Correlation between serum E-selectin levels and panoramic nailfold capillaroscopy in systemic sclerosis

E-selectin is expressed by the activated endothelium and its plasma levels are increased in patients with systemic sclerosis. Eighteen patients fulfilling the American Rheumatism Association criteria for systemic sclerosis, 15 females and 3 males, 42-70 years old, 9 with diffuse and 9 with limited forms, were sequentially recruited for this study. Serum E-selectin levels were determined by commercially available ELISA and their association with nailfold capillaroscopic abnormalities was investigated. Nailfold capillaries were analyzed by 16X magnification wide-field capillaroscopy. Two parameters on capillaroscopy were used to correlate to serum E-selectin: deletion and ectasia. Data were analyzed statistically by the Student t-test and Spearman correlation. Two-tailed P values below 0.05 were considered significant. E-selectin range was 38 to 200 ng/ml (80 ± 39.94). There was a correlation between serum E-selectin levels and the deletion capillaroscopic score (r = 0.50, P < 0.035). This correlation was even stronger within the first 48 months of diagnosis (r = 0.63, P < 0.048). On the other hand, no association was observed between selectin and ectasia. Patients with diffuse disease presented higher serum E-selectin levels than patients with limited disease, although the difference was not statistically significant (96.44 ± 48.04 vs 63.56 ± 21.77 ng/dl; P = 0.08). The present study is the first showing a correlation between soluble serum E-selectin levels and alterations in capillaroscopy. The stronger correlation of deletion score in capillaroscopy in early disease suggests that serum E-selectin levels might be a useful biochemical marker of disease activity in systemic sclerosis.

Long-term thalidomide use in refractory cutaneous lesions of systemic lupus erythematosus

Objective. To evaluate the efficacy of long-term thalidomide treatment in cutaneous lesions os systemic lupus erythematosus (SLE), not responsive to conventional therapy. Patients and Methods. Were selected 18 SLE patients (ACR criteria) with active cutaneous lesions not responsive to chloroquine, photoprotectors and low doses prednisone and who presented good response to thalidomide but relapsed after withdrawal of the drug. All female patients had no risk of pregnancy. Thalidomide was reintroduced and maintained at low dose (25-100 mg/day) for a minimum of 6 months. Results. Eighteen patients (16 females) with mean age of 34.2yo (16-57y.o.) received thalidomide for 6-21 months (mean 8.5m). The mean dose of prednisone at beginning of study was 38.3 mg/d and at the end was 9.7 mg/d (p<0.05). Complete remission of cutaneous lesions was observed in thirteen patients (72 per cent) and partial remission in five (28 per cent). Side effects observed were: drowsiness in eight patients, intestinal constipation in 5, transient oliguria in 1, paresthesia of hand with normal electromyography in another one. All side effects disappeared with reduction of thalidomide dose and no patient needed to stop treatment owing to side effect. Conclusion. Thalidomide is a good alternative therapy to SLE patients with refractory cutaneous lesions and without any risk of pregnancy.

Estudo da densidade óssea na esclerodermia sitêmica / Study of bone density in systemic scleroderma

Objetivo. A osteopenia em pacientes com esclerodermia sistêmica foi descrita, radiologicamente, em maos e, por densidade óssea, no terço proximal e distal do rádio. A reduçao da massa óssea, nesses pacientes, tem sido atribuída à isquemia, imobilizaçao e à menopausa precoce. O objetivo deste estudo é analisar a densidade óssea na coluna, regiao proximal do fêmur e corpo todo de pacientes com esclerodermia sistêmica. Pacientes e Método. Foram examinadas 25 pacientes caucasóides, sem outras condiçoes que pudessem afetar o metabolismo ósseo. A média de idade das pacientes foi de 48 + 12 anos, e o tempo de doença, de 7 + 7 anos; 13 estavam na pós-menopausa há 8 + anos. A medida de massa óssea foi realizada na coluna, regiao proximal do fêmur e corpo todo, utilizando-se densitômetro de dupla emissao com fonte de raios X (Lunar - modelo DPX). Resultados. Nao houve diferenças estatisticamente significante na densidade óssea das regioes avaliadas nas pacientes com esclerodermia sistêmica e as mulheres-controle pareadas para a idade, peso, altura e anos de menopausa. A densidade óssea das pacientes com forma limitada nao foi diferente daquelas com a forma difusa. Pacientes com calcinose apresentaram menor densidade óssea na regiao proximal do fêmur que aquelas sem calcinose. Conclusoes. Os autores concluíram que pacientes com esclerodermia sistêmica nao apresentam perda de massa óssea. Portanto, a esclerodermia nao é um fator de risco para o desenvolvimento de osteoporose generalizada.