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Outcome predictors of biologic therapeutic drugs like TNF inhibitors are of interest since side effects like serious infections or malignancy cannot be completely ruled out. Response rates are heterogeneous. The present study addressed the question whether in patients with rheumatoid arthritis (RA) interleukin-10 (IL-10) promoter genotypes with potential relevance for IL-10 production capacity are associated with response to long-term treatment with etanercept. Caucasian RA patients that, according to the EULAR criteria, responded well (n = 25), moderately (n = 17) or not (n = 8) to etanercept therapy (median 36 months, range 4–52), and 160 matched controls were genotyped for the IL-10 promoter SNPs -2849 G>A (rs6703630), -1082 G>A (rs1800896), -819 C>T (rs1800871) and -592 C>A (rs1800872). Haplotypes were reconstructed via mathematic model and tested for associations with disease susceptibility and therapy response. We identified the four predominant haplotypes AGCC, GATA, GGCC, and GACC in almost equal distribution. Patients that responded well carried the putative IL-10 low producer allele -2849 A or the haplotypes AGCC and GATA (RR 2.1 and 4.0, respectively; 95% CI 1.1–4.0 and 1.1–14.8), whereas an unfavourable response was associated with carriage of the putative high producer haplotype GGCC (RR 1.9, 95% CI 1.1–3.3). No significant associations of alleles or haplotypes with disease susceptibility were observed. In RA, a low IL-10 production which is genetically determined rather by haplotypes than by SNPs may favour the response to etanercept treatment. Iatrogenic blockade of TNF may reveal proinflammatory effects of its endogeneous antagonist IL-10. Further studies are needed to correlate these genetic findings to direct cytokine measurements. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of Raynaud''s phenomenon (RP) in patients with primary Sjogren''s syndrome (pSS) and to identify clinical and immunological characteristics associated with this manifestation. Since increased interferon-γ (INF-γ) has been associated with RP, we also compared the INF-γ production in pSS patients with or without RP. Methods: RP was diagnosed if pSS patients presented with characteristic sequence of skin color changes of the digits. In uncertain cases noninvasive vascular tests were performed by ultrasound examination. The secretion of INF-γ by peripheral blood mononuclear cells was assessed by enzyme-linked immunospot analysis. Further, we examined the expression of different lymphocyte activation markers (CD25, CD45RO, CD69) on CD4+ T-cells by flow cytometric analysis. Results: Thirty-six of 108 patients with pSS had RP. In these patients we found a significantly increased number of INF-γ-secreting peripheral blood mononuclear cells compared with patients without RP or to healthy controls. Further, in patients with RP a significantly increased percentage of CD25-positive T-helper cells was detectable. In addition we found an association of leukopenia, thyroiditis, and lower C3 levels with RP in pSS patients. Conclusions: These results suggest a pathogenic role of INF-γ in pSS patients with RP. Whether the RP is immune-mediated or whether INF-γ directly causes vasospasm still remains to be elucidated. [Copyright &y& Elsevier]

Objective: Presentation of pyoderma gangraenosum (PG) as an important differential diagnosis for wound healing disorders after cesarian section. Adequate therapeutic regimens are discussed. Case report: A 39-year-old woman developed a PG after cesarean section. A treatment with prednisolone and cyclosporine A was started. Within three days of treatment, the inflammatory process was significantly reduced. Serological inflammatory markers and fever dropped to normal levels. Due to the development of a pronounced arterial hypertension, dapsone was additionally applied to reduce glucocorticoids and cyclosporine A doses. Rapid normalisation of blood pressure without aggravation. Modern wound dressings helped to rapidly establish granulation and reepithelialization. The immense ulceration completely healed after six months of therapy. Conclusion: PG is a potentially lethal disease and must be considered as an important differential diagnosis after abdominal surgery and cesarean section. Modern systemic and topical treatments help to treat PG successfully. [ABSTRACT FROM AUTHOR]

Examines the different techniques of immunoadsorption in systemic lupus erythematosus and its role in medical therapy. Effect of plasmapheresis and immunoadsorption in eliminating pathogenic autoantibodies; Efficacy of immunoadsorption in majority of patients; Advantages of immunoadsorption over plasmapheresis.

Objective: To measure the relationship between silicone breast implants and various symptoms using a control group. Study design: A matched-pair-analysis of 96 women with breast-cancer (32 with silicone implants (K I); 64 without implants (K II)) was performed with help of a standardized questionnaire in respect to 50 single criteria. The condition of implants was monitored by MR-imaging. Results: Athralgias and myalgias were not significantly more frequent in K I. Only six symptoms were reported significantly more often in patients with implants. Positive correlation with implant rupture was given only for the numb feeling/tingling sensation in extremities (P=0.02). There was no correlation between silicone implants and the symptoms of the “chronic-fatigue syndrome” nor any other described silicone-induced disease. Conclusions: According to our analysis many of the symptoms examined here are present in middle-aged women regardless of silicone implants and underlying disease. [Copyright &y& Elsevier]

We report on a 57-year-old woman with frequent and powerful retrocollis. The involuntary movements combined with rheumatoid arthritis and osteoporosis led to a fracture of the axial odontoid process. Neurologists with a focus on movement disorders should screen for diseases putting the patient at risk for spinal lesions and consider early treatment. © 2004 Movement Disorder Society [ABSTRACT FROM AUTHOR]