Changes in Composition of ADAMTS-5 and CD-68 in the Knee Joint Synovial Fluid Cells of Meniscal Tears Patients an Immunohistochemical Study / Cambios en la Composición de ADAMTS-5 y CD-68 en las Células del Líquido Sinovial de la Articulación de la Rodilla en Pacientes con Desgarro de Menisco. Un Estudio Inmunohistoquímico

SUMMARY: Meniscus tear is an important injury affecting the quality of life. This work is aimed to investigate the activity of CD68 and ADAMTS-5 in cells in synovial fluid in male and female patients with meniscal tear. In this study ,18 male and 22 female patients with meniscal tears were included. Local pain sensation during patients' physical examination, swelling, performing daily activities and difficulty in running-walking complaints were determined. 5 cc synovial fluids were aspirated from the lateral suprapatellar pouch part of the knees with meniscal pain. After routine histological follow-up of the samples, they were embedded in paraffin and sectioned with microtome and 5 micrometer thickness. CD68 and ADAMTS-5 primary antibodies were used for immunohistochemical analysis. Sections were taken and evaluated with a stylish microscope. The distribution of blood cells after meniscus tear was higher in female patients than in male patients. CD68 distribution in female patients appeared higher than in male patients. CD68 expression was high in macrophage cell cytoplasm. ADAMTS-5 expression was higher in female patients in degenerative cells and apoptotic cells. ADAMTS-5 is an important metallo-protein involved in the development of apoptotic signal and extracellular matrix synthesis in patients with ADAMTS-5 meniscus tear, and it may be an important criterion for the treatment developed after injury. CD68 and ADAMTS-5 activity was thought to be one of the important signal pathways that can be identified in the treatment of meniscus tear.

RESUMEN: La rotura del menisco es una lesión importante que afecta la calidad de vida. El objetivo fue investigar la actividad de CD68 y ADAMTS-5 en células del líquido sinovial en pacientes masculinos y femeninos con desgarro meniscal. Se incluyeron 18 pacientes masculinos y 22 femeninos con desgarros meniscales. Se determinó la sensación de dolor local durante el examen físico de los pacientes, la hinchazón, la realización de actividades diarias y la dificultad al correr y caminar. Se aspiraron 5 cc de líquido sinoviale de la parte de la bolsa suprapatelar lateral de las rodillas de los pacientes con dolor meniscal. Después del seguimiento histológico de rutina, las muestras se incluyeron en parafina y se seccionaron con un micrótomo de grosor de 5 micrómetros. Para el análisis inmunohistoquímico se usaron los anticuerpos primarios CD68 y ADAMTS-5. La distribución de las células sanguíneas después del desgarro del menisco fue mayor en pacientes femeninos que en pacientes masculinos. La distribución de CD68 en pacientes femeninos fue más alta que en pacientes masculinos. Además la expresión de CD68 fue alta en el citoplasma de los macrófagos. La expresión de ADAMTS-5 fue mayor en pacientes femeninos en las células degenerativas y células apoptóticas. ADAMTS-5 es una metaloproteína importante en el desarrollo de la señal apoptótica y la síntesis de matriz extracelular en pacientes con rotura de menisco ADAMTS-5, y puede ser un criterio importante para el tratamiento después de la lesión. La actividad de CD68 y ADAMTS-5 era una de las vías de señal importantes que se pueden identificar en el tratamiento de la rotura del menisco.

