HLA-B27 does not affect invasion of arthritogenic bacteria into human cells.

OBJECTIVE: To investigate the effect of HLA-B27 expression on entry of Salmonella typhimurium and Yersinia enterocolitica into human cells. METHODS: We performed standard bacterial invasion assays with S. typhimurium and Y enterocolitica to analyze isogenic pairs of HeLa (epithelial), U937 (promonocyte), C1R (B lymphocyte), and Jurkat (T lymphocyte) human cell lines and their respective HLA-B27 transfectants. Invasion of peripheral blood derived T lymphocytes, monocytes, and B lymphocytes/dendritic cell fraction (corresponding to peripheral blood cells depleted of monocytes and T lymphocytes) from patients with ankylosing spondylitis and healthy donors was also analyzed. The percentage of internalized bacteria was quantified, and the differences between HLA-B27 positive and negative samples were compared. RESULTS: The percentages of intracellular S. typhimurium and Y enterocolitica in HeLa, U937, and C1R with or without B27 were not statistically different (independent t test). We also found that the percentage of internalized bacteria did not differ significantly between HLA-B27 positive and negative samples in the different populations of peripheral blood derived cells. CONCLUSION: The presence of HLA-B27 on the surface of human cells does not alter the degree of bacterial invasion into either cultured human cell lines or peripheral blood derived human cells, and the influence of HLA-B27 expression on bacterial invasion should not be implicated in the pathogenesis of reactive arthritis related to Salmonella and Yersinia.

Intestinal pseudo-obstruction as an initial presentation of systemic sclerosis in two children.

Two children are reported in whom intestinal pseudo-obstruction was the initial manifestation of systemic sclerosis. Gastrointestinal symptoms and skin changes resolved or improved in both children following treatment with prednisone and penicillamine (case 1) or methotrexate (case 2), although radiological changes of the gastrointestinal tract persisted at 3 and 2 yr of follow-up, respectively.

Validation of a Spanish version of the Childhood Health Assessment Questionnaire.

OBJECTIVE: To determine the reliability and validity of a Spanish version of the Childhood Health Assessment Questionnaire (CHAQ). METHODS: Fifty-five patients with juvenile rheumatoid arthritis (JRA) [35 girls, 20 boys; mean age at onset (+/- SD) 11 +/- 3.3 yrs, mean disease duration 3.3 +/- 2.2 yrs] were included in an observational and cross sectional study that evaluated translation validity, cross sectional construct validity, and test-retest reliability of the Spanish version of the CHAQ. The questionnaire was administered to either patients or one of their parents, and results were correlated with the Steinbrocker functional class, the Juvenile Arthritis Functional Assessment Scale (JAFAS), and disease activity. RESULTS: The mean CHAQ score (mean 0.77, range 0.01-2.25) was found to correlate at different levels with Steinbrocker functional class (r = 0.62, p < 0.0001), JAFAS (r = 0.65, p < 0.0001), and disease activity score (r = 0.40, p < 0.0001). Test-retest and interobserver agreement had good correlations. CONCLUSION: The Spanish version of the CHAQ we studied is a reliable and valid tool for assessment of health status in Spanish speaking children with JRA.

[Research on osteoarthritis in Latin America]. / La investigación latinoamericana sobre osteoartritis.

To evaluate the investigative approach towards osteoarthritis of latinamerican physicians, we reviewed the literature. After a manual and electronic search of Latin american medical publications (1980 to 1990) and of 9 Mexican medical journals (1976 to 1990), we reviewed all papers about osteoarthritis. We found 60 such papers (40 from Mexico and 20 from 7 other countries) and analyzed their goals and methods. The common subject was "treatment with nonsteroidal antiinflammatory drugs" (52%), followed by "quality of attention" (25%); "other treatments" (12%) and "epidemiology" (10%). The most common methodologic design was "series of cases" (28%), followed by "editorials" (17%); "controlled clinical trials" (17%), "interview collected data" (17%), "monographies" (10%) and "comparative cohorts" (8%). An innovative and positive aspect is the presence of 25% of studies on "quality of life", "cost-benefits" and "quality of attention". Most studies used insufficiently valid designs and we did not find studies designed to establish causality or to look for the validation of diagnostic tests or prognostic factors, which we propose as methods and fields to study from now on.

[The degree of agreement of the clinical and the histopathological diagnoses in a tertiary medical care pediatric hospital]. / Grado de concordancia del diagnóstico clínico con el histopatológico en un hospital pediátrico de tercer nivel de atención médica.

In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.

[Heat-shock proteins. Their clinical importance]. / Las proteínas de choque térmico. Su importancia clínica.

Heat-shock proteins (HSP) represents a protein superfamily comprising distinct molecular weights which are synthesized under conditions of cellular stress. The HSP constitute a phylogenetically-conserved response of cell preservation. Their functions are related to mechanisms such as thermotolerance and transport and scavenging of intracellular peptides. Some recent experimental evidence suggests that HSP participate directly in immune responses perhaps facilitating the recognition of exogenous antigens, and its levels are raised in inflammatory situations. Their pathogenic role in the chronic inflammation is still unclear, but the HSP could intervene as immunodominant antigens, mimicking structural proteins or evading the so-called immunological memory. In this review, we update the information concerning the relevance of HSP in medicine and discuss its potential role in autoimmune mechanisms.