Requirement for vitamin D supplementation in patients using photoprotection: variations in vitamin D levels and bone formation markers.

BACKGROUND: Avoiding sun exposure is obligatory in photodermatoses; however, the need for oral supplementation with vitamin D appears unrecognized. The aim of the study was to investigate the seasonal variation of vitamin D level and bone formation markers in healthy individuals and to compare it with vitamin D status in patients using photoprotection. METHODS: Thirty-four healthy inhabitants of the Lodz region, Poland, a country in central Europe (51° and 52° north latitudes), were examined at the baseline visit within 2 weeks of peak sun exposure during recreational activity on vacation, after 8, and after 16 weeks. The group of patients using photoprotection comprised 104 patients with systemic lupus erythematosus. Serum 25(OH) vitamin D, procollagen type I N-terminal propeptide (PINP), and osteocalcin levels were measured. RESULTS: The serum 25-hydroxyvitamin D concentration was lower and vitamin D deficiency more common in patients using photoprotection than in healthy individuals during the warm and the cold season (P < 0.05). In healthy individuals, vitamin D deficiency was more prevalent after 8 and 16 weeks than at baseline assessment (P < 0.001). PINP level was 39.56 (30.51-53.22) ng/ml, and elevated in 50% of individuals, whereas osteocalcin was 18.88 (13.52-21.33) ng/ml, and within reference range. CONCLUSIONS: Diagnoses of vitamin D deficiency and oral supplementation in patients using photoprotection need to be included in practice. Peak 25-hydroxyvitamin D levels are probably achieved from vitamin D skin synthesis during the summertime and fall over time, starting from August. Elevated levels of PINP appear in line with the process of bone remodeling related to age.

Viabilidade da mensuração de marcadores de remodelação óssea em mulheres com lúpus eritematoso sistêmico / Feasibility of measurement of bone turnover markers in female patients with systemic lupus erythematosus

Objetivo: Investigar a viabilidade dos marcadores de remodelação óssea (MRO) na avaliação do metabolismo ósseo em pacientes com lúpus eritematoso sistêmico (LES), de acordo com as diretrizes da International Osteoporosis Foundation e da International Federation of Clinical Chemistry and Laboratory Medicine. Métodos: O estudo incluiu 43 pacientes do sexo feminino com LES. Foram medidos os níveis séricos de propeptídeo N-terminal do procolágeno tipo I (PINP), telopeptídeo C-terminal do colágeno tipo I (CTX), osteocalcina, HPT, 25(OH)D, anticorpos anticardiolipina, antidsDNA e antinucleossomo. Resultados: Os níveis de PINP e CTX estavam elevados em pacientes com LES com idade > 45, em comparação com aqueles com idade < 45 anos, embora com significância estatística limítrofe (p = 0,05). Foram encontradas correlações entre os MRO: a mais forte foi entre o PINP e a osteocalcina (τ = 0,69, p < 0,05). Encontrou-se que o PINP e a osteocalcina estão correlacionados com o HPT (τ = 0,3, τ = 0,29, respectivamente, p < 0,05). A idade estava correlacionada com o PINP (τ = 0,23, p < 0,05). Valores elevados de PINP foram encontrados em maior frequência do que valores elevados de osteocalcina ou CTX, tanto em pacientes com idade < 45 (p = 0,001) quanto > 45 (p < 0,001). Não houve diferença estatisticamente significativa nos níveis de PINP, osteocalcina ou CTX com relação à estação do ano, nem em todo o grupo de pacientes com LES, nem naqueles com mais ou menos de 45 anos. O uso prévio de glucocorticoides não esteve associado a diferenças nos MRO. Conclusões: O aumento nos MRO no LES parece refletir predominantemente o padrão de remodelação óssea relacionado com a idade. Pode-se esperar que o PINP aumentado seja o desfecho mais comumente encontrado entre os MRO. É necessário incluir melhores diagnósticos de distúrbios ósseos com MRO, feitos de acordo com as normas internacionais de referência, na abordagem de ...

