Systemic lupus erythematosus (SLE) is a complex autoimmune disease that exhibits extensive clinical heterogeneity. Several studies have suggested a role for tumor necrosis factor alpha (TNFalpha) in SLE and recently, the locus encompassing the TNF receptor II (TNFRII), which is a mediator of TNF effect, was amongst the candidate loci suggested by genetic linkage studies of multi-case SLE families. Komata et al. reported an association between a polymorphism at position 196 (R allele) of TNFR II and SLE in Japanese patients. We have typed SLE patients from two different ethnic populations, Spanish and UK Caucasoids, for this polymorphism using a polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP)-based technique. No significant differences in allele or genotype frequencies were found between cases and matched controls in either population. The TNFRII 196R allele does not appear to be associated with SLE susceptibility in either Spanish or UK populations.

The MBL gene codon 54 mutant allele appears to be a risk factor for SLE, whilst haplotypes encoding for high levels of MBL are protective against the disease. Differences between controls and patients were not significant when considering the FcgammaRIIa polymorphisms; similar results were observed for renal affectation.

The antiphospholipid syndrome (APS) is usually defined by the association of clinical manifestations that comprise venous and/or arterial thrombosis, recurrent fetal losses, and thrombocytopenia, along with the presence of anticardiolipin (aCL) antibodies and/or lupus anticoagulant. Various infectious diseases can induce aCL; however, these antibodies are not usually associated with thrombotic events, as happens with autoimmune diseases, in which these antibodies need the presence of ␤ 2 -glycoprotein I. Levels of immunoglobulin G (IgG) and IgM aCL antibodies were determined by enzyme-linked immunosorbent assay for 243 patients with chronic hepatitis C virus (HCV) infection and 100 healthy controls. Clinical events of APS, the level of ␤ 2 -glycoprotein dependence of aCL, the presence of cryoglobulins and other autoantibodies, and cross-reactivity between purified aCL and HCV were evaluated. Positive results for aCL antibodies were found more frequently (3.3%) for the patients with HCV infection than for healthy controls (0%). All positive aCL antibodies were ␤ 2 -glycoprotein I independent. No significant association was found between aCL antibodies and clinical manifestations of APS, neither was one found between the presence of other autoantibodies or cryoglobulins and that of aCL. Finally, no cross-reactivity between aCL antibodies and HCV antigens was observed. As previously reported, aCL antibodies seem to be an epiphenomenon, and they do not have clinical or laboratory significance in HCV patients.Infection with hepatitis C virus (HCV) may lead to an autoantibody response. It has been reported that chronically infected HCV patients have anti-smooth muscle antibodies, rheumatoid factor, anti-liver-kidney-microsomal (aLKM) antibodies, anticardiolipin (aCL) antibodies, and low titers of antinuclear antibodies (ANA) (1,6,8,31).Antiphospholipid (aPL) antibodies, such as aCL and lupus anticoagulant (LA), are a group of antibodies with an apparent affinity for anionic phospholipids. New data indicate that the antigenic targets of aPL detected in conventional aCL and LA assays are phospholipid-binding plasma proteins, most notably ␤ 2 -glycoprotein I (␤ 2 GPI) and prothrombin, or complexes of these proteins with phospholipids (28). aPL antibodies are detected in patients with autoimmune and infectious diseases and other conditions. In patients with autoimmune diseases, they have been associated with thrombosis, thrombocytopenia, fetal loss, and a variety of other clinical manifestations (livedo reticularis, valvular heart disease, etc.). This clinical association has been defined as antiphospholipid syndrome (APS) (2, 11). In this syndrome, aCL antibodies require ␤ 2 GPI to bind cardiolipin, but aCL antibodies induced by infections do not usually require this cofactor to bind the anionic phospholipid and are considered nonpathogenic (21, 23).In previous studies, members of our group tested aCL antibodies and their cofactor dependence in sera from patients with infectious diseases such as syphilis, leprosy, human ...

High-resolution ultrasound for the study of target joints in rheumatoid arthritis To the Editor: Conventional radiography remains the "gold standard" for the evaluation of joint damage and its progression in rheumatoid arthritis (RA), but changes may not be evident radiographically until late in the disease course (1). Magnetic resonance imaging (MRI) has been used to study patients with early RA, but high cost and lack of standardization limit its use (2). Several studies have now shown that high-resolution ultrasound (US) of the metacarpophalangeal (MCP) joints can be very informative in the evaluation of RA of various durations (3-5). Erosions have been visualized in selected hand joints (second MCP) and foot joints (fifth metatarsophalageal [MTP]) (5). In fact, detection of more erosions per joint and per patient with US as compared with radiography was demonstrated by Wakefield et al in a recent study reported in Arthritis & Rheumatism (3). The present pilot study was undertaken to assess the feasibility of performing US in selected (target) joints of patients with RA, and to determine if this technique offers additional information beyond that obtained with conventional radiography. MRI was chosen as a comparator method because of its high sensitivity. Our Institutional Review Board approved this study. Ten unselected patients with RA according to the criteria of the American College of Rheumatology (formerly, the American Rheumatism Association) (6) and 5 healthy volunteers who, as a group, were of comparable age (mean 45 years), sex (80% women), and ethnicity (80% white) with the patients were studied. The duration of RA was Ͻ2 years in 2 patients, 3-5 years in 5, and Ͼ5 years in 3. Six of the 10 patients were positive for IgM rheumatoid factor. Five of the 10 were receiving a disease-modifying antirheumatic drug (methotrexate in 4 of the 5); 3 other patients were receiving anti-tumor necrosis factor therapy. Joints selected for US imaging included the second and fifth MCP joints and the fifth MTP joints. These joints were selected on the basis of their likelihood of early involvement in RA as well as their easy accessibility with the US probe. The first MTP joints, not considered targets for involvement early in the course of RA, were also examined because of their easy accessibility with the US probe. Conventional radiographs of the hands/wrists and feet were obtained. These included 3 views (anteroposterior, lateral, and oblique) obtained using standard techniques (Kilovolt peak 54, milliampere-second 2.5, fine detail film-screen combination). Coronal T1-weighted MR images of the hands and feet were obtained using a 1.5T body scanner (Signa; GE, Milwaukee, WI), dedicated extremity coils, and the following parameters: repetition time 500 msec, echo time 15 msec, 256 ϫ 192 matrix, 3 mm thickness with 0.5 mm gap, field of view 20 cm). Finally, US of the joints as noted above was performed by one of us (RL-B), using 10-15 MHz highresolution linear array transducers with small footprints. Indi-2. Molenaar T...

The evaluation of IgG aPE may allow us to detect some more patients with aPL-related clinical manifestations in the SLE population, aPE correlated particularly with valvulopathies and livedo reticularis.