Intima-media thickness of the common carotid artery in rheumatoid arthritis patients

To measure the intima-media thickness [IMT] of the common carotid artery [as an index of subclinical atherosclerosis] and to evaluate the factors associated with arterial wall thickness in RA patients. We used an accurate and reliable imaging technique, high-resolution B-mode ultrasound, to compare common carotid artery [CCA] intima-media wall thickness [IMT] in 40 RA patients and 40 controls. The apparently healthy subjects were comparable with the RA patients as regards the risk factors for atherosclerosis, including age, sex, menopause status, body mass index [BMI], blood pressure, and serum lipid levels. We investigated the association between [IMT] of the [CCA] in RA and clinical and therapeutic variables. The mean level of IMT of the CCA showed a statistically highly significant increase [p<0.001] in RA patients as compared to controls. There were statistically significant correlations [p<0.05] between IMT of the CCA in RA and disease related variables; duration of morning stiffness, articular index, grip strength, ESR, hemoglobin level, pain severity and rheumatoid factor. Highly statistically significant correlations [p<0.001] were found in relation to age, disease duration, spread severity index, Larsen score, HAQ and CRP. Insignificant correlations [p>0.05] were found between IMT of the CCA in RA patients and sex, B.M.I, systolic and diastolic blood pressure, lipid profile and drug treatment. RA patients exhibited greater thickness of the common carotid artery than healthy controls, so RA patients have an ultrasonic marker of early atherosclerosis. The age, disease duration, disease activity and severity, decreased physical activity, but not therapeutic variables, were associated with the increased arterial wall thickness

Detection of carotid atherosclerosis in systemic lupus erythematosus and its relation to risk factors

To detect early atherosclerotic changes in SLE patients and to evaluate its relation to traditional cardiovascular risk factors and lupus-related factors. Forty female SLE patients were included in this study. Their age ranged from 20 to 63 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and assessment of SLE-related disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] damage index. Intima-media thickness [IMT] and carotid plaques were measured with carotid B-mode ultrasound. Risk factors associated with carotid plaques and IMT were determined. They included traditional cardiovascular risk factors, SLE-related disease factors and inflammation markers. Eighteen patients out of the 40 [45%] had plaques. Those patients were statistically significantly [p<0.05] older and had higher systolic and diastolic blood pressure, greater body mass index, higher levels of total cholesterol, low-density lipoprotein [LDL] cholesterol, fibrinogen and C-reactive protein [CRP] than patients without plaques. The patients with plaques had a statistically significant [p<0.05] longer disease duration, higher SLICC damage score and longer duration of prednisone use than those without plaques. The mean level of IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly [p<0.001] as correlated with the age, CRP, and SLICC damage index. The prevalence of the plaques in the studied SLE patients was 45%. There were statistically significant differences between the patients with and those without plaques regarding disease-related factors [disease duration, SLICC damage score and duration of prednisone use] and inflammation markers [fibrinogen and C-reactive protein]. IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly correlated with SLICC damage index. These findings show that SLE-related disease factors and inflammation markers are associated with carotid atherosclerosis in the SLE patients. SLE patients at risk of atherosclerosis should be examined by high resolution ultrasonography for identification of early stage atherosclerosis. Also, dampening of the inflammatory activity has a favorable impact on the progression of atherosclerosis in SLE patients

Serum and synovial fluid concentrations of soluble granzyme B in early rheumatoid arthritis

Cytotoxic cells possess specialized granules which contain perform and a group of serine proteinases termed granzymes. Granzyme B is a serine protease that have been identified in synovial fluid and tissue of rheumatoid arthritis [RA] patients, where they may play an important role as mediators of granule-mediated apoptosis, extracellular proteolysis, and cytokine induction. To assess plasma and synovial fluid soluble granzyme B concentrations in early RA patients and its association to seropositivity, ESR, C-reactive protein [CRP], disease activity and the rate of radiological progression. This was in an attempt to throw light on its possible role as predictive factor for disease severity and joint outcome. This study included 80 early RA patients presenting with knee effusion and 30 matched osteoarthritis [OA] patients presenting with traumatic non-hemorrhagic knee synovial effusion as a control group. Serum and synovial fluid granzyme B concentrations were determined with ELISA. Assessment of disease activity. Rheumatoid factor [RF], CRP and ESR were measured. Radiographs of the hands, wrists and forefeet were taken for all RA patients at baseline and after one year. Radiographical damage and scoring were evaluated. There was a highly significant increase in serum and synovial fluid concentrations of soluble granzyme B in RA patients as compared to OA control group. Also, there was a highly significant increase in synovial fluid concentrations of granzyme B as compared to serum concentrations in RA patients. There was a highly significant increase in serum and synovial fluid concentrations of granzyme B in seropositive RA patients as compared to seronegative patients. There were highly significant elevations in the mean serum and SF granzyme B concentrations at the entry of the study in patients showing radiological progression than non-progressive group. There was a statistically significant positive correlation between serum granzyme B concentration and CRP and a highly significant positive correlation as compared with disease duration, number of swollen joints, Ritchie articular index [RAI], general health status, ESR, disease activity score, RF, radiological progression or granzyme B synovial fluid concentration. High soluble granzyme B concentrations are found in early rheumatoid arthritis patients. Increase in serum concentrations of granzyme B in seropositive RA patients as compared to seronegative patients and increased concentrations associated with the development of radiographic erosions in those patients raise the attention to the importance of granzyme R as a marker for prediction of radiographic joint damage. So granzyme B concentration can be considered as a useful prognostic marker in early rheumatoid arthritis patients