Objective: To investigate the feasibility of bone turnover markers (BTMs) for the assessment of bone metabolism in patients with systemic lupus erythematosus (SLE), according to the guidelines of the International Osteoporosis Foundation and the International Federation of Clinical Chemistry and Laboratory Medicine. Methods: The study included 43 female SLE patients. Serum pro-collagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTX), osteocalcin, PTH, 25(OH)D, anti-cardiolipin, anti-dsDNA, and anti-nucleosome levels were measured. Results: PINP and CTX levels were elevated in SLE patients aged > 45 in comparison to those aged < 45, although with borderline significance (p = 0.05, respectively). Correlations were found between BTMs: the strongest being between PINP and osteocalcin (τ= 0.69, p < 0.05). PINP and osteocalcin were found to be associated with PTH (τ = 0.3, τ = 0.29, respectively, p < 0.05). Age correlated with PINP (τ= 0.23, p < 0.05). Elevated PINP was found more frequently than elevated osteocalcin or CTX, both in patients aged < 45 (p = 0.001) and > 45 (p < 0.001). No significant difference in PINP, osteocalcin or CTX levels was found with respect to season, neither in the entire SLE group, nor in the under-45 or over-45 groups. Previous glucocorticoid treatment was not associated with difference in BTMs. Conclusions: Increased BTMs in SLE appear to predominantly reflect the pattern of bone remodeling related to age. Increased PINP is expected to be the most frequent outcome among BTMs. Better diagnoses of bone disturbances with BTMs performed in accordance with international reference standards need to be included in the approach to SLE patients, in addition to bone mineral density assessment. .

Feasibility of measurement of bone turnover markers in female patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the feasibility of bone turnover markers (BTMs) for the assessment of bone metabolism in patients with systemic lupus erythematosus (SLE), according to the guidelines of the International Osteoporosis Foundation and the International Federation of Clinical Chemistry and Laboratory Medicine. METHODS: The study included 43 female SLE patients. Serum procollagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTX), osteocalcin, PTH, 25(OH)D, anti-cardiolipin, anti-dsDNA, and anti-nucleosome levels were measured. RESULTS: PINP and CTX levels were elevated in SLE patients aged > 45 in comparison to those aged < 45, although with borderline significance (p = 0.05, respectively). Correlations were found between BTMs: the strongest being between PINP and osteocalcin (τ = 0.69, p < 0.05). PINP and osteocalcin were found to be associated with PTH (τ = 0.3, τ = 0.29, respectively, p < 0.05). Age correlated with PINP (τ = 0.23, p < 0.05). Elevated PINP was found more frequently than elevated osteocalcin or CTX, both in patients aged < 45 (p = 0.001) and > 45 (p < 0.001). No significant difference in PINP, osteocalcin or CTX levels was found with respect to season, neither in the entire SLE group, nor in the under-45 or over-45 groups. Previous glucocorticoid treatment was not associated with difference in BTMs. CONCLUSIONS: Increased BTMs in SLE appear to predominantly reflect the pattern of bone remodeling related to age. Increased PINP is expected to be the most frequent outcome among BTMs. Better diagnoses of bone disturbances with BTMs performed in accordance with international reference standards need to be included in the approach to SLE patients, in addition to bone mineral density assessment.

Cambridge Neuropsychological Test Automated Battery in assessment of cognitive parameters in patients with systemic lupus erythematosus in relation to autoantibody profile.

