periodontitis an occult source of recurrent infection in patients with systemic lupus erythematosus?

To determine if periodontitis can be considered as an occult source and septic focus for recurrent infections in patients with Systemic lupus erythematosus [SLE]. The present study was conducted on 60 subjects divided into 4 groups. Group 1: included 30 SLE patients with periodontitis [SLE/P]. They were further subdivided according to the CRP titer into: Group 1A: 20 patients with CRP titer > 6 and Group 1B: 10 patients with CRP titer < 6. Group 2: included 10 SLE patients without periodontitis [SLE/X], Group 3: 10 non SLE subjects with periodontitis [X/P] and lastly Group 4: 10 healthy subjects. SLE disease activity was assessed by SLAM score. Periodontal examination was assessed by periodontal disease index [PDI]. Laboratory investigations: serum [s] and salivary [sal] CRP titre, CBC, ESR and urine analysis. Microbiological examination of plaque specimens was done. Comparative study between Group 1A and Group 3 revealed a highly significant difference as regards PDI and a significant difference as regards WBC count, ESR, s/CRP, sal/CRP titre indicating more severe periodontal disease in patients with SLE. There was a highly significant greater severity of periodontal disease in patients additionally receiving immunosuppressive therapy. The plaque culture showed Streptococci, Klebsiella, Staphylococci, E. coli and Pneumococci. In selected patients from Group 1, there was a highly significant decrease of s/CRP and sal/CRP after periodontal treatment. Periodontitis is an occult infection that can be considered as a septic focus in SLE patients. CRP is a sensitive indicator for the presence of infection in SLE patients. Periodontal examination must be done routinely for all SLE patients

Correlation between old and new immuno-inflammatory markers and disease activity in systemic lupus erythematosus

To compare new SLE activity inflammatory markers with traditional ones. In addition, to correlate those with disease activity index of SLE. Forty-three patients fulfilling the American College of Rheumatology criteria for diagnosis of SLE and 20 apparently healthy controls were subjects for study. Neopterin, soluble intercellular adhesion molecule [sICAM-1] and soluble vascular cell adhesion molecule [sVCAM-1] were measured as well as anti-dsDNA antibodies, C3, C4 and CRP. The British Isles Lupus Assessment Group [BILAG] disease activity index was used to measure disease activity. Twenty-four [55.8%] patients had active SLE [total BILAG score > 5], involving more than one system in nine [37.5%]. Activity was more in musculoskeletal, mucocutaneous, and hematological systems. All markers showed significant differences between SLE patients and controls. Neopterin, sVCAM and CRP were highest when compared to controls [p>0.001] as well as to inactive subgroup. The level of sICAM-1 in active was insignificantly higher than inactive group. Significant correlations were found between total BILAG score and CRP, neopterin, sVCAM. No positive correlation was found between any marker and disease activity of different BILAG organ systems. All tests were done for 22 patients on 3 occasions over 6 months. Highest levels of sVCAM-1 were in active subgroup with flares during the first measurement. Significant decrease between first and third measurement was observed within all subgroups. Neopterin and sVCAM-1 appear to be clinically useful for isolated and serial concentrations assessments of SLE disease activity scored using the BIIAG index. Anti-dsDNA and sVCAM-1 are good markers to predict remission