Investigating diagnosis, treatment, and burden of disease in patients with ankylosing spondylitis in Central Eastern Europe and the United States: a real-world study.

INTRODUCTION/OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory immune-mediated condition. We compared AS diagnosis, treatment, and burden in Central Eastern European countries (CEE), where this has been less researched, and the United States (US) from a real-world perspective. METHODS: Point-in-time survey of rheumatologists and their AS patients was conducted in the US (Apr-Oct 2018) and CEE (Aug-Nov 2019) via physician- and patient-completed record forms, including clinical and patient-reported outcomes. Statistical analysis included descriptive statistics, t-tests, Fisher's exact tests, and generalized linear models. RESULTS: In total, 487 patients were recruited from 88 rheumatologists in the US and 922 patients from 126 rheumatologists in CEE. Time from onset of symptoms to final AS diagnosis was longer in CEE than the US (4.2 vs 2.7 years, p < 0.05). At diagnosis, a greater use of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and injected steroids was reported in CEE vs the US (43.7% vs 27.6%, p < 0.05; 19.3% vs 8.7%, p < 0.05). 22.9% of US patients received a biologic DMARD at diagnosis vs 10% of CEE patients (p < 0.05). At current consultation, biologic DMARD use in CEE was lower vs the US (27.9% vs 71.0%, p < 0.05). CEE vs US patients had greater disease activity (mean Bath Ankylosing Spondylitis Disease Activity Index 4.2 vs 3.1, p < 0.05) and worse quality of life (QoL; mean Ankylosing Spondylitis Quality of Life Questionnaire score 6.2 vs 8.4, p < 0.05). CONCLUSIONS: AS patients in CEE vs the US faced slower diagnosis and worse access to biologics, disease activity, and QoL. Whether early access to biologics can improve symptoms, QoL, and daily activities in AS patients in CEE remains to be seen. Key Points • The study provided evidence on the real-world approach to the diagnosis, treatment, and burden of axSpA (axial spondyloarthritis) in CEE compared with the US. • The study reported patients in CEE experienced longer delays in diagnosis and poorer access to biologics than in the US. • This may have resulted in higher disease activity, greater levels of pain, and poorer outcomes, as reported by patients with axSpA in CEE.

[Association of albuminuria with adipokines, inflammation and insulin resistance in non-diabetic subjects]. / Relatia dintre adipokine, markeri inflamatori, scaderea sensibilitatii la insulina si eliminarea urinara de albumina la subiecti nediabetici.

UNLABELLED: The objective of this study was to evaluate the association of traditional cardiovascular risk factors, adipokines, inflammation and insulin resistance with low-grade urinary albumin-to-creatinine ratio (ACR) in nondiabetic, healthy subjects. MATERIAL AND METHODS: The study included 117 healthy subjects (64 men and 53 women), who were classified according to their body mass index (BMI) into three groups: lean (BMI<25 kg/m2), overweight (25< or =BMI<30 kg/m2) and obese (BMI> or =30 kg/m2). RESULTS: ACR was higher in obese men and women compared to overweight and lean men and women (men - 3 mg/g vs. 6.1 mg/g vs. 8.9 mg/g, p=0.018; women - 2.1 mg/g vs. 6.7 mg/g vs. 9.1 mg/g, p=0.03). In univariate analyses ACR was associated in obese men with adiponectin (r=-0.43, p=0.021) and systolic blood pressure (r=0.51, p=0.006) and in non-obese men with systolic blood pressure (r=0.39, p=0.041). In women systolic blood pressure was the only determinant both in obese (r=0.49, p=0.022) and non-obese subjects (r=0.42, p=0.04). CONCLUSIONS: Adiponectin is an important mediator of low-grade albuminuria in obese, non-diabetic men.

Early detection of atherosclerosis in type 2 diabetic patients by endothelial dysfunction and intima-media thickness.

