Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis

BACKGROUND: To improve quality of life (QOL) in patients with multiple sclerosis (MS), it is important to decrease disability and prevent relapse. The aim of this study was to examine the causal and mutual relationships contributing to QOL in Japanese patients with MS, develop path diagrams, and explore interventions with the potential to improve patient QOL. METHODS: Data of 163 Japanese MS patients were obtained using the Functional Assessment of MS (FAMS) and Nottingham Adjustment Scale-Japanese version (NAS-J) tests, as well as four additional factors that affect QOL (employment status, change of income, availability of disease information, and communication with medical staff). Data were then used in structural equation modeling to develop path diagrams for factors contributing to QOL. RESULTS: The Expanded Disability Status Scale (EDSS) score had a significant effect on the total FAMS score. Although EDSS negatively affected the FAMS symptom score, NAS-J subscale scores of anxiety/depression and acceptance were positively related to the FAMS symptom score. Changes in employment status after MS onset negatively affected all NAS-J scores. Knowledge of disease information improved the total NAS-J score, which in turn improved many FAMS subscale scores. Communication with doctors and nurses directly and positively affected some FAMS subscale scores. CONCLUSIONS: Disability and change in employment status decrease patient QOL. However, the present findings suggest that other factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL

An examination of the Apo-1/Fas promoter Mva I polymorphism in Japanese patients with multiple sclerosis

BACKGROUND: The Apo-1/Fas (CD95) molecule is an apoptosis-signaling cell surface receptor belonging to the tumor necrosis factor (TNF) receptor family. Both Fas and Fas ligand (FasL) are expressed in activated mature T cells, and prolonged cell activation induces susceptibility to Fas-mediated apoptosis. The Apo-1/Fas gene is located in a chromosomal region that shows linkage in multiple sclerosis (MS) genome screens, and studies indicate that there is aberrant expression of the Apo-1/Fas molecule in MS. METHODS: Mva I polymorphism on the Apo-1/Fas promoter gene was detected by PCR-RFLP from the DNA of 114 Japanese patients with conventional MS and 121 healthy controls. We investigated the association of the Mva I polymorphism in Japanese MS patients using a case-control association study design. RESULTS: We found no evidence that the polymorphism contributes to susceptibility to MS. Furthermore, there was no association between Apo-1/Fas gene polymorphisms and clinical course (relapsing-remitting course or secondary-progressive course). No significant association was observed between Apo-1/Fas gene polymorphisms and the age at disease onset. CONCLUSIONS: Overall, our findings suggest that Apo-1/Fas promoter gene polymorphisms are not conclusively related to susceptibility to MS or the clinical characteristics of Japanese patients with MS

Memory and naïve B-cell subsets in patients with multiple sclerosis

Memory and naïve B cells are considered to play distinct roles in immune regulation. However, the roles of memory and naïve B-cell subsets in multiple sclerosis (MS) have not yet been elucidated. In this study, we examined whether memory and naïve B-cell subsets differ between patients with MS and healthy subjects and whether interferon beta (IFNβ)-1b can affect these subsets in patients with MS. We also studied these subsets in relapsing and remitting stages of MS. Subjects included 31 patients with relapsing-remitting MS in the remitting stage, of which 15 were treated with IFNβ-1b and 16 were not treated, and 22 healthy control subjects. For 11 of the 16 untreated patients, blood samples were also obtained in the relapsing stage. Expression of CD5, CD80, CD86, CCR5, CXCR3, CD11a, and CD49d in memory and naïve B cells in blood samples was examined by flow cytometry. The percentages of CD86+ cells and CCR5+ cells in the naïve B-cell subset were significantly higher in untreated patients than in control subjects or IFNβ-treated patients. In patients with MS, the percentages of CD86+ cells and CCR5+ cells in the naïve B-cell subset and the percentage of CD5+ cells in the memory B-cell subset were significantly greater in the remitting stage than in the relapsing stage. These results indicate that memory and naïve B-cell subsets, especially CD86+ naïve B cells, CCR5+ naïve B cells, and CD5+ memory B cells, might be useful in the study of the pathogenesis of and therapy for MS

Aseptic Meningitis with Relapsing Polychondritis Mimicking Bacterial Meningitis

Relapsing polychondritis (RP) is a rare multisystem autoimmune disease. Though meningitis in RP is not common, some cases with cerebrospinal fluid (CSF) pleocytosis of lymphocyte cells have been reported. Of the 18 previously reported cases, two cases demonstrated pleocytosis of polymorphonuclear leukocytes (PMN) in the CSF. In addition, the cases whose glucose level in the CSF was decreased also were seen. Our case also demonstrated pleocytosis of PMN in CSF mimicking bacterial meningitis. In the clinical field, we cannot get the culture of CNF on the day. We regard the gulucose level and cellular fraction as impotant. Therefore, we must look upon meningitis in RP as a differential diagnosis of bacterial meningitis

MRI and pathological findings of rheumatoid meningitis

Rheumatoid meningitis (RM) is one of the severest complications of rheumatoid arthritis (RA) and the mortality rate is relatively high. RM diagnosis is sometimes very difficult. We present the case of an 80-year-old woman who was diagnosed with microscopic findings of RM from the biopsy specimens from a brain lesion. MRI revealed meningeal enhancement in the brain, and the pathological findings were meningeal lymphocytic infiltration, vasculitis and rheumatoid nodules. RM is a treatable disease and this is an important RM case that was diagnosed on the basis of biopsy findings