Correlation of anti C1q antibodies with disease activity in patients with systemic lupus erythematosus

Objective: To study the correlation of anti C1q antibodies with disease activity in patients with systemic lupus erythematosus [SLE]

Study Design: Cross sectional, observational study

Place and Duration of study: The Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi in collaboration with Military Hospital, Rawalpindi, Pakistan Institute of Medical Sciences, Islamabad and Benazir Bhutto Hospital, Rawalpindi, from Jan 2012 to Dec 2013

Material and Methods: Patients with a clinical diagnosis of SLE were included in the study on fulfilling revised American College of Rheumatology [ACR] criteria [1997]. Main outcome measures were SLE disease activity index [SLEDAI] score and anti C1q antibody levels in serum. SLEDAI scores were calculated for each patient on the basis of physical examination, patient interviews and previous clinical records. Anti C1q antibody levels in the serum were determined by enzyme-linked immunosorbent assay [ELISA] and correlated with the SLEDAI scores by calculating Pearson's correlation coefficient 'r'. The cutoff value for anti C1q antibody positivity in the serum was determined by evaluating the serum levels of anti C1q antibodies in 25 healthy subjects and was 12 U/ml

Results: Six male and forty nine female SLE patients with an age range of 16-47 years [mean 34.5 years] and 8-70 years [mean 31.7 years] respectively were studied. The correlation between anti C1q levels and SLEDAI scores in all patients was demonstrated by calculating the correlation coefficient and was not significant [r=0.19, p=0.14]. However, there was an inverse correlation between anti C1q levels and SLEDAI scores in patients with severe disease and this was statistically significant [r=-0.448, p=0.037]. The difference in anti C1q antibody positivity between patients with and without nephritis was not significant. The anti C1q antibody levels correlated poorly with anti double stranded deoxyribonucleic acid [dsDNA] antibody positivity. A significantly higher percentage of patients with evidence of complement consumption was found to be positive for anti C1q antibodies [p=0.01]. This significance was only seen in patients with reduced C3 levels [p=0.04] and not reduced C4 levels [p=0.23] or both [p=0.23]. Anti C1q antibody levels had significant inverse correlation with serum C3 levels. [p=0.007]

Conclusion: A significant inverse correlation was found between SLEDAI scores and serum anti C1q antibody levels in patients with severe SLE. The anti C1q antibody positivity is significantly higher in patients with reduced C3 levels

Identification of laboratory markers of disease activity in rheumatoid arthritis

To identify the laboratory markers of disease activity, by finding relationship of biochemical markers with clinical disease activity measurement in patients suffering from rheumatoid arthritis [RA]. Cross sectional analytical study. Department of Immunology, Armed Forces Institute of Pathology [AFIP], Rawalpindi from January 2009 to January 2010 in collaboration with Fauji Foundation Hospital and Military Hospital Rawalpindi. One hundred patients diagnosed as having rheumatoid arthritis [RA] as per American college of Rheumatology [ACR] revised criteria 1987 and fulfilling the study's inclusion criteria were studied. These patients were assessed clinically according to Simplified Disease Activity Index [SDAI] and divided into three groups which were mild, moderate and severe based on disease activity. These three groups were then assessed for disease activity by Rheumatoid factor [RA factor], Anti Cyclic Citrullinated Peptide antibodies [anti CCP antibodies], Erythrocyte Sedimentation Rate [ESR] and C- Reactive Proteins [CRP]. The association of these laboratory markers with three groups of disease activity was analyzed to detect most sensitive disease activity markers for RA. All the assessed laboratory markers that are RA factor, anti CCP antibodies, ESR and CRP are directly related with RA disease activity and any of them can be used to assess disease activity in RA. However a combination of the tests, analyzed in this study markers maybe used for better prediction of disease activity. The identification of the laboratory markers of disease activity may help physician to diagnose aggressive disease early and evaluate prognosis in RA patients

HLA DR beta1 alleles in Pakistani patients with rheumatoid arthritis

To determine frequencies of HLA DR beta1 alleles in rheumatoid arthritis in Pakistani patients. Cross sectional / analytical study. Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi in collaboration with Rheumatology departments of Military Hospital, Rawalpindi and Fauji Foundation Hospital, Rawalpindi, from January 2009 to January 2010. HLA DR beta 1 genotyping of one hundred Pakistani patients, diagnosed as having RA as per American College of Rheumatology revised criteria 1987, was done. HLA DR beta 1 genotyping was carried out at allele group level [DR beta1[asterisk]01-DR beta1[asterisk]16] by sequence specific primers in RA patients. Comparison of HLA DR beta1 allele frequencies between patients and control groups was made using Pearson's chi-square test to find possible association of HLA DR beta1 alleles with RA in Pakistani rheumatoid patients. HLA DR beta1[asterisk]04 was expressed with significantly increased frequency in patients with rheumatoid arthritis [p <0.05]. HLA DR beta1[asterisk]11 was expressed statistically significantly more in control group as compared to rheumatoid patients indicating a possible protective effect. There was no statistically significant difference observed in frequencies of HLA DR beta1 allele [asterisk]01, DR beta1 allele [asterisk]03, DR beta1 allele [asterisk]07, DR beta1 allele [asterisk]08, DR beta1allele [asterisk]09, DR beta1 allele [asterisk]10, DR beta1 allele asterisk12, DR beta1 allele [asterisk]13, DR beta1 allele [asterisk]14, DR beta1 allele [asterisk]15 and DR beta1 allele [asterisk]16 between patients and control groups. The identification of susceptible HLA DR beta1 alleles in Pakistani RA patients may help physicians to make early decisions regarding initiation of early intensive therapy with disease modifying anti rheumatic medicines and biological agents decreasing disability in RA patients

