Reversible dementia in systemic lupus erythematosus without antiphospholipid antibodies or cerebral infarction

Reversible Cognitive Dysfunction in Elderly-onset Systemic Lupus Erythematosus, Successfully Treated with Aggressive Immunosuppressive Therapy

A 70-year-old Japanese woman presented to our hospital with gait disturbance and cognitive dysfunction. Since she had arthritis, lymphopenia, hypocomplementemia, and anti-nuclear and anti-double-stranded DNA antibodies, she was diagnosed with systemic lupus erythematosus (SLE). T2-weighted magnetic resonance imaging revealed bilateral hyperintensities in the putamen. Based on her cognitive impairment, muscle rigidity, and high levels of interleukin-6 in the cerebrospinal fluid, we believed she had developed a complication of a neuropsychiatric disease and administered corticosteroids and intravenous cyclophosphamide therapy. Her cognitive function fully recovered, and her gait disturbance improved. Attending to cognitive impairment in elderly SLE patients is necessary.

Association of interleukin-1 receptor antagonist gene polymorphism with response to conservative treatment of lumbar herniated nucleus pulposus

STUDY DESIGN

A case-control study.

OBJECTIVE

To evaluate the relationship between gene polymorphism in interleukin 1 receptor antagonist (IL1RN) and response to conservative treatment of lumbar herniated nucleus pulposus (HNP).

SUMMARY OF BACKGROUND DATA

There had been several studies on IL1RN polymorphism related with incidence of disc degeneration or back pain but, there had been no report on clinical features of lumbar HNP.

METHODS

We analyzed the variable number tandem repeat polymorphism of IL1RN genes in 54 single level subligamentous extruded lumbar HNP patients and compared allele frequency and incidence of heterozygote with 227 healthy adult controls. Within HNP group, we compared 2 groups; surgery group and conservative treatment group according to response to conservative treatment.

RESULTS

The prevalence of A1 (odd ratio = 0.45, P = 0.0009) and A3 (odd ratio = 3.86, P = 0.0006) was significantly higher in HNP group than control group. The allele frequency of A1, A2, A3, A4, and A5 were 84.2:84.6, 7.3:15.4, 8.5:0, 0:0, 0:0, respectively, in surgical and conservative treatment group. The allele frequency for A3 was found significantly higher in the surgery group than in the conservative treatment group.

CONCLUSION

These results suggest that a high allele prevalence of A3 contribute to the clinical progression and the response to conservative treatment for lumbar HNP. IL1RN gene polymorphism may affect the clinical course of lumbar HNP.

Association of interleukin-1 genetic polymorphisms with the risk of rheumatoid arthritis in Chinese population

BACKGROUND

Previous studies suggest that a variable number of tandem repeats polymorphism in the second intron of the interleukin-1 receptor antagonist gene and two single nucleotide polymorphisms at positions -511 and +3954 of the interleukin-1beta (IL-1B) gene are associated with an increased risk of autoimmune diseases. In the present study, we evaluated associations between these genetic factors and an increased risk of rheumatoid arthritis (RA) in a population from Northwest China.

METHODS

A total of 240 patients with RA and 227 healthy controls from Northwest China were investigated using PCR and PCR-restriction fragment length polymorphism. Genotype and allele distributions and haplotype construction were analyzed.

RESULTS

The genotype and allele distributions of IL-1B +3954 and IL-1RN polymorphisms were significantly different in RA patients compared to controls (p<0.001 and p<0.001; p=0.028, p=0.023, respectively). Significant differences were also observed between the RA and control groups for the haplotypes IL-1B -511C/+3954C/IL-1RN *1, IL-1B -511C/+3954T/IL-1RN *1 and IL-1B -511T/+3954T/IL-1RN *1 [p=0.017, odds ratio (OR) 0.721, 95% confidence interval (CI) 0.551-0.944; p=0.030, OR 2.111, 95% CI 1.060-4.204; and p=0.029, OR 2.909, 95% CI 1.066-7.902, respectively].

CONCLUSIONS

These findings suggest that IL-1B +3954 and IL-1RN genetic polymorphisms are associated with a significantly increased risk of RA in this Chinese population.

Interleukin-1 receptor antagonist gene polymorphism and gingivitis in children

AIM

To investigate the role of the polymorphism of a variable numbers of tandem repeats of interleukin-1 receptor antagonist gene (IL-1RN) on gingivitis in children.

MATERIALS AND METHODS

A total of 146 Caucasian subjects (98 subjects with gingivitis and 48 controls) aged 8-12 years, were enrolled. Plaque and Calculus Indices were recorded to assess the oral hygiene. Gingival and Bleeding on Probing Indices were used to identify patients with gingivitis. DNA was extracted from epithelial cells of the cheek. Normal polymerase chain reaction was used for IL-1Ra genotyping.

RESULTS

A significant association was observed between IL-1Ra gene polymorphism and gingivitis in children (P = 0.008). The IL-1RN*2 allele (A2) was significantly more frequent in controls (37%vs 22% in children with gingivitis). In addition, the carriage of A2 seemed to be protective against gingivitis, and it was more frequent in controls (60%vs 40% in children with gingivitis, P = 0.008). Moreover, multiple logistic regression analysis showed that the association between IL-1Ra gene polymorphism and gingivitis in children remained significant (P = 0.014) regardless of the significant influence of plaque (P = 0.013).

CONCLUSION

IL-1Ra gene polymorphisms could have an active role in the pathogenesis of gingivitis in Caucasian children and IL-1RN*2 allele could be a protective marker against gingivitis.

