No abstract

No abstract

Summary The role of T cells in idiopathic inflammatory). Percentage, absolute numbers and mean fluorescence intensity were analysed. We found increased numbers of total Tfh cells (28 ± 8·16 versus 6·64 ± 1·29, P = 0·031) in IIM patients when compared to healthy controls. Moreover, this increment was dependent upon Tfh2 and Tfh17 (Tfh2:9·49 ± 2·19 versus 1·66 ± 0·46, P = 0·005; Tfh17 9·48 ± 2·83 versus 1·18 ± 0·21, P = 0·014). Also, IIM patients showed higher numbers of Th17 cells (30·25 ± 6·49 versus 13·46 ± 2·95, P = 0·031) as well as decreased number of Tregs (5·98 ± 1·61 versus 30·82 ± 8·38, P = 0·009). We also found an expansion of CD28 null cells (162·88 ± 32·29 versus 64 ± 17·35, P = 0·015). Our data suggest that IIM patients are characterized by an expansion of peripheral proinflammatory T cells, such as Tfh and Th17, as well as pro-apoptotic CD28 null cells and a deficiency of suppressor populations of Tregs (CD4 + and CD8 + ).

No abstract

Introduction Pain is a core complaint among rheumatoid arthritis (RA) patients, and persistent pain requires treatment adjustments according to current strategies. We aimed to quantify the impact of hand osteoarthritis (OA) on health status and residual pain in patients with RA. Methods This cross-sectional survey compared RA patients with and without osteoarthritis of the hand. The main outcome was pain intensity. Other measurements included disease activity scores (the Disease Activity Score 28-joints; the Simplified Disease Activity Index, SDAI; the Clinical Disease Activity Index, CDAI), functional disability and self-reported quality of life, and the proportion of patients with residual pain (Patient Acceptable Symptom State, PASS). Results Eighty-one patients were analyzed, including 39 with RA and OA and 42 with RA only. The patients were mainly women (94%), with a median disease duration of 13 years. This group also reported a higher intensity of pain (visual analogue scale, VAS 70 mm vs. 30 mm; p = 0.003), higher disease activity (3.89 vs. 2.88; p = 0.001), and greater functional disability irrespective of treatment and comorbidities. A strong correlation (r 2 = 0.69; p < 0.001) between pain and disease activity was observed, although no differences in pain were observed between groups according to disease activity categories. Patients with RA and OA had a higher proportion of residual pain (59% vs. 29%; p = 0.006) even in the absence of clinical inflammation. Conclusion The coexistence of RA and hand OA is associated with distorted disease activity measurements in RA. Osteoarthritis contributes to persistent pain and greater disability in patients with RA.

No abstract

Response to: 'Semi-quantitative analysis of line blot assay for myositis-specific and myositisassociated antibodies: a better performance?' by Cavazzana et alWe have with great interest read the response from Cavazzana et al. 1 We agree that increasing the cut-off of the line blot test for myositis-specific and myositis-associated autoantibodies could help to avoid false-positive responses. Our experience from more than a decade of using different versions of the Euroline (Euroimmun, Lübeck, Germany) line immunoassays (LIA) is, in agreement with the suggestion from Cavazzana et al that in the absolute majority of sera with multiple autoantibody specificities the autoantibody reactivities are present in the low range. When investigating only moderate and high reactivities from our previous comparison between LIA and an immunoprecipitation-based algorithm, 2 we do, however, not generally improve the kappa statistics, in the way described by Cavazzana et al. We obtained an overall agreement between both approaches of 78% (vs previous 76%) and a kappa coefficient 0.48 (vs previous 0.54). Regarding individual specificities, we did not find important differences neither in agreement nor in kappa statistics. Moreover, associations between relevant clinical features and positive autoantibodies remained similar.Generally increasing the cut-offs to only regard samples with moderate (26-50 densitometry units (DU)) and high (>50 DU) reactivity as positive will also affect individual antibody specificities differently with the risk of missing clinically significant cases. We have, for example, observed patients presenting with amyopathic dermatomyositis and rapidly progressive interstitial lung disease with anti-MDA5 levels in the very low range. The trade-off between sensitivity and specificity is in this case very delicate.There is a large variability how the Euroline LIA performs in different laboratories; the performance can vary with the temperature in the laboratory. 3 The intensity of the band staining can also be evaluated either on wet or dried strips, and our impression is that this can induce considerable differences between reports from individual laboratories. A weakness with the assay is the lack of internal controls, monitoring the effect of differences in laboratory assay conditions. Bundell et al investigated 197 healthy controls with a previous version of the Euroline LIA (Euroline 3) according to the instructions from the manufacturer. They found 38 positive reactions for 10 myositis antibody specificities (excluding Ro52, not investigated by us), corresponding to a total diagnostic specificity of 98.9%. 4 For the corresponding 10 specificities, we found one anti-Ku-positive serum among 60 healthy controls, corresponding to a diagnostic specificity of 99.8%.In agreement with others, we therefore think that calibration of the Euroline LIA is very important and that use of autoantibody-specific internal controls investigated in parallel to clinical samples on every test occasion should be mandatory in laborat...

The sIFA will ensure patient-relevant patient-reported assessment of activity limitations in patients with inclusion body myositis. The AMAT is a partly validated tool that needs to be used in clinical trials for further validation. The response criteria will enhance assessment of individual response to different treatments.