ABSTRACT
AIM: Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that can affect almost all organs of the body. Lupus is a non-curable disease and the treatment is based on symptom control by immunosuppressive and anti-inflammatory treatment. The disease itself as well as treatment-related adverse events have a significant negative impact on life expectancy and quality of life of patients. The aim of this study was to identify the impact of the disease on life of SLE patients. METHODS: Data were collected anonymously using a special questionnaire. The survey involved 76 patients with SLE, results were processed by conventional methods and descriptive statistic methods. RESULTS: The survey has confirmed the impact of SLE on professional activities i.e. up to 63% of patients are registered disabled, of which 46% are granted full disability pension. SLE negatively affects patients' career--up to 39% of SLE patients stated that they had to change a job due to their disease. SLE has a strong impact on everyday life of patients. SLE symptoms are significant even during the period of quiescence--predominantly fatigue, reduced physical activity, pain. The most influenced activities of daily living included sunbathing and more strenuous activities or sport. The fact that limitations in all monitored activities are present in more than 50% of patients is a serious finding. Treatment-related adverse events have negative impact on the quality of life in almost 70% of patients. The most frequent events include gastrointestinal symptoms, visual disturbance and osteoporosis. CONCLUSION: SLE has a significant impact on the quality of life of patients and hinders them from leading everyday life at the level comparable to healthy population.
Subject(s)
Cost of Illness , Lupus Erythematosus, Systemic/complications , Adult , Aged , Disabled Persons , Employment , Female , Humans , Male , Middle Aged , Mobility Limitation , Quality of Life , Severity of Illness IndexABSTRACT
OBJECTIVES: Congestive heart failure (CHF) and inflammation are important contributors to the excess of overall morbidity and mortality in patients with rheumatoid arthritis (RA). CHF rather than ischaemic heart disease (IHD) appears to participate on the mortality in these patients. However, there are controversial results about significance of plasma N-terminal of pro-B type natriuretic peptide (NT-proBNP) and other inflammatory markers investigation for an early detection of heart dysfunction. The aim of this study was to examine the cardiac morphology and function in patients with RA in relation to the plasma NT-proBNP and to inflammatory markers. SUBJECTS AND METHODS: Sixty patients with RA (52 women and 8 men) and 30 gender and age matched controls were included in the study. Blood samples were analyzed for NT-proBNP, tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), and C-reactive protein (CRP). Transthoracic echocardiography was performed on the same day in all subjects. RESULTS: RA patients had significantly higher plasma NT-pro BNP as compared with controls (99.39 ± 8.98 vs. 66.90 ± 7.93 pg/ml, p < 0.05) and significantly higher levels of TNF-alpha, IL-6 and CRP (for all p < 0.01). In RA group higher levels of NT-proBNP were detected in rheumatoid factor (RF) posivite patients. Patients with RA had significantly worse left ventriclular (LV) systolic function (LV ejection fraction (LVEF) 64.6 ± 0.8 vs. 70.1 ± 1.3 %, p < 0.01) and diastolic function (E/A 1.11 ± 0.05 vs. 1.32 ± 0.07, p < 0.05). There were no correlations of NT-proBNP with paramaters of systolic and diastolic function, however, a negative correlation of TNF-alpha with these parameters was detected (TNF-alpha vs. LV mass index (LVM-i): r = - 0.34, p < 0.05), TNF-alpha vs. LVEF: r = - 0.30, p < 0.05 and TNF-alpha vs. E/A: r = - 0.30, p < 0.05). CONCLUSION: We conclude that TNF-alpha may be better marker of heart impairment caused by chronic inflammation in RA patients than NT-proBNP.
Subject(s)
Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Heart Ventricles/diagnostic imaging , Inflammation/diagnosis , Inflammation/epidemiology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/epidemiology , Adult , Arthritis, Rheumatoid/blood , Causality , Comorbidity , Female , Humans , Inflammation/blood , Male , Middle Aged , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Slovakia/epidemiology , Ultrasonography , Young AdultABSTRACT
Tumor necrosis factor alpha (TNF-alpha) plays an important role in the pathogenesis of chronic inflammatory diseases, i.e., rheumatoid arthritis (RA), ankylosing spondylitis (AS), Crohn's disease (CD), and ulcerative colitis (UC). Anti-TNF-alpha strategies are successfully used in their treatment. However, their effect on heart function is still uncertain. The objectives of the study were to examine the acute and long-term effect of infliximab on the heart morphology and function in patients with chronic inflammatory disorders. Thirty-one patients (21 men and 10 women) were included. Ten percent of them were diagnosed with RA, 22.5 % with AS, 22.5 % with CD, and 45 % with UC, respectively. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) was measured before and immediately after infliximab administration at the beginning of the study and in the sixth and 12th months. Echocardiography was performed at baseline and in the sixth and 12th months. There was a significant increase in NT-proBNP after the first infliximab infusion (88.40 ± 14.09 vs. 95.24 ± 14.28 pg/ml, p = 0.0046) and similar response was detected after each infusion in the sixth and 12th months. Plasma NT-proBNP slightly but not significantly decreased (88.40 ± 14.09 vs. 81.74 ± 23.14 pg/ml, p = 0.583, and 88.40 ± 14.09 vs. 56.83 ± 17.77 pg/ml, p = 0.0576, in the sixth and 12th months, respectively). There were no significant changes in echocardiographic structural and functional parameters of the left ventricle during follow-up. Plasma NT-proBNP mildly but significantly increases immediately after infliximab infusion. However, long-term infliximab administration does not deteriorate both cardiac morphology and function.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Arthritis/drug therapy , Heart Diseases/etiology , Heart/drug effects , Inflammatory Bowel Diseases/drug therapy , Adult , Arthritis/blood , Arthritis/physiopathology , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/physiopathology , Colitis, Ulcerative/blood , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/physiopathology , Crohn Disease/blood , Crohn Disease/drug therapy , Crohn Disease/physiopathology , Echocardiography/methods , Female , Heart/physiopathology , Heart Diseases/physiopathology , Humans , Inflammatory Bowel Diseases/blood , Inflammatory Bowel Diseases/physiopathology , Infliximab , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Spondylitis, Ankylosing/blood , Spondylitis, Ankylosing/drug therapy , Spondylitis, Ankylosing/physiopathology , Time Factors , Young AdultABSTRACT
Gonadotropin-releasing hormone (GnRH) is the first key hormone of reproduction. GnRH analogs are extensively used in in vitro fertilization and treatment of sex hormone-dependent cancers due to their ability to bring about 'chemical castration'. Recently it has been showed that it also plays an important role in the modulation of the immune system. We report a case of vasculitis and histologically proven severe polymyositis developed 5 days after GnRH administration due to ovulation induction in an infertile patient with no previous history of autoimmune diseases. After treatment with corticosteroids (prednisone, 30 mg daily), aspirin, and pentoxyphyllin in combination with rehabilitation, an amelioration of muscle impairment was observed.