Determination of diagnostic value (validity) leukocyte esterase (urine dipstick strip) in differentiating inflammatory arthritis from bacterial arthritis

Abstract Background: The current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis. Methods: We collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Each group included 34 patients. We compared the result of the synovial LE test with the result of the culture of each patient. Results: The mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture. Conclusion: The leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis.(AU)

Clinical significance of detection of soluble interleukin 2 receptor alpha chain in the assessment of rheumatoid arthritis disease activity / 北京大学学报(医学版)

OBJECTIVE@#To evaluate soluble interleukin-2 receptor alpha chain (sIL-2Rα, sCD25) in serum for the determination of rheumatoid arthritis (RA) activity.@*METHODS@#Peripheral blood was collected from 108 patients with RA, 39 patients with osteoarthritis (OA) and 50 healthy control subjects, and synovial fluids were from 40 patients with RA. The sera from the patients with RA, the disease control group (osteoarthritis), the healthy control group, and the synovial fluids of the RA patients were detected by enzyme-linked immunosorbent assay (ELISA).The clinical manifestations and laboratory parameters of the patients with RA were recorded and the correlation with the serum sCD25 level was analyzed.@*RESULTS@#The serum sCD25 concentration in RA group was (2 886±1 333) ng/L, the serum sCD25 concentration in OA group was (2 090±718) ng/L, and the serum sCD25 concentration in healthy group was (1 768±753) ng/L. The serum sCD25 level in the patients with RA was significantly higher than that in the disease controls and healthy controls (P<0.001). Sensitivity of serum sCD25 in the diagnosis of RA was 66.1% and specificity was 83.0%;serum sCD25 levels and erythrocyte sedimentation rate (r=0.321, P=0.001), C-reactive protein (r=0.446, P<0.001), DAS28 score (r=0.324, P<0.001), joint tenderness count (r=0.203, P=0.024), D-dimer levels (r=0.383, P<0.001), age (r=0.24, P=0.007), IgG (r=0.207, P=0.028), HRF-IgG (r=0.345, P=0.034) showed a significant positive correlation, and disease duration (r=-0.206, P=0.021) showed a negative correlation with sCD25;In patients with rheumatoid arthritis, the positive rates of serum ESR, CRP, and sCD25 were 14.3% (2 cases), 14.3% (2 cases), and 71.4% (10 cases) in the low disease activity group. The positive rates of serum ESR, CRP and sCD25 in the moderate disease activity group were 94.2% (49 cases), 82.7% (43 cases), and 86.5% (45 cases). The positive rates of serum ESR, CRP, and sCD25 in the high disease activity group were 100% (42 cases), 95.2% (40 cases), and 90.5% (38 cases);36 cases of ESR and/or CRP were negative (about 33.3%) in 108 patients, serum sCD5 levels of 17 cases in these 36 cases (about 47.2%)increased, of which 14 cases (about 82.4%) had a DAS28 score higher than 3.2.@*CONCLUSION@#The serum sCD25 has a high specificity for diagnosis of RA and a poor sensitivity. The serum level is closely related to the activity of RA, indicating that sCD25 may be involved in the inflammatory process of RA and may become a new inflammatory marker of RA. It is more meaningful for detection of serum sCD25 when RA is active, but ESR and/or CRP is negative.

Esterasa leucocitaria como prueba diagnóstica ante un proceso infeccioso articular de rodilla / Leukocyte esterase as a diagnostic tool for an infectious disease of the knee

Resumen: Antecedentes: La infección articular es un reto ortopédico por su complejidad diagnóstica y efectos devastadores al no tratarse oportunamente. Contamos con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren de infraestructura compleja. En este estudio determinamos la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. Material y métodos: Durante Noviembre de 2015 a Abril de 2016, se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante, y de otros sin infección, con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos; se determinó positivo para infección con dos cruces; el resto de la muestra fue enviado a cultivo. Resultados: Realizamos el test en 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad de 100%, especificidad de 88.24%, VPP de 68.42% y VPN de 100%; índice de Kappa de .753. Conclusiones: La esterasa leucocitaria es una prueba eficaz para detectar un proceso infeccioso contra uno inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia Kappa de 0.753, con lo que demostró ser reproducible, por lo que recomendamos implementarlo en los servicios de urgencias a nivel nacional.