UNLABELLED: Endothelial dysfunction (ED) is regarded as an early functional marker and intima-media thickness (IMT) as an early morphological marker of atherosclerosis. The aim of this study was to evaluate whether peripheral endothelial function and common carotid IMT are impaired in type 2 diabetic patients with inadequate glycemic control. MATERIAL AND METHODS: We examined 20 subjects--10 controls (aged 54.2 +/- 4.37 years) and 10 type 2 diabetic patients (aged 55.6 +/- 3.66 years) with HbA1c level >8.5% (mean 9.25% +/- 0.54%), with an average duration of diabetes of 5.65 +/- 2.34 years, all without clinical evidence of atherosclerosis. B-mode ultrasonography was used to assess both intima-media thickness in the common carotid artery and endothelium function in the brahial artery. In order to evaluate endothelium function brachial artery diameter was measured at rest, during reactive hyperemia, which causes endothelium-dependent vasodilation and after sublingual administration of nitroglycerin (500 microg), which causes endothelium-independent vasodilation. RESULTS: There was no statistical difference between the two groups regarding age. Systolic blood pressure, diastolic blood pressure, total cholesterol were higher and HDL-cholesterol was lower in the diabetic group, but the differences didn't reach statistical significance. Triglycerides concentration and BMI were significant greater in the diabetic group (triglycerides-204 +/- 48.5 mg/dl vs. 117 +/- 22.2 mg/dl, p<0.0001; BMI-28.6 +/- 1.28 kg/m2 vs. 26.7 +/- 1.93 kg/m2, p=0.021). Diabetic subjects had significantly impaired flow-mediated vasodilation (FMD) in the brachial artery compared with control group (5.65% +/- 1.42% vs. 7.11% +/- 1.01%, p=0.016). Endothelium-independent vasodilation induced by nitroglycerin did not differ between the two groups (15.4% +/- 2.01% in diabetic subjects vs. 15.7% +/- 2.58% in control subjects, p=0.75). Intima-media thickness was significantly increased in diabetic patients (0.87 +/- 0.07 mm vs. 0.77 +/- 0.06, p=0.0022). CONCLUSION: In diabetic patients with inadequate glycemic control and without clinical evidence of atherosclerosis endothelial function assessed by FMD is significantly impaired and IMT is significantly greater compared to nondiabetic healty subjects. Large clinical trials should evaluate if in clinical practice FMD and IMT are useful in identification of high-risk subjects.

Proteic sulphur levels in hair, a possible tool to manage the balance of IDDM.

Assays of proteic sulphur levels in the hair of patients with new detected IDDM which were followed up for 6 months, showed a negative correlation between HbA1c and proteic sulphur levels. Because the length of hair could provide in evolution a longer period than HbA1c (for every month hair raise with 1 cm), assays of proteic sulphur levels could give information about balance of diabetes for much more time than HbA1c.

Detection of T suppressor cells in patients with organ allografts.

Specific immunosuppression of host's immune response to donor HLA antigens has been a major goal to clinical transplantation. Recent evidence has been accumulating to show that a distinct population of T cells expressing the CD8(+) CD28(-) phenotype display suppressor function and inhibit Th activation and proliferation by modulating the APC function. To assess the presence of Ts in transplant recipient's circulation, we have developed a flow cytometry method that measures the expression of costimulatory molecules on donor APC exposed to recipient Th and Ts. Our results demonstrate that quantitation of the capacity of CD8(+) CD28(-) T cells from patient circulation to suppress the activation of costimulatory molecules (CD80, CD86) on donor APC offers a reliable tool for monitoring specific immunosuppression against the graft in solid organ transplantation.

Clinical evidence for genomic imprinting in bipolar I disorder.

The phenotypic indicators of the genomic imprinting model were applied to clinical psychopathology data on 100 bipolar (BP) I probands and their families. The paternal transmission was associated with a significantly younger age of onset of the BP illness in probands and a higher rate of affective disorders in first- and second-degree relatives. The effect of the sex of the transmitting parent on age of onset in probands decreased but remained significant when controlling for the effect of the probands' age at investigation. Probands' sex had no significant influence on their age of onset. The severity of the BP illness in probands in terms of number of illness episodes and annual frequency was not influenced by the sex of the transmitting parent.

Polymorphism of HLA in the Romanian population.

We have investigated the HLA-class I and class II polymorphism in a population of 83 Romanians using conventional serology together with PCR amplification and oligonucleotide typing of HLA-class II genes. Romanians show a higher frequency of HLA-A11, B13, B18, B37, B39, B51 and DR2 than other European populations. HLA-DRB1*1501 and 1601 account for the high frequency of the serologic specificity DR2. In Romanians, HLA-DR2 is in linkage disequilibrium with HLA-B18 and HLA-Bw52 rather than with HLA-B7 as in the case in other Europeans. Unexpected HLA-DR2 haplotypes include HLA-DRB1*1502, DQA1*0102, DQB1*0601; HLA-DRB1*1602, DQA1*0102, DQB1*0502. Other unusual haplotypes include HLA-DRB1*0405, DQA1*03, DQB1*0302; HLA-DRB1*1305, DQA1*0103, DQB1*0603; and HLA-DRB1*1405, DQA1*0101, DQB1*05032. Analysis of the genetic distance between Romanians and other Europeans who have been studied serologically are consistent with the hypothesis that Romanians descend from Roman ancestors who colonized Dacia between the 1st century B.C. and 1st century A.D.