[Adult-onset Still's disease]

Adult-onset Still's disease is a rare inflammatory systemic disease. Cardinal symptoms/manifestations are fever, arthralgias or arthritis, myalgias, the typical skin rash, sore throat, hepatosplenomegaly, lymphadenopathy and serositis. Several other symptoms and organ involvements are possible. The clinical picture is variable with mild to life-threatening courses. The disease is self-limiting, intermittently active or chronic. Because of the lack of a defined diagnostic test the diagnosis of AOSD can only be made after exclusion of several differential diagnoses in particular of infectious, malignant and autoimmune origin. For therapy non-steroidal anti-inflammatory drugs, glucocorticoids, disease modifying antirheumatic drugs and biologics can be used.

Intensive resistance exercise induces lymphocyte apoptosis via cortisol and glucocorticoid receptor-dependent pathways

Intensive endurance exercise is known to induce lymphocyte apoptosis, which might affect immune function. Less is known about the effects of resistance exercise on apoptosis and its underlying mechanisms. In this study, subjects performed an intensive resistance test (IRT) and a moderate resistance test, and lymphocyte apoptosis, apoptosis-related parameters, and underlying mechanisms were investigated. IRT induced a significant increase of lymphocyte apoptosis 3 h after exercise, which was accompanied by a significant decrease of mitochondrial membrane potential, a reduction of Bcl-2, and an upregulation of the CD95 receptor. Blood lactate, IL-6, C-reactive protein, and cortisol increased significantly 3 h after IRT. A significant correlation was observed between the increase of apoptosis and cortisol levels 3 h after IRT. Incubation of freshly isolated lymphocytes in IRT serum indicated an important role of serum correlates for apoptosis induction. Selective incubation of lymphocytes in concentrations of selected serum parameters corresponding to levels found post in IRT serum demonstrated a major role for cortisol in apoptosis induction. This result was confirmed by attenutation of apoptosis after addition of mifepristone before incubation in IRT serum. In summary, resistance exercise induced lymphocyte apoptosis in an intensity-dependent way. Furthermore, cortisol signaling via glucocorticoid receptors might be an important mechanism for lymphocyte apoptosis after resistance exercise.

Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects - a double-blind, placebo-controlled, randomized trial

The incidence of insulin resistance and metabolic syndrome correlates with the availability of magnesium (Mg). We studied the effect of oral Mg supplementation on insulin sensitivity and other characteristics of the metabolic syndrome in normomagnesemic, overweight, insulin resistant, non-diabetic subjects. Subjects were tested for eligibility using oral glucose tolerance test (OGTT) and subsequently randomized to receive either Mg-aspartate-hydrochloride (n = 27) or placebo (n = 25) for 6 months. As trial endpoints, several indices of insulin sensitivity, plasma glucose, serum insulin, blood pressure and lipid profile were determined. Mg supplementation resulted in a significant improvement of fasting plasma glucose and some insulin sensitivity indices (ISIs) compared to placebo. Blood pressure and lipid profile did not show significant changes. The results provide significant evidence that oral Mg supplementation improves insulin sensitivity even in normomagnesemic, overweight, non-diabetic subjects emphasizing the need for an early optimization of Mg status to prevent insulin resistance and subsequently type 2 diabetes.

PTPIP51 interaction with PTP1B and 14-3-3β in adipose tissue of insulin-resistant mice

OBJECTIVE

We investigated the expression of protein tyrosine phosphatase-interacting protein 51 (PTPIP51) and its interaction with protein tyrosine phosphatase 1B (PTP1B) and 14-3-3β in mice exhibiting insulin resistance and obesity.

DESIGN

A total of 20 mice were included in the study. Eight control animals were fed a normal standard diet, six animals were fed a high-fat diet and six animals were submitted to a treadmill training parallel to the feeding of a high-fat diet. After 10 weeks, a glucose tolerance test was performed and abdominal adipose tissue samples of the animals were collected.

RESULTS

PTPIP51 protein was identified in the adipocytes of all samples. PTPIP51 interacted with PTP1B and with 14-3-3β protein. Compared with untrained mice fed a standard diet, the interaction of PTPIP51 with PTP1B was reduced in high-fat diet-fed animals. The highest interaction of PTPIP51 with 14-3-3β was seen in trained animals on high-fat diet, whereas untrained animals on high-fat diet displayed lowest values.

CONCLUSION

PTPIP51 is expressed in adipose tissue of humans, rats and mice. Obesity with enhanced insulin resistance resulted in a reduction of PTPIP51 levels in adipocytes and influenced the interactions with PTP1B and 14-3-3β. The interaction of PTPIP51 with PTP1B suggests a regulatory function of PTPIP51 in insulin receptor signal transduction. The interaction of PTPIP51 with 14-3-3β, especially in trained individuals, hints to an involvement of PTPIP51 in the downstream regulation of insulin action.

[Relevance of MRI for endometriosis diagnosis]

Endometriosis is a disease of the uterus with displacement of endometrium-like tissue outside the endometrium. Endometriosis is a common benign chronic often debilitating disease that primarily affects young woman. The estimated prevalence is about 10 %. In addition to the uterus and ovaries, clinically important localisations are the rectovaginal space, rectum, sigmoid colon, urinary bladder, ureter and peritoneum. The most common localisation outside the pelvis is the abdominal wall. Today, MRI is one of the most important tools in the diagnosis of endometriosis. The detection of peritoneal manifestations and the exact definition of the depth of infiltration in the rectum, sigmoid colon and bladder walls are limitations of MRI.

