Rheumatoid arthritis and metabolic syndrome.

In the past 20 years, the life expectancy of patients with rheumatoid arthritis (RA) has been shown to be reduced by three to ten years as compared to that of the general population. Currently, cardiovascular disease (CVD) is the major cause of death in patients with RA, and acute myocardial infarction can be up to four times more frequent in these patients. The autoimmune systemic inflammatory response, along with the presence of metabolic syndrome (MetS), doubles the risk for fatal or non-fatal CVD and coronary atherosclerosis, regardless of age and sex. Rheumatoid arthritis has been associated with increased prevalence of MetS, but its role in the different characteristics of the disease, such as disease duration, activity, and treatment with glucocorticoids, is not well defined. This study aimed at reviewing the prevalence of MetS and the factors implicated in the development of atherosclerosis in RA patients, assessing the clinical aspects of RA and its association with the development of MetS.

Antibodies to the atherosclerotic plaque components beta2-glycoprotein I and heat-shock proteins as risk factors for acute cerebral ischemia.

One third of cases of cerebral ischemia have no clear etiology. A humoral response to the atherosclerotic plaques components beta2-glycoprotein l (beta2-gpl) and heat-shock proteins (Hsp) might be involved in the pathogenesis of stroke. This case-control study includes a complete profile of anti-beta2-gpl antibodies and testing of IgG antibodies to the 60/65 kilodaltons (kDa) Hsp in stroke patients. Ninety-three patients with acute ischemic stroke and 93 controls were evaluated for age, sex, race, hypertension, smoking, previous cardiopathy, diabetes mellitus, hypercholesterolemia and previous history of cerebral ischemia. lgG/lgM/lgA anticardiolipin (aCL) and anti-beta2-gpl antibodies, as well as lgG antibodies to human 60 kDa Hsp and to Mycobacterium bovis 65 kDa Hsp, were detected by immunoassay. Adjusted odds ratios (OR) were calculated by logistic regression. The adjusted OR for IgA anti-beta2-gpl antibodies was 4.6 (90%Cl 1.5 to 14.3; p = 0.025). The non-adjusted OR for IgG antibodies to Hsp 60 was 26.1. The adjusted OR for IgG antibodies to Hsp 65 was 3.2 (90%Cl 1.2 to 8.3; p = 0.044). The adjusted OR for lgG to any Hsp (60 or 65) was 4.8 (90%Cl 1.9 to 12.1; p = 0.006). This study demonstrates that elevated IgA anti-beta2-gpl and lgG anti-Hsp 60/65 antibodies are associated with increased risk of ischemic stroke. The association occurred independently of other risk factors. This humoral response might link autoimmunity, thrombophilia and atherosclerosis in stroke patients.