A low balance between microparticles expressing tissue factor pathway inhibitor and tissue factor is associated with thrombosis in Behçet's Syndrome.

Thrombosis is common in Behçet's Syndrome (BS), and there is a need for better biomarkers for risk assessment. As microparticles expressing Tissue Factor (TF) can contribute to thrombosis in preclinical models, we investigated whether plasma microparticles expressing Tissue Factor (TF) are increased in BS. We compared blood plasma from 72 healthy controls with that from 88 BS patients (21 with a history of thrombosis (Th+) and 67 without (Th-). Using flow cytometry, we found that the total plasma MP numbers were increased in BS compared to HC, as were MPs expressing TF and Tissue Factor Pathway Inhibitor (TFPI) (all p < 0.0001). Amongst BS patients, the Th+ group had increased total and TF positive MP numbers (both p ≤ 0.0002) compared to the Th- group, but had a lower proportion of TFPI positive MPs (p < 0.05). Consequently, the ratio of TFPI positive to TF positive MP counts (TFPI/TF) was significantly lower in Th+ versus Th- BS patients (p = 0.0002), and no patient with a TFPI/TF MP ratio >0.7 had a history of clinical thrombosis. We conclude that TF-expressing MP are increased in BS and that an imbalance between microparticulate TF and TFPI may predispose to thrombosis.

Male lupus: a diagnosis often delayed--a case series and review of the literature.

INTRODUCTION: Systemic lupus erythematosus (SLE) is an auto-immune disease that is characterised by autoantibody production. Male lupus is rare, apart from at either end of the age spectrum. AIM: In this series, we review the histories of six male lupus patients attending our service. RESULTS: Our patients presented in middle age and tended to develop haematological abnormalities, renal involvement and neurological manifestations which preceded the onset of their skin and joint complaints. Our patients accrued damage rapidly and overall did badly. They tended to respond sub-optimally to standard treatments. These cases highlight the need an increased awareness that male SLE patients present with a wide variety of symptoms, and that they accrue damage quickly. There is a need for timely diagnosis and appropriate initiation of treatment. This may help avoid preventable organ damage and increase the survival of men with SLE.

Obesity and disability in the symptomatic Irish knee osteoarthritis population.

BACKGROUND: Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. AIMS: In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. RESULTS: The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. CONCLUSION: Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.

Importance of full evaluation in patients who complain of neck pain.

INTRODUCTION: Although neck pain is common in patients with chronic rheumatic disorders, any change in the quality or severity of pain should be further investigated. MATERIALS AND METHODS: We report two patients who recently presented with increasing neck pain on a background of chronic inflammatory arthritis. RESULTS: Both patients were found to have suffered fractures of the cervical spine. In each case, the bones appeared osteopenic and reduced bone density is likely to have made the patients susceptible to fracture. CONCLUSION: This report highlights the need to comprehensively evaluate patients with chronic rheumatic disorders who note a significant change in their neck symptoms.

Limiting cardiovascular risk in Irish rheumatoid arthritis patients.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease and premature death. OBJECTIVES: Our aims were: (1) to assess how thoroughly RA patients were being screened for cardiovascular risk factors in our outpatient population and (2) to evaluate the benefit of introducing a shared care cardiovascular booklet. METHODS: We assessed 80 patients who attend our service with RA. Our initial audit revealed that 80% of patients had not been thoroughly assessed for basic cardiovascular risk. Based on these findings, we created a shared care booklet. RESULTS: On re-auditing our service, we found a significant improvement in the assessment of cardiovascular risks. CONCLUSION: There is currently a low level of screening for cardiovascular risks in busy outpatient clinics. We felt the introduction of a shared care booklet allowed an increased level of screening in our clinics and also acted as a tool for doctor and patient education.