IL-1B and IL-1RN gene polymorphisms in rheumatoid arthritis: relationship with protein plasma levels and response to therapy

OBJECTIVES

To analyze the association of interleukin (IL-1) gene polymorphisms with susceptibility to, and severity of, rheumatoid arthritis (RA) patients, comparing them with the genotype distribution in healthy controls. Also, to assess the influence of IL1-B and IL1RN gene polymorphism on IL-1beta/IL-1Ra plasma levels and response to therapy.

PATIENTS AND METHODS

We tested the allelic distribution of IL-1B (-511 and +3953) and IL-1RN (variable number of tandem repeats) gene polymorphism in 126 RA patients and 178 healthy blood donors (HBDs). The patients were categorized into two subgroups in relation to the response to methotrexate (MTX) therapy. Group A included 70 RA patients in stable partial remission after 6 months of MTX treatment (MTX-R). Group B included 56 RA patients with active disease despite MTX therapy. This group received antitumor necrosis factor (TNF) biological drugs and were defined MTX-nonresponders (MTX-NR).

RESULTS

None of the two IL-1B (-511 and +3953) gene polymorphisms were significantly different in frequency between RA patients and healthy controls. We observed an increased frequency of the rare allele IL1RN*3 in RA patients with active disease, not responding to MTX therapy (MTX-NR) (4.5%) vs MTX-R (3.6%) and healthy controls (0.8%). Interestingly, RA patients whose genotypes included the IL1RN*long allele (haplotype long-C-T) showed the worse response to MTX. HBDs harboring the IL1RN*2/2 genotype showed significantly lower levels of plasma IL1-Ra, but comparable levels of IL-1beta with regard to subjects with the presence of the IL1RN* long allele. Furthermore, the presence of the TT IL-1B +3953 genotype was associated with lower plasma levels of IL1-Ra, both in HBDs and in RA patients. Carriers of the IL1RN*2 allele responded better to infliximab therapy.

CONCLUSIONS

The results of this study provide evidence of an association between the IL1RN*long allele and RA, the strongest association being observed in RA patients with an aggressive disease resistant to MTX treatment.

Understanding the genetic contribution to rheumatoid arthritis

PURPOSE OF REVIEW

The identification of the genetic variants that mediate the risk for susceptibility and severity of rheumatoid arthritis will allow the development of new drug targets and also increase the ability to predict disease course. Technical and methodologic progress has fueled the advances in this field.

RECENT FINDINGS

The second risk factor for rheumatoid arthritis, the PTPN22 polymorphism, has been identified. This genetic variant regulates the threshold of T cell activation. Intriguingly, this variant is a risk factor for diabetes as well. Moreover, it has been shown that multiple genetic variants in one pathway (both in a transcription factor, RUNX-1, as in the transcription factor binding site of RUNX1 in the SLC22A4 gene) can each confer very small risks but by gene-gene interactions can confer a ninefold risk for rheumatoid arthritis. These genetic risk factors have been found to confer risk for multiple autoimmune diseases. Phenotype-genotype interactions were described by the enhanced prevalence of a rheumatoid arthritis-specific autoantibody (anti-cyclic citrullinated peptide antibodies) in rheumatoid arthritis patients that harbor the rheumatoid arthritis-associated human leukocyte antigen class II genes, the shared epitope alleles. An environmental factor, smoking was demonstrated to confer risk for rheumatoid arthritis, especially in patients positive for both shared epitope and rheumatoid arthritis-specific anti-cyclic citrullinated peptide antibodies.

SUMMARY

Two new pathways, T cell receptor signaling and a hematopoietic-specific signal transduction pathway, have been discovered that allow future pharmacologic interventions. The description of the new genetic risk factors and the interaction with environmental triggers as well as phenotypic features are gradually expanding the ability to predict disease susceptibility and course.

Polymorphism of the interleukin-1 receptor antagonist gene: A factor in susceptibility to rheumatoid arthritis in a Spanish population

OBJECTIVE

To assess whether an interleukin-1 receptor antagonist gene (IL1RN) polymorphism is associated with disease susceptibility and/or severity in a Spanish population of patients with rheumatoid arthritis (RA).

METHODS

An 86-bp variable-number tandem repeat polymorphism within IL1RN intron 2 was analyzed by polymerase chain reaction in genomic DNA obtained from 247 unrelated patients with RA (group A) and 287 healthy control subjects. The polymorphism analysis was repeated in a second group of 194 patients with RA (group B). Clinical information from patients in group A was used to compare activity and severity data in patients stratified according to the different alleles or genotypes. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to determine the strength of the association of the different alleles or genotypes with RA activity or severity.

RESULTS

In the control group, the allelic frequencies were 76% for IL1RN*1 (4 repeats), 21% for IL1RN*2 (2 repeats), 3% for IL1RN*3 (5 repeats), and 0.3% for IL1RN*4 (3 repeats). In group A patients with RA, both the frequency (OR 1.47, 95% CI 1.1-1.96, P = 0.007) and carriage rate (OR 1.6, 95% CI 1.1-2.2, P = 0.01) of allele IL1RN*2 were significantly increased. The increased frequency of IL1RN*2 was confirmed in group B patients with RA (OR 1.44, 95% CI 1.1-1.97, P = 0.01). In patients with RA, homozygosity for IL1RN*2 was associated with an increased number of affected articular areas during the first year of followup but not with other parameters of disease activity or severity.

CONCLUSION

Our results suggest that IL1RN has a role in determining susceptibility to RA in the Spanish population.