CD6 is a 105–130&#x2009;kDa surface glycoprotein expressed on the majority of T cells and a subset of B cells. The human <i>cd6</i> gene maps to chromosome 11, and the expression of its protein product is tightly regulated. CD6 mediates cellular adhesion migration across the endothelial and epithelial cells. In addition, it participates in the antigen presentation by B cells and the subsequent proliferation of T cells. CD6 may bind in <i>trans</i> to surface glycoproteins (such as ALCAM and 3A11), or to microbial lipopolysaccharides, and may bind in <i>cis</i> to endogenous ligands (such as CD3 and CD5), and thereby deliver a costimulatory signal. Transinteractions are reinforced during autoimmune diseases (e.g., rheumatoid arthritis (RA), Sj&#xf6;gren's syndrome, and multiple sclerosis) and some cancers. Based on experimental data and on clinical results in RA and psoriasis, we believe that the recent humanized anti-CD6-specific mAb T1h may act as a regulator of the immunological response in addition to its function as an anti-T- and -B cell agent.

Ruby Alonso-Ramirez

Séverine Loisel

Caroline Buors

Jacques-Olivier Pers

Enrique Montero

Pierre Youinou

Yves Renaudineau

Rationale for Targeting CD6 as a Treatment for Autoimmune Diseases


		Macrophage migration inhibitory factor (MIF) was originally identified in the culture medium of activated T lymphocytes as a soluble factor that inhibited the random migration of macrophages.  MIF is now recognized to be a multipotent cytokine involved in the regulation of immune and inflammatory responses. Moreover, the pivotal nature of its involvement highlights the importance of MIF to the pathogenesis of various inflammatory disorders and suggests that blocking MIF may be a useful therapeutic strategy for treating these diseases. This paper discusses the function and expressional regulation of MIF in several rheumatic diseases and related conditions.

Tsuyoshi Kasama

Kumiko Ohtsuka

Michihito Sato

Ryo Takahashi

Kuninobu Wakabayashi

Kazuo Kobayashi

Macrophage Migration Inhibitory Factor: A Multifunctional Cytokine in Rheumatic Diseases

We investigated the effects of implementation of an institution-wide screening and decolonization protocol on the rates of deep surgical site infections (SSIs) in patients undergoing primary knee and hip arthroplasties. 2058 patients were enrolled in this study: 1644 patients in the treatment group and 414 in the control group.  The treatment group attended preoperative admission testing (PAT) clinic where they were screened for MSSA and MRSA colonization. All patients were provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower.  Additionally, patients colonized with MRSA received Vancomycin perioperative prophylaxis. The control group did not attend PAT nor receive mupirocin treatment and received either Ancef or Clindamycin for perioperative antibiotic prophylaxis. There were a total of 6 deep infections in the control group (1.45&#x25;) and 21 in the treatment group (1.28&#x25;); this represented a decrease of 13&#x25; (<svg style="vertical-align:-0.2475pt" id="M1" height="9.8999996" version="1.1" viewBox="0 0 50.349998 9.8999996" width="50.349998"  xmlns="http://www.w3.org/2000/svg"    >
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</svg>) in the treatment versus control group. This decrease represented a positive trend in favor of staphylococcus screening, decolonization with mupirocin, and perioperative Vancomycin for known MRSA carriers.

Scott Hadley

Igor Immerman

Lorraine Hutzler

James Slover

Joseph Bosco

Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement

Juvenile Idiopathic Arthritis (JIA) is the most common cause of chronic arthritis in childhood and adolescents and encompasses a heterogeneous group of different diseases. Due to the promising results of B-cell depleting therapies in rheumatoid arthritis the role of B-cells in autoimmune diseases has to be discussed in a new context. Additionally, experiments in mouse models have shed new light on the antibody-independent role of B-cells in the development of autoimmune diseases. In this review we will discuss the importance of B-cells in the pathogenesis of JIA appraising the question for an immunological basis of B-cell targeted therapy in JIA.

V. Wiegering

H. J. Girschick

H. Morbach

B-Cell Pathology in Juvenile Idiopathic Arthritis

Polyarteritis nodosa is a rare vasculitis of childhood. Cutaneous PAN (cPAN) is limited to the skin, muscles, joints, and peripheral nerves. We describe a 7.5-year-old girl with cPAN presenting initially as massive cervical edema who later went on to develop subcutaneous nodules, livedo reticularis, myositis, arthritis, and mononeuritis multiplex. The use of corticosteroids resulted in initial clinical improvement, but symptom recurrence necessitated disease modifying antirheumatic drugs and biologic therapy. We review a further 119 reports of biopsy proven cPAN in the literature. A majority of patients (96.6%) had cutaneous involvement; musculoskeletal involvement was common and included both articular (58.0%) and muscular (42.9%) symptoms, and nervous system involvement was least common (18.5%). Corticosteroids were used in the majority of patients (85.7%), followed by use of disease modifying antirheumatic drugs (33.0%), nonsteroidal anti-inflammatory drugs (10.7%), and intravenous immunoglobulin (9.8%). Therapy of cPAN with biologics has only been reported in 2 patients, and we report the first patient treated with Rituximab. A diagnosis of cPAN should be considered in a child with fever, vasculitic rash, and musculoskeletal symptoms. Most children respond to corticosteroids and have a benign course, but some require disease modifying antirheumatic drugs and biologic therapies.

Nina-Karen Bansal

Kristin Michelle Houghton

Cutaneous Polyarteritis Nodosa in Childhood: A Case Report and Review of the Literature

Using item response theory (IRT), we examined the Rheumatoid Arthritis Self-efficacy scale (RASE) collected from a People with Arthritis Can Exercise RCT (346 participants) and 2 subscales of the Arthritis Self-efficacy scale (ASE) collected from an Active Living Every Day (ALED) RCT (354 participants) to determine which one better identifies low arthritis self-efficacy in community-based adults with arthritis. The item parameters were estimated in Multilog using the graded response model. The 2 ASE subscales are adequately explained by one factor. There was evidence for 2 locally dependent item pairs; two items from these pairs were removed when we reran the model. The exploratory factor analysis results for RASE showed a multifactor solution which led to a 9-factor solution. In order to perform IRT analysis, one item from each of the 9 subfactors was selected. Both scales were effective at measuring a range of arthritis SE.

Thelma J. Mielenz

Michael C. Edwards

Leigh F. Callahan

Item Response Theory Analysis of Two Questionnaire Measures of Arthritis-Related Self-Efficacy Beliefs from Community-Based US Samples

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