Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

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

Simultaneous combined measurement of antikeratin antibody and rheumatoid factor: additive value in the diagnosis of rheumatoid arthritis

Rheumatoid arthritis [RA] is a systemic inflammatory autoimmune disease of unknown etiology characterized by chronic polyarthritis. Its highly variable and unpredictable course is the underlying reason for the search for new and more sensitive and specific laboratory markers. The only serologic test routinely used in RA assessment is the determination of rheumatoid factor [RF] in the serum. Although RF has sensitivity up to 80%, still it lacks specificity. To evaluate a new marker "antikeratin antibody" [AKA] regarding its sensitivity and specificity and its relation to disease activity. Also the combined RF and AKA, does it add to the diagnosis of RA. Sera from 88 consecutive RA patients, 40 disease controls and 50 healthy controls were tested for RF with latex agglutination and AKA with indirect immunofluorescence assay that used rat esophagus as a substrate. The proportion of RA patients who had AKA [49/88] was higher than in healthy controls 4/50 [X[2]=28.6, p<0.001], and in disease controls 5/40 [X[2] =19.2, p<0.001]. AKA gives weaker sensitivity than RF [55.7%], but stronger specificity [87.5% versus other rheumatic, and 92% versus healthy controls]. The frequency of AKA positivity was higher among patients who had severe disease [being positive in 41/50 of active RA patients], this gives a highly significant association p<0.001. Also, AKA shows significant positive association with RF+ve results [45/71]. Combined results of both AKA and RF gave overall best results as both positive results gave a sensitivity of 97.7%, and both negative results gave a specificity of 97.5% versus rheumatic and 98% versus healthy controls. AKA adds a valuable diagnostic tool in the diagnosis of RA. It is more specific than RF. Its positivity is associated with active RA disease. Combined AKA and RF measurement gives the best sensitivity and specificity for diagnosing rheumatoid disease than each test individually

Serum and synovial fluid insulin like growth factor-1 and its binding protein-3 in rheumatoid arthritis

Insulin-like growth factor-1 [IGF-1] and its binding protein-3 [IGFBP-3] in human synovial fluid play an important role in maintaining articular cartilage metabolism. In this study, we measured serum and synovial fluid [SF] concentrations of IGF-1 and IGFBP-3 in 20 rheumatoid arthritis patients [RA] and 10 matched controls [with traumatic knee effusion] using radioimmunoassay. Also, we tried to correlate serum and synovial levels with each other and with disease activity and severity measures. Our results showed a significant increase in synovial fluid level of both IGF-1 and IGFBP-3 in RA patients as compared to controls. Serum IGF-1 correlated with synovial fluid level but serum IGFBP-3 did not correlate with synovial fluid level. Disease activity markers correlated significantly with synovial fluid IGF-12 and IGFBP-3 levels, but did not show significant correlation with their serum level. In conclusion the pattern of IGF-1 and IGFBP-3 in SF differs in inflammatory versus non-inflammatory joints