = 0.03), and RF (r = 0.28, p = 0.03). Median U-half levels were significantly higher in patients with stage III (249.9 pmol/mmol Cr) and IV (251.6 pmol/mmol Cr) disease than in patients with stage I (98.6 pmol/mmol Cr) disease. CONCLUSION: Our results suggest that urine levels of the thrombin-cleaved isoform of OPN may reflect the severity of active inflammatory arthritis in patients with RA.

Primary biliary cirrhosis complicated by polymyositis and pulmonary hypertension.

A 68-year-old woman was admitted to a hospital with pulmonary hypertension (PH) in August 2006. Perfusion scintigraphy of the lung was normal and showed no interstitial change. Liver dysfunction was noted and antinuclear antibodies (x1,280) were positive. In November 2006, muscle pain and weakness gradually developed in the brachial muscle and a quadriceps. She was referred and admitted to our hospital for elevated CPK and liver dysfunction in March 2007. She was diagnosed with polymyositis (PM) on the basis of the histological findings of muscle biopsy and treated with prednisolone. In addition, because anti-centromere antibodies and anti-mitochondrial M2 antibodies were positive with high titers, she was also diagnosed with primary biliary cirrhosis (PBC). Although PBC is often associated with other autoimmune diseases, there have been no reports of PBC complicated by PM and PH.

Doppler ultrasound measurements of knee joint synovitis in rheumatoid arthritis patients treated with infliximab.

Doppler ultrasound measurements were done for the thickness of synovial effusion and synovial proliferation (pannus), and diameter of the flow signals using digital calipers as well as flow signal grades and vascular resistance in the knee joint synovitis of patients with rheumatoid arthritis (RA) treated with infliximab. Forty knee joints of 20 RA patients were assessed before and after three injections of infliximab. The flow signals in the pannus were classified into the superficial and the deep signals and the joints were classified into the superficial signal pattern and the deep signal pattern. After treatment, the number of joints with superficial signal pattern reduced from 23 to 11, whereas the number of joints with deep signal pattern increased from 17 to 29 (P=0.0066), with a significant reduction of the superficial signal grades (P=0.0003). The mean cortical (posterior) pannus thickness increased significantly in the joints with superficial signal pattern (P=0.022) and in the total joints (superficial plus deep signal pattern) (P=0.031) but not in the joints with deep signal pattern. After 6 weeks of treatment with infliximab, the hyperemia in the superficial layer of the pannus developed into proliferation of the cortical pannus in the knee joints.

Power Doppler and spectral Doppler measurements of knee-joint synovitis in rheumatoid arthritis patients with superficial pattern signals and in those with deep pattern signals.

Power Doppler and spectral Doppler ultrasonography were used to scan 127 knee joints of 72 patients with rheumatoid arthritis (RA). Synovial effusion thickness and synovial proliferation (pannus) thickness, as well as the flow signal diameter, were measured on ultrasonogram prints of the power Doppler using digital calipers. In addition, color-flow signal grades on power Doppler and the resistance index (RI) values on spectral Doppler were evaluated. The values of these five variables were compared among 58 joints with superficial pattern flow signals and 69 joints with deep pattern flow signals. Compared with the joints with deep pattern signals, the joints with superficial pattern signals had significantly higher mean values of effusion thickness (P < 0.0001) and flow signal grades (P < 0.0001), and significantly lower mean RI (P < 0.0001). On the other hand, the joints with deep pattern signals had a significantly higher value of signal diameter (P = 0.0125) and had a trend to higher value of pannus thickness (P = 0.079) as well. Significant correlations were observed between effusion thickness and signal grades (P < 0.0001); effusion thickness and RI (P < 0.0001); signal diameter and pannus thickness (P = 0.0102); signal diameter and RI (P < 0.0001); and signal grades and RI (P < 0.0001). The ultrasonographic measurements of synovitis in RA patients provide valuable information on synovial inflammation.

Doppler sonographic comparative study on usefulness of synovial vascularity between knee and metacarpophalangeal joints for evaluation of articular inflammation in patients with rheumatoid arthritis treated by infliximab.