OBJECTIVES: To relate the cognitive parameters of systemic lupus erythematosus (SLE) patients in remission to their profile of autoantibodies. MATERIAL AND METHODS: The study included 32 patients with SLE in remission, with mild disease activity as indicated by SELENA-SLEDAI < 6. For neuropsychological assessment, the Cambridge Neuropsychological Test Automated Battery (CANTAB) was applied, using motor screening (MOT), big little circle (BLC), paired associated learning (PAL), stockings of Cambridge (SOC), and graded naming tests (GNT). Detection of autoantibodies against dsDNA, nucleosome (aNuc), Sm, and anticardiolipin (aCL: IgG and IgM) was performed with immunoassays. RESULTS: The SLE patients demonstrated standard scores below norms, matched according to age and gender, in the following tests: GNT (-0.87 ±0.85), SOC PSMM (-0.47 ±0.97), PAL (-1.88 ±3.58), and BLC (-0.31 ±1.90). GNT scores under -0.5 were found significantly more frequently in SLE patients, seen in roughly 66% of test subjects. Values for PAL and mean subsequent thinking time of stockings of Cambridge (SOC MSTT) were found to be lower than -0.5 in approximately half of the patients. Mean error of motor screening (MOT ME) was found to negatively correlate with mean latency of motor screening (MOT ML) (r = -0.55). PAL significantly correlated with SOC MSTT (r = 0.38) and with GNT (r = 0.36). Anti-dsDNA antibody level correlated negatively with MOT ME (r = -0.46). Anti-Nuc antibodies correlated with MOT ML (r = 0.41) but negatively correlated with MOT ME (r = -0.58). The levels of anti-Sm, anti-CL IgM and IgG did not correlate significantly with the outcomes of CANTAB. The age of the patients correlated negatively with MOT ME (r = -0.36), positively with BLC (r = 0.53) and negatively with SOC MSTT (r = -0.43). The level of anti-Nuc antibodies correlated with anti-dsDNA level (r = 0.62) and of anti-CL IgM with anti-Sm (r = 0.39) and anti-CL IgG (r = 0.87). CONCLUSIONS: CANTAB reveals a decrease in selected cognitive functions in patients with SLE. ACL IgG and anti-dsDNA antibodies indicated SLE patients prone to develop a decrease in cognitive functions.

Hepatitis C virus (HCV) infection of peripheral blood mononuclear cells in patients with type II cryoglobulinemia.

OBJECTIVES: Type II cryoglobulinemia is a common extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. The mechanisms behind its development are unclear, but could be related to direct infection of the immune cells. METHODS: Peripheral blood mononuclear cells from 18 patients with type II cryoglobulinemia were separated into CD3+ (T cells), CD19+ (B cells) and CD14+ (monocytes) and analyzed for the presence of negative strand HCV RNA, which is a viral replicative intermediate, and for the presence of HCV non-structural protein 3 (NS3). Control group consisted of 182 consecutive chronic hepatitis C patients prior to initiation of antiviral therapy. RESULTS: Negative strand HCV RNA was detected in PBMC from six (33.3%), patients and in 15 (8.2%) controls (p < 0.01). Negative strand was most frequently detected in B cells (3 patients), followed by T cells (2 patients), and monocytes (2 patients). One patient was positive both in CD3+ and CD14+ cells. NS3 protein was detected in six (33.3%) patients; five were positive in T cells, three in B cells, and another three were positive in monocytes. Two patients were positive in all analyzed cell subpopulation and one patient was positive in CD14+ and CD19+ cells, but not in CD3+ cells. Altogether, 11 patients (61.1%) were positive either for the negative strand HCV RNA or NS3 protein in at least one of the analyzed cell compartments. CONCLUSION: Our findings of common presence of viral replication in cells of the immune system suggest that direct HCV infection could play a role in the etiology of cryoglobulinemia.

CD4⁺ CD25⁺ FOXP3⁺ regulatory T cells in peripheral blood and peritoneal fluid of patients with endometriosis.

STUDY QUESTION: Is endometriosis associated with changes in CD4⁺ CD25⁺ FOXP3⁺ regulatory T cells (Treg cells)? SUMMARY ANSWER: Endometriosis is associated with disturbed compartmentalization of CD25(high) FOXP3⁺ Treg cells. WHAT IS KNOWN ALREADY: Endometriosis is associated with an abrogated immune response and displays some features of an autoimmune disorder. Treg cells play a part in the development of autoimmune reactions; however, their role in pathogenesis of endometriosis is still poorly recognized. STUDY DESIGN, SIZE AND DURATION: Case-control study comparing 17 women with laparoscopically and histopathologically confirmed ovarian endometriosis with 15 control women without visible endometriosis foci, pelvic inflammation or related pathology who were subjected to laparoscopic surgery between 2010 and 2011. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Peripheral blood and peritoneal fluid were collected during laparoscopy and T cell subpopulations were analysed by flow cytometry using specific monoclonal antibodies recognizing CD4⁺, CD25⁺ and FOXP3⁺ markers. MAIN RESULTS: The percentage of CD25(high) FOXP3⁺ Treg cells was significantly decreased in the peripheral blood of women with ovarian endometriosis compared with control women. On the other hand, the proportion of these cells was significantly increased in the peritoneal fluid of women with endometriosis. LIMITATIONS, REASONS FOR CAUTION: The present study is limited to patients with ovarian endometrioma and further investigations are needed, including patients with lower grade of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS: The present results suggest that Treg cells may play a part in immunopathogenesis of endometriosis being responsible for abrogated local cellular immune responses and facilitation and development of autoimmune reactions. Treg cells may be thus a potential target in the treatment of endometriosis. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by 1M15/N/2011 and NK1W grants from the I Faculty of Medicine, Warsaw Medical University. None of the authors has any competing interests to declare.

