Value of measuring anti-cyclic citrullinated peptide antibody [ACCP2] in rheumatoid arthritis

To assess the value of the second test generation A-CCP2 compared with rheumatoid factor isotypes [IgG-RF and IgM-RF] in RA patients. Also to test the additional diagnostic value of combined measurement of both A-CCP2 and RF, and to clarify the relation between anti-CCP2 and disease activity, disease duration and joint destruction. Ninety RA patients, 40 patients with other different connective tissue diseases or vasculitis and 50 healthy normal controls were included in the study. After thorough history, clinical assessment of RA was done. Erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP], as laboratory parameters of disease activity were measured. Radiological evaluation was done. Then RF isotypes [both IgG and IgM] and A-CCP2 were assessed. A-CCP2 was less sensitive than RF [sensitivity = 60.0% vs. 80.0% respectively], but A-CCP2 showed a better specificity than RF [96.0% in A-CCP2 vs. 92.0% in RF]. Best sensitivity [88.9%], specificity [98.0%] and test accuracy [90.7%] were recorded in combined RF and A-CCP2 measurement. A-CCP2 could detect 44.4% more cases of RA that were negative when tested with RF, 25% were early within 1 year. There is significant association between A-CCP2 positivity and increased score of disease activity, either clinically [X[2]=9.0, p<0.05] or laboratory wise [t=11.4, p<0.001 for ESR and t=18.9, p<0.001 for CRP]. Also showed more frequent positivity with increased score of X-ray grading [X[2]=8.35, p<0.05], but no relation with disease duration [t=1.6, p>0.05]. A-CCP2 has a higher specificity and RF has a higher sensitivity. Best sensitivity, specificity and accuracy were recorded in combined RF and A-CCP2 measurement. The additional diagnostic value of A-CCP2 is even more impressive in the early course of disease, in patients with severe joint destruction, and in patients with very active disease. Its presence is indicative for poorer radiological outcome. We recommend adding A-CCP2 measurement to the routinely used RF tests

Soluble thrombomodulin [STM] and human adrenomedullin [AM] in systemic lupus erythematosus [SLE] and their relation to disease activity and renal affection

To study the status of endothelial markers as plasma soluble thrombomodulin [sTM] and adrenomedullin [AM] in systemic lupus erythematosus [SLE] patients versus control subjects. Also, to clarify their relation to renal affection in these patients and to highlight their association with disease activity as evaluated with SLE-disease activity index [SLEDAI] and other laboratory parameters of disease activity. We recruited forty five SLE patients and twenty healthy matched controls. After thorough history taking, clinical examination and laboratory investigations were done, we assessed disease activity and looked for clinical and laboratory parameters of renal affection. Then we measured plasma sTM with ELISA and AM with RIA techniques. Thrombomodulin [sTM] and adrenomedullin [AM] were found to be significantly higher in SLE patients group than control group. On dividing our patients according to disease activity and comparing both groups, we found that sTM and AM were significantly more in the active than in the inactive group. The group of renal affection included 14 cases [31.1%], and on comparing them with the rest of SLE patients, we found a significant difference regarding sTM and AM, being higher in the patients with renal disease. sTM and AM were also found to be correlated with SLEDAI, laboratory parameters of disease activity as ESR, Hb% and anti-ds-DNA; Also with parameters of kidney affection as C3c, serum albumin, 24-h urinary protein, BUN and serum creatinine. Both sTM and AM showed a significant positive intercorrelation. Thrombomodulin [sTM] and adrenomedullin [AM] are elevated in SLE patients and correlated with disease activity and with renal affection. They are involved in the pathophysiology of SLE and reflect a state of persistent endothelial cell activation. They may help as indicators for early and more aggressive treatment

Vascular endothelial growth factor and BCL-2 oncogene in systemic lupus erythematosus

Angiogenesis and defective regulation of programmed cell death [apoptosis] may play a role in the pathogenesis of autoimmune diseases. We aimed to assess the role of the angiogenic cytokine vascular endothelial growth factor [VEGF] and the oncogene Bcl-2 as markers of systemic lupus erythematosus [SLE] disease activity, with particular emphasis on their relation to lupus nephritis [LN]. Using the ELISA technique, VEGF and Bcl-2 plasma levels were measured in 40 SLE patients and 20 healthy matched controls. SLE disease activity index [SLEDAI] was assessed; renal biopsy was taken from 15 patients with manifestations of LN. VEGF plasma level was significantly higher in SLE patients than in controls, and significantly increased in patients with LN. Immuno-staining of LN renal tissue samples showed a strong expression of VEGF. No significant difference was found in Bcl-2 levels between SLE patients and the controls but there were increased levels in active SLE patients as compared to inactive ones. There was a positive correlation between each of VEGF and Bcl-2 and SLEDAI. VEGF and Bcl-2 may serve as markers of SLE activity. VEGF can be used as a reliable non-invasive marker for follow-up of patients with LN

Effect of different hemodialysis modalities on pulmonary function test

The aim of this study was to compare the effects of conventional thrice weekly dialysis versus daily hemodialysis on pulmonary function tests [PFTs]. Sixty subjects were included in this study: The first group included 20 healthy volunteers as controls, the second group included 20 patients maintained on thrice weekly hemodialysis [HD] and the third group included 20 patients maintained on daily HD [six days/week]. All studied personnel were subjected to perform PFTs [forced vital capacity [FVC], volume of air expired in the first second [FEV1], forced expiratory volume in the first second/forced vital capacity [FEV1/FVC], forced expiratory flow rates in the 25-27% range [FVF 25-75%], forced expiratory flow rates in the 50% range [FEV 50%], peak expiratory flow rate [PEFR] and diffusion capacity by measuring transfer factor [DLCO]]. The study concluded that although there was a deterioration in PFTs in both regimens of HD, these changes were much less in daily HD than thrice weekly HD, which indicates that daily HD is the method of choice in treating uremic patients, specifically in some patients who have underlying chest disease

Effect of smoking on the cell adhesion molecules in type 2

The study comprised 100 subjects: A diabetic group including 50 patients [30 males and 20 females, their mean age was 48.36 +/- 8.7 years] and a non-diabetic control group including 50 subjects [30 males and 20 females, their mean age was 48.5 +/- 7.1 years]. Both groups were subdivided into nonsmoker and smoker subgroups; they were matched for age, sex and smoking habits. All members were subjected to thorough history and clinical examination, assay of plasma total cholesterol, triglycerides, HDL, glycohemoglobin, insulin and intercellular cell adhesion molecules-1 [ICAM-1] and vascular cell adhesion molecular-1 [VCAM-1] and urinary albumin excretion rate [AER]. The study concluded that there is an increased level of ICAM-1 and VCAM-1 concentrations in normoalbuminuric type 2 diabetic patients. Furthermore, cigarette smoking has an additional deleterious effect on the level of ICAM-1 and VCAM-1, which supported the importance of promoting smoking cession and discouraging the initiation of smoking in people with type 2 diabetes