Abstract: Background: Articular infection is an orthopedic challenge due to its difficult diagnosis and devastating results. Various diagnostic studies exist: culture, ESR, CRP, count of leukocytes, among others, but none is specific, they all take more than 30 minutes to complete, and require complex infrastructure. In this study, we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. Material and methods: During November 2015 to April 2016, we obtained synovial fluid from two groups of patients: one with a diagnosis of synovial joint infection with or without implant, and the control group, without infection but with degenerative pathology of the knee. We evaluated the sample using the leukocyte esterase test COMBI-SCREEN 11SYS with colorimetric reading at two minutes; two crosses determined positive for infection; the remainder of the sample was sent for culture. Results: We performed the test in 64 samples of synovial fluid, 19 diagnosed with articular infection and 45 without it. We obtained a sensitivity of 100%, specificity of 88.24%, PPV of 68.42%, and NPV of 100%; Kappa index of .753. Conclusions: Leukocyte esterase is an effective test to detect an infectious process against an inflammatory one with a high probability of success. This study presented an index of agreement Kappa of 0.753, proving to be reproducible.

Características fisicoquímicas e citológicas do líquido sinovial da articulação temporomandibular em eqüinos / Physical, biochemical and cytological characteristics of the equine temporomandibular joint synovial fluid

Foram estudadas as características fisicoquímicas e citológicas do líquido sinovial da articulação temporomandibular de dez eqüinos hígidos. Verificou-se que o líquido é viscoso, amarelo claro a citrino, límpido e livre de partículas à temperatura ambiente. Houve contaminação da amostra por sangue em três amostras que se apresentaram amarelo avermelhadas a vermelhas e de aspecto turvo. A taxa de glicose variou entre 100 e 250 e a concentração protéica não ultrapassou 3,8g/dL. O número médio de células nucleadas foi de 417 células/µL, com predominância de grandes células mononucleares e linfócitos. As mensurações das características pesquisadas no líquido sinovial da articulação temporomandibular de eqüinos são de execução simples e passíveis de implantação na rotina de atendimentos clínico-cirúrgicos.

Physical, biochemical and cytological characteristics of the temporomandibular joint synovial fluid were studied in ten clinically normal horses. It is a viscous, pale yellow, clear fluid and without flocculent material at room temperature. There was blood contamination in three samples, they presented red-yellow to red and cloudy. The range of glucose levels were 100 to 250 and its protein concentration was up to 3,8g/dL. Nucleated cells mean number was 417 cells/µL, with predominating large mononuclear cells and lymphocytes. Equine temporomandibular synovial fluids can be easily evaluated, being feasible in clinical and surgical routine, and the information may be useful to the diagnosis, treatment and prognosis of animals with temporomandibular alterations.

expression of osteopontin in synovial fluid of patients with rheumatoid arthritis: relation to high resolution ultrasound and disease activity

To demonstrate the expression of OPN in the synovial fluid of patients with RA and to correlate it with high resolution ultrasonographic [HRUS] findings and disease activity. This study was conducted on 30 RA patients and 20 patients with osteoarthritis [OA]. For RA patients, disease activity was assessed using the modified disease activity score [DAS]. For all patients, plasma and synovial fluid OPN concentrations were quantified using ELISA system. HRUS with B-mode ultrasound supplemented with power Doppler [PDUS] using standardized technique, was done for joints from which synovial fluid was obtained, then the cartilage thickness was measured, synovial thickening and bone erosions were recorded, and the resistive index was calculated. OPN levels were elevated in plasma and synovial fluid of RA patients. Comparison of OPN synovial fluid between RA and OA patients showed a highly significant statistical difference [p<0.001], being higher in the RA patients. OPN synovial fluid level in RA correlated significantly with disease activity score as well as with HR US findings. OPN levels were elevated in plasma and synovial fluid of RA patients. OPN level correlated significantly with disease activity, also with increased synovial thickness and bone erosions, as detected by HRUS. OPN could serve as a useful biochemical marker of RA

[Determination of lactate level in serum and joint knee synovial fluid in patients with arthritis]

