Effects of infliximab on sister chromatid exchanges and chromosomal aberration in patients with rheumatoid arthritis.

The aim of this study was to evaluate in a 24-weeks the effect of anti-TNF-alpha, infliximab, on cytogenetic biomarkers in peripheral lymphocytes of patients with rheumatoid arthritis (RA). A total of 40 patients with RA met the criteria to be treated with methotrexate (15 mg/week) were evaluated. Twenty patients, randomly selected, were treated with infliximab in addition to methotrexate (group I), whereas the other 20 patients continued with only methotrexate treatment (group M). Twenty healthy volunteers matched for age, gender and smoking habits served as control group (group C). At baseline, sister chromatid exchange rate was 7.20 ± 2.21 in group I, 7.40 ± 1.60 in group M and 4.97 ± 1.32 in group C (P < 0.01 vs group I and M). After 24-weeks, sister chromatid exchange rate was 7.87 ± 2.54 in group I and 7.81 ± 1.95 in group M (P = ns). High frequency cells count was 4.9 % and 4.7 % in the groups I and M, respectively, at the end of the study (P = ns). The basal chromosomal aberration frequency was 4.90 % in group I and 5.20 % in groups M; after 24-weeks, this was 5.10 % in group I and 5.10 % in groups M (P = ns). Infliximab treatment, for 24 weeks, did not increase the cytogenetic biomarkers in patients with RA. Our data show that the use of infliximab has not a genotoxic effect in patients with RA.

Far infrared emitting plaster in knee osteoarthritis: a single blinded, randomised clinical trial.

OBJECTIVE: Therapeutic approach of osteoarthritis (OA) still represents a challenge in clinical practice. The aim of the study is to assess the efficacy of far infrared (FIR) emitting plaster in the treatment of knee OA. DESIGN: This is a randomized, single-blind, placebo-controlled, parallel group with equal randomization (1:1), clinical trial. Patients affected by knee OA were randomly allocated to 1 of 2 treatment groups, either placebo plaster or far infrared emitting plaster. Primary endpoint was to assess pain improvement from baseline to 1 months posttreatment in the visual analogue score (VAS). Secondary end point was to evaluate pain score after 1 week of treatment and to compare ultrasonographic findings after 1 month of treatment. RESULTS: Each group comprised 30 (in the FIR group) and 30 (in the placebo group) completers. VAS scores of the placebo and the FIR group were significantly lower at 1 week post-treatment (95% confidence interval CI = -1.14 to 0.31; P<0.05) and at the end of the study (95% confidence interval CI = -2.57 to -0.89; P=0.01). Effect size was -0.43 after one week of treatment and -1.38 after one month of treatment. The mean decrease in VAS values was ≥ 20% in the FIR group. The number of patients from the FIR group with joint effusion was lower (40%) compared to baseline (80%), while no changes were seen among the placebo group. CONCLUSIONS: Far infrared emitting plaster could be considered an effective non-pharmacological choice for the therapeutic management of knee OA.

Hemostatic changes in vasculitides.

The systemic vasculitides are an heterogeneous group of rare diseases characterized by inflammation and fibrinoid necrosis of blood vessel walls. Today it is well known that the inflammatory process characterizing vasculitides activates coagulation factors, inhibits anticoagulant factors, inhibits fibrinolytic processes, increases platelet activity and production and determines endothelial dysfunction. So far the mortality in vasculitides, even if falling, remains substantially high. Patients with vasculitic syndrome are at increased risk of developing atherosclerosis and in these patients prevalence of cardiovascular disease and cardiovascular events is higher than in the general population. Vasculitides can be associated with antiphospholipid syndrome. It is important to establish a strategy of antithrombotic therapy management in vasculitic patients, but this has not yet been clearly achieved.

Osteoporotic fractures: mortality and quality of life.

Osteoporosis is a widespread disease, affecting about 75 million people, mostly postmenopausal women. It is called ''the silent disease'', since there are very few associated symptoms: anyway osteoporotic fractures are the chief clinical feature, with an enormous burden on health related quality of life and mortality. The aim of this study was to review the literature on the evaluation of mortality and health related quality of life as consequences of osteoporotic fractures. Fractures, the clinical manifestation of osteoporosis, are extremely common and are devastating both to affected patients and to society that must bear the enormous cost of fracture treatment and subsequent disability. Hip and spine fractures are linked with increased mortality, and all fractures may lead to disability and reduced quality of life. Since patients with osteoporosis usually have no symptoms before fracture, early diagnosis and treatment of the disease are of great importance to the quality of life in these patients. To reduce mortality, attention must focus on optimising health status preoperatively, preventing postoperative complications, and, when these complications develop, providing optimal specialist medical care.

