Circulating levels of soluble CD30, a marker of cells producing Th2-type cytokines, are increased in patients with systemic lupus erythematosus and correlate with disease activity.

OBJECTIVE: To measure the levels of serum soluble CD30 (sCD30), a marker of cells producing T helper 2(Th2)-type cytokines, in systemic lupus erythematosus (SLE) and undifferentiated connective tissue disease (UCTD), and to determine its value in assessing disease activity. METHODS: Serum levels of sCD30 were measured by ELISA in 21 patients with SLE, in 17 patients with UCTD and in 40 normal donors. Disease activity was evaluated according to the ECLAM scoring system. RESULTS: sCD30 values were 53.84 +/- 58.24 U/mL in SLE, 22.65 +/- 9.82 U/mL in UCTD and 5.3 +/- 5.7 in normal controls (p < 0.0005 SLE vs controls; p < 0.05 SLE vs UCTD). sCD30 levels were directly related to the disease activity (p < 0.002). CONCLUSION: These data support a relationship between the Th2-type immune response and the pathogenesis of SLE, and suggest that sCD30 can be used as a simple marker for the evaluation of disease activity.

Analysis of T-cell clones in systemic lupus erythematosus.

BACKGROUND AND OBJECTIVE: It is fairly well established that T-helper (TH)((1)) cells play a role in the pathogenesis of organ-specific autoimmune diseases, while their role and their relationship with TH((2)) cells is far from being defined in systemic lupus erythematosus (SLE). To address this issue, six female patients who fulfilled the American Rheumatism Association criteria for the diagnosis of SLE were studied. DESIGN AND METHODS: We analyzed the intracellular production of cytokines by T-cells from the peripheral blood (PB). Then, we established T-cell clones (TCC) from the peripheral blood (PB) of all cases as well as from the synovial fluid of one patient with an articular flare-up. RESULTS: The percentages of IL-4 positive and IFN-g positive PB T-cells were not different between SLE patients and normal controls. When 93 TCC (67 CD4(+), 23 CD8(+)) from the PB of 5 different SLE patients were compared to 118 TCC (94 CD4(+), 23 CD8(+)) from 5 healthy controls no statistical difference was observed between SLE and controls in terms of TH((1)), TH((2)) or TH((0)) phenotype. However, SLE clones showed a reduced ability to secrete IL-10 (p = 0. 002). In contrast, the analysis of the 30 clones obtained from synovial fluid revealed that 11/23 CD4(+) clones were TH((1)), 12/23 were TH((0)), 2/7 CD8(+ )clones were TH((1)) and 5/7 were TH((0)). No TH((2)) clones were obtained from the synovial fluid. INTERPRETATION AND CONCLUSIONS: The data suggest that the T-cell subsets operating in actively inflamed organs of SLE may belong to the TH((1)) and TH((0)) subsets.

Respiratory function in systemic lupus erythematosus: relation with activity and severity.

The objective of this study was to examine the relation between respiratory function tests, disease activity and disease severity in ambulatory patients with systemic lupus erythematosus (SLE) who did not present with overt respiratory problems. Lung volumes, maximal expiratory flows at 50% and 25% of vital capacity (MEF50 and MEF25), bronchial threshold to methacholine (PD15FEV1), transfer factor CO (KCO) were measured in 24 consecutive SLE outpatients (22 women, age 41 +/- 14.8 years) and in 24 healthy controls matched for age and sex. In SLE patients alveolar-arterial oxygen gradient (AaO2) was also measured. Disease activity was assessed by European Consensus Lupus Activity Measurement (ECLAM) scoring system and disease severity by Lupus Severity of Disease Index. In comparison to controls SLE patients showed a significant decrease of total lung capacity (TLC) (91.7 +/- 16.5 vs 102.7 +/- 12.9% predicted, P < 0.01), MEF25 (58.4 +/- 25.2 vs 73.5 +/- 19.5% predicted, P < 0.005) PD15FEV1 (2164 +/- 1122 vs 4230 +/- 1014 micrograms methacholine, P < 0.0001) and KCO (77.1 +/- 20.5 vs 96.3 +/- 12.4% predicted, P < 0.001). AaO2 (mean value 13.2 +/- 8.4) was abnormally high (> 20 mmHg) in 12 patients. The ECLAM score of activity was inversely related with KCO (r = 0.48, P < 0.02). The severity index was significantly related with FEV1/VC ratio (r = 0.43, P < 0.05), MEF50 (r = 0.51, P < 0.01), MEF25 (r = 0.40, P < 0.05) and PD15FEV1 (r = 0.51, P < 0.01). In eight patients, evaluated also after treatment intensification, there was a significant increase in KCO (from 71.8 +/- 24.7 to 84.9 +/- 22.3% predicted, P < 0.01) along with a decrease in ECLAM score (from 3.0 +/- 1.34 to 0.69 +/- 0.75, P < 0.01). The relation between disease activity and KCO suggests a relation between systemic and alveolar inflammation whereas the relation between severity index, airway patency and reactivity indices suggests a cumulative damage to the airways in SLE patients, even in the absence of overt respiratory manifestations.

