Neutrophil/lymphocyte ratio and mean platelet volume in Behçet's disease.

OBJECTIVE: With this retrospective study, we researched the effects of mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) on the activity of Behçet's disease and susceptibility to thrombosis. PATIENTS AND METHODS: One hundred eighty-six patients with Behçet's disease, who met the inclusion criteria, were separated into two groups: 120 patients had active Behçet's disease (Group I) and 66 patients with inactive Behçet's disease (Group II). 79 healthy subjects as controls were included in the study. RESULTS: MPV was similar between all three groups. CRP (C reactive protein) was statistically higher in the active BD group when compared to the inactive BD group and the control group. CRP of the inactive BD and the healthy control group were similar. In addition, erythrocyte sedimentation rate (ESR) was found higher than the control group in both active and inactive BD groups, whereas ESR of the active BD group was higher than the inactive BD group. N/L ratio was found statistically higher in the active BD group when compared to inactive BD and healthy control groups, while the N/L ratio of inactive BD and healthy control groups were found similar to each other. While MPV, CRP, and NLR didn't statistically differ between active BD subgroups with and without thrombosis, ESR was statistically and significantly higher in the active BD group with thrombosis when compared to the active BD group without thrombosis. CONCLUSIONS: The data obtained from the present study showed that the patients with BD are exposed to chronic inflammation. And the N/L ratio may be a simple, inexpensive, and convenient diagnostic marker of active BD.

Cardiac autonomic profile in rheumatoid arthritis and systemic lupus erythematosus.

Neurological involvement is a well-documented issue in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about the involvement of the autonomic nervous system. This study was conducted to investigate autonomic nervous system dysfunction in patients with RA and SLE. Twenty-six RA patients, 38 SLE patients and 40 healthy controls were recruited from our in- and out-patient departments. Heart rate variability (HRV) parameters (the power of the high- [HF] and low-frequency [LF] band of haemodynamic time series, the ratio between low- and high-frequency components [LF/HF ratio], the power spectral density), baroreflex sensitivity (BRS) and beat-to-beat blood pressures were assessed by a novel non-invasive haemodynamic monitoring tool (Task Force Monitor [TFM], CNSystems Medizintechnik GmbH, Graz, Austria). Autonomic nervous system dysfunction was determined according to classical Ewing autonomic test battery. Furthermore, we implemented a secondary autonomic test score by modifying the Ewing test battery with additional criteria. Both the classical and modified Ewing test batteries have revealed that the frequencies of autonomic neuropathy were significantly higher in patient groups compared with controls (p < 0.001). Evaluation by TFM revealed that deterioration of sophisticated autonomic parameters (such as HRV and BRS) were more pronounced in the patient groups compared with controls. There was a significant association between BRS and Ewing test scores and abnormal BRS results were more frequent in patients with autonomic dysfunction according to Ewing test batteries. No relation was found between autonomic neuropathy and disease duration, disease activity and autoantibody positivity. Consequently, we believe that further large-scale studies investigating cardiovascular autonomic neuropathy in rheumatic diseases should be carried out to verify our findings and manifest clinical consequences beyond these results.

Bone marrow infection caused by Mycobacterium avium complex in a patient with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a disease with wide range of signs and symptoms. SLE patients have increased infective diathesis, and infections are a very important cause of death in these patients. Infections can sometimes mimic the signs and symptoms of SLE. Thus, it is important to recognize that infection can induce a lupus flare-up or can be difficult to distinguish from a lupus flare-up. We describe a 36-year-old female patient with SLE, who presented with skin lesions and pancytopenia, and clinical manifestations similar to a flare-up of SLE. Bone marrow examination revealed infection with Mycobacterium avium complex (MAC). The patient had no history or clinical evidence of pulmonary involvement. This patient is the first case of invasive bone marrow MAC infection in SLE. With this unique case, we would like to emphasize that SLE patients can also be infected by non-tuberculous mycobacteria, and that bone marrow examination for tuberculosis as well as for non-tuberculosis mycobacteria should be considered in SLE patients with refractory pancytopenia.

The numbers of Foxp3 + Treg cells are positively correlated with higher grade of infiltration at the salivary glands in primary Sjogren's syndrome.

This study was designed to investigate whether Foxp3( +) regulatory T (Treg) cells play a role in the histopathologic changes of primary Sjögren's Syndrome (pSS) and to evaluate other factors possibly associated with Foxp3(+) Treg cells in pSS patients. The number of FoxP3-expressing T cells in peripheral blood (PB) of 39 patients with pSS, 40 patients with rheumatoid arthritis (RA), and 28 healthy controls was measured by flow-cytometer analysis. FoxP3-expressing CD4(+)CD25(+) Treg cells were analyzed in minor salivary gland (SG) tissues of 39 pSS patients. Histopathologic changes were examined by light microscopy according to Chisholm's classification. Immunohistochemistry and immunofluorescence were performed to assess the Foxp3(+) Treg in SG biopsy specim-ens. The numbers of CD4(+) T cells and FoxP3-expressing CD4(+) T cells in PB were similar in all groups. Expression of CD25 on CD4(+) T cells in PB of patients with pSS and RA was significantly higher than in healthy controls, especially for RA patients. Immunohistochemistry and immunofluorescence showed that FoxP3(+) Treg were enriched in the SGs of pSS patients, with a positive correlation between the increase in FoxP3(+) Treg in SG and the Chisholm score in pSS (p < 0.001, r = +0.605). The increase of FoxP3( +) Treg cells in the SGs of pSS patients, which is correlated with gland infiltration, suggests that natural regulatory T cells play an important role in the pathogenesis of pSS. Further studies are required to explore the mechanisms that mediate the relationship between Treg and the pathogenesis of pSS.

Development of Crohn's disease following anti-tumour necrosis factor therapy (etanercept).

Inhibition of tumour necrosis factor (TNF)-alpha is effective in the treatment of rheumatoid arthritis and other inflammatory rheumatic diseases. Anti-TNF antibodies such as infliximab, etanercept and adalimumab are commonly used. There are structural and functional differences among these agents. We describe development of Crohn's disease in a patient with ankylosing spondylitis receiving anti-TNF therapy. This case suggests that the appearance of gastrointestinal symptoms in patients on anti-TNF therapy must be evaluated to find out whether this is a new onset or an exacerbation of underlying inflammatory bowel disease.