Rheumatic symptoms in patients with human immunodeficiency virus are related to levels of tumor necrosis factor-alpha but not to viral load.

Infection with human immunodeficiency virus (HIV) can lead to osteoarticular involvement, usually in the late stages. The pathogenesis of these symptoms has usually been attributed to viral load or to dysregulated cytokine production. We evaluated the presence of rheumatic symptoms and levels of tumor necrosis factor (TNF)-alpha viral load and CD4 count in 46 patients with HIV from southern Italy. The prevalence of rheumatic symptoms was 23.9%; CD4 count and viral load presented no statistically significant differences between patients with rheumatic symptoms and patients without osteoarticular involvement, whereas TNF-alpha levels were increased in HIV patients with arthralgias compared with those in patients without arthralgias (p = 0.02). Evidence that TNF-alpha is increased in patients with osteoarticular or soft tissue involvement is a clear index of the pivotal role this cytokine plays in the pathogenesis of these manifestations.

Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy.

The aim of the present study was to detect entheseal abnormalities by means of ultrasonography (US) in patients with psoriasis. We evaluated 24 patients with psoriasis who underwent clinical and ultrasonographic examination of both lower limbs at the calcaneal insertions of the Achilles tendons and at the flexor and extensor tendons of all fingers of the hand. Fourteen patients with psoriatic arthritis were used as controls. US was performed using a real-time scanner (ATL SDI 3000) with a 5-12 MHz linear array transducer. Longitudinal and transverse scans of the talocrural joints, Achilles tendons and both the flexor and extensor tendons of the fingers of both hands were obtained at rest and during active and passive movements. On clinical examination no entheseal site was abnormal, but on US examination 33% of patients showed abnormalities. In particular, six psoriasis patients (25%) who were asymptomatic showed effusion around the extensor tendon of the first digit of the left hand and around the extensor tendon of the third and fourth digits of both hands; two patients (8.3%) showed a hypoechoic nodular formation of the flexor tendon sheath of the left hand. We conclude that entheseal abnormalities not detected at clinical examination were present in 33% of patients with psoriasis who underwent US examination. Therefore, we suggest the routine use of ultrasonography in the early diagnosis and in treatment and follow-up of patients with tendon enthesopathy, since these factors may have implications for therapy.

Bronchial hyperresponsiveness in subjects with gastroesophageal reflux.

BACKGROUND: The relationship between gastroesophageal reflux (GER) and asthma has been widely studied in the last years. GER may interfere with airway reactivity and aggravate or even induce asthma. OBJECTIVE: To assess the prevalence of bronchial hyperresponsiveness (BHR) in patients with GER disease with a view to judging the potential influence of GER on BHR. METHODS: 30 patients with GER disease and no clinical evidence of asthma and 30 normal subjects underwent a methacholine bronchial challenge. The methacholine concentration that caused a 20% fall in the FEV(1) (PC20) was used to assess bronchial responsiveness. RESULTS: In the GER group 11 subjects of the 30 studied showed a PC20 methacholine equal to or less than 8 mg/ml while in the control group only 2 subjects had a PC20 methacholine equal to or less than 8 mg/ml (p < 0.01; ANOVA test). CONCLUSIONS: Subjects with GER had a greater increase in airway reactivity when inhaling methacholine compared to disease-free normal subjects.

Unusual polyarthritis as a unique clinical manifestation of coeliac disease.

This report describes a patient who presented with an unusual polyarthritis accompanied by myalgia, fever and anxiety. After extensive clinical and serological evaluation, duodenal biopsy and serological tests provided evidence for the diagnosis of coeliac disease (CD). The patient was promptly put on a gluten-free diet, which led to an improvement in the clinical abnormalities.

Effect of inhaled glutathione on airway response to 'Fog' challenge in asthmatic patients.

OBJECTIVE: We report on the effect of glutathione, an antioxidant compound on the airway response to the ultrasonically nebulised distilled water (UNDW, 'fog') challenge. METHODS: 12 subjects with mild-to-moderate bronchial asthma underwent double-blind, cross-over pretreatment, administered 30 min earlier, in a randomised order with inhaled glutathione (G) (600 mg), sodium cromoglycate (SCG) (20 mg) and placebo (P), followed by the challenge. RESULTS: After P pretreatment UNDW challenge caused a mean 20.41% decrease in FEV-1 (p < 0.05), after G, a mean 6.04% fall in FEV-1 (p = n.s.), and after SCG a mean 5.99% fall in FEV-1 (p = n.s.). CONCLUSIONS: G significantly attenuated 'fog'-induced falls in FEV-1 (p < 0.001 compared with P) and showed a protective effect on UNDW-induced bronchoconstriction.

