The aim of our study was to analyse the serum interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta) and interferon-gamma (IFN-gamma) levels in patients with AS and their relationship with disease activity. An ELISA test was used to analyse serum cytokine (IL-6, TNF-alpha, IL-1 beta and IFN-gamma) levels in 69 patients with AS. Results were compared with those from 43 patients with RA and 36 patients with non-inflammatory back pain. The relationship between serum concentrations of the different cytokines and parameters of disease activity and severity in AS patients was also evaluated. IL-6 and TNF-alpha serum levels, but not IL-1 beta and IFN-gamma, were significantly higher in AS than in NIBP. However, patients with RA showed higher serum levels of IL-6, TNF-alpha and IFN-gamma than both AS and NIBP patients. In AS, IL-6 correlated with clinical parameters of disease activity with significant correlation being observed with laboratory parameters of inflammation such as ESR, CRP, platelet count and clinical parameters of severity such as vertebral mobility. TNF-alpha did not correlate with laboratory or clinical parameters of activity. Macrophagic cytokines (TNF-alpha and IL-6), are increased in AS patients and IL-6 closely correlated with the activity of the disease.
Fibromyalgia (FM) is characterized by widespread pain and other symptoms, such as psychiatric and physical comorbidities. The heterogeneity of FM hinders its assessment and management.
Objectives
The aim of this work is to identify FM subgroups by classifying clinical data into simplified dimensions.
Methods
44 variables were evaluated in 560 unrelated Spanish FM cases of Caucasian origin. All participants fulfilled 1990 ACR FM criteria and were evaluated at one of five Rheumatology Units. A partitioning analysis was performed to find groups of variables similar to each other, thus describing underlying FM dimensions. Given the mixed nature type of the variables, these were transformed into binary types (0=mild; 1=severe), and a generalization of the Gower method was applied to find similarities between variables. A score was constructed per sample and dimension based on the weights of the variables depicting the specific dimension. Kmeans clustering procedure was then applied into resulting scores to create FM subgroups. This analysis was also performed in a replication set of 950 cases.
Results
Variables clustered into three independent dimensions: pain and other symptoms, family and personal comorbidities and clinical scales (fig. 1). Only the two most reliable dimensions (pain and other symptoms and comorbidities) were considered for FM subgroups construction. Resulting scores classified FM samples into three subgroups: high symptomatology and comorbidities, high symptomatology but low comorbidities and low symptomatology and comorbidities. Both the variable clustering and the sample subgrouping were replicated in the second cohort.
Conclusions
We have identified three subgroups of FM samples in a large cohort of FM by clustering clinical data. This partitioning method could be used as a useful tool in FM severity assessment and personalized treatment.
espanolSe analizan los motivos de consulta de los pacientes con edades comprendidas entre los 2 y 18 anos, atendidos en la consulta de psicologia integrada dentro del equipo de atencion primaria de Hospitalet-Vandellos, durante los anos 1992 y 1993. Las patologias diagnosticadas con mayor frecuencia fueron la ansiedad en un 36.92% de los casos y la enuresis en un 25%, seguidas de la irritabilidad en un 9.52% y los trastornos del estado de animo en un 8.32%. para su clasificacion se siguieron los criterios del DSM-III-R y del CIE-10. La tasa de derivacion a otros centros fue escasa (2.32%). Se concluye que la integracion del psicologo dentro del Equipo de Atencion Primaria, es util, ya que permite una valoracion del entorno global del nino, coordinada con el resto de miembros del equipo, y con el resto de equipos de la Red de Salud Mental. catalaS'analitzen els motius de consulta dels pacients amb edats compresesentre els 2 i 18 anys, atesos a la consulta de psicologia, integrada dins de l'equip d'atencio primaria de L'Hospitalet-Vandellos, al Ilarg dels anys 1992 i 1993. Les patologies diagnosticadesamb major frequencia varen ser l'ansietat en un 36.92% dels casos i l'enuresi en un 25%, seguides de l'irritabilitat en un 9.52% i els trastorns de l'estat d'anim en un 8.32%. Per la seva classificacio es van seguir els criteris del DSM-III-R i CIE-10. La taxa de derivacio a altres centres va ser escassa (2.32%). Es conclueix que la integracio del psicoleg dins l'equip d'atencio primaria es util, ja que permet una valoracio de l'entorn global del nen, coordinada amb els diferents membres de l'equip, aixi com la resta d'equips de la Xarxa de Salut Mental EnglishAn analysis has been made of the reasons why patients, aged between 2and 18 years old, seeked the medical advice of psycologist integrated in the Primary Care team at Hospitalet-Vandellos during the years 1992 and 1993. What was diagnosed with mood disordes in 8.32%. For clasification, the criteria of DSM-III-R and CIE-10 were followed. The rate of derivation to other centers was very low (2.52%). The authors concluded that the integration of a psicologist within the Primary care Team, is useful, as this permits an evaluation of the whole enviroment of the child,co-ordinatedwith the other members of the team, and with the other teams of the Mental Health Network
Secondary amyloidosis is a well recognised complication of rheumatic diseases, but the association with systemic lupus erythematosus is very unusual. We report the case of a patient with systemic lupus erythematosus who developed proteinuria due to renal amyloidosis. We also review the cases previously reported and the hypothesis on the pathogenic mechanisms.
IgA antibodies against Klebsiella pneumoniae were measured by immunofluorescence in 84 Catalan patients with ankylosing spondylitis (AS), 41 patients with non-inflammatory arthropathies (NIA) and 22 patients with rheumatoid arthritis (RA). Patients with AS showed higher levels of anti-klebsiella IgA antibodies (IgA-Kp) than NIA and RA patients (4.7 +/- 1.6 U vs 3.7 +/- 1.5 U and 3.1 +/- 1.4 U respectively, p = 0.001). In AS patients a significant correlation between IgA-Kp and levels of C-reactive protein was observed. Although no clear correlation was found between IgA anti-klebsiella and total serum IgA levels, a significant correlation between IgA anti-klebsiella and serum levels of secretory IgA was detected (r: 0.43, p = 0.003). In conclusion, some patients with AS disclosed raised levels of Klebsiella antibodies in sera and this is related to an increase of secretory IgA level. Analysis about the relationship between response to klebsiella and the presence of gut inflammation in AS patients could be of interest.