Cornelia M. Weyand, Naomi Tetzlaff, Johannes Bjornsson, Alexander Brack, Brian Younge, and Jorg J. Goronzy 19

Giant cell arteritis causes a spectrum of clinical manifestations, including end-organ ischemia, aortic arch syndrome, constitutional symptoms, and polymyalgia rheumatica. The inflammatory infiltrate in temporal artery specimens is characterized by the production of T cellN and macrophage-derived cytokines. The present study indicates that differences in in situ cytokine expression can be correlated with histologic features as well as with different patterns of the disease.

Domenico Caccavo, Bruno Lagana, Anna P. Mitterhofer, Giovanni M. Ferri, Antonella Afeltra, Antonio Amoroso, and Lorenzo Bonomo 27

The results of this study indicate that CSA is an effective drug in reducing disease activity in SLE patients. In addition, treatment with CSA allowed a significant reduction of steroid dosage. The most frequent side effect observed during CSA therapy was hypertrichosis, which occurred in 63

of patients.

R. J. S. Chinn, I. D. Wilkinson, M. A. Hall-Craggs, M. N. J. Paley, E. Shortall, S. Carter, B. E. Kendall, D. A. Isenberg, S. P. Newman, and M. J. G. Harrison 36

The prevalence and extent of cerebral changes in a series of patients with SLE who did not have clinical evidence of neuropsychiatric involvement were investigated. The findings give the clinician a baseline of cerebral involvement against which the investigation of acute neuropsychiatric disease can be interpreted. This is particularly pertinent in the interpretation of magnetic resonance spectroscopy examinations, a technique that has only recently been applied to the investigation of this patient group.

Elizabeth W. Karlson, Lawren H. Daltroy, Robert A. Lew, Elizabeth A. Wright, Alison J. Partridge, Anne H. Fossel, W. Neal Roberts, Steven H. Stern, Karin V. Straaton, Mary C. Wacholtz, Arthur F. Kavanaugh, Jodi M. Grosflam, and Matthew H. Liang 47

This study of 200 patients with SLE, balanced in terms of race and socioeconomic status, demonstrated that greater disease activity and worse physical and mental health status were correlated with potentially modifiable psychosocial factors such as self-efficacy for disease management, while none of the outcomes measured were associated with race. This suggests that increased psychosocial interventions (e.g., education and counseling) might improve outcomes in patients with SLE.

Anita E. Wluka, Matthew H. Liang, Alison J. Partridge, Anne H. Fossel, Elizabeth A. Wright, Robert A. Lew, and Elizabeth W. Karlson 57

This study used the Systemic Lupus Activity Measure to compare 2 methods of assessing disease activity in SLE: retrospective abstraction from the medical chart versus a direct clinical assessment. The results provided insight into the validity, potential biases, and limitations of chart abstraction. These findings have important implications for clinical research, as well as for the evaluation of published studies in which medical record review is used.

Eric M. Veys, Charles-Joel Menkes, and Paul Emery 62

In a multicenter double-blind trial that involved 197 patients with rheumatoid arthritis, the effects of recombinant interferon-|gg were compared with those of placebo. A significant improvement from baseline to end point visit was observed in both groups, but no significant intergroup differences were seen. Interferon-|gg did not induce increased toxicity compared with placebo, but proved no more effective than placebo in this large double-blind trial.

Zhinan Yin, Jurgen Braun, Lucia Neure, Peihua Wu, Ulrich Eggens, Andreas Krause, Thomas Kamradt, and Joachim Sieper 69

This study gives important information about the cytokine pattern of T cells and its regulation in the joints of patients with Lyme arthritis. The findings should help clarify the pathogenesis of Lyme disease.

Tomoko Hasunuma, Nobuhiko Kayagaki, Hiroshi Asahara, Satoru Motokawa, Tetsuji Kobata, Hideo Yagita, Hiroyuki Aono, Takayuki Sumida, Ko Okumura, and Kusuki Nishioka 80

This work attempts to elucidate the mechanism of Fas-dependent apoptosis in rheumatoid joints. With the demonstration of the presence of a soluble form of Fas in rheumatoid joints, it is proposed that such a molecule might be involved in maintaining the state of synovial hyperplasia and inflammation in patients with RA.

