Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis

Most people presenting with rheumatoid arthritis today can expect to achieve disease suppression, can avoid or substantially delay joint damage and deformities, and can maintain a good quality of life. Optimal management requires early diagnosis and treatment, usually with combinations of conventional disease modifying antirheumatic drugs (DMARDs). If these do not effect remission, biological DMARDs may be beneficial. Lack of recognition of the early signs of rheumatoid arthritis, ignorance of the benefits of early application of modern treatment regimens, and avoidable delays in securing specialist appointments may hinder achievement of best outcomes for many patients. Triage for recognising possible early rheumatoid arthritis must begin in primary care settings with the following pattern of presentation as a guide: involvement of three or more joints; early-morning joint stiffness of greater than 30 minutes; or bilateral squeeze tenderness at metacarpophalangeal or metatarsophalangeal joints.

IL10 and IL12B polymorphisms each influence IL-12p70 secretion by dendritic cells in response to LPS

Dendritic cells (DC) are the main producers of the cytokine IL-12p70, through which they play a direct role in the development of IFN-gamma-secreting Th1 cells, costimulation of CTL differentiation and NK-cell activation. In contrast, IL-10, which is also produced by DC, negatively regulates IL-12 production. IL-12p70 production varies widely between individuals, and several polymorphisms in the gene encoding IL-12p40 (IL12B) have been identified that influence susceptibility and severity of infectious, autoimmune and neoplastic disease. Here we show that polymorphisms not only of IL12B, but also in the IL10 promoter, influence IL-12p70 secretion by monocyte-derived DC in response to LPS. Although IL12B promoter homozygotes were prone to making more IL-12p70, presence of the IL10 high genotype restricted IL-12p70 production in these individuals. These observations provide a further genetic control of IL-12p70 regulation and emphasize the complexity of production of this cytokine. They also suggest genotypes that might influence the outcome of DC immunotherapy.

A pathology of the animal spirits – the clinical neurology of Thomas Willis (1621–1675) Part II – Disorders of intrinsically abnormal animal spirits

Thomas Willis (1621-1675), author of the classical work Cerebri Anatome (1664), was arguably the father of the modern era of neurology. His clinical neurology, as described in his Pathologiae Cerebri (1667) and De Anima Brutorum (1672), was largely derived from personal observations and not from traditional authorities and was based around his concept of the animal spirits, a fictitious entity in many ways analogous to the present day idea of the nerve impulse. This concept allowed him to develop a pathology of the animal spirits which embraced the whole content of the clinical neurology and psychiatry of his times. The anatomical and physiological background to Willis' concepts of animal spirit dysfunction, and those disorders he regarded as due to disturbed function of intrinsically normal animal spirits, have been dealt with in the previous part of this paper. The disorders he attributed to intrinsically abnormal animal spirits, dealt with in this part of the paper, comprised two categories. In one, the animal spirits possessed explosive properties, whilst in the other the abnormalities were non-explosive in their nature. The former category included epilepsy, hysteria and hypochondriasis, whilst the latter included mainly disorders now considered psychiatric e.g. delirium, melancholy, madness and stupidity. Willis' ideas about the pathogenesis of nervous system disorder seem never to have been generally accepted, partly because they appeared at a time when others were increasingly calling into question the existence of the animal spirits. Nevertheless, Willis' attempt to record and interpret all nervous system disease on the basis of disorder of function of a single underlying mechanism represents a formidable synthetic intellectual endeavour on the part of a very busy physician. (C) 2002 Elsevier Science Ltd. All rights reserved.

Ankistromeces mariae n. g., n. sp (Digenea : Sanguinicolidae) from Meuschenia freycineti (Monacanthidae) off Tasmania

Ankistromeces mariae n. g., n. sp. is described from Meuschenia freycineti (Monacanthidae), the six-spined leatherjacket, from off northern Tasmania. The new genus differs from the 21 other sanguinicolid genera in the combination of the anteriorly intercaecal and posteriorly post-caecal single testis, the presence of a cirrus-sac, the absence of an auxiliary external seminal vesicle, separate genital pores, the typically post-ovarian uterus and the H-shaped intestine. A. mariae is the first sanguinicolid to be reported from a monacanthid fish.

Grammatorcynicola n. g. (Bucephalidae : Dolichoenterinae) from Grammatorcynus spp. (Scombridae) on the Great Barrier Reef, Australia

A new trematode genus, Grammatorcynicola n. g. (Bucephalidae: Dolichoenterinae), and two new species, G. brayi n. sp. and G. nolani n. sp. from the intestines of the scombrids, Grammatorcynus bicarinatus and Gr. bilineatus respectively, are reported from the Great Barrier Reef, Australia. Grammatorcynicola n. g. is placed in the Dolichoenterinae, as the pharynx is in the anterior quarter of the body, the caecum is tube-like and extends to the posterior quarter of the body, the cirrus-sac is small relative to the size of the worm when compared with other bucephalids and the pars prostatica is curved. Grammatorcynicola n. g. differs from other dolichoenterine genera in having a simple sucker-like rhynchus, the ovary anterior to the testes and by not having a particularly thick cirrus-sac wall.