Correlation between homocysteine plasma levels and nailfold videocapillaroscopic patterns in systemic sclerosis.

The aim of the study is to investigate the relationship between microangiopathy as assessed by nailfold videocapillaroscopy (NVC) and plasma level of homocysteine (Hcy) in systemic sclerosis (SSc). As known, Hcy is a nonessential amino acid that interferes with normal properties of a vascular tree. Sixty patients affected by SSc (4 men and 56 women, mean age 54.6) underwent the determination of plasma Hcy level; at the same time, NVC was performed. Hcy level was also determined in 30 sex- and age-matched controls. In patients affected by SSc the plasma Hcy level was significantly higher than in healthy controls (11.8 and 6.5 micromol/l, respectively; p < 0.001). A significant correlation was found between plasma Hcy concentration and the pattern of NVC with a progressive increase from early to active and above all to late pattern (10.7, 11.8, and 17.4 micromol/l, respectively; p < 0.001). Subjects with high Hcy level (i.e., >75th percentile of Hcy level in controls and in patients considered altogether) were mostly represented in the scleroderma patients with late nailfold videocapillaroscopic pattern; the crude odds ratio was 9.0 (significant; 95% CI from 2.1 to 38.8). In conclusion, Hcy plasma level is related to microvascular involvement in patients affected by SSc; the concentration increases with the progression of the nailfold videocapillaroscopic pattern. Hyperhomocysteinemia may represent an aggravating factor among the complex mechanisms involved in scleroderma damage contributing to the injury of endothelium.

Low levels of activated factor VII in systemic sclerosis.

INTRODUCTION: Recent investigations show that activated factor VII, the primary enzyme in the extrinsic pathway of blood coagulation, exerts additional extra-coagulant functions, such as apoptosis and angiogenesis. On the basis of these recent acquisitions, the present study was aimed to evaluate activated factor VII in patients with systemic sclerosis and to establish a potential association with pathogenesis and complications of this severe autoimmune disorder. MATERIALS AND METHODS: Activated factor VII level was measured in twenty-eight consecutive scleroderma patients (2 men and 26 women, mean age 49.7 +/- 14.8 years). The main clinical correlates of disease, such as disease activity, renal function, skin, vascular and lung involvement, were evaluated by clinical and instrumental investigations. Activated factor VII level was also evaluated in 28 sex and age matched controls. RESULTS: Systemic sclerosis patients exhibited plasma activated factor VII activities significantly lower than those of healthy matched controls (15.2 versus 37.7 U/l, respectively; p < 0.001). No correlation was observed between plasma activated factor VII concentration and age, disease duration, disease subset, disease activity, renal, lung, skin and microvascular involvement. CONCLUSIONS: Results of our investigation provide first evidence of low activated factor VII activity in patients with systemic sclerosis. Reduced activated factor VII activity might be involved in the pathogenesis of the ischemic complications, by modulating apoptotic and angiogenetic processes.

Evaluation of finger skin temperature in scleroderma patients cyclically treated with iloprost.

OBJECTIVES: To evaluate by computerized digital thermometry (CDT) the effect of cyclic iloprost infusions on finger skin temperature (FST) in scleroderma patients. METHODS: Twenty-two scleroderma outpatients (one man, 21 women, mean age 54.2 years) underwent three computerized digital thermometries, the first one 3 days before a 5-day cycle of iloprost infusion, the second the day of the fifth infusion soon after the end of the therapy and the third 1 month after. FST was evaluated under basal conditions, immediately after a cold test and after an 18 min recovery period. For comparison CDT was performed in 10 sex and age matched control subjects. RESULTS: FST was lower in scleroderma patients before iloprost infusion than in the control group either after cold test either at the end of the recovery period while no difference was found before the cold test. Soon after iloprost infusion and 1 month later the FST at the end of the recovery period increased from the pre-treatment value of 27.8 +/- 5.3 to 30.4 +/- 3.5 degrees C and to 30.0 +/- 4.5 degrees C, respectively (P < 0.05 for both values). No substantial differences were found concerning FST before and at the end of the cold test. CONCLUSION: Iloprost administration for 5 days allows to normalize the FST value after cold exposition not only immediately after the infusions but even at 1 month distance from the therapy. Despite its short half-life the effect of the drug on endothelium is protracted.

[Infliximab in aggressive and refractory rheumatoid arthritis. A pilot study]. / Infliximab nell'artrite reumatoide aggressiva e refrattaria. Esperienza preliminare.

UNLABELLED: Rheumatoid arthritis is a chronic inflammatory disease with a progressive course, that frequently provokes permanent incapacity if not adequately treated. Rheumatoid arthritis may be not responsive to the common second line drugs. This study was aimed to treat 15 patients affected by severe refractory rheumatoid arthritis with infliximab. PATIENTS AND METHODS: Fifteen patients with refractory rheumatoid arthritis were treated with infliximab--monoclonal antibody direct to TNF alpha--in association with methotrexate or azathioprine. Infliximab was administered at the dosage of 3 mg/Kg at the weeks 0, 2 and 6 and then every 8 weeks. RESULTS: About half patients ameliorated in agreement with both ACR 20 criteria and DAS28 evaluation. The clinical improvement was accompanied by a reduction of the steroid daily dosage. No relevant side effects were observed. CONCLUSION: Infliximab is effective in a significant number of patients with severe rheumatoid arthritis, with a good tolerability.