Subject(s)
Interleukin 1 Receptor Antagonist Protein , Humans , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Still's Disease, Adult-Onset/drug therapy , Still's Disease, Adult-Onset/complications , Antirheumatic Agents/therapeutic use , Recurrence , Myocarditis/drug therapy , Pneumonia/drug therapy , Male , Female , Adult , Pericarditis/drug therapy , Treatment OutcomeABSTRACT
Proinflammatory cytokines and growth factors, which regulate mutual interactions between immune system cells and bone tissue cells, play a major role in the formation of bone changes in rheumatoid arthritis (RA). The aim of the work was to assess serum concentration of osteoprotegerin (OPG), RANKL, Dkk-1 and sclerostin in RA patients compared to a control group and to analyze changes of these concentrations during methotrexate (MTX) therapy. Patients enrolled in the study were 30 women of Caucasian origin aged 30-74 years with RA. Patients with active form of the disease were administered recommended doses of MTX for at least 6 months. The study group was divided into subgroup I-patients with improvement; and subgroup II-patients with no improvement. The control group consisted of 12 healthy women in the age of 41-73. Before MTX therapy, RA patients had higher levels of RANKL (644.97 ± 477.13 vs. 255.19 ± 130.26 pmol/l), lower values of OPG/RANKL (0.01 ± 0.0101 vs. 0.02 ± 0.0078) and higher levels of Dkk-1 protein (1821.32 ± 1060.28 vs. 548.52 ± 36.35 pg/ml) compared to the control group. In the analyzed group of patients (all patients receiving MTX regardless of responder non responder status) after 6 months of therapy, a statistically significant increase in the ratio of OPG/RANKL was found (0.0118 ± 0.0102 vs. 0.0141 ± 0.0118; p = 0.02). The index value of OPG/RANKL differed significantly depending on the resultant effect of treatment (0.01702 ± 0.01274 in the subgroup of improvement vs. 0.00675 ± 0.00289 in the subgroup without improvement). The difference in the mean concentrations of Dkk-1 before and after treatment with MTX between subgroups I and II was statistically significant (p = 0.002). In subgroup I, mean concentration of Dkk-1 decreased after 6 months of treatment with MTX (2054.72 ± 1004.74 vs. 1831.70 ± 851.70 pg/ml); while in subgroup II, the mean concentration of Dkk-1 increased (1214.48 ± 738.32 vs. 2275.01 ± 1385.23 pg/ml). There were no statistically significant changes in the mean concentrations of sclerostin before and after treatment with MTX (in whole group treatment with MTX, in subgroup I, and in subgroup II). The results confirm the presence of disorders of bone metabolism in patients with RA. Treatment with MTX affects the value of the ratio of OPG/RANKL and concentration of Dkk-1.
Subject(s)
Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Bone and Bones/drug effects , Intercellular Signaling Peptides and Proteins/blood , Methotrexate/administration & dosage , RANK Ligand/blood , Adaptor Proteins, Signal Transducing , Adult , Aged , Antirheumatic Agents/adverse effects , Biomarkers, Pharmacological/blood , Bone Morphogenetic Proteins/blood , Bone and Bones/metabolism , Disease Progression , Female , Genetic Markers , Humans , Methotrexate/adverse effects , Middle Aged , Osteoprotegerin/bloodABSTRACT
UNLABELLED: Reactive arthritis (ReA) is a sterile inflammation of the synovial membrane of one or more joints developing after urogenital or gastro-intestinal infection. The syndrome most frequently follows infection with Chlamydia trachomatis. Useful for the diagnosis can be the serological tests. At present there is the possibility to identify the specific antibodies (IgG, IgA, IgM) to Chlamydia trachomatis. The subject of the study was the group of 87 patients in age 19-78; 58 women and 29 men from whom urogenital smear and serum were tested. The control group were 30 people age 25-70 without rheumatological disorders. Chlamydia trachomatis was found in urogenital smear in 42 (48%), in 56 (64%) patients immunoglobulin IgG were positive, and immunoglobulin IgA in 16 (18%). The laboratory tests and clinical symptoms allow to make a diagnosis of ReA in 38 (43%) and possible ReA in 5 (5.7%) of patients. CONCLUSIONS: 1. There is no gold standard for the diagnosis of ReA. 2. None of the tests or the clinical symptoms alone are strong enough to make a definite diagnosis of ReA. 3. Tests to identify Chlamydia trachomatis, with respect of typical clinical symptoms are useful the diagnosis of ReA. 4. The diagnosis of ReA is most probable if we have typical clinical symptoms, clinical evidence of a preceding infection plus a positive result of serology or PCR plus positivity for HLA-B27.
Subject(s)
Arthritis, Reactive , Chlamydia Infections , Chlamydia trachomatis/immunology , Chlamydia trachomatis/isolation & purification , Immunoglobulins/immunology , Adult , Aged , Arthritis, Reactive/diagnosis , Arthritis, Reactive/immunology , Arthritis, Reactive/microbiology , Chlamydia Infections/diagnosis , Chlamydia Infections/immunology , Chlamydia Infections/microbiology , Female , HLA-B27 Antigen/immunology , Humans , Male , Middle Aged , ProhibitinsABSTRACT
Reactive arthritis triggered by a sexually transmitted infection is referred to as sexually acquired reactive arthritis (SARA). There is no gold standard for the diagnosis of SARA. None of the tests or the clinical symptoms alone are strong enough to make a definite diagnosis of SARA. Tests to identify Chlamydia trachomatis, when respect typical clinical symptoms are helpful to make the diagnosis of ReA.
