Maintained clinical response of infliximab treatment in ankylosing spondylitis: A 6-year long-term study

ObjectivesTo investigate the efficacy, safety and drug discontinuation in patients with ankylosing spondylitis treated with infliximab, as well as the drug survival over a period of 6 years.MethodsForty patients with ankylosing spondylitis treated with infliximab were included in this open label study. All patients fulfilled the New York revised criteria for ankylosing spondylitis. Infliximab was given intravenously (5 mg/kg/body weight) at weeks 0, 2, 6 and every 8 weeks thereafter for a period of 6 years. Data concerning infliximab efficacy, tolerability, adverse events and drug discontinuation, were recorded. Clinical improvement according to the Bath Ankylosing Spondylitis Disease Activity Index 50% and the Ankylosing Spondylitis Assessment Study Group 20% and 40% were also recorded.ResultsA significant improvement in the Bath Ankylosing Spondylitis Disease Activity Index and Ankylosing Spondylitis Assessment Study Group scores was noted in the first year which sustained through the sixth year of treatment. More specifically, after the sixth year of treatment, Bath Ankylosing Spondylitis Disease Activity Index 50% was achieved by 65% of patients (26/40), Ankylosing Spondylitis Assessment Study Group 20% by 72.5% (29/40) and Ankylosing Spondylitis Assessment Study Group 40% was reached by 70% (28/40) of patients. Clinical improvement was associated with the reduction of acute phase reactants, such as C-reactive protein levels. After the first and the second year of treatment, the survival rate of infliximab reached 95%, after the third year it was 80%, while after the fourth year it was 72.5%, which was maintained throughout the fifth and sixth year of therapy. Five patients were increased the dose of infliximab and three of them had shortened the interval infusion. Overall, 11 patients were withdrawn during the observational period, three because of adverse events, two because of lack of efficacy, while six were lost from follow-up.ConclusionInfliximab was effective, safe and well-tolerated in patients with ankylosing spondylitis. The clinical response was maintained for a period of 6 years, with high infliximab survival rate, reaching the percentage of 72.5%.     

Peroneal nerve damage by bicortical tibial screw in ACL reconstruction

Arthroscopically assisted anterior cruciate ligament reconstruction is regarded as a minimally invasive surgery with low morbidity but complications still occur. Reports of neurovascular injuries related to graft harvesting, tunnel placement, or graft fixation are limited. A rare case of peroneal nerve injury related to hardware used for graft fixation in the tibial in a 28-year-old female patient who underwent an anterior cruciate ligament reconstruction surgery using a patellar tendon graft (bone-tendon-bone graft) is presented. Post-operatively, the patient presented with clinical signs of peroneal nerve damage and a reduced range of motion of the knee. Plain radiographs of the knee showed the bicortical screw which used for tibial fixation of the graft, penetrating the fibula and projecting beyond the lateral cortex of the fibular neck. The patient was treated with removal of the hardware and the graft. Intensive physiotherapy resulted in gradual improvement and at 6 months after the second operation the patient regained full range of motion of the knee and almost full muscle strength performing her daily activities without any difficultly and she is at the moment unwilling to undergo further procedure.     

HLA-alloantigen associations in Greek patients with Sj?gren's syndrome

The frequency of HLA-A, -B, and -DR alloantigens was studied in 46 patients with primary Sj?gren's syndrome (pSS), 14 patients with secondary Sj?gren's syndrome (sSS) and rheumatoid arthritis (RA), 26 classical RA patients without clinical or histologic evidence of Sj?gren's syndrome (SS) and 172 normal controls. A statistically significant increase in the frequency of HLA-DR5 alloantigen was observed in the pSS patients, compared with the controls (P less than 0.007, corrected). No differences were detected between pSS patients with or without extraglandular manifestations, nor were any found between anti-Ro(SSA) positive and negative patients. The frequency of HLA-DR3 alloantigen (30%) was not significantly higher in our pSS population than in controls (25%), nor was that of -DR4 in the RA or the sSS patients. The results of the present study indicate that the 'SS susceptibility gene' in Greek patients is linked with the HLA-DR5 expression gene and they support the hypothesis that the fundamental pSS gene may belong to another locus.     

Fine antigenic specificities of antibodies in sera from patients with D-penicillamine-induced myasthenia gravis.

A small fraction of patients with rheumatoid arthritis and other diseases on D-penicillamine treatment may develop antibodies against the acetylcholine receptor (AChR) and symptoms of myasthenia gravis (MG). The mechanism leading to this phenomenon is not known. We have studied the fine antigenic specificities of the anti-AChR antibodies in 19 D-penicillamine-induced MG (pen-MG) patients and compared them with those of antibodies from 204 idiopathic MG patients (the data for 122 obtained from earlier experiments). Antigenic specificities of the circulating antibodies were determined by the capacity of monoclonal antibodies (MoAbs), against certain determinants on the AChR, to inhibit binding of the serum antibodies to the AChR. Monoclonal antibodies against alpha, beta and gamma subunits were used. The anti-AChR antibody patterns of pen-MG patients were very similar to those of idiopathic MG patients. Antibodies to the main immunogenic region, which is located on the extracellular surface of the alpha-subunit, were the predominant group. The variations of antibody specificities in serial sera collected from individual patients at different times were usually small, as were those of idiopathic MG. These results strongly suggest that the antibody repertoire in the sera of idiopathic and pen-MG patients is very similar.     

