[Societals costs of trauma]. / Maatschappelijke kosten van trauma.

BACKGROUND: Knowing the costs of trauma aids in making informed decisions about investments to prevent and treat trauma. AIM: To provide an overview of the potential societal costs of psychological problems caused by traumatic experiences. METHOD: Using a narrative review based on the available literature on PTSD and adverse childhood events (ACEs), we estimated the possible societal costs for the Netherlands. We used literature on the domains of wellbeing, healthcare, education and labour, crime and justice, and intergenerational transfers. RESULTS: We estimated that costs due to loss of wellbeing may span from tens of millions to several billion euros annually for the Netherlands. Healthcare costs and costs due to lower educational attainment and reduced labor productivity were likely to amount to hundreds of millions of euros annually. Other domains were not quantifiable given current knowledge. CONCLUSION: Although societal costs cannot completely reliably be determined with current literature, there are reasons to assume that these costs can be significant. Investments in prevention and effective treatment could therefore lead to significant savings.

The tetracycline derivative minocycline differentially affects cytokine production by monocytes and T lymphocytes.

Minocycline is a tetracycline derivative that has beneficial effects in noninfectious forms of arthritis and dermatitis. To investigate whether this effect may be attributed to interference with cytokine production, we studied the effect of minocycline on cytokine production by T cells and monocytes. Minocycline exerted an inhibitory effect on tumor necrosis factor alpha (TNF-alpha) and gamma interferon production by stimulated T cells, whereas the production of interleukin 6 (IL-6) remained unaffected. The effect of minocycline on TNF-alpha mRNA synthesis by T cells was shown to be stimulus specific. T cells stimulated by a Ca2+-independent mode exhibited a decrease in TNF-alpha mRNA in the presence of minocycline, whereas the TNF-alpha mRNA level remained unaffected by minocycline when cells were stimulated in a Ca2+-dependent manner. In contrast to the effect on T cells, addition of minocycline to lipopolysaccharide-stimulated monocytes led to a dose-dependent increase in TNF-alpha and IL-6 production which was paralleled by an enhancement of TNF-alpha mRNA synthesis. These results indicate that minocycline exerts differential effects on the regulation of cytokine production by T cells and monocytes that are partly reflected at the mRNA level. Given the pleiotropic effects of minocycline, it is suggested that the immunostimulatory effect on monocytes might counteract its beneficial properties in the treatment of several forms of chronic inflammation.

Cutaneous immunofluorescence in ankylosing spondylitis. Absence of correlation with disease activity.

Biopsy specimens of normal skin from 43 patients with ankylosing spondylitis (AS) were studied for immunoglobulin and complement deposition by immunofluorescence and for histological abnormalities by light microscopy. The results were compared with those of 17 healthy subjects. Perivascular deposits of IgA, IgG, IgM and C3 were found in 26, 47, 56 and 33%, respectively, of the patients with AS. Skin deposits of IgA, IgG and C3 occurred significantly more frequently in patients with AS compared to healthy subjects. Perivascular mononuclear cell infiltration was found in only 8 (19%) of the patients with AS. The results of both immunofluorescence and histologic studies did not correlate with disease duration, disease activity, extraarticular features or the presence of circulating immune complexes. Our findings suggest a role of humoral immunopathological mechanisms in AS but also show that cutaneous immunofluorescence cannot serve as a marker of disease activity.

Spontaneous immunoglobulin synthesis by peripheral mononuclear cells in active rheumatoid arthritis.

Spontaneous production of immunoglobulins (Igs) by peripheral blood mononuclear cells (PBMC) in vitro was investigated to assess B cell activity in a group of 24 patients with rheumatoid arthritis (RA) with or without active joint disease and with or without rheumatoid vasculitis (RV) at the time of study. PBMC of patients with active arthritis (Ritchie index above 16) produced significantly more IgG and IgA than those of patients with inactive joint disease or those of 12 healthy controls. Enhanced production of IgG was found mainly among RA patients with concomitant RV, whereas markedly enhanced IgA production could also be found in patients without symptoms of RV. IgM production was only enhanced in two patients who had both active arthritis and RV. High production of IgG and IgA was probably due to increased numbers of Ig-secreting cells among freshly isolated PBMC, since the concentrations of Ig produced in vitro rose steadily, starting on day 0 and persisting throughout the entire culture period. Moreover, IgG and IgA concentrations measured after 7 days of culture showed significant correlations with the numbers of IgG- and IgA-containing plasma cells in PBMC on day 0. Comparison of the spontaneous production of Igs by PBMC with the levels of circulating immune complexes (CIC), showed that CIC levels were also significantly higher in active arthritis and in RV, but that there was no correlation between the CIC levels in individual patients and Ig production by their PBMC in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

The significance of immunofluorescent immunoglobulin inclusions in polymorphonuclear leucocytes for the detection of circulating immune complexes.

Cytoplasmic inclusions of immunoglobulins and complement, detected by fluorescent antibodies in polymorphonuclear leucocytes (PMNs) that have been incubated with sera of certain patients, are considered to represent immune complexes (IC). The usefulness of this test--the indirect PMN phagocytosis test (IPPT)--for the detection of circulating IC was investigated using preparations of free and heat-aggregated immunoglobulins. Free IgG and IgM were phagocytozed by PMNs at high concentrations only, while free IgA was not phagocytozed at all. Normal human serum slightly enhanced the uptake of free IgG and IgM, but not of free IgA. Aggregates of IgG and IgA underwent phagocytosis at low concentrations, but IgM aggregates were not taken up more readily than free IgM. The uptake of IgG aggregates decreased in the presence of serum, while there was no influence upon the phagocytosis of IgA aggregates. Phagocytosis of C3 occurred only with IgG aggregates. In the presence of aggregates of IgG or IgA the phagocytosis of free immunoglobulins of other classes, in particular IgM, increased. The results of the IPPT for patients' sera showed that inclusions of C3 were found more frequently in combination with IgA or IgM than with IgG. Comparison with the 125I-Clq binding assay and the anti-IgA inhibition binding assay disclosed significant correlation between the phagocytosis of IgG and the precipitation of 125I-Clq and between the phagocytosis of IgA and the results of the anti-IgA inhibition binding assay. The PMN phagocytosis test may be useful for the detection of IgG and IgA containing IC but inclusion of IgM and C3 should be interpreted with some reserve.