Use of methotrexate in young patients with respect to the reproductive system

Methotrexate (MTX) is one of the most commonly used drugs in the treatment of inflammatory rheumatic diseases. Unfortunately, MTX is an FDA Pregnancy Category X medication, which means it is contraindicated during pregnancy. The following review of the literature, with international guidelines, gives in addition an overview of current scientific knowledge on the topic. MTX is a teratogenic substance. It accesses the placenta and, for the dosage of 5 to 25 mg per week normally used in rheumatic diseases, can lead to both habitual abortions and anomalies in the neonate. Folic acid antagonism of MTX is the reason. In the rheumatologic setting, small case reports are available for the usage of MTX of 101 pregnant women at the time of conception or during pregnancy, mostly during the first trimester. Individual casuistry also exists. An abortion rate of 23% was found to result from these case reports. The anomaly rate for neonates was >5%. Only a few pregnancies with neonatal anomalies are described with the child's father taking MTX at the time of conception. MTX is taken up (in small amounts) by the mother's milk, and breast feeding under MTX therapy, therefore, is also contraindicated. Detailed and exact information on female patients taking MTX during the reproduction phase, but also for the father-to-be of the child if treated with MTX, with reference to the required contraception until at least three months before a planned conception and stopping of MTX at least at that time, is essential.

[Non-TNF biologicals in the therapeutic strategy for rheumatoid arthritis]

The spectrum of agents available for the treatment of rheumatoid arthritis (RA) has become more diversified: In addition to TNF-blocking agents, Abatacept, Rituximab and Tocilizumab have now become available for the treatment of RA. All three agents were approved for patients with insufficient response/intolerability to TNF-blockers; Tozilizumab and Abatacept have also been approved for TNF-naive patients with insufficient response to Methorexate.The present article clarifies the efficacy of these three substances in the treatment algorithm of RA. Current data do not suggest differences in general; therefore, individual considerations may result in patient-specific decisions as to which drug should be used after insufficient response to a TNF-blocking agent or Methotrexate. Possible arguments are discussed.

Effect of a one-session versus two-session procedure on different parameters of interventional therapy for peripheral arterial occlusive disease: results of a retrospective cohort study

PURPOSE

To compare the effects of a one-session procedure (ie, diagnostic angiography immediately followed by intervention) versus a two-session procedure (ie, diagnostic angiography and intervention in two separate sessions) on interventional therapy in patients with peripheral arterial occlusive disease (PAOD).

MATERIALS AND METHODS

Interventional therapy was performed immediately after diagnostic angiography in one session in 228 patients (group 1) and in a chronologically separate, later session in another 43 patients (group 2). The retrospectively captured parameters were Fontaine stage, TransAtlantic InterSociety Consensus II criteria, angiographic severity, type, technical success and complication rates, examination times, volume of contrast media, radiation exposure, and fluoroscopy time for intervention.

RESULTS

There were no between-group differences in clinical and interventional parameters. In group 1 there were 340 interventions performed, and there were 61 in group 2 with an interval before intervention of 1-55 days. The groups showed comparable success rates (92.6% vs 91.8%; P = .79) and complication rates (5.7% vs 4.65%; P = 1.0). The examination times were similar at 82.6 minutes +/- 40.5 and 91.3 minutes +/- 69.9, respectively (P = .92). Volume of contrast media (301.7 mL +/- 81.3 vs 459.2 mL +/- 123.7) and radiation exposure (140.5 Gy/cm(2) +/- 152.1 vs 304.7 Gy/cm(2) +/- 217.4) were significantly lower in group 1 (P < .001 each). Fluoroscopy times trended lower in group 1.

CONCLUSIONS

In patients with PAOD, interventional therapy of iliac and femoropopliteal artery lesions performed in the same session as diagnostic angiography yields technical success and complication rates comparable to those seen with a two-session procedure, but is associated with significantly less contrast media use and radiation exposure.

Physical activity and memory functions: an interventional study

Previous studies have suggested beneficial effects of physical activity on cognition. Here, we asked in an interventional approach if physical activity performed at different intensity levels would differentially affect episodic memory function. Additionally, we tried to identify mechanisms mediating these changes. Sixty-two healthy elderly individuals were assessed for level of physical activity, aerobic fitness, episodic memory score, neurotrophin and catecholamine levels, and received a magnetic resonance image of the brain at baseline and after a six months intervention of medium or low-intensity physical activity or control. Increase in total physical activity was positively associated with increase in memory score over the entire cohort, without significant differences between intensity groups. It was also positively associated with increases in local gray matter volume in prefrontal and cingulate cortex, and BDNF levels (trend). In conclusion, we showed that physical activity conveys the beneficial effects on memory function independently of its intensity, possibly mediated by local gray matter volume and neurotrophic factors. Our findings may carry significant implications for prevention of cognitive decline in the elderly.

[Recommendations for tuberculosis screening before initiation of TNF-alpha-inhibitor treatment in rheumatic diseases]

Due to the increased risk of tuberculosis (TB) under treatment with TNF-alpha-inhibitors for rheumatoid arthritis and other autoimmune diseases, precautionary measures are required before initiating TNF-alpha-inhibitor therapy. Patients should have active TB ruled out and screening for latent TB infection should be performed. The screening should include chest X-ray, complete medical history, and the administration of a highly specific Interferon-gamma-Release Assay (IGRA). As tuberculin skin test (TST) results can be expected to be either false-positive or false-negative in these patients, the TST, as commonly performed in the past, is recommended only for exceptional situations. For chemopreventive treatment of latent TB infection (LTBI), isoniazid is usually given for 9 months.