Increased nitric oxide in exhaled air of patients with systemic lupus erythematosus.

OBJECTIVE: In experimental animals, elevated nitric oxide (NO) production has been implicated in the pathogenesis of a lupus-like syndrome. Abnormalities of lung function tests are reported in a high proportion of patients with systemic lupus erythematosus (SLE). We investigated whether NO output in exhaled air might be increased in patients with SLE and whether it is related to disease activity and to respiratory function abnormalities. METHODS: Lung volume, maximal expiratory flow at 50 and 25% of vital capacity (MEF50 and MEF25), diffusion coefficient for carbon monoxide (KCO), and NO in the exhaled air were measured in 27 outpatients with SLE (23 women, age 39.2 +/- 16.3). NO in exhaled air was also measured in 30 healthy control subjects. Disease activity was assessed by the European Consensus Lupus Activity Measurement (ECLAM) scoring system. RESULTS: Mean values of peak concentrations of NO exhaled air were 64.8 +/- 27.9 parts per billion (ppb) in patients and 31.6 +/- 7.7 ppb in controls, p < 0.001. Peak NO concentration was directly related to ECLAM activity score (p < 0.05) and inversely related to MEF25 (p < 0.05). CONCLUSION: NO in exhaled air is significantly increased and correlated with disease activity in patients with SLE. Whether increased NO output depends on respiratory tract inflammation, as the relationship with MEF25 may suggest, or on circulating cytokines produced elsewhere remains to be investigated.

Campos eletromagneticos produzidos por equipamentos de ondas curtas usados em fisioterapia: uma avaliaçäo em Presidente Prudente, SP

Este trabalho tem o objetivo de avaliar a quantidade de radiacao eletromagnetica a que o fisioterapeuta esta submetido quando utiliza equipamentos de ondas curtas no tratamento de pacientes, em clinicas de Fisioterapia de Presidente Prudente, SP. Para isso, foram medidas densidades de potencia em alguns lugarres proximo ao paciente e ao equipamento, durante um procedimento-padrao de tratamento de coluna lombar. O paciente foi colocado em decubito dorsal e foram usados eletrodos (ou aplicadores) de placas. Os locais escolhidos para medidas foram: 1) acima do painel do equipamento, 2) ao redor do cabo dos aplicadores e 3) na altura do abdomem e dos olhos do paciente. As medidaas foram feitas usando um medidor de densidade de potencia (mW/cm) NARDA, com um sensor para a faixa de frequencia de 10 a 300 Mhz. Os resultados mostram uma queda exponencial da intensidade, em funcao da distancia ao ponto escolhido. Alguns equipamentos apresentam valores da densidade de potencia de ate 20mWcm, proximo dos cabos e dos aplicadores. Acima do painel de controle do equipamento os valores variam de 0,5 a 4,0 mW/cm em distancias de ate 30 cm. Proximo aos olhos do paciente o valor medido e da ordem de 2,0 mW/cm. Esses resultados indicam que em alguns locais o fisioterapeuta esta sujeito a riscos de exposicao acima dos valores recomendados pelos orgaos internacionais