Correlation of myeloid related proteins [MRP8/MRP14] and disease activity in juvenile rheumatoid arthritis

To evaluate the expression of myeloid related proteins MRP8/MRP14 in the serum and synovial fluid of JRA and their correlation with local and systemic parameters of disease activity. Thirty JRA patients [Group I], and ten controls [Group II] were included in the study. The patients were subjected to thorough history taking and clinical examination. Synovial fluid aspiration was done from ten JRA patients. Laporatory investigations included CBC, ESR, RE, ASO, ANA, CRP, ALT, urine analysis and synovial fluid analysis for white blood cell count [SF-WBCs], lymphocytes%, and acute phase serum amyloid. MRP8/MRP14 was assessed with ELISA technique in serum and synovial fluid samples. Serum level of MRP8/MRP14 was elevated in Group I in comparison to up II. The serum and synovial levels of MRP8/MRP14 in Group I showed no significant inter-correlation. The MRP8/MRP14 in group I showed significant positive correlation with ESR, CRP, DAS, and A-SAA. The SF MRP8/MRP14 in group I showed positive significant correlation with SF-WBCs and A-SAA. The elevated MRP8/MRP14 in the serum and synovial fluids of patients with JRA showed a significant correlation with local and systemic disease activity parameters. So, it can be used to monitor disease activity and patient's response to treatment

Soluble selectin adhesion molecules in systemic sclerosis and Behcet's disease

To detect the serum level of soluble E, P and L-selectins in systemic sclerosis [SSc] and Behcet's disease [BD] patients and compare them to normal healthy controls. Also, to determine their relation to clinical parameters of disease activity Serum samples from 15 SSc patients, 10 BD patients and 10 apparently healthy age and sex matched controls were examined with a sensitive linked immunosorbent assay. All patients were evaluated for the presence of gastrointestinal, pulmonary, renal, cardiac, Raynaud's phenomenon as well as joint or muscle involvement. Serum levels of E and P-selectins were highly significantly increased in SSc patients as compared to healthy controls. L-selectin was significantly higher in Raynaud's related scleroderma. Serum level of P-selectin was found to be higher in the diffuse form of SSc. There was no correlation of any selectin and pulmonary fibrosis. As regards BD, there was a highly significant increase in E-selectin and a significant increase in P-selectin in comparison with normal controls. Comparing SSc and BD as regards selectin; there was a significant increase of E and P-selectins in SSc. The values of E and P-selectins were found to be elevated in SSc and BD patients that might reflect their role in the pathogenesis of both diseases. The correlation of E, P and L-selectins with clinical parameters of SSc may help in evaluation of progression or remission of the disease. Further large long term study and serial measurements at different intervals of therapy are needed to correlate it with clinical deterioration or improvement and response to therapy

Serum and synovial fluid levels of vascular endothelial growth factor in rheumatoid arthritis: correlation with disease activity

To study serum and synovial fluid levels of vascular endothelial growth factor [VEGF] in Rheumatoid arthritis [RA] and to investigate its association with clinical and laboratory parameters in order to assess its value as a marker of disease activity and development of joint synovitis. Measurement of VEGF levels in serum of 40 RA patients, synovial fluid obtained from 15 patients of them and 10 healthy age and sex matched subjects taken as controls using enzyme linked immunosorbent assay [ELISA] technique. Subjects underwent thorough clinical examination, assessment of disease activity using disease activity score [DAS] and radiological evaluation using the Larsen scale. Serum VEGF levels in RA patients [436.5 +/- 286.3 pg/ml] and that in synovial fluid [640.7 +/- 305.4 pg/ml] were significantly higher than in controls [252.0 +/- 51.6 and 276.0 +/- 48.8 pg/ml] respectively [p<0.001]. Twenty two RA patients out of 40 [55%] had increased serum VEGF while 14 RA patients out of 15 [93.3%] had increased synovial fluid VEGF There was a highly significant difference between serum VEGF [590.9 +/- 303.2 pg/ml] and synovial fluid VEGF [756.0 +/- 313.8 pg/ml] of RA patients [p<0.001]. Moreover, there was a statistically significant positive correlation between serum and synovial fluid VEGF [p<0.05] of RA patients. Also, there was a highly significant difference [p<0.001] and a significant positive correlation [<0.05] between serum VEGF and 28 swollen joint count, ESR, DAS score and Larsen grades. Again, there was a statistically significant difference [p<0.05] and significant positive correlation [p<0.05] between serum VEGF and age and 28 tender joint count while there was a significant negative correlation with Hb level [p<0.05]. Serum and synovial fluid VEGF levels were increased in RA patients and reflect the extent of joint disease severity. So VEGF levels can be a reliable marker in assessment of early active joint destruction in RA patients and evaluate the antiangiogenic therapy especially with VEGF inhibitors, which can represent a novel therapy for RA in the future