[Prevalence of autoantibodies directed against 1,25(OH)2D3 in patients with systemic lupus erythematosus]. / Wystepowanie przeciwcial skierowanych przeciwko 1,25(OH)2D3 u chorych na toczen rumieniowaty ukladowy.

UNLABELLED: In systemic lupus erythematosus (SLE) patients photosensitivity is considered as a factor which may cause exacerbation of skin lesions and provoke organ damage. Therefore in all therapeutic standards photo protection is recommended which may diminish vitamin D synthesis. Because of the enhanced activity of the humoral immunity which is present in the course of disease one postulates the possibility of the production of antibodies directed against vitamin D, that would be able to intensify this deficiency independently from consequences of photoprotection. THE AIM of the study was to estimate the frequency of occurrence of antibodies directed against 1,25(OH)2D3 in patients with SLE and to assess serum concentration of 25 (OH)D3 in comparison with clinical and laboratory parameters. MATERIAL AND METHODS: The study encompassed 45 patients with SLE. The control group in the 25(OH)D3 investigation comprised 49 healthy individuals but in autoantibodies against 1,25(OH)2D3 evaluation involved 30 sera obtained from healthy blood donors. In the determination of autoantibodies directed against 1,25(OH)2D3 ELISA method was employed. The concentration of 25 (OH)D3 in the serum was evaluated with automatized electrochemi-luminescence method on the automatic platform Elecsys 2010 in the control system DEQAS (vitamin D external quality assessment scheme). RESULTS: Serum concentration of 25(OH)D3 was significantly decreased in SLE patients in comparison with the control group (15.03 +/- 8.69 vs 23.37 +/- 12.34 ng/ml, respectively; p = 0.0005). Vitamin D deficit (25(OH)D3 < 10 ng/ml) was ascertained in 16 patients (35.55%), deficiency (10-20 ng/ml) in 16 (35.55%) and hypovitaminosis (20-30 ng/ml) in 10 (22.22%). Values within the recommended range (30-80 ng/ml) were established in 3 (6.66%) patients. The risk for vitamin D deficiency was 3.28 folds higher in SLE patients than in healthy controls (OR = 3.28; p = 0.005). Autoantibodies directed against 1,25(OH)2D3 were found in 4 (8.88%) patients. No statistically significant difference in the concentration of 25 (OH)D3 between SLE anti-1,25(OH)2D3 positive and anti-1,25(OH)2D3 negative patients was disclosed. The study did not reveal the correlations between the presence of antibodies directed against 1,25(OH)2D3 and the occurrence of ascertain clinical and laboratory parameters of SLE. The winter times was found to be the risk factor for vitamin D deficiency (OR = 7.33; p = 0.005). Sunscreen usage was revealed to be the predictor of serum 25(OH) vitamin D, concentration (beta = -0.44; p = 0.04). CONCLUSIONS: The low concentration of vitamin D in lupus patients indicates that they are at the essential risk for vitamin D deficiency, however the presence of the antibodies directed against 1,25(OH)2D3 seems not to influence vitamin D status.

Clinical manifestation of systemic lupus erythematosus in patients with antiribosomal P protein antibodies.

