Serum leptin levels do not correlate with disease activity in rheumatoid arthritis.

OBJECTIVES: Leptin, is a fat tissue hormone which effects energy expenditure, food intake , hematopoiesis, osteogenesis, angiogenesis, reproductive and immune systems. We aimed to determine serum leptin levels and investigate the association between disease activity and other parameters in RA patients. METHODS: Patients with RA (n=106) as the study group, healthy controls (n=52) and osteoarthritis (OA) patients (n=37) as a control group were enrolled to the study. RA patients were categorized in four different groups according to DAS28 scores: remission ,low (LDA), moderate (MDA) or high (HDA) disease activity . RESULTS: No differences were present between the body mass indices of the three groups. Mean leptin levels in RA patients, OA group and healthy individuals were 25,60 ± 13,41, 23,03 ± 11,51 and 23,81 ± 12,85 ng/ml, respectively and no significant difference was present between the groups. Nine of (8,5%) RA patients were in remission, 16 (15,1%) were in LDA, 40 (37,7%) in MDA and 41 (38,7%) were in HDA. Leptin levels did not correlate with DAS28 scores of RA patients (r=-0,12, p=0,11). Mean leptin levels in RA patients with remission was 32,65 ± 7, 28 in LDA 23,94 ± 10,94 in MDA 26,73 ± 14,92 and in HDA 23,59 ± 13,50 ng/ml (p=NS). No associations were observed between leptin levels and CRP, ESR, RF positivity and disease duration. CONCLUSIONS: Our study revealed no correlation of disease activity and serum leptin levels. Therefore leptin does not seem to be an appropriate biomarker to monitorize inflammation in RA.

Impact of rheumatoid arthritis in Turkey: a questionnaire study.

OBJECTIVES: Unmet needs of rheumatoid arthritis (RA) patients regarding physician/patient communication, treatment preferences and quality of life issues were investigated in a Turkish survey study. METHODS: The study was conducted with the contribution of 33 rheumatologists, and included 519 RA patients. The study population included patients who had been on biologic therapy for >6 months and were still receiving biologic therapy (BT group), and those who were biologic naive, but found eligible for biologic treatment (NBT group). Of the RA patients, 35.5% initially had a visit to an internal disease specialist, 25.5% to a physical therapy and rehabilitation specialist, and 12.2% to a rheumatology specialist for their RA complaints. The diagnosis of RA was made by a rheumatologist in 48.2% of patients. RESULTS: The majority of RA patients (86.3%) visit their doctor within 15-week intervals. Most of the physician-patient communication focused on disease symptoms (99.0%) and impact of the disease on quality of life (61.8%). The proportion of RA patients who perceived their health status as good/very good/excellent was higher in the BT group than in the NBT group (74.3% vs. 51.5%, p<0.001). However, of those RA patients in the NBT group, only 24.8% have been recommended to start a biologic treatment by their doctors. With respect to dose frequency options, once-monthly injections were preferred (80%) to a bi-weekly injection schedule (8%). CONCLUSIONS: In conclusion, RA patients receiving biologic therapy reported higher rates of improved symptoms and better quality of life and seemed to be more satisfied with their treatment in our study.

An adult case of temporomandibular joint osteoarthritis treated with splint therapy and the subsequent orthodontic occlusal reconstruction.

Herein we report treatment for a 19-year-old female patient with severe osteoarthritis of the temporomandibular joint. The patient had severe open bite with a Class II molar relationship. She had limited mouth opening and pain. Clinical examination and magnetic resonance imaging revealed that she had anterior disc displacement without reduction. By splint therapy, limited mouth opening and pain was eliminated, but an anterior open bite developed after the treatment. By orthodontic treatment, an acceptable occlusion was achieved with a Class I molar relationship.

Comparative performance analysis of 4 different anti-citrullinated protein assays in the diagnosis of rheumatoid arthritis.

OBJECTIVE: To evaluate the diagnostic performances of 2 recently developed assays, third-generation anti-cyclic citrullinated peptide (anti-CCP3) and anti-mutated citrullinated vimentin (anti-MCV), in comparison to conventional second-generation anti-cyclic citrullinated peptide (anti-CCP2) assay; and to assess a novel fully automated, random-access AxSYM anti-CCP assay for early diagnosis of rheumatoid arthritis (RA). METHODS: A cohort of 176 patients was enrolled in our study; 93 were diagnosed as having RA. The non-RA group consisted of 83 patients including 38 with systemic lupus erythematosus, 17 with primary Sjögren's syndrome, 11 with osteoarthritis, and 17 healthy controls. All were tested for presence of anti-CCP2, anti-CCP3, AxSYM anti-CCP, anti-MCV, and rheumatoid factor (RF)-IgM according to the manufacturers' instructions. RESULTS: Diagnostic performance of the assays revealed the highest area under the curve for the novel AxSYM anti-CCP [89.1; 95% confidence interval (CI) 84.3-93.8], followed by anti-CCP3 (86.7; 95% CI 81.6-91.9), anti-CCP2 (82; 95% CI 75.8-88.3), and anti-MCV (71.9; 95% CI 64.4-79.5). The sensitivities and specificities were 60.2% and 98.8% for anti-CCP2, 61.3% and 97.6% for anti-CCP3, 80.6% and 84.3% for AxSYM anti-CCP, 49.8% and 91.6% for anti-MCV, and 67.8% and 91.6% for RF-IgM, respectively. CONCLUSION: At cutoff of 5 U/ml, AxSYM anti-CCP emerged as a highly sensitive first-line early diagnostic tool for RA, with the greatest discrimination power, above 16 U/ml, in case of positive result. Using a single easily performed automated assay at 2 determined decision limits we were able to diagnose 81% of cases of RA and missing only 1.2%.

Mannose binding lectin levels in spondyloarthropathies.

OBJECTIVE: Mannose binding lectin (MBL), a member of the collectin family proteins, is a major molecule of the innate immune system; MBL deficiency is associated with increased susceptibility to infections. As gastrointestinal and genitourinary infections are suggested to be among the etiological factors of spondyloarthropathies (SpA), we investigated MBL deficiency in ankylosing spondylitis (AS) and undifferentiated SpA (uSpA). METHODS: One hundred seven patients with AS, 43 patients with uSpA, and 74 healthy controls were studied. Disease activity, radiological scores, and demographic features were recorded. MBL levels were measured with standard ELISA kits. RESULTS: Median MBL levels in AS, uSpA, and controls were 2705 (range 0-5861) ng/ml, 2897 (36-7586) ng/ml, and 3468 (0-7950) ng/ml, respectively. No significant differences were observed in median MBL levels and the prevalence of MBL deficiency between the groups. Bath AS Radiological Index scores were not affected by MBL levels. However, although statistically not significant, radiographic damage quantified by modified Stoke AS Spine Score (mSASSS) was 3 times higher in AS patients with MBL deficiency. Disease activity, clinical picture, and therapies were not associated with MBL levels. CONCLUSION: In AS patients with MBL deficiency, there was a tendency towards a more severe radiographic progression detected by mSASSS.