There is not a suitable marker in dilution method in analysis of biomarker in joint fluid. In past, dye dilution method was used for joint fluid, but there were some errors. The aim of this work is the use of rate change lactate level in serum and synovial fluid of patients with arthritis by application of dilution method and direct aspiration as a biomarker. In this cross-sectional study synovial fluid were obtained from 30 arthritis patients by direct aspiration. Also, serum sample were obtained from these patients. Serum and synovial fluid lactate level was measured by standard biochemical methods. For analysis results Students t-test was used and P was less than 0.05. lactate concentration increases in synovial fluid [14.1 +/- 2.3 mg/dl] in compare with serum [12.9 +/- 2.1 mg/dl], but the differences were not significant [p>0.05]. The difference between lactate concentration in synovial fluid and serum is not significant. The rate change of lactate concentrations in synovial fluid and serum was stable

Production and characterization of glucosamjne from bovine synovial fluid

Glucosamine is a natural aminomonosaccharide, which is a normal constituent of glycosaminoglycans in cartilage matrix and synovial fluid. Glucosamine has a role in the synthesis of cell membrane [building] lining, collagen, osteoid, and bone matrix. The present work was undertaken to investigate bovine synovial fluid for the production of glucosamine. The method used for isolation of glucosamine included acid hydrolysis of the fluid. The produced glucosamine [0.73-2.60%] had been purified and characterized by different identification methods that include: chemical colour tests; thin layer chromatography; C[18]- high performance liquid chromatography and infrared spectrophotometeiy compared to standard glucosamine. We can conclude that, there is an essential need for every body to produce and/or to take glucosamine supplements to stimulate the production of synovial fluid which lubricates cartilage and keeps joint healthy. This led to the fact that reliable analytical methods should be carried for quality assessment of glucosamine commercial products used by consumers. In this research the investigated bovine synovial fluid was recognized to afford a considerable amount of glucosamine obtained by acid hydrolysis. The adopted and the described methods of analysis could be applied in qualitative and quantitative determination surveys of different supplement products containing glucosamine

The preservation method and timing on accuracy of manual leukocytes counts in synovial fluid.

OBJECTIVES: To compare the efficacy of heparin and EDTA and determine the impact of time delays in stabilizing leukocyte counts in synovial fluid. MATERIAL AND METHOD: 33 specimens were collected in heparin-preserved and EDTA-preserved containers. Total cell count was performed manually at 1 hour and 24 hours. Correlation between cell counts from both preservatives and the leukocyte number at 1 hour and 24 hours were analyzed by means of agreement measurement. RESULTS: There were good correlations between the leukocyte numbers from the specimens preserved by heparin and EDTA (ICC = 0.889, r = 0.879, P < 0.0001 at 1 hour and ICC = 0.822, r = 0.693, p < 0.0001 at 24 hour). At 24 hours, total cell counts from EDTA-preserved samples were comparable to those obtained at 1 hour (ICC = 0.985, r = 0. 986, p < 0. 0001) and were not different from those of the heparinized samples (ICC = 0.833, r = 0. 751, p < 0.0001) but the ICC value was higher. CONCLUSION: EDTA was as effective as heparin for preservation of synovial fluid. Therefore, it can be used routinely as a preservative of synovial fluid.

Search for crystals in synovial fluid

Synovial fluid analysis is a very important diagnostic procedure in rheumatology. Cell count allows the differentiation between inflammatory arthritis, in which cell count exceeds 2000 cells/mm3, and non inflammatory arthropathy, in which cell count is less than 1000 cells/mm. Demonstration of crystals in synovial fluid is a rapid and inexpensive way to diagnose microcrystalline arthritis. Synovial fluid must be examined under normal and polarized light. Monosodium urate crystals are negatively birefringent, whereas calcium pyrophosphate dihydrate crystals are positively birefringent. Other crystals [cholesterol, oxalate, corticosteroids] can also be identified in synovial fluid. Various artefacts must be avoided including anticoagulant crystals and synovial fluid must be anticoagulated with sodium heparin or citrate