A controlled study on the effectiveness of loratadine in combination with flunisolide in the treatment of nonallergic rhinitis with eosinophilia (NARES).

BACKGROUND: Nonallergic rhinitis with eosinophilia (NARES), accounting for some 15% of perennial rhinitis, is a nasal disorder whose main features are eosinophil counts in nasal smear higher than 10% and negative IgE tests. The mainstay of treatment is topical corticosteroids. OBJECTIVE: To evaluate the adjunctive effect of loratadine, a non-sedating antihistamine with anti-allergic activity, on nasal symptoms and eosinophil counts in nasal secretions in patients with NARES. METHODS: Thirty patients with NARES were divided in two groups, half receiving flunisolide two 25 microg puffs per nostril morning and night plus loratadine 10 mg u.i.d. and half the same doses of flunisolide plus placebo, according to a double-blind fashion, for 3 weeks. The effectiveness of the treatment in the two groups was evaluated by comparing symptom scores and eosinophil counts, and safety was assessed by comparing the adverse effects. RESULTS: The loratadine treated group had better results both in nasal symptoms, with a decrease in sneezing (P < 0.000001) and rhinorrhoea (P < 0.006), respectively, corresponding with 73.4% and 66.7% with respect to 46.6% and 26.7% in the control group, and in eosinophil counts which decreased by 20% compared with 14.3% in patients treated with placebo and flunisolide. As to safety, only nasal irritation in two patients, one in each group, was reported. CONCLUSION: Loratadine improves the effectiveness of flunisolide in treatment of NARES with no change in safety, and with no sedation.

Urticaria from Trichomonas vaginalis infection.

We report the case of a 32-year-old woman who had pruritic urticarial skin lesions associated with episodes of arthralgia. The first site affected by the eruption was the inside surface of the thighs; the patient also reported the presence of leukorrhea. The woman had previously been treated with H1 antagonist with moderate and transitory results; skin lesions reappeared just after the interruption of the treatment. Her biochemical data showed increased levels of erythrocyte sedimentation rate, blood eosinophilia and hypocomplementemia. Antinuclear antibodies, rheumatoid factor, cryoglobulins and serological diagnosis for hepatitis or mononucleosis viruses resulted negative. Considering the initial site of the cutaneous features and the presence of leukorrhea, we requested a vaginal smear and a culture of the cervical secretion, which revealed the presence of a Trichomonas infection. Furthermore, the SDS-PAGE revealed the presence of a molecular mass of 230,000 Da (230-kDa) in the serum, which indicated a Trichomonas surface protein. The following treatment with oral metronidazole caused the eradication of the Trichomonas infection after 3 weeks and subsequently the resolution of the urticarial clinical features. We wish to underline that in the presence of a case of urticaria vasculitis syndrome which seems to be without cause, it is important to investigate every diagnostic suspicion scrupulously.

Non invasive assessment of cardiac function in patients with bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD).

BACKGROUND: Most respiratory diseases involve the heart and can lead to acute or chronic pulmonary heart in the most serious cases. The common pathogenetic element is pulmonary arterial hypertension which es secondary to the resistance of the pulmonary circulation together with hypertrophy and/or dilatation of the right ventricle, caused mainly by chronic hypoxia. METHODS AND RESULTS: In order to verify the effects induced on pulmonary circulation and right heart by BA or COPD the cardiac function was assessed by mono and bidimensional Doppler echocardiography in 10 patients with BA (group A), 10 with COPD (group B) and 10 healthy control subjects (group C). At the M-mode echocardiography examination no significant difference was observed among the three study groups. By Doppler pw the peak velocity of early tricuspidal flow (VmaxE) was significantly higher in the group A when compared to the group B (p = 0.03). No subject had pulmonary hypertension. The pulmonary acceleration time (PAT) using pw Doppler technique was similar in groups A and B but it was significantly different when compared to group C (p = 0.006:A vs C; p = 0.03:B vs C). CONCLUSIONS: Our results suggest in patients either with BA or COPD, an early involvement of the right heart even if they had a clinical stable condition and no pulmonary hypertension.

Urticaria in a tattooed patient.

We present a case of urticaria in a tattooed patient due to hypersensitivity to the cobalt chloride contained in the blue ink used for tattoo. The patch test with the series of International Contact Dermatitis Research Group was positive only for chloride cobalt. Cobalt is believed to be responsible for contact urticaria through a non-immunological mechanism. On reviewing the literature we have found no report of contact urticaria to cobalt in tattooed patients.

Tolerability of doxofylline in the maintenance therapy of pediatric patients with bronchial asthma.

