Association study of single nucleotide polymorphisms of IL23R and IL17 in rheumatoid arthritis in the Algerian population.

OBJECTIVE: Previous studies implicated that IL17/IL23 pathway and TH17 cells play an important role in autoimmune inflammation. Genome wide association studies have identified multiple single nucleotide polymorphisms (SNPs) in the IL23R and IL17 genes region associated with rheumatoid arthritis (RA). METHODS: In this study, we investigated the association of IL23R, IL17A and IL17F genes SNPs with RA susceptibility in the Algerian population. 343 patients with RA and 323 healthy subjects were genotyped for IL23R (rs11209026, rs1343151, rs10489629), IL17F (rs763780, rs2397084) and IL17A (rs2275913) variants by TaqMan technology. RESULTS: There was no evidence of a genetic association between IL23R, IL17F and IL17A SNPs and RA susceptibility in our population. However, IL23R rs1343151 variant enhanced the development of RF IgM and IgG positive (+) RA as compared with RF IgM and IgG negative (-) RA (OR 2.29, p = 0.004 and OR 0.64, p = 0.014 respectively). Also, IL23R rs10489629 was associated with all RF isotypes positive disease (IgM+: OR 2.16, p = 0,006; IgG+: OR 0.64, p = 0,004 and IgA+: OR 1.54, p = 0,013). A moderate association of IL17A rs2275913 with RF IgA- RA subgroup was shown (OR 1.95, p = 0,039). Moreover, our data showed a correlation between IL23R and IL17F variants and the parameters of disease activity such as HAQ score and disease duration. CONCLUSION: The current study emphasizes the lack of association of IL23R and IL17 polymorphisms with RA susceptibility in the Algerian population. However, the data showed the relationship between IL23R and IL17A polymorphisms and the production of the different RF isotypes in RA patients.

Cardiovascular risk and lupus disease.

AIM: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate subclinical atherosclerosis and to determine the prevalence of risk factors for CVD in SLE patients. METHODS: One hundred fifty-three patients (149 women and 4 men), aged (37±11.6) years with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology (ACR), underwent physical examination, carotid and leg arteries B-mode ultrasound with a measure of ankle-brachial pressure index (ABPI); 94 patients had myocardial tomoscintigraphy. The laboratory check-up was: total cholesterol (TC), HDLc, LDLc, homocystein, glycemia, vascular cell adhesion molecules (VCAM-I). All patients had a normal renal function at the time of the study. RESULTS: The mean age is 37 years. Cardiovascular events were noticed in 15 patients (6 angina, 2 myocardial infarction and 7 strokes). Cardiovascular risk factors (CVRF) were: dyslipidemia (62.8%), moderate homocysteinemia (55%), BMI>25 (39%) and hypertension (35%) which is associated with a stroke (P<0.0006). The cumulative prednisone dose per patient was 45.5g. V.C.A.M-I level was high in 86.2 % of cases.95% of our patients had at least two CVRF. Myocardial perfusion stress scanning showed abnormalities in 21 patients (22.3%). Perfusion defects were linked with a stroke (P<0.01) and coronary events (P<0.02). Carotid atheroma was present in 32 patients (20.9%). Carotid plaques were associated with age (P<0.01), total cholesterol (TC)(P<0.05), and steroid dose (P<0.01). Intima-media-thickness was correlated with age (P<0.0003), TC (P<0.0007), LDLc (P<0.002), and homocysteine (P<0.03). 70% patients had a mediacalcinosis in femoral and popliteal arteries. The ABPI was correlated with V.C.A.M-I (P<0.0005). CONCLUSION: In Algeria, as elsewhere, young women with SLE have subclinical atherosclerosis which must be detected and they are at high risk of a vascular event.

Features associated with juvenile onset of spondylarthropathies in north Africa.

To determine whether juvenile onset of spondylarthropathy is associated with specific features, a prospective, cross-sectional study comparing juvenile-onset and adult-onset spondylarthropathies was conducted in the Maghreb in 523 patients meeting Amor's criteria or the ESSG's criteria for spondylarthropathy. Demographic data and clinical findings at the time of inclusion and during the first two years of the disease were compared in the 437 patients with onset at 16 years of age or older and in the 86 patients with onset before 16 years of age using a Student's t test or a chi-square test. The risk of hip involvement during the course of the disease was estimated using Kaplan-Meier curves and compared in the two groups using a Cox model. Early in the disease, patients in the juvenile onset group were more likely to have peripheral arthritis (52% vs 39%, p = 0.021) and enthesopathies (55% vs 40%, p = 0.002) and less likely to have axial manifestations (41% vs 62%, p = 0.0001), as compared with the adult-onset group. These differences persisted after a follow-up of 9.2 years. Juvenile-onset disease was associated with a greater likelihood of hip involvement (54 +/- 6% vs 34 +/- 3% after ten years, p = 0.012). The male bias was more marked in the juvenile onset group (85%) than in the adult-onset group (72%) (p = 0.016). These data confirm that demographic characteristics, clinical manifestations, and disease severity differ between juvenile-onset and adult-onset spondylarthropathies.

Predictive factors of severity of spondyloarthropathy in North Africa.

Both genetic and environmental factors probably influence the severity of Spondyloarthropathies. Hip involvement, which may be used as a marker of disease severity, is more frequent in spondyloarthropathies developed in North Africa. The objective of this study was determine the predisposing factors of hip involvement in spondyloarthropathy in North Africa. Patients fulfilled the Amor or European Spondyloarthropathy Study Group (ESSG) criteria of spondyloarthropathy. The study was retrospective, cross-sectional, multicentre and carried out in North Africa. The data collected were demographic data, socio-cultural factors and clinical presentation at onset. The risk of hip involvement with regard to disease duration was estimated using Kaplan-Meier's method. The predictive value of each variable with regard to time to hip involvement was evaluated using a uni- and then a multivariate Cox proportional hazard model. Five hundred and eighteen patients were included. The risk of hip involvement was estimated at 39+/-3% after 10 yr disease duration. The factors picked up by the multivariate analysis were: diagnostic delay less than 7 yr, age at onset below 24 yr and a combination of 'lower social class' and 'no refrigerator at home'. This study confirms the high prevalence of hip involvement during the course of spondyloarthropathy in North Africa and suggests a role of environmental factors in its appearance.