INTRODUCTION: Antibodies against ribosomal P protein (anti-P) are detected predominantly in patients with systemic lupus erythematosus (SLE). However, the data on their frequency and clinical relevance remain inconclusive. OBJECTIVES: The aim of the study was to assess the frequency as well as clinical and serological relevance of anti-P autoantibodies in Polish patients with SLE and to determine the significance of these antibodies in the diagnosis of SLE. PATIENTS AND METHODS: Anti-P antibody levels were measured in the sera of 100 SLE patients using an enzyme-linked immunosorbent assay and Western blotting. All patients underwent a routine clinical and laboratory evaluation. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. RESULTS: Anti-P antibodies were detected in 14 of 100 patients. When compared to anti-P-negative patients, this group was characterized by earlier onset of SLE, higher disease activity, more frequent occurrence of fever and facial erythema, decreased serum levels of complement, and elevated levels of alanine and aspartate aminotransferases. In 2 cases, anti-P antibodies were the only serological marker of SLE detected in these patients. CONCLUSIONS: SLE with the presence of anti-P antibodies is characterized by an early onset and high disease activity.

Anti-influenza vaccination in systemic lupus erythematosus patients: an analysis of specific humoral response and vaccination safety.

The objective of this study is to evaluate efficacy and safety of influenza vaccine in systemic lupus erythematosus (SLE) patients. We studied SLE patients and healthy subjects immunised with inactivated influenza vaccine. Efficacy was measured by comparing humoral response to vaccine antigens between groups. Safety was monitored by SLEDAI and serological markers. Subjects attended visits at baseline and on post-vaccination weeks 4 and 12. We enrolled 62 SLE patients and 47 healthy subjects. In post-immunisation week 4, anti-haemagglutinin antibody titres rose in the patient group at least 6.23-fold, compared to 11.90-fold among controls (P < or = 0.05). The seroconversion rate range was 53-56% among patients and 72-85% among controls (P < 0.05 for strains H1N1 and H3N2, NS for strain type B). The seroprotection rate ranged between 62% and 73% and between 90% and 98% in the patient and control group, respectively (P < 0.05). In post-vaccination week 12, the antibody titre was higher at least 3.86-fold in the patient group and 7.65-fold among controls. The seroconversion rate range was 32-40% among patients and 64-70% among controls, while the seroprotection rate ranged between 43% and 50% and between 79% and 94%, respectively (P < 0.005 for three strains). We identified one severe and six mild to moderate SLE exacerbations by week 12. The anti-nuclear antibodies and anti-double-stranded DNA titres grew by post-immunisation week 4 (P < 0.05). The post-vaccination response was weaker in SLE patients compared to healthy subjects. Immunisation did not change underlying disease activity.

PTPN22/LYP 1858C>T gene polymorphism and susceptibility to endometriosis in a Polish population.

Endometriosis is a common gynaecological disorder due to ectopic implantation of endometrial tissue. It is manifested by pelvic inflammation and abrogation of cell-mediated immunity and may be also characterised by autoantibody production, thus suggesting that endometriosis might be an autoimmune disorder. Genetic factors also play a role in the aetiopathogenesis of this disease. Therefore, the present study was aimed at testing the association of endometriosis with the PTPN22/LYP 1858C> T gene polymorphism, which appears to be related to the development of a variety of autoimmune disorders. The study included 171 Polish patients of Caucasian origin with laparoscopically and histopathologically confirmed endometriosis and 310 unrelated, ethnically matched control individuals. DNA and serum were isolated from the peripheral blood. The PTPN22/LYP 1858C> T polymorphism was typed using a PCR-RFLP method. Anti-nuclear (ANA) and anti-cardiolipin (ACA) autoantibodies were detected by the Hep-2 indirect immunofluorescence test and a specific ELISA respectively. No statistically significant differences were found in distribution of C and T PTPN22/LYP alleles and genotypes in patients with endometriosis compared with the control population. However, on exploratory analyses we noted that the PTPN22/LYB T allele and the TT genotype may be associated with the prevalence of double positivity for ANA and ACA (p=0.003 by chi(2) test for trend and p=0.009 by Fisher's exact test respectively). The results of the present study show that endometriosis in a Polish population is not associated with the PTPN22/LYP 1858C> T gene polymorphism. The putative effect of the PTPN22/LYP genotype on the development of autoantibodies is potentially interesting, but it should be verified in further studies.

Perceived work-related stress and early atherosclerotic changes in healthy employees.

