Menstrual disorders in girls with systemic lupus erythematosus treated with cyclophosphamide.

To study the ovarian toxicity associated with cyclophosphamide in girls with systemic lupus erythematosus (SLE), we retrospectively reviewed the charts of 30 SLE girls aged 16 yr or younger at diagnosis, followed at three university hospitals. Gynaecological history was extracted from the charts or obtained prospectively. Ten had not received cyclophosphamide therapy, six were treated with daily oral cyclophosphamide, 10 with intravenous pulses and four with daily oral and intravenous pulses. Median oral cyclophosphamide dose was 38 g (inter-quartile range 75) and median intravenous dose 12.95 g (inter-quartile range 6.2). Six girls had oligomenorrhoea (20%) and one amenorrhoea (3%). Two treated with oral cyclophosphamide had oligomenorrhoea (33%) and one amenorrhoea (17%), two treated with both oral and intravenous pulses had oligomenorrhoea (50%), and none of those treated with intravenous pulses alone had menstrual disturbances (50% oral vs 0% intravenous pulses; P = 0.016). Girls who had menstrual disturbances had received higher doses of cyclophosphamide than those who did not (medians: 63 vs 15 g; P < 0.05). In summary, menstrual disturbances in SLE girls treated with cyclophosphamide are related to the total dose and perhaps to the administration method.

A long term study of 22 children with brucellar arthritis.

Brucellar arthritis remains a serious a problem in Mediterranean countries. In the pediatric group it has not received enough attention. We have analysed the clinical features of 22 children followed in a large hospital for the last 10 years. Fever (68%), malaise (50%), myalgia (18%) and abdominal pain (14%) were the most common systemic symptoms. Three different patterns of arthritis were observed: acute (45%), chronic (41%) and recurrent (14%). Monoarthritis (45%) with hip involvement was very common. Response to treatment with large doses of cotrimoxazol for a long period of time was good. No toxicity was observed.

Both HLA class II and class III DNA polymorphisms are linked to juvenile rheumatoid arthritis susceptibility.

HLA-DR5 and DRw8 are not significantly linked to juvenile rheumatoid arthritis (JRA) in the Spanish population. However, we have found restriction fragment length polymorphisms (RFLPs) beta DR-2.9-kb-EcoRI and C4-14.3-kb-EcoRI, that correlate significantly with JRA. Eighty-six percent of our patients present either HLA-DR5 or the beta DR-2.9-kb-EcoRI allogenotope or lack the C4-14.3-kb-EcoRI allogenotope compared to 48% in controls; however, these particular DR and C4 RFLPs may not represent the corresponding DRB1 or C4 genes but rather neighboring ones which may be relevant to confer JRA susceptibility. The C4-14.3-kb-EcoRI RFLP decrease in patients may reflect a decrease in C4 B "long" phenotypes. Also, both RFLPs are the only markers able to identify most of the JRA patients in our population. On the other hand, the findings of both class II and III genes associated to JRA may reflect the existence of epistatic interactions (cis or trans) within the HLA gene cluster which lead to a particular pathology in certain diseases.

Brucellar arthritis in children and its successful treatment with trimethoprim-sulphamethoxazole (co-trimoxazole).

The clinical characteristics and the response to treatment with high doses of co-trimoxazole in 12 children with brucellar arthritis were analysed retrospectively. The children lived in an urban area and all but two had a history of unprocessed milk or cheese ingestion. Fever and oligoarthritis of the lower extremities were the most common clinical findings. Control of the disease was achieved by three months of treatment. Compliance with the medication was excellent, and no significant side effects occurred.

DR, C4, and Bf allotypes in juvenile rheumatoid arthritis.

HLA-DR, C4, and Bf typing was performed in 99 patients with juvenile rheumatoid arthritis (JRA). DR1 was found with higher frequency in patients with polyarticular JRA than in controls (P less than 0.05). DR3 was more common in patients with fever and/or rash than in those without these manifestations (P less than 0.05). A significant negative association between JRA and C4A6 (P less than 0.05), C4BQ0 (P less than 0.0005), and BfF1 (P less than 0.05) was found. It is possible that a disequilibrium between DR and C4/Bf genes plays a role in the pathogenesis of JRA.