Objective-To investigate possible diVerences in Th1 and Th2 cytokine mRNA expression in the synovial tissue (ST) of patients with rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA) with diagnostic and/or pathogenic interest. Methods-Eleven RA patients and 14 SpA patients (10 with undiVerentiated spondyloarthropathy (USpA), two with ankylosing spondylitis (AS) and two with psoriatic arthritis (PsA)) were included. Th1 (interferon , interleukin 2) and Th2 (interleukin 4, interleukin 5 and interleukin 10) cytokine mRNA levels from arthritic knee ST were quantified by using an optimised polymerase chain reaction method with a computerised analysis system. Protein levels of proinflammatory cytokines (interleukin 1, tumour necrosis factor and interleukin 6) in synovial fluid were quantified with a specific ELISA test. Results-Th1 cytokines were detected in all of RA ST samples in contrast with 58% (interferon ) and 71% (interleukin 2) of SpA samples. Th2 cytokines were expressed in 90% of RA ST samples, but the findings in SpA were interleukin 10 in 90%, interleukin 4 in 60% and interleukin 5 in 40% of ST samples. However, when the mRNA levels of each cytokine were quantified and corrected for T cell mRNA levels, only interferon levels were significantly higher in RA than in SpA (p<0.003). Thus, the Th1/Th2 cytokine ratio in RA was fivefold that of SpA. Synovial fluid interleukin 1 concentrations were higher in RA than in SpA (p<0.05); there were also higher synovial fluid levels of tumour necrosis factor in RA than in SpA, but without statistical significance. Conclusion-This study has detected both Th1 and Th2 cytokine gene expression in ST from RA and SpA patients. Synovium interferon mRNA levels and SF interleukin 1 protein levels were significantly higher in RA than in SpA, so reflecting the known proinflammatory activity of interferon through macrophage activation. Thus, the Th1 (interferon )/Th2 (interleukin 4) ratio is significantly higher in RA than in SpA ST. These data confirm previous studies on ST Th1/Th2 balance in RA and extend previous work in comparing ST RA with subgroups of SpA distinct of ReA.

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SummaryAntifilaggrin autoantibodies (AFA) have described to be the most specific markers of rheumatoid arthritis (RA) and epitopes containing citrulline within the sequence of filaggrin identified as major antigenic sites recognised by AFA. In this paper we confirm that citrulline is an essential constituent of filaggrin related antigenic determinants recognised by RA specific autoantibodies, thus having an important role for the development of filaggrin peptides based serological tests. Moreover, we describe our findings on the comparative conformational analysis of filaggrin (306-324) peptide sequence and an analogue in which two arginines were simultaneously substituted by citrulline carried out by Circular Dichroism (CD) and Fourier-Transform Infrared Spectroscopy (FTIR). Results might contribute to the understanding of the structural features that may be important to explain the enhanced binding characteristics of citrullinated peptides to the autoantibodies in rheumatoid arthritis.

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PurposeReal-life experience with eslicarbazepine acetate (ESL) after first monotherapy failure in a large series of patients with partial epilepsyMethodMulticenter, retrospective, 1 year, observational study. Inclusion criteria: 1) patients older than 18 years; 2) partial-onset seizures; 3) Failure of first monotherapy for any reason (efficacy, tolerability, compliance). Time-points for revision were at 3, 6 and 12 months. Main objectives were to assess efficacy and tolerability.ResultsA total of 253 patients were collected. The one-year retention rate was 92.9%. The mean dose after 12 months was 903.6±267 mg (range 400–1600). At 12 months, the percentage of seizure-free patients was 62.3%, 82.5% were responders and 5.6% did worse. Along the follow-up 31.6% of the patients reported adverse events and 3.6% discontinued for that reason. The main side effects were somnolence (8.7%) and dizziness (5.1%). A total of 127 patients (50.2%) were converted to monotherapy for at least 6 months. In this group, 77.2% were seizure-free and 29.1% of the patients reported AE after 1 year.ConclusionESL outcome along 1 year follow-up after first monotherapy failure showed an optimal efficacy and tolerability profile. Half of patients were converted to monotherapy and followed for at least 6 months.

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Background A significant proportion of patients with knee osteoarthritis (OA) show local features of inflammation such as synovial effusion and synovial hypertrophy. On the other hand, in recent years it has been recognized the existence of a link between hand OA and systemic inflammation. Objectives To evaluate the possible influence of the presence of comorbid OA on the inflammatory features of knee OA measured by ultrasound (US). Methods METHODS: Cross-sectional study including consecutive patients aged 50 years or more with symptomatic OA of the knee and joint effusion, moderate radiographic OA (Kellgren-Lawrence II-III). Demographics, BMI, disease duration, pain assessed by VAS (0-100 mm) and algofunctional Lesquesne index were assessed. Knee ultrasound was performed evaluating and measuring the presence of effusion and synovial hypertrophy at the suprapatellar midline. Results We have analyzed 50 patients, F/M 39/11, age 61.8 ±10.1 years, disease duration 44.6 ±44.7 months, BMI 31.4 ±5.1 kg/cm2. Ten patients (20%) had concomitant hand OA. There were no significant differences in age, disease duration, BMI or radiological grade between patients with knee and hand OA compared with those with only knee OA. On ultrasound examination patients with concomitant hand osteoarthritis showed a trend to have a more prominent joint effusion (7.4 ± 3 vs. 7.1 ±2.3 mm) and synovial hypertrophy (3.6 ± 2.6 vs. 2.8 ±2.5 mm), although not statistically differences were found. Patients with concomitant hand OA also had a non-significant trend to experience greater knee pain (VAS 70.3 ±12.5 vs. 60.3 ±18.1 mm) and Lesquesne index scores (11.5 ±3.3 vs. 9.8 ±2.9). Conclusions The results from this study suggest that the coexistence of hand OA appears to be associated with more prominent inflammatory features in patients with knee OA and synovial effusion, although results were not statistically significant probably in relation to small size sample. Disclosure of Interest None Declared