OBJECTIVE: This study was conducted to investigate the relationship between perceived work-related stress and preclinical atherosclerosis. METHODS: A total of 100 managers and 50 office workers aged 35-65 participated in a questionnaire study. Individual, family and work-related stress risk factors and coping were evaluated in all the studied individuals. Serum levels of biochemical (total cholesterol, LDL, HDL, TG, glucose) and serological risk factors of atherosclerosis (anticardiolipin, anti-beta(2) GPI, anti-oxLDL, anti-HSP and anti-hsCRP antibodies) were evaluated. A computer analysis of B-mode ultrasound images was used to assess carotid artery intima-media thickness (IMT) and atherosclerotic plaque in carotid arteries. Statistical analysis was conducted with SPSS v. 11.5. RESULTS: The studied individuals showed average ranges of both the global stress level and of coping results. In 71% no changes were found in the ultrasound image and in 29% of individuals (43) the presence of plaque was shown. The mean value of the IMT measure was 0.0618 +/- 0.013 mm. IMT and plaque correlated negatively with the level of global work-related stress (r = -0.26; P < 0.01; and r = -0.28; P < 0.01; respectively). No correlation was found either between work-related stress and coping, or between coping and IMT (P > 0.05), or between work-related stress and healthy lifestyle (no smoking, no excessive use of alcohol, high physical activity), or between healthy lifestyle and IMT (P > 0.05). Positive correlation between IMT and LDL and smoking did not result from higher stress reaction in the studied individuals. CONCLUSIONS: The explanation of the negative correlation between perceived work-related stress and preclinical atherosclerosis was not confirmed either by the subjects under high stress undertaking healthy protective activities or by their escaping into unhealthy behaviour. The most probable interpretation of the results is that in individuals with a low level of perceived work-related stress, somatization of stress takes place.

[The occurrence of anticardiolipin antibodies bound in circulating immunological complexes in sera of patients suffering from juvenile lupus erythematosus and juvenile idiopathic arthritis]. / Wystepowanie przeciwcial antykardiolipinowych w krazacych kompleksach immunologicznych u dzieci z mlodzienczym toczniem rumieniowatym ukladowym i mlodzieniczym idiopatycznym zapaleniem stawów.

BACKGROUND: The presence of antiphospholipid antibodies (APA), especially anticardiolipin antibodies (ACA), antibodies against beta2-glikoprotein I and lupus anticoagulant leads to thrombotic disorders. The pathogenetic role of APA in children is not exactly explained. The frequency of occurrence of APA and antiphospholipid syndrom in children is 2 to 3 times lower than in adults. OBJECTIVES: The aim of the study was to indicate the presence of ACA in circulating immunological complexes (CIC) from sera of patients suffering from juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE). PATIENTS AND METHODS: 31 sera were investigated, 16 from JIA patients and 15 from JSLE patients. The free ACA IgG class, ACA bound in CIC were estimated by the ELISA method (after dissociation of CIC and y-fraction paecipitation). RESULTS: In CIC isolated from sera of JIA and JSLE patients ACA were discovered. ACA, possessing high avidity, in CIC were more frequently discovered than unbound ACA (38.7% vs. 25.8%). CONCLUSIONS: ACA in CIC were more frequent in sera of JIA patients, unbound ACA were more frequent in sera of JSLE patients.

[Presence of anticardiolipin antibodies in cryoglobulins isolated from sera of hepatitis C virus infected patients]. / Obecnosc przeciwcial antykardiolipinowych w krioglobulinach izolowanych z surowic pacjentów zakazonych wirusem zapalenia watroby typu C.

INTRODUCTION: Most extrahepatic manifestations of the hepatitis C virus (HCV) infection are connected with influence of virus on the host's immune system. An important part of immunologic disturbances in chronic infections is the presence of circulating immune complexes. Standard serologic methods are not applicable in analysis of complexes composition. OBJECTIVES: Detection of anticardiolipin antibodies (ACA) in cryoglobulins of patients with the HCV infection before and after dissociation of immune complexes. PATIENTS AND METHODS: Sera and croglobulins of 27 patients (19 female, 8 male) with chronic hepatitis C and with cryoglobulinemia were tested. RESULTS: ACA were searched in serum and cryoprecipitate of 27 HCV infected patients with cryoglobulinemia--before and after dissociation of immune complexes. The presence of ACA was not confirmed in sera, but in 59% of cases they were detected in dissociated complexes from cryoprecipitate. The correlation between the presence of anti-HCV antibodies and ACA in cryoprecipitate before dissociation of immune complexes was 0.47 (p < 0.01) and after dissociation--0.61 (p = 0.0007). There was a statistically significant correlation between the presence of purpura (vasculitis) and the presence of ACA before (p < 0.002) and after dissociation of complexes (p < 0.05). CONCLUSIONS: In the tested group of patients there was a high incidence of ACA (non detectable in sera) detectable after dissociation of immune complexes from cryoglobulins. The presence of ACA in cryoprecipitate is significantly connected with clinical signs of cutaneus vasculitis.

