Value of endothelin-1 in rheumatoid vasculitis and synovitis

Rheumatoid vasculitis is a potentially serious complication of RA, usually occuring in long standing erosive nodular disease. It has several clinical presentations, which can be sometimes difficult to diagnose. Endothelial cells produce a variety of vasoactive substances including the potent vasoconstrictor peptide Endothelin-1 [ET-1], which has a wide range of action on mammalian tissues. ET-1 produces sustained vasoconstriction; such action may have an important pathophysiological role in initiation and development of vascular injury and hence vasculitis. Was to study plasma and synovial fluid ET-1 levels in RA and its role in pathogenesis of rheumatoid vasculitis and its correlation to disease activity in an attempt to throw light on possible new strategies in the management of this disease. We conducted our study on 30 RA patients, in addition to 10 normal healthy subjects who served as a control group. Patients and control plasma and synovial fluid samples were subjected to EIA test to measure endothelin-1 level. There was a highly significant high level of plasma ET-1 in the patient's group as compared to the control group and it was positively correlated with the presence of vasculitis in these patients and there was no correlation with the disease activity. Synovial ET-1 in the patient"s group [n = 10] was lower than their plasma level. ET-1 may play a role in pathogenesis of rheumatoid vasculitis rather than arthritis. Under this point of view, ET-1 receptor antagonist will be a novel strategy for the treatment of vasculitis associating rheumatoid arthritis

Serum thrombomodulin as a marker in assessment of systemic lupus erythematosus

Systemic lupus erythematosus is the prototype of autoimmune disease. Since organ involvement in SLE is due to a vascular inflammatory process, many researchers try to find a marker of endothelial cell damage, which may indicate active vasculitis in SLE. Serum thrombomodulin [TM] is considered a marker of endothelial cell dysfunction. It is one of the soluble forms of tissue TM. A common mechanism for the increase of soluble TM may be an accelerated release of TM from injured endothelial cells. Measurement of the level of serum TM in systemic lupus erythematosus patients and to correlate it with the different clinical manifestations and laboratory parameters. This work was performed on 30 Egyptian SLE female patients and 10 .controls. Those patients were subjected to thorough clinical examination, laboratory tests including complete blood picture, ESR serum creatinine level, SCOT, SGPT, blood glucose level, serum C3, C4 level, ANA, anti-DNA, in addition to complete; urine analysis and estimation of the level of TM with ELISA. The level of serum TM differentiated lupus patients from controls. In addition it correlated strongly with disease activity score [as assessed with SLEDAI], with activity parameters and parameters of renal damage as serum creatinine level and proteinuria.[s]TM was higher among patients with pleurisy, pericarditis and thromboembolic manifestations and vasculitis, and this implies its valuable role in the immune pathogenesis of vasculitis in SLE. Results recommend measurement of serum TM in the assessment of SLE patients regarding activity and endothelial cell injury

Clinical significance of serum thrombomodulin level in rheumatoid arthritis patients

To determine the soluble thrombomodulin [TM] level in sera of rheumatoid arthritis [RA] patients and to evaluate its relationship to disease activity in those patients. Twenty rheumatoid arthritis patients were included in this study. They were 18 females and 2 males. Their age ranged from 25 to 62 years. The Disease Activity Score [DAS] was used for the assessment of disease activity in the patients. The DAS was divided into 3 categories: 2.4 and 3.7 [high disease activity]. Ten age and sex-matched healthy subjects were included as a control group. The soluble thrombomodulin level was measured with a solid phase sandwish-Enzyme-Linked-Immuno-Sorbent Assay [ELISA] in the sera of the twenty RA patients and ten controls. The relationship between serum TM levels and disease activity in the patients was assessed. The frequency of patients with high serum TM levels [> 5.33 ng/ml] was 7/20 [35%]. Serum TM levels in the patients were significantly higher than those in the control group [p < 0.05] and there was a significant positive correlation between serum TM levels and the DAS [p < 0.05]. Comparison between patients with different categories of the DAS and controls regarding serum TM level showed that patients with high disease activity [DAS > 3.7] had a highly significant higher serum TM levels than the control group [p < 0.001]. Patients with moderate disease activity [DAS > 2.4 and 0.05]. Serum TM levels were elevated in RA patients and correlated with the disease activity score. These results may indicate that serum TM measurement may be valuable in the evaluation of the RA disease activity