Urinary Transforming Growth Factor-beta Induced Gene-h3 (betaig-h3)as a Marker of Lupus Activity in SLE with Nephritis / 대한류마티스학회지

BACKGROUND: TGF-beta-induced gene-h3 (betaig-h3) is a novel gene induced by active TGF-beta and the association with other renal disease is reported. Lupus nephritis is characterized by excessive extracelluar matrix accumulation and the implication that TGF-beta is increased in lupus nephritis is known. We measured the urinary betaig-h3 in lupus nephritis and sought its association with the activity of lupus nephritis through renal biopsy. The objective of this study was to examine urinary betaig-h3 excretion in lupus nephritis and the association with activity of lupus nephritis. METHODS: Fifteen patients (median age 32.6 2.9 years, range 18~64) who developed lupus nephritis underwent renal biopsy. At the time of biopsy, they showed significant proteinuria. Total urinary betaig-h3 concentration was assayed by enzyme-linked immunoabsorbent assay and expressed as a ratio to urinary creatinine concentration. RESULTS: There were correlations between urinary betaig-h3 and the reduction of C3 (r= 0.566, p=0.028<0.05), the magnitude of proteinuria (r=0.531, p=0.042<0.05). The Activity Index, Chronicity Index in the renal biopsy, C4, anti-dsDNA Ab titer were not significantly correlated with urinary betaig-h3 excretion, but the patients with high Activity Index had the increased level of urinary betaig-h3. Five patients who had fibrinoid necrosis in renal biopsy showed higher level of urinary betaig-h3 than the others (107.78 43.02 vs. 50.21 10.12 ng/ ml, p=0.061) CONCLUSION: In this study, There is some correlation between urinary betaig-h3 and the activity of lupus nephritis. Urinary betaig-h3 may play a role in predicting the active lupus nephritis. A further study is needed in large population and in situ expression of betaig-h3.

Efficacy of High Dose Intravenous Immunoglobuline Therapy in Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: Although clearly demonstrated in idiopathic thrombocytopenic purpura, Kawasaki disease, the efficacy of intravenous immunoglobulins in the treatment of rheumatic diseases is still being debated. We investigated the effect of high dose intravenous immunoglobulins in selected rheumatic diseases. METHODS: Twenty nine patients with rheumatic diseases who had received high dose intravenous immunoglobulins were studied. There were 18 patients with systemic lupus erythematosus (SLE), 8 dermatomyositis/polymyositis (DM/PM) patients, 2 adult onset still's disease (AOSD) patients and 1 Henoch-schnlein purpura patient. They were treated with high dose intravenous immunoglobulins (each course consisted of 400 mg/kg for 5 days). Each patient received between 1-37 treatment courses. These patients were evaluated both by clinical outcome and by serologic profile that were taken before and after treatment. RESULTS: Clinical improvement was observed in 16 patients out of 29 patients. Nine patients of them could decrease daily prednisolone doses. The clinical manifestations that responded good were: skin rash and ulcer, high fever, vasculitis, hemolytic anemia, throm-bocytopenia, myositis. However lupus nephritis and interstitial lung disease did not benefit from the treatment. CONCLUSION: The high dose intravenous immunoglobulin treatment is good in patients with SLE, DM/PM and AOSD when they are steroid dependent or steroid resistant.