[Antinucleolar antibodies in diagnostics of antiphospholipid syndrome]. / Przeciwciala przeciwjaderkowe w serodiagnostyce zespolu antyfosfolipidowego.

INTRODUCTION: Anti "nucleolar" antibodies are estimated to be present in about 5-10% of anti-nuclear antibodies-positive (ANA), but only in about 15% of cases (sometimes in lower percentages) it is possible to assess precisely the specificity of antibodies responsible for this pattern of ANA. Nucleoli are composed of many proteins, e.g., nucleolin, fibrillarin, Pm-Scl (spliceosome component), RNA-polymerases and different sizes rRNA transcripts. Nucleoli also contain annexins (ANX) II and V. Many of these proteins are target molecules for autoantibodies generated in connective tissue diseases (CTD)--especially in scleroderma and overlap syndromes. OBJECTIVES: The aim of this study was to work out methods for differentiation of antibody specificities in the case of sera ANA-positive with the nucleolar pattern in indirect immunofluorescence (IIF), with a particular concern directed to anti-Annexin V antibodies (belonging to anticofactor antibody system--characteristic of antiphospholipid syndrome [APS]). PATIENTS AND METHODS: In the sera of the tested group of 12 (selected from 150 subjects suffering from different kinds of CTD) ANA-positive (Western-blott negative) and showing the nucleolar type of ANA pattern patients, the following autoantibodies were assessed: ANA-IIF, anti-Pm-Scl (overlap syndrome marker), anticardiolipin, antiannexin V, anti-RNA-ase--all using the ELISA method. With the use of the Western-blott method a basic set "marker" autoantibody in CTD was estimated, and the RNA-ase was used for elimination (by enzymatic digestion) of RNA-s and RNA-protein complexes--a possible target for autoantibodies giving the nucleolar pattern. RESULTS: In 5 out of 12 sera (41.7%) of ANA-positive/Western-blott-negative CTD patients antibodies against Annexin V, cardiolipin, Pm-Scl were detected. In 2 out of 12 patient sera antibodies to the RNA-ase were found. None of the tested sera showed the presence of autoantibodies against antigen Scl-70 (scleroderma marker), and SS-A (Sjögren syndrome marker), which can also give the atypical nucleolar ANA-pattern. Only in few sera "my ositis"--blotts showed antibodies to antigen Ku (nuclear protein), Jo-1 and PI-7 (anti-tRNA synthetases--polymyositis markers)--myositis and overlap syndrome markers. In 80% of tested sera the co-appearance of anti-ANX-V and anticardiolipin antibodies was observed. The presence of antibodies against ANX-V together with Pm-Scl was confirmed in 60% of sera The RNA-ase, used as a specific rRNA and RNP-protein blocker, resulted in a partial or total disappearance of the "nucleolar" pattern, but independently of the tested serum specificity (anti-ANX-V, anti-Pm-Scl or both together). The observed RNA-ase treatment of the Hep-2 cells effects are equivocal and they may result from either binding or digestion the antigen by the RNA-ase, but also from forming a sterical hindrance for the autoantigen binding to another "nucleolar" antigens. CONCLUSIONS: These preliminary results are interesting, especially as concerns anti-ANX-V autoantigens (associated with APS), but they require further research including bigger groups of CTD patients.

Symptoms and signs of polymositis, systematic lupus erythematosus and antiphospholipid syndrome follow consecutively / Sekwencyjne pojawianie sie objawów zapalenia wielomiesniowego, tocznia rumieniowatego ukladowego i zespolu antyfosfolipidowego.