Role of placental growth factor and high resolution ultrasound in evaluation of hypervascularity in psoriatic arthritis

To measure the levels of placental growth factor [PIGF] in the serum and synovial fluid of in psoriatic arthritis [PsA] patients. Also, to evaluate any possible role of high resolution US in the angiogenesis observed in this disease. The study was conducted on 25 PsA patients and 10 apparently healthy age and sex matched subjects who served as controls. All subjects were subjected to thorough clinical and laboratory examination. PIGF levels were measured in the serum of all of them with ELISA technique. This was confirmed with Western blotting for PIGF in synovial fluid. Assessment of vascularity of the small joints of the hands and other affected knee joints with high resolution US was performed. The mean value of serum PIGF level in the serum of PsA patients was [66.52 +/- 12.44 pg/ml] and that in the synovial fluid was 79.82 +/- 14.92]. There was a highly statistical significant difference between them and serum/synovial fluid levels in controls [16.20 +/- 7.33 and 19.44 +/- 8.79 pg/ml] respectively [p<0.001]. Moreover, there was a highly significant association [p<0.001] and a statistically significant positive correlation [p<0.05] between serum and synovial fluid levels of PIGF in PsA patients. There was a statistically significant difference between PsA patients and controls as regard Hb levels, ESR and serum uric acid [p<0.05]. Also, there was a significant positive correlation between synovial fluid PIGF levels and the onset of joint affection [p<0.05]. High resolution US can measure the synovial thickness in the small joints of the hands as well as knee joints in PsA patient. It can also detect increased blood flow in joints, so can measure the resistive index and can detect effusion. Our results showed that there was a highly statistical significant difference between PsA patients and controls as regard synovial thickness [p<0.001]. Also, there was a significant negative correlation between serum PIGF and resistive index of PsA patients Angiogenesis plays an important role in the pathogenesis of PsA. This is confirmed by the presence of higher PIGF levels in both serum and synovial fluid. Inhibition of PIGF and its receptor [Flt-1] constitute potential candidates for therapeutic modulation of angiogenesis and inflammatory joint destruction in arthritis. High resolution ultrasound can be very useful to detect early hypervascularization and joint inflammation which guide treatment towards an early or more aggressive therapy

Serum matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase-1 [TIMP-1] in rheumatoid arthritis, psoriatic arthritic and osteoarthritis

To investigate whether serum levels of MMPs and TIMPs are specifically elevated in rheumatoid arthritis as compared to other inflammatory and degenerative joint diseases. We compared serum levels of matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase [TIMP-1] of RA with psoriatic arthritis [PsA] and osteoarthritis [OA]. Serum samples were obtained from 30 RA, 20 psoriatic arthritis and 30 knee osteoarthritis patients. Serum concentration of stromelysin-1 [MMP-3], gelatinase B [MMP-9] and TIMP-1 were measured with quantitative sandwich enzyme-linked immunosorbent assay [ELISA] technique. Clinical examination and assessment of disease activity in RA using disease activity score [DAS] were carried out. Radiological evaluation in RA patients using the Larsen scale and in OA patients using the Kellgren and Lawrence scale were also done. Unique serum profiles of MMPs and TIMP-1 were identified in the two inflammatory arthritis groups [RA and PsA]. The serum concentrations of MMP-3 and MMP-9 were significantly higher in RA patients than in OA patients used as a control groups [p<0.001]. These two MMPs dominated in the serum of RA patients than PsA patients [p<0.001]. The analysis of the serum concentrations of TIMP-1 was also elevated in RA patients as compared with OA knee patients [p<0.001]. Also TIMP-1 was found in a significantly higher concentration in the serum of RA patients than PsA patients [p<0.05]. MMP-3 and MMP-9 correlate significantly with disease activity [DAS] in RA patients and with radiological scores. Serum levels of MMP-3, MMP-9, and TIMP-1 were significantly higher in RA and PsA than OA patients. MMP-3 and MMP-9 could be specific markers of joint inflammation and destruction. These variables are neither specific for RA nor for diseases in which bone erosions occur. These markers were correlated with the clinical activity of the disease. Early detection of these markers may herald progressive course and modulate the lines of treatment