Pattern of young and elderly onset rheumatoid arthritis among a group of Egyptian patients

Rheumatoid arthritis [RA] differs depending on the age of disease onset. The differences between young onset rheumatoid arthritis [YORA] and elderly onset rheumatoid arthritis [EORA] are important because they have clinical and therapeutic implications. The study was conducted on 1185 patients who were ranked after classification according to age at onset of the disease into YORA I, 16-40 years, YORA II, 41-60 years and EORA >60 years. All were compared, based on disease duration [DD], disease activity, severity parameters and drug history. YORA I comprised 298 patients, 28.85% males, age 29.4 +/- 6 and DD 4 +/- 3.3 y, YORA II included 539 patients, 33.77% males, age 49.7 +/- 6.1 y. and DD 6.5 +/- 5.6 y. EORA included 348 RA patients 40.5% males, age 67.1 +/- 6.6 y, DD 9.95 +/- 7.2 y. Activity was increased in EORA compared to YORA I and YORA II, while severity decreased in EORA. ESR, CRP and degree of anemia were higher in EORA. RF titer was higher in YORA. In YORA peripheral joints of the hands and feet were more involved while, large joints in EORA. Rheumatoid nodules were increased in YORA I than EORA p= 0.04. Polymyalgia rheumatica was exclusively present in EORA group 25 patients 7.2%. YORA used methotrexate and its mean dose was higher than EORA. EORA on multiple DMARD 57.9% or biologics 0.8% was significantly lower compared with YORA 186.3% and 1.7%, p= 0.001. EORA has more active and less disabling and affects more males than YORA. The use of biologic therapy and combination DMARD therapy was less in EORA

Interleukin-18 and nitric oxide and gene expression of IL-18 in children with lupus nephritis

Autoimmune diseases might be caused by an imbalance of T-helper cell [Th] cytokines. Lupus nephritis [LN] is dominated by a Th1 immune response in systemic lupus erythematosus [SLE]. Interleukin-18 [IL-18] promotes polarization of the immune response towards Th1 in LN. Nitric oxide [NO] is involved in the pathogenesis of glomerulonephuitis and collagen-vascular diseases. The aim of the present study is to investigate role of IL-18 and NO in patients with LN and to study the correlation between them and Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score and whether these two molecules are associated with renal involvement in patients with SLE. We investigated plasma concentrations of IL-18 and NO and gene expression of IL-18 was analyzed by Reverse transcription-polymerase chain reaction [RT-PCR] in 19 SLE patients with LN, [group1] and 15 SLE patients without renal involvement [group2] and 15 age- and sex-matched healthy control subjects [group3]. IL-18 and NO concentrations were measured by ELISA and colourimetric non-enzymatic assay, respectively. Plasma IL-18 and NO concentrations were significantly higher in renal group 1 than non renal group 2 and normal control group 3 [p=0.001 and 0.01 respectively]. Elevation of plasma IL-18 in renal group 1 correlated positively with SLE disease activity index and plasma NO concentration [r=0.35, p=0.0001 and r= 0.46, P=0.01, respectively], and the latter also showed a positive correlation with serum creatinine [r=0.69, P=0.001] and urea [r = 0.28, P = 0.001]. There was no significant difference in gene expressions of IL-18 in peripheral blood mononuclear cells among renal group 1, non renal group 2 and normal control group3. IL-18 is therefore suggested to play a crucial role in the inflammatory processes of renal disease in SLE. IL-18 may play a crucial role in the inflammatory process of renal disease in SLE and its measurement may be helpful for the early identification of lupus patients with LN. Elevated concentrations of circulating NO can serve as indicators of endothelial activation and/or damage, which may occur in the pathogenesis of SLE with LN