ABSTRACT
Objective: the aim of this study was to elucidate early macrovascular affection in systemic sclerosis [SSc] patients and to find out its relation to ant centromere antibody [ACA] in order to attenuate such complication if present
Methodology: this study was carried out on thirty SSc female patients fulfilling the 1980 American Rheumatology Association [ARA] Criteria for systemic sclerosis. They were classified into twenty limited cutaneous SSc [LcSSc] and ten diffuse cutaneous SSc [DcSSc] patients according to clinical examinations. Fifteen, age and sex matched healthy controls were also included. Serum ACA was assessed by ELISA technique. Ankle brachia! Pressure index [ABPJ] and Carotid Duplex Scan [CDS] were used to detect the presence of large vessel affection. Patients with high risk factors for peripheral arterial occlusive disease [PAOD] were excluded from the study. Patients receiving steroids and oral contraceptive pills were also excluded from the study
Results: the results of our study showed no statistically significant difference in the levels of basic risk factors for PAOD [serum cholesterol, triglycerides and glucose, high and low density lipoproteins] between LcSSc, DcSSc and the control group [p>0.05]. There was a high statistically significant reduction in ABPI in LcSSc patients compared to controls, while no statistically significant difference was found between DcSSc patients and controls, whereas a statistically significant reduction in ABPI was found in LcSSc compared to DcSSc patients as p<0.001, p>0.05 and p<0.05 respectively. There was a statistically significant increase in carotid artery intimal thickening [CAIT] in DcSSc patients compared to controls as well as between DcSSc patients compared to LcSSc patients while no significant difference was found between LcSSc patients and controls as p<0.05, p<0.05 and p>0.05 respectively. There was a statistically significant reduction in ABPI in SSc patients with positive ACA compared to those with negative ACA asp< 0.05
Conclusion: macrovascular affection is considered a complication in SSc patients who have higher incidence of lower limb large vessel abnormalities in LcSSc patients as evidenced by ABPI and central large vessel affection in DcSSc patients as evidenced by CDS. Also, we can conclude that there is an association between ACA and peripheral macrovascular affection in LcSSc patients
ABSTRACT
To estimate the serum macrophage inflammatory protein-1alpha [MIP-1alpha] and serum/urinary monocyte chemoattractant protein-1 [MCP-1] in systemic lupus erythematosus [SLE] patients. This is in order to highlight their possible roles in the pathogenesis of SLE, disease activity and renal involvement. Forty SLE patients [group I] and 20 apparently healthy controls [group II] were included in the study. SLE patients were subdivided into group IA patients with active lupus nephritis [13 patients] and group IB patients without nephritis [27 patients]. Nephritis was diagnosed by active urinary sediments, impaired serum creatinine or creatinine clearance and graded by renal biopsy according to the WHO classification. SLE activity was measured using SLEDAI. The serum MIP-1 and serum/urinary MCP-1 were measured in all patients and controls using the ELISA technique. SLE patients had a significantly higher level of serum MIP-1alpha in group IA [105.2 +/- 12.9 pgm/mL] and group IB [93.9 +/- 3.5 pgm/mL] when compared to the control group [69.1 +/- 4.9 pgm/mL]. Also, there was a significant positive correlation [p<0.05] between MIP-Ialpha and both clinical [SLEAI], serological [dsDNA, ESR levels] parameters of disease activity and serum/urinary MIP1alpha. There was a statistically significant difference between the means of MCP-1 [serum 16.40 +/- 5.97 and urinary 21.20 +/- 3.12] among the controls and SLE group IA [serum 488.6 + 354.61, urinary 590.3 +/- 339.54], also between the controls and SLE group IB [serum 32.20 +/- 12.65, urinary 35.5 +/- 18.55]. The serum and urinary MCP-1 showed positive correlation with disease activity [SLEDAI], serum creatinine, and creatinine clearance. Also, urinary MCP-1 had positive correlation with ESR. Again, there was a significant difference between groups IA and IB regarding serum levels of MIP-1alpha and serum/urinary MCP-1 [p < 0.05]. The levels of serum MIP-1alpha and the serum/urinary MCP-1, may be used as laboratory parameters of disease activity in SLE and may reflect its immunopathogentic role and proinflammatory activity in SLE. Also, the urinary MCP-1 may be a useful simple tool for monitoring disease activity of lupus nephritis