A retrospective open study was performed to ascertain the tolerability of doxofylline in pediatric patients with bronchial asthma or airway obstruction complicating acute bronchitis. The study population included 806 patients aged between 3 and 16 years. Doxofylline (200 mg sachets) was administered at daily doses ranging from 100 to 400 mg. The percentage of patients reporting side effects was 11%. The percent of patients reporting moderate side effect was 5%, the others being mild. The percent of patients reporting adverse event very likely due to doxofylline was 6%. The percent of patient drop-outs related to side effects was 5%.

Comparative study between fluticasone propionate and cetirizine in the treatment of allergic rhinitis.

Among the most frequently used drugs in the treatment of allergic rhinitis we have to mention topical nasal corticosteroids and H1 antihistamines used both systemically and topically. The present study focused the effectiveness and tolerability of cetirizine and fluticasone propionate in seasonal allergic rhinitis. 54 patients, divided into three homogeneous groups, underwent the following different treatments: Group 1: Placebo of fluticasone (2 puff per nostril once daily by aerosol) + cetirizine (10 mg/die per os) for 60 days. Group 2: Fluticasone (100 mg per nostril once daily by aerosol) + placebo of cetirizine (per os) for 60 days. Group 3: Cetirizine (10 mg/die per os) for 60 days + fluticasone (100 mg per nostril once daily by aerosol) for 20 days. The patients reported nasal symptoms (sneezing, obstruction, itching, rhinorrea) on a clinical diary. ECP levels in nasal secretions were investigated in all patients to determine the anti-inflammatory activity of both treatments. Cetirizine resulted very effective in the treatment of sneezing, itching and acqueous rhinorrea whereas not much effective on nasal obstruction. On the contrary, fluticasone, which acted effectively on nasal obstruction, resulted inefficacious on the other symptoms. The third group of patients achieved the best results on all four symptoms, including obstruction, which continued even after interrupting the treatment with fluticasone. The ECP levels were significantly reduced by both treatments. The side effects in all 3 groups were rare and not serious. From these results we can assert that the synergic action of the two drugs, achieves the best effectiveness, that the fluticasone treatment can be limited to 20 days cycles and finally that both molecules are well tolerated.

Ethylene oxide allergy in dialysis patients.

DESIGN OF STUDY: Two groups of patients undergoing long-term dialysis were studied in order to evaluate the importance of ethylene oxide (EtO) in causing allergic reactions during dialysis. The first group of 50 subjects had never shown any hypersensitivity reactions related to dialysis, whereas the second group of 20 subjects had previously complained of reactions. All the patients underwent a prick test with a standard kit of aeroallergens in order to assess the presence of atopy (in doubtful cases a RAST test was carried out with the same aeroallergens). A blood sample for the investigation of EtO specific IgE antibodies was taken from all the patients; the immunoenzymatic method was used. RESULTS: Sensitivity to EtO is significantly higher in the group of patients with previous allergic reactions during dialysis (55 vs 6% in the control group).

Measurement of allergen-induced skin reactions by computerized dynamic telethermography (CDTT).

Cutaneous thermic changes induced by a skin prick test reaction were measured by an infrared thermography camera (computerized dynamic telethermography, CDTT). Changes in skin temperature (T degree) detected by CDTT were compared with the mean diameter of allergen-induced skin reactions. Cutaneous thermic increase detected by CDTT correlated well with the mean wheal diameter measured in millimeters (r = 0.938, p < 0.001). Average coefficient of variation for repeated CDTT measurements was 4.6%. CDTT provides a reproducible and precise method for measuring allergen-induced skin reactions. Moreover, the continuous recording of the skin temperature represents an additional parameter for the quantification of wheal reactions.

Acute cardiovascular effects of salmeterol in subjects with stable bronchial asthma.

The airway response and cardiovascular effects of salmeterol (SM) and salbutamol (SB) given as a single dose from metered-dose inhalers were studied in 10 patients with mild asthma. In a double-blind, randomized, cross-over, placebo-controlled study, the subjects received SM 100 micrograms (four puffs, 25 micrograms per actuation), SB 200 micrograms (four puffs, 50 micrograms per actuation) or placebo (P) (four puffs). SM caused a greater and longer lasting increase of peak expiratory flow rate (PEFR) value than SB and P. There was no significant difference either with P or the study drugs in heart rate, PR interval, QT interval corrected for heart rate (QTc), incidence of ventricular and supraventricular ectopics, and in echocardiogram evaluation. These findings show that at dosages based on those used in clinical practice salmeterol causes cardiovascular effects comparable to those induced by salbutamol and confirm the favourable cardiac safety profile of this drug.