Lipid profiles in early untreated rheumatoid arthritis: relation to disease activity

Rheumatoid arthritis [RA] is a chronic, systemic inflammatory disorder of unknown etiology that primarily targets the synovium. Cardiovascular morbidity and mortality appear to be increased in rheumatoid arthritis which might be due to increased prevalence of risk factors for disease such as an accelerated progression of atherosclerosis. Patients with active rheumatoid arthritis show an atherogenic lipid profile, which has been linked with the inflammatory reaction. The effect of treatment of RA on the adverse lipid profile is the subject of intensive research. We investigated lipid profile in newly diagnosed untreated RA patients, compared it with matched control and determined the relation of these lipid profiles to disease activity. Fifty three patients with early RA who met the American College of Rheumatology criteria were included in this study. They had disease duration of less than one year and had not had prior treatment for it. Thirty healthy volunteers [controls] were also included. Serum lipid profile including total cholesterol [TC], low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], triglyceride [TG], apolipoprotein A-l [apo-A], apolipoprotein B [apo-B] and lipoprotein [a] were measured in the controls and in patients with RA at baseline and 6 months after treatment. Patients with RA exhibited higher serum levels of TC, LDL-C, and TG compared to controls whereas their serum HDL-C and apo-A levels were significantly lower compared to controls. As a consequence, the atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C was significantly higher in RA patients compared to controls. From the included 53 patients with RA, 39 patients [73.6%] met the improvement criteria in RA after 6 months of treatment with DMARDs. Those responders showed a significant reduction of atherogenic ratio of TC/HDL-C as well as that of LDL-C/HDL-C [p value 0.008 and 0.02 respectively], a finding that was primarily due to the increase of serum HDL-C levels [p. value 0.0004]. Patients with early untreated RA are characterized by an atherogenic lipid profile, which improves after therapy. Thus, early immunointervention to control disease activity may reduce the risk of atherosclerotic process and cardiovascular events in RA patients

Evaluation of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women

Osteoporosis is a major global health problem affects mainly elderly and postmenopausal women with increased risk of bone fractures. The value of different biochemical markers of bone turnover as diagnostic tool for osteoporosis is still debated. The aim of this study is to assess the value of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women. We measured fasting urinary calcium [Uca], total ALP, inorganic phosphorus [Pi], urinary deoxypyridino-line [DPD], carboxyterminal telopeptide of collagen type I [ICTP] and serum N-terminal telopeptide [NTX] in 40 postmenopausal females [diagnosed by DEXA as osteoporotic, | mean age, 60.2 years], 16 preimenopausal non-osteoporotic females [mean age, 39.1 years] and 24 healthy controls [mean; age, 29.2 years]. The postmenopausal osteoporotic group showed significantly higher levels of ALP, DPD, NTX and ICTP compared to controls [p<0.001] and only ALP was significantly higher in preimenopausal group compared to controls [p<0.001]. However, there was no significant difference of Uca and Pi among the three groups. On comparing peri and postmenopausal groups together, DPD, NTX and ICTP were the only markers that clearly discriminate the two groups being higher in the osteoporotic postmenopausal group. There were significant negative correlations between bone mineral density [BMD] and each of ALP, DPD, NTx, and ICTP. The clinical utility of DPD, NTx and ICTP in identifying patients with osteoporosis was assessed by ROC [receiver operating characteristic] curve analysis. This revealed that the best diagnostic cut-off level for DPD was 6.8nM DPD/mM creatinine. This gave a diagnostic sensitivity of 100% and specifity 100%, whereas NTx at a level 17.0 nM BCE had a diagnostic sensitivity of 100% and specifity of 98%. Regarding ICTP at cut-off level of 3.6 microg/L its sensitivity was 88% and specifity was 65% which considered the lesser better sensitivity and specifity among the three studied parameters

Serum insulin like growth factor-1 in diabetic patients with macrovascular complications

The incidence of cerebrovascular, cardiovascular disease [CVD] and peripheral vascular disease in patients with type 2 diabetes is approximately twice as high as in the non-diabetic populations. Conventional cardiovascular risk factors such as plasma lipids, lipoproteins and hypertension only partially explain this excessive risk of developing atherosclerosis and CVD. IGF-1 is an important metabolic regulatory hormone. Thus the premature and progressive decline in serum IGF-I bioactivity in ageing patients with type 2 diabetes is an important pathophysiological abnormality. It contributes not only to elevated glucose and lipid levels, but also to the progression and the poor outcome of cardiovascular disease [CVD]. The objective of this study is to evaluate the level of IGF-1 in diabetic patients with macrovascular complications. The study was conducted on 30 patients with type 2 diabetes with macrovascular complications, 30 patients with type 2 diabetes without macrovascular complications and 20 persons as a control group, the following investigations were done: Fasting and postprandial blood sugar, lipid profile [LDL, HDL cholesterol and triglycerides], liver and kidney function tests and serum IGF-I. Our results showed no significant difference as regard IGF-I levels in type 2 diabetic patients without macrovascular complications compared to control group, but there were significant difference as regard IGF-I levels in diabetic patients with macrovascular complications compared to control group. Also it showed no correlation of serum level of IGF-I with either blood sugar or blood lipids. We concluded that: Serum levels of IGF-I was decreased in diabetic patients with macro vascular complications. There were no correlations between serum levels of IGF-I and other risk factors of macrovascular complications as blood sugar and blood lipids