Psychiatric diagnosis in patients with systemic lupus erythematosus (SLE) is controversial: variations have been reported in frequency, diagnostic assays, associations with disease activity, autoantibodies, and contributing social factors. Eighty-three consecutive non-selected Chilean patients with SLE were evaluated for: (i) 26 common mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the Mini-International Neuropsychiatric Interview (MINI-plus); (ii) psychological suffering measured by Hospital Anxiety and Depression Scale (HADS); (iii) ACR 1999 neuropsychiatric (NP)SLE criteria; (iv) SLE disease activity (SLEDAI-2K); (v) cumulative damage (SLICC/ACR); and (vi) anti-ribosomal P antibodies by enzyme-linked immunoassay and immunoblot. Psychiatric diagnoses occurred in 44.6% of patients; the most frequent (21.7%) was major depressive episode (MDE). No association with lupus activity was observed in patients with a DSM-IV diagnosis or MDE or psychological suffering. ACR 1999 NPSLE criteria were present in 42.2% of patients, the majority corresponding to mood (28.9%) or anxiety disorders (15.6%). Suicidal risk was present in 9.6% of patients. Anti-ribosomal P antibodies (13.3%) were not associated with DSM-IV diagnosis. Severe psychiatric disorders in SLE are common and not associated with disease activity.

BACKGROUND:Patients with inactive systemic lupus erythematosus (SLE) and elevated high affinity double-stranded anti-DNA antibodies (anti-dsDNA), measured using Farr technique, would have a risk of relapse that fluctuates between 40 to 80% according to different series.AIM:To study the association between anti-dsDNA levels measured using Farr technique and disease activity and their predictive capacity for relapses.MATERIAL AND METHODS:Anti-dsDNA antibodies were measured according to Farr method in 60 healthy subjects, 69 patients with other connective tissue diseases and in 120 patients with SLE. Farr positive were considered those individuals with anti-dsDNA levels over 10.4 IU/ml. Disease activity, assessed using MEX-SLEDAI score was related with anti-dsDNA levels in 101 patients. Forty seven patients with inactive disease were followed for 17 +/- 14 months.RESULTS:Anti-dsDNA levels were 3 +/- 2.5 IU/ml (range 1-26) in subjects without LED, and 127 +/- 500 IU/ml (range 1-5280) in patients with LED. Sixty subjects had an active SLE and 43 (72%) were Farr positive; in 41 the disease was inactive and 13 (32%) were Farr positive (p < 0.001), OR 5.45. Twelve of the 47 followed patients had a relapse and 10 (83%) were Farr positive. Of those that did not have a relapse, 13 (37%) were Farr positive (p < 0.02, RR 5.22). Six of 15 patients that were followed for more than on year (40%), were Farr positive.CONCLUSIONS:Elevated anti-dsDNA antibodies measured using Farr technique in patients with inactive generalised lupus erythematosus, predicted the risk of relapse. However less than half of patients with inactive disease and elevated Farr relapsed in a period of one year. The need to treat patients with inactive SLE and positive Farr should therefore be considered debatable.

BACKGROUND:Neuroendocrine factors play an important role in the expression of autoimmune diseases. Prolactin (PRL) can induce T-cell proliferation and macrophage activation. Elevated PRL levels have been described in patients with rheumatoid arthritis (RA).AIM AND METHODS:We studied immunological and clinical effects of PRL suppression in 9 RA patients with active disease, treated for 3 months with bromocriptine (BRC), an inhibitor of PRL secretion.RESULTS:BRC induced a significant depression of the peripheral blood mononuclear cells response to antigen (p = 0.008) and mitogen (p = 0.008) which was significantly correlated with improvements in the HAQ disability index (r = 0.68; p = 0.04) and grip strength (r = 0.7; p = 0.02). Also, the in-vitro production of IL-2, nitric oxide and poliamines--that are critical for the proliferative response of lymphoid cells--decreased significantly. The group experienced significant improvement of grip strength (p = 0.028) and the HAQ disability index (p = 0.025), whereas 4 individuals achieved clinical improvement according to the American College of Rheumatology preliminary definition. We conclude that BRC treatment induces a significant depression of in-vitro immune function in RA patients and that these changes are related to parameters of disease activity. The effects of BRC on immune function and disease activity in RA patients warrant further investigation.