Polymyositis (PM) and dermatomyositis (DM) are very rare connective tissue disorders which only in exceptional circumstances affect white men. The present paper describes the case of an obese 55-years-old man in whom no muscular-skeletal system symptoms were found during the period of 2 years before the onset of arthritis, and who was treated because of cardiac involvement (pericarditis, PAF), pleuritis, malaise and fever. Only the occurrence of non erosive arthritis decided on the connective tissue disorder as a cause of his complaints. Previously the diagnostics was based on the exclusion of malignant diseases and bacterial and viral infections. The determination of antinuclear antibodies in high titer without any specific, typical of individual disease entities antinuclear antibodies allowed only the diagnose of undifferentiated connective tissue disease. Glucocorticosteroid treatment was initiated, however six months later despite treatment with metyloprednisolone the symptoms and signs associated with PM accompanied by high level of creatinophosphokinase and elevated transaminase were found. The muscle biopsy revealed myositis, but no specific antibodies, especially anti-Jo-1, were detected. It is very interesting that cyclophosphamide + glucocorticoids pulse therapy failed to prevent the development of antiphospholipide syndrome and interstitial pulmonary fibrosis in the PM patient. Overlapping of immunological tissue disorders is a well-known phenomenon, but in the case of fulminating and distinct symptoms and signs the lack of detection of specific antibodies is quite uncommon.

[Lyme carditis--a bitter lesson or a delayed diagnostic success--a case report]. / Borelioza serca - gorzka lekcja czy spózniony sukces diagnostyczny? Opis przypadku.

Lyme carditis is a well known disorder; however, its diagnosis still remains a challenge because of varied clinical picture, low incidence rate and difficulties in detection of the aetiological agent (Borrelia burgdorferi). We report a case of a 60-year-old man with a 2.5-year history of dilated cardiomyopathy, recurring episodes of acute heart failure and arrhythmias which finally were diagnosed as Lyme carditis. The diagnosis was confirmed by endomyocardial biopsy that revealed spirochetes as well as by serological tests which showed complexed Borrelia antibodies. The patient responded to treatment with ceftriaxone and doxycycline.

[Infections and antiphospholipid syndrome]. / Zakazenia a zespól antyfosfolipidowy.

In the presented paper the author discusses the association of antiphospholipid and anticofator antibodies appearance in the sera in a variety of bacterial, viral and parasitic infections coinciding with some antiphospholipid syndrome (APS) clinical manifestations or full manifested APS, including so called catastrophic APS.

[Preliminary studies on presence of antineuronal antibodies in serum of patients with Lyme borreliosis]. / Wstepne badania dotyczace obecnosci przeciwcial anty-neuronalnych w surowicach od chorych z borelioza z Lyme.

Wide spectrum of autoantibodies reactive against neuronal antigens was detected in sera of 32 of 50 studied patients with Lyme borreliosis. This may be potentially of importance in the pathogenesis of neuroborreliosis.

Clinical features and prognosis of patients with idiopathic inflammatory myopathies and anti-Jo-1 antibodies.

The idiopathic inflammatory myopathies are a heterogeneous group of diseases that can involve various systems. Antibodies directed against aminoacyl-tRNA synthetases, such as anti-Jo-1 antibodies, are strongly associated with a syndrome which consists of myositis, interstitial lung disease (ILD), arthritis and Raynaud's phenomenon. Forty-one patients with various forms of idiopathic inflammatory myopathies were assessed: 14 patients with anti-Jo-1 antibodies and 27 patients without anti-Jo-1 antibodies as a control group. We retrospectively analysed clinical symptoms, treatment and outcome in both groups. Patients with anti-Jo-1 antibodies more often had ILD (64.2 vs. 11.1%), arthritis (64.2 vs. 18.1%) and Raynaud's phenomenon (38 vs. 0%). Patients without the anti-Jo-1 antibody presented worse muscle strength and more frequently myalgia (37 vs. 21%), cutaneous rash (18.5 vs. 7%), heliotrope rash (29% vs. 7%) and periungueal changes (22 vs. 0%) than the anti-Jo-1-positive patients. Outcome was good in both groups. Improvement was achieved in the 14 (100%) Jo-1 positive patients, and in 25 (92.5%) controls. Two (7.5%) patients from control group achieved remission.