Expression of the multidrug resistance glycoprotein 170 in the peripheral blood lymphocytes of rheumatoid arthritis patients. The percentage of lymphocytes expressing glycoprotein 170 is increased in patients treated with prednisolone.

The objective was to evaluate the expression of the multidrug resistance P-glycoprotein (P-gp) in peripheral blood lymphocytes (PBL) of patients with rheumatoid arthritis (RA). PBL from 68 RA patients and 44 controls were evaluated. RA patients had a mean disease duration of 10.7 yr, with a mean number of past resistances to DMARDs of 0.82, and were treated with NSAIDs (n = 34), DMARDs (n = 25) and prednisolone (n = 40). Fluorescence flow cytometry was used to assess P-gp membrane expression on PBL. In the RA group, the percentage of PBL expressing P-gp was higher in patients treated with prednisolone than in other patients [mean +/- S.D.: 10.7 +/- 15.8% vs 3.3 +/- 7.6%, P < 0.03, Student] and was not related to other therapies, age, sex, RA duration, number of past resistances to DMARDs, activity, ESR, CRP. The percentage of PBL expressing P-gp did not differ in RA and control groups, but was higher in the prednisolone-treated RA patients than in controls. Prednisolone could induce a rise in the percentage of PBL expressing P-gp. On the contrary, patients with a high percentage of PBL expressing P-gp could be more resistant to DMARDs and need prednisolone earlier. Further studies are needed to address this question and to evaluate the potential implication of P-gp in drug resistance in RA.

Systemic effects of epidural dexamethasone injections.

OBJECTIVES: to evaluate potential systemic effects of a single epidural injection of dexamethasone. PATIENTS AND METHODS: each of nine patients (five males and four females, mean age 47 +/- 11.8 years) admitted for sciatica was given a single epidural injection of 15 mg dexamethasone acetate. Before the injection (D0) and two (D2), seven (D7) and 21 (D21) days after the injection, the following laboratory tests were performed: serum cortisol and ACTH in the morning after an overnight fast, free cortisol in a 24-hour urine collection, fasting serum levels of glucose, triglycerides and cholesterol, serum levels of sodium and potassium. Blood pressure was measured on D0, D2, and D7. RESULTS: Serum cortisol, ACTH and urinary cortisol were profoundly decreased on D2 and D7 but normal on D21. There were no changes in fasting serum glucose, triglycerides, cholesterol, sodium or potassium levels. CONCLUSION: a single epidural injection of 15 mg dexamethasone acetate is associated with transient adrenal suppression, denoting passage of the steroid into the systemic bloodstream. However, evidence of hypercorticism is usually lacking.

[Dilated cardiomyopathy disclosing dermatopolymyositis. Management]. / Cardiomyopathie dilatée révélant une dermatopolymyosite. Attitude thérapeutique.

Cardiac involvement in dermatopolymyositis is common but rarely symptomatic. Cardiac failure as the presentation is very rare. No correlation exists between the severity of muscular involvement and cardiac involvement. Myocarditis is not uncommon and must be borne in mind if CK MB are above 3% of total CK. It is always associated with electrocardiographic abnormalities. Corticosteroids remain first line treatment. They generally lead to regression of cardiac problems which are usually of secondary importance. If cardiac involvement is severe, the spectacular action of venoglobulins should lead to their use being envisaged from the outset, combined with corticosteroids.