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
Objective: to identify angiogenesis imbalance in systemic sclerosis [SSc] by measuring serum level of the main angiogenic inducer marker [vascular endothelial growth factor VEGF] and the main angiogenic inhibitor marker [endostatin] in order to find out their possible role in the pathogenesis of the disease
Methodology: this study was conducted on twenty five SSc patients, 15 with limited SSc [LSSc] and 10 with diffuse SSc [DSSc]. They were further classified into early LSSc, late LSSc, early DSSc and late DSSc according to Medsger and Steen, 1996, as well as 15 apparently healthy controls participated to this study. Skin involvement was assessed using the modified Rodnan Skin Score, nailfold Video Capillaroscopy [NVC] and pulmonary function tests [PFTs] were done. Serum VEGF and endostatin levels were measured using enzyme linked immunosorbent assay [ELISA]
Results: there was a statistically highly significant increase in the mean values of both serum VEGF and serum endostatin in SSc patients compared to control subjects [p<0.001]. Early DSSc and early LSSc patients had a statistically highly significant increase in the serum levels of VEGF compared to late DSSc and late LSSc patients [p<0.001]. Late LSSc patients had a statistically significant increase in the mean value of serum endostatin compared to early LSSc patients [p<0.01], as well as late DSSc patients had a statistically highly significant increase in the mean value of serum endostatin compared to early DSSc patients [p<0.001]. A highly significant positive correlation was found between serum levels of endostatin and modified Rodnan Skin Score in SSc patients [r=0.69, p<0.001], while no significant correlation was found between serum VEGF and modified Rodnan Skin Score [r=0.293, p>0.05]. SSc patients without ischemic manifestations had a statistically significant higher level of serum VEGF compared to those with ischemic manifestations [p<0.01], while SSc patients with ischemic manifestations had a statistically highly significant increase in the mean value of serum endostatin compared to those without ischemic manifestations [p<0.001]. SSc patients with early NVC pattern had highly significant increase in the mean value of serum VEGF compared to those revealing late NVC pattern [p< 0.001], while SSc patients with late NVC pattern had highly significant increase in the mean value of serum endostatin compared to those revealing early NVC pattern [p<0.001]. SSc patients with restricted PFTs had a statistically significant higher level of serum endostatin in comparison to those without pulmonary affection [p<0.001], while no significant difference regarding mean levels of serum VEGF in patients with or without restricted PFTs [p>0.05]
Conclusion: we may conclude that angiogenic inhibitor [endostatin] is induced and outweighs angiogenic inducer [VEGF] in late disease. Increased serum endostatin level is associated with skin sclerosis severity, ischemic manifestations and pulmonary fibrosis in SSc patients. This angiogenesis inhibitor favors disease progression and it is a good candidate for further evaluation of disease severity and treatment purposes