Bone mineral density in premenopausal systemic lupus erythematosus patients: influence of serum leptin, disease related variables and use of corticosteroids

To evaluate bone mineral density [BMD] in premenopausal female patients with SLE and to assess the influence of serum leptin, disease related variables and use of corticosteroids. We analyzed only the premenopausal SLE patients to eliminate the confounding effect of menopause on bone loss. Forty pre-menopausal systemic lupus erythematosus patients [SLE] who fulfilled the revised criteria for classification of SLE of the American College of Rheumatology [ACR] and twenty healthy control subjects apparently free from any relevant disease were included in this study. All patients were subjected to full history taking, thorough clinical examination and assessment of disease activity using the SLE disease activity index [SLEDAI], assessment of functional status using Steinbrocker grades as well as measurement of serum leptin level with ELISA. Bone densitometry was performed by Dual Energy X-Ray Absorptiometry [DEXA] at the lumbar spine from L2-4 and left hip [femoral neck, trochanter]. Our results showed a high frequency of low BMD at the lumbar spine [L2-L4] and left hip [femoral neck, trochanter] as diagnosed by using DEXA in premenopausal female patients with SLE as compared to controls. BMD correlated negatively with age, disease activity, functional capacity, and corticosteroid treatment and correlated positively with bone mass index [BMI] and serum leptin level. Premenopausal SLE patients had significantly lower BMD than controls. Also, a high incidence of osteopenia and osteoporosis was found in premenopausal patients with SLE. Bone diminution in SLE seemed to be attributable to age, BMI, disease activity, functional capacity and serum leptin level and corticosteroid treatment. Regular DEXA screening, controlling of disease activity, improving of functional capacity and reduction of steroid dose as much as possible may be of beneficial effects upon BMD in SLE patients. Leptin may be useful in the future for further research in the treatment of osteoporosis

Cognitive functions in systemic lupus erythematosus patients

To assess cognitive function in patients with SLE and to determine its correlation to demographics, quality of life, and disease- related variables. Twenty patients with systemic lupus erythematosus [SLE] who fulfilled the revised criteria for classification of SLE of the American College of Rheumatology and twenty healthy control subjects apparently free from any relevant disease were included in this study. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using SLAM index and assessment of quality of life using Beck Questionnaire as well as detection of IgG anticardiolipin antibodies using ELISA. Cognitive function tests were performed by Stanford-Binet IV scale which measure verbal ability, visual/ abstract ability, short-term memory, and general intelligence quotient [IQ]. The mean scores of all cognitive function tests] verbal ability, visual ability, short term memory and [I.Q.] [in SLE patients showed a statistically significant decrease [p<0.05] as compared to controls. Cognitive functions of SLE patients correlated positively with quality of life and correlated negatively with disease activity, antiphospholipid antibodies, and CNS manifestations of SLE patients. Cognitive functions of SLE patients showed a significant impairment compared with normal people. Disease activity, antiphospholipid antibodies, quality of life and CNS manifestations of SLE patients were associated with impairment in cognitive functions. Evaluation of cognitive function, improving of disease activity and quality of life should be given greater emphasis in SLE patients especially in the presence of antiphospholipid antibodies and CNS manifestations

Serum and synovial fluid concentrations of soluble granzyme B in early rheumatoid arthritis

Cytotoxic cells possess specialized granules which contain perform and a group of serine proteinases termed granzymes. Granzyme B is a serine protease that have been identified in synovial fluid and tissue of rheumatoid arthritis [RA] patients, where they may play an important role as mediators of granule-mediated apoptosis, extracellular proteolysis, and cytokine induction. To assess plasma and synovial fluid soluble granzyme B concentrations in early RA patients and its association to seropositivity, ESR, C-reactive protein [CRP], disease activity and the rate of radiological progression. This was in an attempt to throw light on its possible role as predictive factor for disease severity and joint outcome. This study included 80 early RA patients presenting with knee effusion and 30 matched osteoarthritis [OA] patients presenting with traumatic non-hemorrhagic knee synovial effusion as a control group. Serum and synovial fluid granzyme B concentrations were determined with ELISA. Assessment of disease activity. Rheumatoid factor [RF], CRP and ESR were measured. Radiographs of the hands, wrists and forefeet were taken for all RA patients at baseline and after one year. Radiographical damage and scoring were evaluated. There was a highly significant increase in serum and synovial fluid concentrations of soluble granzyme B in RA patients as compared to OA control group. Also, there was a highly significant increase in synovial fluid concentrations of granzyme B as compared to serum concentrations in RA patients. There was a highly significant increase in serum and synovial fluid concentrations of granzyme B in seropositive RA patients as compared to seronegative patients. There were highly significant elevations in the mean serum and SF granzyme B concentrations at the entry of the study in patients showing radiological progression than non-progressive group. There was a statistically significant positive correlation between serum granzyme B concentration and CRP and a highly significant positive correlation as compared with disease duration, number of swollen joints, Ritchie articular index [RAI], general health status, ESR, disease activity score, RF, radiological progression or granzyme B synovial fluid concentration. High soluble granzyme B concentrations are found in early rheumatoid arthritis patients. Increase in serum concentrations of granzyme B in seropositive RA patients as compared to seronegative patients and increased concentrations associated with the development of radiographic erosions in those patients raise the attention to the importance of granzyme R as a marker for prediction of radiographic joint damage. So granzyme B concentration can be considered as a useful prognostic marker in early rheumatoid arthritis patients

Assessment of pulmonary function in ankylosing spondylitis patients

This study was carried out to assess pulmonary function in ankylosing spondylitis [AS] patients. Pulmonary function tests and integrative cardiopulmonary exercise testing [CPET] were studied in 20 AS patients and 20 healthy individuals. All subjects were also assessed for functional status with BASFI, measurement of chest expansion, lumbar spinal flexion with the modified Schober's method, and peripheral muscle function]assessed by measuring both muscle strength [knee extensors] and amount [lean body mass][. The typical respiratory function abnormalities in AS were those of restrictive changes with decreased FVC, FEV1, VO2 max., and normal FEV1/FVC. Pulmonary function showed correlations with chest expansion, lumbar stiffness as well as peripheral muscle function. This study showed that, in AS patients, pulmonary function tests were defective and confirmed a restrictive type of impairment. Evaluation of pulmonary function and encouragement for more regular exercise to improve spinal mobility and muscle function should be given greater emphasis in ankylosing spondylitis patients