Características físico-químicas e citológicas do líquido sinovial da bainha tendínea digital de eqüinos / Physical, biochemical and cytological characteristics of the equine digital flexor tendon sheath synovial fluid

Foram estudadas as características físico-químicas e citológicas do líquido sinovial da bainha tendínea digital de nove eqüinos hígidos. Verificou-se que o líquido é viscoso, amarelo claro, límpido, livre de partículas e que não coagula à temperatura ambiente. Sua concentração média de ácido hialurônico foi 60,20mg/dl, a taxa de glicose, similar à plasmática e sua concentração protéica não ultrapassou 1,74g/dl, com relação média albumina:globulina de 0,94. O número médio de células nucleadas foi de 313 células/æl, com predominância de grandes células mononucleares e linfócitos. Houve correlação significativa (r = - 0,649, P<0,01) entre o aumento da concentração de ácido hialurônico e a diminuição percentual de linfócitos. As mensurações das características pesquisadas no líquido sinovial da bainha tendínea digital de eqüinos são de execução simples e passíveis de implantação na rotina de atendimentos clínico-cirúrgicos.

Studies on the normal synovial fluid from the carpal joints of Iranian water buffaloes: physical and biochemical parameters

Reports on the physical and biochemical parameters ofsynovial fluid in buffaloes are limited. This study was conducted to evaluate the normal parameters ofsynovial fluid on buffaloes that can be very helpful in diagnosis of arthropathy. Synovial fluid of carpal joints was collected by arthrocentesis of the right and left forelimbs in 21 water buffaloes immediately after slaughtering of animals in abattoir. The quality of mucin clot and viscosity were normal in 100% of animals. The synovial fluid was colorless in 50% of cases and the other 50% had a yellowish color. Only 77.5% of samples were transparent and 22.5% were semitransparent. The range of values for different measured parameters were: AST: [27.65 +/- 5.9] IU/L, ALT: [15.08 +/- 2.75] IU/L, LDH: [36.55 +/- 13.28] IU/L, glucose: [59.25 +/- 3.39] mg/dL, total protein: [0.89 +/- 0.055] g/dL, urea nitrogen: [7.96 +/- 1] mg/dL. There was no significant difference between groups according to age, sex and side [left and right forelimbs] for all parameters except ALT and LDH which differed according to sex, ALT and LDH were significantly [P<0.05] greater in females

Conceptos actuales del tratamiento de las alteraciones en la articulación temporomandibular / Current concepts in the treatment of temporomandibular joint disorders

Se presenta en este artículo una explicación de la patología de la articulación temporomandibular, así como los procesos bioquímicos y destructivos que desencadenan el problema articular, explicándose la terapéutica actual de la misma

Laboratory investigations for rheumatic disease.

Laboratory investigations are very important tools in the diagnosis of rheumatic diseases. Nowadays a large number of tests are available. The authors have discussed some important tests of value in day to day practice.

Clinical application of tests used in rheumatology.

Laboratory investigations are an integral part of evaluation of a child with rheumatic disease. In rheumatic diseases markers of inflammation like CRP and erythrocyte sedimentation are usually raised. In addition, various autoantibodies like anti-nuclear antibody, rheumatoid factor, anti-neutrophil cytoplasmic antibody help in diagnosis of systemic autoimmune rheumatic diseases. Synovial fluid analysis is useful in evaluating a patient with monoarthritis. The lab tests should not be done indiscriminately and choice of test should be based on provisional clinical diagnosis. A high pre-test probability increases the utility of test. Tests with high sensitivity should be used for screening whereas tests with high specificity should be used for confirmation of diagnosis. Finally, mere presence of an abnormal test does not mean disease.

