Retroperitoneal fibrosis: a case of a patient (63y/o) treated with low-dose methotrexate (MTX) and 6-methylprednisolone (6-MP)

Retroperitoneal fibrosis (RPF), is a rare fibroinflammatory disease. The pathogenesis of RPF is still unclear and numerous theories have been reported such as environmental factors, immunologic process, genetic component, local inflammation and advanced atherosclerosis. RPF is characterized by the presence of a particular retroperitoneal fibrotic tissue which is white, woody and involving retroperitoneal structures such as the great vessels, ureters and psoas muscle. The main complication of RPF is the obstruction of local structures such as the ureters due to the fibrosis and the treatment of this aspect represents the main challenge for this pathology. RPF medical treatment consists of corticosteroids or/and immunosuppressive therapy. We report a case of a patient (63y/o) affected by idiopathic RPF treated with low-dose methotrexate (MTX) and 6-methylprednisolone (6-MP) for two years, describing and confirming the effectiveness and safety of a long-term low-dose MTX and 6-MP treatment

The role of Interleukin-12 in immune-mediated rheumatic diseases

Objective: IL-12 is a proinflammatory cytokine produced by different antigen presenting cells. It has been shown to exert a critical role in inducing Th1 phenotype, thus initiating cell-mediated immune responses, but the significance of IL-12 in rheumatic diseases is not clear. Aim of the study was to determine IL-12 serum levels in immune rheumatic diseases and to analyse the relationship of this cytokine with main clinical and laboratory parameters. Methods: we analysed, by ELISA, serum IL-12 levels in 114 patients with SLE, 47 with SS, 32 with SSc, 84 with RA, 138 with PA and in 17 healthy controls. We also examined main clinical and laboratory parameters, including autoantibody profile and clinical indices of disease activity. Results: IL-12 serum levels were significantly higher in SLE and SS patients respect to controls. IL-12 serum levels were significantly higher in SLE patients compared to those affected by RA, PA and SSc. When we evaluated disease activity in SLE patients, we found significantly higher IL-12 serum levels in subjects with fever or in those without renal involvement, while no correlation was found in the other rheumatic immune diseases. Conclusions: these findings suggest that IL-12, modulating cell and humoral immune responses, is involved in the pathogenesis of immune rheumatic diseases, such as SLE and SS

Psoriatic polyarthritis of the elderly: radiological assessment

The authors examined retrospectively 157 patients with psoriatic polyarthritis and found in 9 cases (5.7%) a late onset (≤60 yrs) of the articular involvement. The radiological features of these patients were compared with those of 32 subjects presenting an earlier onset (20-45 yrs) but a comparable disease duration, to point out any relevant differences due to the age of onset. The late onset psoriatic arthritis is characterized by a more frequent involvement of DIP (p < 0.01) and PIP-MCP (p < 0.04) joints. In patients with late onset polyarthritis the mean number of DIP (p < 0.01), PIP-MCP (p < 0.004) and DIP-PIP-MCP (p < 0.01) joint erosions, the mean degree of carpal involvement (p < 0.04) and the number of proximal limb joints with radiological lesions (p < 0.03) are significantly higher. Moreover 44% of elderly onset patients have a severe radiological axial involvement. The evidence of severe radiological joint lesions in late onset psoriatic polyarthritis suggests that a careful radiological assessment is required for a better prognostic and therapeutic evaluation of the disease

Red blood cell methotrexate levels in rheumatoid arthritis: Correlations with changes of class specific circulating rheumatoid factors

Red blood cell (RBC) methotrexate (MTX) levels have been studied in rheumatoid arthritis (RA) in attempt to correlate them with efficacy or toxicity, but the relationship with humoral immune system has not been analyzed. We determined the RBC concentrations of MTX in 27 RA patients treated with low-dose MTX and we studied the correlations with changes of immunological, clinical and biological parameters from baseline. After 12 months of therapy, erytrocyte MTX levels, ranging fram 20 to 248 nM/l (m ± sd = 50 ± 58 nM/l), varied considerably among patients and were significantly correlated only with changes from baseline of IgA-RF (p < 0.05). Changes of clinical and biological parameters from baseline were not correlated with MTX levels of RBC and the lowering of IgA-RF during the treatment. Thus we believe that the meaning of this correlation between erytrocyte MTX levels and changes of IgA-RF is unclear and does not seem clinically relevant

Advances in immunology and rheumatoid arthritis pathogenesis

The pathogenesis of Rheumatoid Arthritis (RA) is still largely unknown. From the seminal experimental studies, suggesting a multifactorial mechanism leaded by an antigen specific activation, the direct role of innate immunity in the disease progression has been recently emphasized. In the natural history of RA, characterized by the three phases of the induction, maintenance and tissue destruction, innate immunity seems to be the central player. On the other hands the recent advances about the molecules involved in the T lymphocyte activation, the T cell role in the mechanism of erosion, and the studies about chemochines in the homing and angiogenesis processes support the theory of an antigen specific activation of the adaptive immune system. Therefore, during RA, the pathogenesis of sinovitis and erosions comes from independent pathways involving either innate and adaptive immunity resulting in the final induction of the articular damage

Comparison of ultrasound transmission velocity with computed metacarpal radiogrammetry and dual-photon absorptiometry

The aim of our study was to evaluate the validity of a quantitative US technique for measuring the bone density of the proximal phalanges of the nondominant hand compared with computed meta carpal radiogrammetry and dual-photon absorptiometry (DPA) of the lumbar spine. Mean US bone velocity (UBV) correlated with mean metacarpal cortical index (MCI), with mean metacarpal bone density (MBD) and with bone mineral density (BMD) of the lumbar spine, whereas it was correlated negatively with age and menopause duration. The average UBV was significantly higher in premenopausal women than in postmenopausal women, and higher in normal lumbar DPA patients than in reduced lumbar DPA patients. We conclude that the US evaluation of the nondominant hand proximal phalanges may be a new alternative way for measuring bone mass in screening of osteoporosis