We used Doppler sonography to evaluate the therapeutic effects of infliximab on the knee and metacarpophalangeal (MCP) joints of 10 patients with rheumatoid arthritis (RA), based on the color flow signals (CFS) and resistance index (RI) of synovial vascularity. After three injections of infliximab, we observed significant improvement in numbers of tender joints (P < 0.01), values of C-reactive protein (CRP) (P < 0.01), erythrocyte sedimentation rate (ESR) (P < 0.001), disease activity scores including tender joints, swollen joints, and ESR (DAS28-E3) (P < 0.0001), and CFS of knee (P < 0.001) and MCP (P < 0.05) joints. There was no significant improvement in RI values of knee or MCP joints after the therapy. We observed significant correlation between CFS of knee joints (knee-CFS) and values of CRP (P < 0.01), ESR (P < 0.01), and DAS28-E3 (P < 0.05), but not between CFS of MCP joints (MCP-CFS) and values of CRP, ESR, and DAS28-E3. However, no significant correlation was observed between 10 difference values (before values-after values) of CFS grades of knee or MCP joints and 10 difference values each of CRP, ESR, or DAS28-E3. The knee joints are more suitable than MCP joints for obtaining CFS in Doppler sonography, and are more useful than MCP joints for evaluation.

A case of systemic lupus erythematosus complicated by pure red cell aplasia and idiopathic portal hypertension after thymectomy.

We describe a 49-year-old woman who presented in 2002 with pure red cell aplasia (PRCA), systemic lupus erythematosus (SLE), and idiopathic portal hypertension (IPH) that developed following a thymectomy. She underwent a thymectomy at 40 years of age to treat myasthenia gravis. PRCA developed 3 years after the thymectomy and she was successfully treated with cyclosporin. Systemic lupus erythematosus and IPH were diagnosed 6 years later. We conclude that immunological dysfunction resulting from the thymectomy contributed significantly to the subsequent development of PRCA, SLE, and IPH in this patient. This is the first report to describe this extremely rare occurrence.

Usefulness of complement split product, Bb, as a clinical marker for disease activity of lupus nephritis.

To evaluate the usefulness of Bb, a split product of complement factor B, as a clinical marker for disease activity of lupus nephritis, we measured the Bb concentration of sera from 42 patients with lupus nephritis. Serum Bb levels were significantly higher in patients with active nephritis (active nephritis group, n= 30) than in patients with nephritis in remission (remission group, n=12) (14.3+/-8.3 versus 7.4+/-5.9 microg/ml; p = 0.012). In contrast, there was no significant difference in serum C3 levels between active nephritis group and remission group (42.5+/-20.9 versus 44.7+/-15.9 mg/dl ; p = 0.77). In the comparison of Bb levels between active nephritis group and remission group, the sensitivity was 66.6%, specificity was 83.3%, and the positive and negative likelihood ratios were 3.95% and 0.41%, respectively. The present results suggest that serum Bb level is a useful clinical marker for disease activity in lupus nephritis.

Case of an elderly man with associated Henoch-Schönlein purpura during treatment of acute pancreatitis.

A 70-year-old man with acute pancreatitis (acute exacerbation of chronic pancreatitis) was admitted to our department. Despite temporary improvement, the pancreatitis worsened on the 21st hospital day, forming a pancreatic pseudocyst, with infection in the cyst. After treatment with various antibiotics, a blood test on the 71st hospital day indicated improved inflammatory response despite continuing abdominal cramps. From the 75th hospital day, the patient developed purpura and arthralgia of the lower limbs, with melena and hematuria. Henoch-Schonlein purpura was diagnosed definitively by skin biopsy. Such a complication of acute pancreatitis with Henoch-Schönlein purpura is rare. This case also suggests that microvasculitis around the pancreas resulting from Henoch-Schonlein purpura might have prolonged the pancreatitis.

HLA-B52-positive vasculo-Behçet disease: usefulness of magnetic resonance angiography, ultrasound study, and computed tomographic angiography for the early evaluation of multiarterial lesions.

We report a case of HLA-B52-positive Behçet disease accompanied by multiarterial lesions. A 24-year-old woman was suffering from sporadic high fever and recurrent oral and genital ulcers, and laboratory data revealed severe inflammation. A diagnosis of Behçet disease was made. Magnetic resonance angiography, ultrasound study, and computed tomographic angiography demonstrated multiarterial lesions that had caused no symptoms. These noninvasive examinations were extremely useful in evaluating asymptomatic early vascular lesions.

Ulcerative colitis occurring in the course of rheumatoid arthritis: a case successfully treated with mesalamine enema.

We report a case of ulcerative colitis (UC) that occurred during the course of rheumatoid arthritis (RA). A 29-year-old woman with a 25-year history of RA was hospitalized for high fever, abdominal pain and hematochezia. Colonoscopy revealed erosive and reddish mucosa from the distal transverse colon to rectum. Histology revealed cryptitis (mainly caused by neutrophils), mild crypt abscess and goblet cell depletion. She was diagnosed with left-sided UC and treated with mesalamine enema. The abdominal symptoms and colonoscopic findings were greatly ameliorated. We conclude that the mesalamine enema was effective in this case of UC occurring during the course of RA.