Influence of gender on disease activity in patients suffering from rheumatoid arthritis

To study the influence of gender on disease activity in patients of rheumatoid arthritis. One hundred patients suffering from Rheumatoid Arthritis [RA], fulfilling the American College of Rheumatology [ACR] revised criteria 1987 and study's inclusion criteria were randomly selected for this study. The influence of gender on disease activity was measured in patients suffering from Rheumatoid Arthritis by the help of Erythrocyte Sedimentation Rate [ESR], C- Reactive Proteins [CRP], Rheumatoid factor [RA factor] and Anti Cyclic Citrullinated Peptide [anti CCP] antibodies. Age and duration of illness in both genders were also compared to find statistically significant differences. The female to male ratio was 7.3:1. Mean age in males was 53 years and in female patients 43 years. Duration of illness was found to have no significant difference in male and female patients. A relative increase in ESR, CRP, RA factor and anti CCP antibodies was observed in the males when compared to females. The median value of ESR in males was 61 mm/hour and in females was 31 mm/hour. The median value of CRP was 31 rng/dl in males and 9.2 mg/dl in females. The median values of anti CCP antibodies were 100 U/ml for the male group and 4.7 U/ml for the female groups respectively. The differences in these parameters between the two groups were found to be statistically significant [p value <0.05]. The median values of RA factor was 43 IU/ml in males and 10 lU/ml in females and the difference was not statistically significant [p value .072]. The prevalence of RA in females is found to be high in this study. Male patients have a significantly later onset of RA and presented with severe disease as compared to female patients suffering from RA

Diagnostic application of smooth muscle antibodies in autoimmune hepatitis

To measure the level of C-reactive protein and find its association with the glycaemic status [fasting plasma glucose, glycosylated haemoglobin] of metabolically normal and diabetic albino rats. Total 60 Albino rats were included [normal n=30; diabetic n=30]. Plasma glucose levels were determined by using glucose oxidase method while determination of total Hb and glycosylated hemoglobin [HbA[1]c] was done by diagnostic kit that uses weak cation-exchange resin to bind Hb. The% HbA[1]c was determined by measuring the absorbance at 415 nm of the glycosylated hemoglobin fraction and the total hemoglobin fraction. The ratio of the two absorbances gave the% of HbA[1]c. C-reactive protein was measured by the ELISA kit. Significant difference was found in the values of fasting glucose, of the normal and diabetic groups [p<0.05] but no significant difference was present in the values of HbA[1]c of both groups. There was no significant difference in the values of C-reactive protein of the normal and diabetic groups. Short duration hyperglycemia has no role in producing inflammation and raising the levels of bioinflammatory marker C-reactive protein

Suppression of humoral immune response due to psychological stress in survivors of large scale natural disaster

To study the impact of psychological stress following a natural disaster on specific immunological parameters. The study was carried out over a 3 month period [Feb 2006 to May 2006] at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan. Physically uninjured male adults between 15-60 years of age, with no prior history of an active physical or psychological disorder, who witnessed the earthquake on 8[th] Oct, 2005 in Pakistan but escaped physical injury, were included in the study. Age and gender matched healthy adults were also studied as control group. Analysis of haemoglobin, total leucocyte count, lymphocyte count, lymphocyte subsets, IgG, IgA, IgM levels, C reactive protein and nitrobluetetrazolium [NBT] dye reduction test was carried out on both the groups. Psychologically distressed individuals had increased CD 3+ cells [p=0.02], increased CD4:CD8 ration [p=0.04], reduced CD19+ cells count [p=0.03] and IgG levels [p=0.01]. Neutrophil oxidative burst activity without stimulation was increased [p=0.02]. Psychological stress consequent to exposure to a natural disaster can suppress humoral immune response

Lymphocyte subpopulations in pakistani patients with acid fast bacilli positive and acid fast bacilli negative pulmonary tuberculosis

This study was done to comparethe lymphocyte subpopulations in the peripheral blood of patients of acid fast bacilli positive active pulmonary tuberculosis with similar patients who were negative for acid fast bacilli on sputum examination. After exposure to Mycobacterium tuberculosis, only 15% of the infected individuals develop active tuberculosis while about 90% can control and contain the infection successfully. This ability to control the infections is the function of T lymphocytes. Different profiles of lymphocyte subpopulation possibly reflect the immune status of the individual against tuberculosis infections. This study was carried out to compare the lymphocytes subpopulations in the peripheral blood of patients of AFB negative tuberculosis. A total of forty adult patients of pulmonary tuberculosis having positive sputum smears for acid fast bacilli along with fifteen acid fast bacilli negative patients were included in the study. Peripheral blood samples from the patients of both groups were collected aseptically in EDTA containers. A panel of monoclonal antibodies was used to delineate different lymphocyte subsets by flow cytometry. Haemoglobin levels, total leucocyte counts, absolute neutrophil counts and absolute lymphocyte counts were determined by haematology autoanalyser. Total CD4 count was not significantly different in the two groups but activated CD4+ T cell number was significantly high in smear positive patients. Smear positive patients also showed significantly increased total number of CDS positive T lymphocytes but activated CDS lymphocyte number was significantly decreased. Total number as well as activated fraction of gamma dejta T cells was markedly enhanced in smear negative group of patients. Activation status of CD8+ T lymphocytes along with increased number of gamma delta cells [absolute number as well as activated fraction] make important contributions in limiting the extent of disease in pulmonary tuberculosis