Clinical features and personality traits associated with psychological distress in systemic sclerosis patients

OBJECTIVE: The aim of the present study was to identify certain clinical parameters and personality characteristics associated with various forms of psychopathology in systemic sclerosis (SSc) patients. METHODS: Fifty-six SSc patients participated in the study, and 74 healthy participants served as controls. A wide range of clinical information was collected, and the following self-report instruments were used: General Health Questionnaire, Symptom Distress Checklist-90-R, Defense Style Questionnaire, Sense of Coherence (SOC) Scale, and Hostility and Direction of Hostility Questionnaire. RESULTS: The odds of being assessed with a psychiatric diagnosis upon interview were 4.5 times greater among SSc patients compared with controls. Disease duration and lower rates of SOC were found to be associated with elevated symptoms of general psychological distress. Elevated symptoms of depression were strongly associated with esophageal involvement, hostility, and defense style used. Elevated symptoms of anxiety were mainly associated with arthritis-related painful conditions and SOC, while psychotic-like symptoms were only associated with age and a specific personality structure. CONCLUSIONS: SSc patients experience elevated symptoms of psychological distress. Several clinical parameters are associated with distress, but the role of various personality traits could not be disregarded. Early psychiatric assessment and intervention could prevent psychological distress in SSc patients.     

HLA antigens in patients with Sj?gren's syndrome

HLA-antigens were studied in 116 Greek patients: 22 with pSS, 14 with sSS and RA, 26 with classical RA and 420 healthy controls. A statistically significant increase in HLA-DR5 was observed mainly in pSS patients with anti-Ro (SSA). A significant increase in HLA-B8, HLA-DR3 and HLA-DR5 was observed in pSS patients with anti-La (SSB) antibodies as compared to the controls.     

Reappraisal of respiratory abnormalities in primary and secondary Sj?gren's syndrome. A controlled study

In order to appraise the significance of respiratory abnormalities in primary and secondary Sjogren's syndrome (pSS and sSS), we evaluated 40 patients with pSS, 26 with sSS, 40 with rheumatoid arthritis (RA) but no SS, and 100 age- and sex-matched control subjects. The most common functional abnormality was diffuse interstitial lung disease (DILD) in patients with pSS (37.5 percent) and obstructive ventilatory defect in RA and sSS patients (40 and 19 percent, respectively). DILD was also present in the last two groups (11.8 percent in sSS and 27.5 percent in RA), while obstructive defect was rare in pSS (2.5 percent). Abnormalities suggesting small airways disease were present in all patient groups and also in the control group with similar frequency. Patients with extraglandular pSS had most often DILD (52 percent). Patients with pSS and cryoglobulinemia had low C3 and C4 levels and decreased Dco, suggesting that interstitial lung disease may be a result of immune complex deposition. Clinical input of the functional abnormalities was minimal, expressed as dry cough and mild dyspnea. Pneumonia was not frequent, while pleurisy was present only in patients with sSS and RA. We suggest that, even though pulmonary abnormalities can frequently be detected with sensitive tests in patients with SS, they are not significant if compared with control subjects and are clinically negligible.     

Immunopathology of the salivary glands of the lips in Sj?gren's syndrome

The cellular composition of the salivary gland infiltrates in primary Sjogren's syndrome and the presence of lymphokines were evaluated using the Avidin-Biotin-Peroxidase technique in 10 biopsies from Sjogren's syndrome patients. The predominant cell was the T-helper/inducer lymphocyte. T-helper/T-suppressor ratio ranged from 1/1 to 10/1. Only few M were observed while NK cells were rare. More than 50% (50-100%) of the infiltrating cells were HLA-DR positive while epithelial cells were positive from 40-90% in all but 2 cases in which the positivity was 10%. The infiltrating cells were also positive for Leu-10 antigen (40-95%) in contrast to the epithelial cells. Both infiltrating and epithelial cells were reacting with anti IL-2 MoAb in high percentages (50-100%), while none of the infiltrating cells expressed IL-2 receptor. Finally, 40-100% of the infiltrating cells were IFN-gamma positive. The above data indicate that a salivary gland lesion in Sjogren's syndrome is the result of an immune process in which T-lymphocytes predominate producing lymphokines while the epithelial cells by expressing class II MHC molecules, play an important role in the general picture.     

Pulmonary function of nonsmoking patients with systemic lupus erythematosus

The pulmonary function of 70 nonsmoking patients with systemic lupus erythematosus (SLE) was evaluated, and the results were compared with those of 70 age- and sex-matched, nonsmoking healthy individuals. Isolated reduction of carbon monoxide diffusing lung capacity (DCO), usually subclinical, was the most commonly detected functional abnormality in the SLE population, whereas it was absent in the comparison group. Isolated small airways disease (SAD) was observed in a relatively high percentage of patients, but not significantly different from that in the healthy people. Restrictive and obstructive patterns were very unusual in the SLE people and absent in the members of the comparison group. Finally, normal lung function was seen in the majority of the latter, but only in one third of the lupus patients. Subclinical respiratory dysfunction, most commonly expressed as diminished DCO, is a common feature of SLE.