Cartilage proteoglycan aggrecan as a predictor of joint damage in juvenile rheumatoid arthritis

Aggrecan was measured in the sera of 31 children with juvenile rheumatoid arthritis and in the synovial fluid of 10 of them. Patients were evaluated at baseline and 3 months later. Radiographs were repeated also after 1 year. As comparison, 15 apparently healthy children with no disease and 10 children with arthritis due to other collagen vascular diseases were studied. Baseline serum aggrecan was significantly higher in juvenile rheumatoid arthritis patients compared to controls and other patients. On re-evaluation, a significant drop in serum aggrecan from baseline values coincided with a significant drop in clinical and laboratory indices of active inflammation. Serum aggrecan can help to assess the extent of cartilage destruction and is useful as a prognostic tool to predict joint damage in patients with juvenile rheumatoid arthritis

Artrocentesis temporomandibular como modalidad terapéutica para desarreglos internos. Reporte de 23 casos en el Hospital Central Dr. Ignacio Morones Prieto, SLP / Temporomandibular arthrocentesis as a therapeutic modality for internal derangements. Report of 23 cases in the Hospital Central Dr. Ignacio Morones Prieto, SLP

La artrocentesis temporomandibular, descrita por primera vez en la literatura norteamericana en 1991, es un método sencillo para el tratamiento del bloqueo articular (limitación aguda, persistente y dolorosa de la movilidad). El propósito del presente es evaluar la eficacia de dicha técnica en el tratamiento del bloqueo temporomandibular. Se realizó artrocentesis en 23 paciente con bloqueo temporomandibular en fase aguda, registrando previamente el valor del dolor mediante una escala visual análoga, así como la apertura bucal, protrusión y lateralidades derecha e izquierda en milímetros, antes y después del tratamiento durante un seguimiento de seis meses a un año. Resultados: durante el seguimiento, la apertura bucal y función mandibular mejoró considerablemente, con un decrecimiento del dolor en todos los pacientes. Conclusión: la artrocentesis temporomandibular se recomienda como una alternativa sencilla y efectiva para el tratamiento del bloqueo articular temporomandibular agudo y persistente

Synovial fluid respiratory gases: a laboratory approach to synovium circulatory-metabolic imbalance in rheumatoid arthritis

To investigate the impact of circulatory insufficiency relative to synovial tissue metabolism in rheumatoid arthritis [RA] and its differentiation from other causes of knee effusions and arthritis, 60 synovial fluid specimens from adult females with age ranging 18-72 years were studied. They were further subdivided into 20 patients with osteoarthritis [OA] [group-I], 25 patients with RA [group II] and 15 cases of traumatic knee effusion [group III] serving as controls. Synovial fluids were analyzed for partial pressure of oxygen [PO2], carbon dioxide [PCO2], hydrogen ion concentration [pH], glucose content, cell counts and mucin clot test. The obtained data were correlated with the severity of the clinical status. The results were presented and discussed

IL-1beta, IL-6 and TNF-alpha in synovial fluid of patients with non-gonococcal septic arthritis.

Interleukin-1 beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) are the main proinflammatory cytokines responsible for the inflammatory process and cartilage destruction of inflammatory arthropathies. The present study sequentially measured the concentrations of these cytokines and their proportions of detectable levels in the synovial fluid (SF) of 23 patients with non-gonococcal (GC) septic arthritis before and after treatment. Persistently high concentrations and proportions of IL-6 and TNF-alpha were found up to day 7 of treatment, while SF IL-1beta concentration declined significantly after day 7 (p = 0.036). SF IL-1beta and TNF-alpha correlated with each other significantly and with SF WBC counts (p < 0.01). Positive correlations between SF IL-1beta concentration and joint effusion (p < 0.01) and between SF TNF-alpha concentration and joint tenderness (p < 0.001) were observed. SF IL-1beta and TNF-alpha were significantly higher in patients with local complications of septic arthritis. In conclusion, high levels of IL-1beta, IL-6 and TNF-alpha were detected in SF of patients with non-GC septic arthritis. Only IL-1beta decreased significantly after day 7 of treatment, but IL-6 and TNF-alpha concentrations were persistently high. SF IL-1beta and TNF-alpha may be useful in predicting the outcome and complications of patients with this disease.