relation between inflammatory markers, lipid parameters and antioxidant vitamins in rheumatoid arthritis patients

The association between rheumatoid arthritis and increased risk of atherosclerosis and coronary heart disease is well recognized. The role of chronic inflammation, dyslipoproteinemia, lipid peroxidation and low levels of antioxidant vitamins [vitamin A and E] in the development of atherosclerosis and coronary heart disease is being established. To study the relationship between lipid profile abnormalities, antioxidant vitamins and inflammatory markers in rheumatoid arthritis patients. Thirty rheumatoid arthritis patients and twenty apparently healthy volunteers as a control group were studied .The following parameters were measured for all included subjects: markers of inflammation; CRP, RF, ESR, and VCAM [Vascular Cell Adhesion Molecule], lipid parameters; total cholesterol, triglycerides, direct HDL and LDL cholesterol and Lp [a] and antioxidant vitamins A and E. The inflammatory markers [CRP, ESR and VCAM] were significantly higher in patients compared to controls [p<0.01]. Total cholesterol and LDL cholesterol in rheumatoid arthritis patients were significantly higher compared to the controls [p<0.05]. Also Lipoprotein [a] was significantly higher in rheumatoid arthritis patients compared to the controls [p<0.01]. Vitamins A and E were significantly lower in rheumatoid arthritis patients compared to the control group [p<0.01]. A significant positive correlation was found between total cholesterol, LDL-C, lipoprotein [a] and VCAM [p<0.001, and p<0.01 and p<0.01] respectively. A significant negative correlation between the antioxidant vitamins E and A and VCAM [p<0.05 and p<0.05] in rheumatoid arthritis patients was also observed. A significant negative correlation was also found between lipoprotein [a] and both vitamins [E and A] [p<0.01 and p<0.001] respectively. The association of VCAM with high lipid parameters and low levels of antioxidant vitamins, might explain the association of chronic inflammatory processes with atherosclerosis and the high risk of cardiovascular disease in rheumatoid arthritis patients

possible prognostic role of VCAM-1 in stroke patients

The vascular endothelium promotes inflammation through the up-regulation of inflammatory leukocyte-endothelial cell adhesion molecules such as intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1] and E-selectin. These molecules bind to circulating leucocytes and facilitate their migration into the Central Nervous system CNS. In the CNS, these cells produce a number of cytotoxic molecules that may facilitate cell death and increase the infarct volume. To define the extent of expression of VCAM-1 in correlation to the clinical disability and outcome in stroke patients. Complete lipid profile, fibrinogen assay, lipoprotein [a] and FIM were determined in 25 recent stroke patients at the time of admission and compared with 15 matched apparently healthy control subjects. The difference between the mean total cholesterol [TC] level of patients and controls was not significant. However, high density lipoprotein [HDL] was significantly lower in patients as compared to controls but low density lipoprotein LDL was significantly higher. The concentration of Lp [a] and fibrinogen level, were significantly higher in the patients' group than controls. The concentration of VCAM-1 was significantly higher in stroke patients as compared to controls. Multiple regression analysis was performed to assign the predictors for functional independence measures [FIM] as a clinical outcome for the functional disability. The independent parameters were the duration of stroke as well as the laboratory tests [lipid profile, Lp [a], fibrinogen and VCAM-1]. The duration of stroke and VCAM-1 level negatively correlated with FIM, meaning that patients with high VCAM-1 level demonstrated more functional disability as manifested by low FIM score. The most sensitive parameters that can predict FIM were the duration of stroke and VCAM-1 level. Further research on the role of inflammatory CAMs in the pathogenesis of ischemic cerebrovascular disorders should lead to new diagnostic and therapeutic strategies in an attempt to reduce leukocyte-induced damage in stroke

Anti-neutrophil cytoplasmic antibodies in juvenile chronic arthritis and rheumatoid arthritis

To assess the incidence and clinical significance of ANCA in RA and JCA patients, and to study the relation between ANCA and granulocyte specific ANA. Serum antineutrophil cytoplasmic antibodies were determined with indirect immunofluoresescent [IIF] technique in 20 RA and 12 JCA patients. ANCA was detected in sera from 10 RA patients [50%] and their titer ranged from 110-350 and JCA patients [25%], their titer ranged from 70-230. ANCA titer was not correlated with RF, disease duration and the presence of ANA. p-ANCA were found in 25% RA patients and 8% of JCA patients, c- ANCA were seen in 25% of RA patients and 17% of JCA patients. The laboratory and histologically proven nephropathy were seen in 25% of RA patients 8% of JCA patients, they were associated with p- ANCA. We concluded that early diagnosis of ANCA associated vasculitides is a key to prevent renal failure, and to measure the serum ANCA titer not only for the diagnosis the clinical course, but also to early treatment of renal affection

Validity of radiological methods in early detection of rheumatoid shoulder synovitis and correlation with disease activity

This study was carried out on 34 active rheumatoid arthritis [RA] patients. All studied cases were subjected to careful history, clinical and joint examination, routine laboratory investigations and Interleukin -1beta [IL-1beta] level determination. Twenty-seven patients who had painful shoulders were radiologically examined with PR, US, CT and MRI with quantitative evaluation of bone erosions and joint space narrowing to assess disease activity. Positive correlations were found between IL-1beta and Ritchie articular index [RAI], ESR, disease activity score [DAS] and RF in all patients [p=0.007, <0.05, = 0.007 and <0.001 respectively]. Radiologically, glenohumeral erosions were detected with PR in 15-patients [55.5%], with US in 21 patients [77.7%], with CT in 15 patients [55.5%] and with MRI in 19 patients [70.3%]. US was the most sensitive in detecting erosion of the glenohumeral articulations [77.7%] while MRI was more sensitive in acromioclavicular erosions, as well as major and minor tuberosities [81.4% and 88.8% respectively]. Grading of these erosions was done with the 4 modalities effusion and rotator cuff tear was detected with US in 25.9% and with MRI in 33.3%. Pannus was only detected with MRI. Total scores for bone erosions and joint space narrowing showed significantly positive correlations with serum levels of IL-1beta in our patients. [p<0.001 and 0.005 respectively]. All four radiological modalities are complementary in the diagnosis and monitoring of rheumatoid shoulder patients and there is a positive correlation between these radiographic scoring methods and the clinical and laboratory parameters of disease activity