Liping Kong, Noriyoshi Ogawa, Toru Nakabayashi, George T. Liu, Errol D'Souza, H. Stan McGuff, Daniel Guerrero, Norman Talal, and Howard Dang 87

The presence of Fas and its ligand was demonstrated in the glandular epithelial cells of patients with Sjogren's syndrome, as well as on infiltrating lymphocytes. However, the epithelial cells were found to undergo apoptosis. Fas-mediated apoptosis may be important in the pathogenesis of Sjogren's syndrome.

Lars Bendtsen, Jesper Norregaard, Rigmor Jensen, and Jes Olesen 98

This study investigated the perception of pain from tender muscles in patients with fibromyalgia. The results demonstrate that fibromyalgic pain has a physiologic basis.

Sozos Loizou, John K. Cazabon, Mark J. Walport, Dereck Tait, and Alex K. So 103

Acute infection by parvovirus B19 is commonly accompanied by the production of aPL. These antibodies differ from those found in other acute viral infections, but resemble those found in SLE. In light of the similarity of some of the clinical features between acute B19 infection and SLE, this cause must be borne in mind in the interpretation of laboratory results that show raised levels of aPL.

Ralph C. Williams, Jr., Christine C. Malone, Kelly Cimbalnik, Matthew A. Presley, Kenneth H. Roux, Lioudmila Strelets, and Franco Silvestris 109

Patients with systemic lupus erythematosus often show high levels of antiNdouble-stranded DNA antibodies. This study indicates that anti-DNA antibodies in both SLE patients and normal subjects cross-react with IgG F(ab`)<sub>2</sub> as well as with other nuclear antigens. These findings indicate that IgG antibodies with presumed autospecificity, such as anti-dsDNA, may also cross-react with autologous antigens, such as F(ab`)₂, that are not generally considered a pathogenic initiator of SLE.

Michael J. Yellin, Vivette D'Agati, Glenn Parkinson, Angelina Soh-Yung Han, Anthony Szema, David Baum, Dorothy Estes, Matthias Szabolcs, and Leonard Chess 124

CD40L is an activation-induced CD4+ T cell surface molecule that delivers contact-dependent activation signals to CD40+ target cells. CD40LNCD40 interactions have been shown to play important roles in murine models of autoimmune diseases; however, the mechanisms responsible for this effect are not precisely known. This study shows that CD40 expression is markedly up-regulated and CD40L+ mononuclear cells infiltrate the renal interstitium in lupus glomerulonephritis and other inflammatory renal diseases. These findings suggest that direct interaction of CD40L+ mononuclear cells with CD40+ target cells in the kidney might play a role in the immunopathogenesis of lupus nephritis and other glomerulonephritides.

Hendryk P. Strunz, Elena Csernok, and Wolfgang L. Gross 135

This report describes a monoclonal PR3-ANCA antiidiotype antibody which is a promising tool for the development of specific immunotherapy in Wegener's granulomatosis. The corresponding ANCA idiotype may have immunodiagnostic value beyond that of the established ANCA serologic profile and clinical parameters.

Rosario Garcia-Vicuna, Federico D|fiaz-Gonzalez, Isidoro Gonzalez-Alvaro, Miguel A. del Pozo, Faustino Mollinedo, Carlos Cabanas, Roberto Gonzalez-Amaro, and Francisco Sanchez-Madrid 143

This study demonstrates that NSAIDs from the oxicam family are able to interfere with the activity of proinflammatory stimuli on human leukocytes, including induction of changes in the expression and activation state of adhesion receptors. These findings indicate that oxicams have the potential ability to interrupt intermediate steps in the leukocyteNendothelial adhesion cascade. Such an effect may significantly contribute to the antiinflammatory activity of these drugs.

Elisabet Josefsson and Andrej Tarkowski 154

This study shows that 2-methoxyestradiol, an endogenous metabolite of estradiol, significantly suppresses experimental type II collagen-induced arthritis. In vitro studies revealed that this compound suppresses the proliferation of endothelial cells and the production of nitric oxide in a dose-dependent manner. In contrast to estradiol, 2-methoxyestradiol lacks feminizing and immunosuppressive effects, which makes this agent an interesting candidate for therapeutic use in the human arthritides.

L. Didem Kozaci, David J. Buttle, and Anthony P. Hollander 164

This study attempts to elucidate the proteolytic mechanisms which contribute to collagen degradation in cartilage. A good understanding of these biochemical events is essential for the future development of new drugs to treat the damage to cartilage in the synovial joints of arthritis patients.