Serum concentration of IL-17, IL-23 and TNF-α among patients with chronic spontaneous urticaria: association with disease activity and autologous serum skin test.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common skin disorder, which is considered in a subset of patients to be an autoimmune disorder. T helper 17 (Th17) cells are crucially involved in the pathogenesis of some autoimmune diseases. OBJECTIVES: Our aim was to test the association of Th17 with CSU. We examined interleukin (IL)-17, IL-23 and tumor necrosis factor-alpha (TNF-α) serum levels in CSU patients and studied their association with urticaria activity and autologous serum skin test (ASST). SUBJECTS AND METHODS: Serum concentration of IL-17, IL-23 and TNF-α were measured in 75 patients with CSU and 30 healthy control subjects. Disease activity was assessed by using urticaria activity score (UAS) as recommended by EAACI/GA(2)LEN/EDF/WAO Guidelines. RESULTS: Serum concentration of IL-17, IL-23 and TNF-α were significantly higher in CSU patients as compared with the healthy control subjects (mean: 35.51 ± 31.14 vs. 4.60 ± 1.38 pg/mL; P < 0.001, 38.95 ± 27.82 vs. 9.87 ± 4.62 pg/mL; P > 0.001 and 17.93 ± 6.05 vs. 6.87 ± 3.73 pg/mL; P = 0.004, respectively). There were significant positive correlation between serum IL-17, IL-23, TNF-α and disease activity assessed by cumulative UAS for 7 days before blood sampling. The Serum concentration of IL-17, IL-23 and TNF-α were also significantly higher in ASST positive patients than in ASST negative patients. CONCLUSION: Our results showed high serum levels of IL-17, IL-23 and TNF-α among CSU patients which may highlight a functional role of these cytokines in the pathogenesis of this important and common skin disease. It also may provide the rationale for new treatment strategies in chronic urticaria.

Botulinum toxin injection for management of temporomandibular joint clicking.

The aim of the present study was to investigate the effect of botulinum toxin type A (BTX-A) injection in the lateral pterygoid (LP) muscle on temporomandibular joint (TMJ) clicking. The study enrolled seven patients with a total of 11 joints; all patients were stage I or II of Wilke's staging for internal derangement. BTX-A was injected in the ipsilateral LP muscle with electromyogram (EMG) guidance and the subjects were assessed for 4 months. Maximum inter-incisal opening, range of lateral movement, and the presence of a click were recorded throughout the follow-up period, and magnetic resonance imaging (MRI) was ordered at the end of the 4 months. The results showed that the decrease in inter-incisal opening and side to side movement immediately postoperative was statistically significant, while the difference by the end of the follow-up period was insignificant. MRI showed a marked improvement in disc position postoperatively. It may be concluded that BTX injection in the LP muscle leads to the disappearance of joint clicking clinically and a significant improvement in disc position as shown on MRI.