Hepatocyte growth factor in serum and bronchoalveolar lavage fluid versus exhaled nitric oxide in systemic lupus erythematosus

The present study tried to evaluate the clinical significance of hepatocyte growth factor [HGF] in the serum and bronchoalveolar lavage fluid [BALF] in systemic lupus erythematosus [SLE] patients and their relation to nitric oxide [NO] in exhaled air. Forty SLE patients were investigated along with ten apparently healthy individuals. The patients' group was divided into two groups: group [A] Inactive SLE patients without pulmonary affection [n=14] and group [B] SLE patients with pulmonary affection [n=26]. The last group was further classified into 4 sub groups: - B1= Active SLE patients without interstitial lung disease [ILD], B2= Active SLE patients with interstitial lung disease + Alveolitis [ILD +A], B3: Inactive SLE patients without ILD and B4= Inactive - SLE patients with ILD. All patient and control groups were evaluated for chest X-ray, pulmonary function tests and high-resolution computerized tomography [HRCT], along with systemic lupus erythematosus [SLE routine laboratory investigations. Measurement of HGF Levels in serum and BALF by Immunoassay and exhaled nitric oxide [NO] was measured by chemiluminescence. There were abnormal pulmonary function tests in 65% [26/40] of SLE patients and abnormal HRCT in the form of ILD in 32.5[13/40] of SLE patients. The exhaled NO showed a significant elevation in patients with activity especially those with evidence of active inflammation of the lung. There was no significant elevation of exhaled NO for patients with ILD without evidence of active inflammation. The level of HGF in serum and BALF showed a significant elevation in patients with activity especially with the presence of active lung inflammation. Also, there was a significant elevation of serum HGF and BALF-HGF for patients with ILD without evidence of inflammation. The level of HGF in serum and BALF showed significant elevation in patients as compared with control subjects. HGF levels in BALF of patients was more elevated than HGF levels in serum of patients groups. HGF in serum and BALF was increased in patients with pulmonary fibrosis and correlated with clinical parameters. Measurement of exhaled NO is a simple and non-invasive method to detect the presence of inflammatory lung disease

Prevalence of staphylococci in rheumatoid arthritis patients

Recent studies suggested that staphylococcal exotoxin may be involved in the pathogenesis of rheumatoid arthritis. The objective of this study was to determine the prevalence of oral staphylococcal carriage in patients with RA compared with healthy controls. This study was performed on 27 patients with RA and 25 healthy volunteers. Clinical and laboratory data of RA activity were studied. Tongue and anterior nasal swabs were obtained for culture on blood agar. Isolates of staphylococci were identified and collected from oral cavity of 96.3% of RA patients, 53.8% of whom carried staphy. aureus. On the other hand 88% of the healthy volunteers showed staphylococci, 36.4% of whom carried staph aureus. The carriage rate of staph aureus was significantly higher in RA patients than in healthy controls [P<0.05]. So we conclude that the oral carriage of staph. aureus was common in patients with RA. This may be the source of septic arthritis in such patients

Serum matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase-1 [TIMP-1] in rheumatoid arthritis, psoriatic arthritic and osteoarthritis

To investigate whether serum levels of MMPs and TIMPs are specifically elevated in rheumatoid arthritis as compared to other inflammatory and degenerative joint diseases. We compared serum levels of matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase [TIMP-1] of RA with psoriatic arthritis [PsA] and osteoarthritis [OA]. Serum samples were obtained from 30 RA, 20 psoriatic arthritis and 30 knee osteoarthritis patients. Serum concentration of stromelysin-1 [MMP-3], gelatinase B [MMP-9] and TIMP-1 were measured with quantitative sandwich enzyme-linked immunosorbent assay [ELISA] technique. Clinical examination and assessment of disease activity in RA using disease activity score [DAS] were carried out. Radiological evaluation in RA patients using the Larsen scale and in OA patients using the Kellgren and Lawrence scale were also done. Unique serum profiles of MMPs and TIMP-1 were identified in the two inflammatory arthritis groups [RA and PsA]. The serum concentrations of MMP-3 and MMP-9 were significantly higher in RA patients than in OA patients used as a control groups [p<0.001]. These two MMPs dominated in the serum of RA patients than PsA patients [p<0.001]. The analysis of the serum concentrations of TIMP-1 was also elevated in RA patients as compared with OA knee patients [p<0.001]. Also TIMP-1 was found in a significantly higher concentration in the serum of RA patients than PsA patients [p<0.05]. MMP-3 and MMP-9 correlate significantly with disease activity [DAS] in RA patients and with radiological scores. Serum levels of MMP-3, MMP-9, and TIMP-1 were significantly higher in RA and PsA than OA patients. MMP-3 and MMP-9 could be specific markers of joint inflammation and destruction. These variables are neither specific for RA nor for diseases in which bone erosions occur. These markers were correlated with the clinical activity of the disease. Early detection of these markers may herald progressive course and modulate the lines of treatment

association between rheumatoid arthritis and hepatitis C virus infection

To study the association between rheumatoid arthritis and HCV infection. The study included 40 RA patients diagnosed according to the ACR criteria [group I]. It also included 20 inflammatory arthritis patients with RF positive but not fulfilling the criteria for diagnosis of RA [group II]. Ten age and sex matched subjects were taken as controls. Anti HCV antibodies were detected in the sera of these patients. 0.5% of the patients of group I had anti HCV antibodies while 20% of patients of group II had anti HCV antibodies. As regards the control group, none was anti HCV antibody positive. There is a strong association between the presence of anti HCV antibodies and rheumatoid factor that is stronger than the association between anti HCV antibodies and rheumatoid arthritis. Patients with anti HCV antibodies may have rheumatoid factor positive in their serum, but the picture may not fulfill the criteria of RA. Thus in any case of inflammatory arthritis, hepatitis C virus must be put in consideration

Neurological features and anti-myeloperoxidase antibodies in rheumatoid arthritis patients

To determine if there is a relation between the level of anti-myeloperoxidase antibodies [AMP] and the occurrence of peripheral neuropathy [PN] in rheumatoid arthritis [RA] patients. Serum levels of C3, C4 and circulating immune complex [CIC] were also assayed to determine whether their levels are related to RA activity or not. The levels of AMP antibodies as well as that of C3, C4 and circulating immune complex [CIC] were measured in 48 RA patients. All patients underwent electrophysiological studies for both median and radial nerves in the upper limbs and the sural nerve in the lower limbs to detect peripheral neuropathy. Peripheral neuropathy was found in thirteen out of 48 patients. There was a significantly higher level of serum AMP antibodies in patients with PN, the mean being 11.4 +15.1 microg/ml as compared to patients without PN [4.5 + 2.1 microg/ml]. Serum level of C4 was significantly lower in patients with PN [30.9 +10.4 IU/ml] than those without PN [37.2+ 17.1 IU/ml]. No significant difference was found as regards either C3 or CIC between the two groups. Also, a significant correlation was found between AMP and clinical vasculitis. Peripheral neuropathy seems to be a common complication of RA. The high level of AMP anti-bodies in RA complicated with PN suggests that PN is associated with vasculitis that may be fatal if it involves other main organs