Cerebral magnetic resonance imaging in a patient with ankylosing spondylitis and multiple sclerosis-like syndrome.

Clinical and cerebral magnetic resonance imaging (MRI) findings in a patient with ankylosing spondylitis (AS) and multiple sclerosis-like (MS-like) syndrome are reported. Cerebral MRI demonstrated multiple, MS-like, scattered foci of signal abnormality, one of which showed contrast enhancement. Lesion dissemination in "space and time" is a hallmark for diagnosis of MS, and its demonstration by enhanced cerebral MRI prompted suspicion of coexistence of MS and AS in our patient.

[Presence of HLA-DRB1 alleles in a group of patients with rheumatoid arthritis treated with low doses of sodium aurothiomalate]. / Presenza degli alleli HLA DRB1 in un gruppo di pazienti con artrite reumatoide trattato con basse dosi di aurotiomalato di sodio.

The good results of a therapy with small doses of sodium aurothiomalate (20 mg/month) in 17 patients suffering from rheumatoid arthritis are reported. The mean age +/- ESM at the beginning of treatment was 59.9 +/- 3.2 years, the mean duration of disease was 1.3 +/- 0.5 years. The lowest grade of disease activity (1) according to Mallya and Mace's (1981) criteria was observed in 12 patients (70%) after a period of 1.7 +/- 0.6 years (mean +/- ESM). This grade of activity persisted in 11 patients and remained for 3 years in 1 patient. In the other 5 patients a low or middle activity of disease persisted. The relationship between therapeutic results and HLA DRB1 prevalence was investigated. The LLEQRRAA and LLEQKRAA sequences are present in 3 patients, i.e. 17.9%. This frequency is not significantly different from the frequency (28.6%) observed in a control group of healthy subjects. Therefore these sequences, at least in Italian people, cannot be considered a factor of susceptibility to RA. They may be a factor of evolution to a more severe disease. Dermatological side effects were evident only in 2 patients; one of these patients was HLA DR5 positive. The results observed in DR7 positive patients were not different from the results observed in the other patients; therefore, DR7 positive patients could responders to gold treatment, even with low doses.

[Salivary and serum beta 2-microglobulin in the diagnosis of primary Sjögren's syndrome]. / La beta 2-microglobulina salivare e sierica nella diagnostica della sindrome di Sjögren primitiva.

beta 2-microglobulin (beta 2m) serum and salivary levels and total protein salivary levels were determined in 15 patients with primary Sjögren's syndrome (pSS), 14 patients with sicca syndrome and 11 healthy subjects. beta 2m serum and salivary levels were higher (p < 0.005) in the patients with pSS than in the healthy subjects and in the patients with sicca syndrome. The bioptic focus scores of minor salivary glands were correlated to beta 2m salivary levels with a high significance (p < 0.001) but were not correlated to beta 2m serum levels. The assessment of beta 2m serum and salivary levels is a non-invasive clinical investigation, which may be easily repeated. It is a very sensitive and highly specific test for the diagnosis of pSS. It may be therefore a useful mean to follow the natural course of pSS and to evaluate the effects of therapy.

Critical evaluation of gamma-glutamyl transpeptidase levels in rheumatoid arthritis and laboratory indices of disease activity.

Fifty patients with rheumatoid arthritis (RA) were studied to find a possible correlation between some humoral parameters, considered as indexes of the active inflammation, and serum gamma-glutamyl transpeptidase (GGTP); 31 patients with osteoarthrosis were examined as controls. The low coefficient of correlation, obtained in subjects with RA, between GGTP and CRP, alpha 1-acid glycoprotein, fibrinogen and ESR (p less than 0.05) seems to indicate that measurement of this enzyme is of little practical value as an index of the activity of RA. Furthermore, the resulting correlations between serum GGTP and other liver function tests in relation to anti-inflammatory and sedative therapy in patients with RA are considered.