Salivary gland ultrasonography findings are associated with clinical, histological, and serologic features of Sjögren's syndrome.

OBJECTIVE: Salivary gland ultrasonography (SGUS) has been applied in the diagnosis of Sjögren's syndrome (SS). The aim of this study is to investigate the association of SGUS findings with clinical, histological, and serologic features of SS. METHODS: A total of 104 patients with suspected SS underwent SGUS for evaluation of salivary gland involvement. Patients with primary SS were determined according to the classification criteria for SS. The parenchymal inhomogeneity of bilateral parotid and submandibular glands was graded from 0 (homogeneity) to 4 (gross inhomogeneity). Receiver operating characteristic curve analysis was performed to compare the diagnostic performance of different SGUS scoring methods. Clinical and serologic features were compared between groups classified by SGUS score. The association between SGUS and these features of SS was explored by multivariable linear regression analysis. RESULTS: Study participants were predominantly women (96.2%) and had a mean age of 54.1 years. Eighty-seven patients and 88 patients with primary SS were identified based on AECG criteria and ACR/EULAR classification criteria for SS, respectively. Among the different scoring methods, the sum of the grades of four salivary glands (range 0-16) had the best diagnostic performance, with sensitivity of 77.3% and specificity of 87.5% (cutoff value, 7) for distinguishing primary SS from sicca non-SS. SGUS score was associated with focus score in labial salivary gland biopsy (ß = 0.240, p = 0.033) and anti-Ro/SSA serology (ß = 0.283, p = 0.016) and inversely associated with unstimulated whole salivary flow (ß = -0.298, p = 0.011). CONCLUSION: Ultrasonography of major salivary glands is associated with histopathology of minor salivary glands, serology of SS, and salivary gland function.

Effect of alcohol consumption and smoking on disease damage in systemic lupus erythematosus: data from the Korean Lupus Network (KORNET) registry.

Background We assessed correlations of smoking habits and alcohol consumption with disease activity or damage in patients with systemic lupus erythematosus (SLE). Methods A total of 505 patients with SLE were enrolled in the Korean Lupus Network (KORNET) SLE registry from January 2014 to January 2016. Disease activity and organ damage were measured by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index, respectively. Multivariate logistic regression analysis was used to analyze associations with cutaneous lesions. Results There were no differences in SLEDAI-2K and SLICC/ACR damage indices according to either smoking status or alcohol consumption. More frequent cutaneous damage was observed in current alcohol drinkers compared with non-current alcohol drinkers ( p = 0.020). Cutaneous damage was significantly associated with alcohol consumption (odds ratio (OR) 4.048, 95% confidence interval (CI) 1.251-12.102, p = 0.020). Both low (1-5 glasses/week) and high (≥6 glasses/week) amounts of alcohol consumption had a significant impact on cutaneous damage compared with the absence of current alcohol consumption ( p = 0.033 and p = 0.027, respectively). Pairwise comparison of alcohol consumption and smoking status with cutaneous damage showed that only alcohol consumption was significantly associated with the presence of cutaneous damage, compared with non-current alcohol consumption and non-current smoking (OR 3.513, 95% CI 1.130-10.920, p =0.030). Conclusions Current alcohol consumption, but not smoking, might influence the development of cutaneous damage in patients with SLE.

Urine ß2-microglobulin is associated with clinical disease activity and renal involvement in female patients with systemic lupus erythematosus.

OBJECTIVE: We investigated the association of serum and urine ß2-microglobulin (ß2MG) with renal involvement and clinical disease activity in systemic lupus erythematosus (SLE). METHODS: Sixty-four female patients with SLE were enrolled. We assessed SLE disease activity (SLEDAI)-2K and measured serum and urine ß2MG levels, as well as complement (C3 and C4) and anti-dsDNA levels. According to the SLEDAI scores, two groups were categorized: low (0-5 of SLEDAI) and high (6-19 of SLEDAI) disease activity groups. The presence of renal involvement was determined by renal SLEDAI score. Statistical analysis was performed using Spearman's correlation analysis, Mann-Whitney U test, multivariate regression analysis, and logistic regression analysis. RESULTS: Urine ß2MG levels were significantly different between low and high SLEDAI groups (p = 0.001), but not for serum ß2MG levels (p = 0.579). Patients with renal involvement showed higher urine ß2MG levels compared to those without renal involvement (p < 0.001), but again there was not a difference in serum ß2MG levels (p = 0.228). Urine ß2MG was closely associated with SLEDAI (r = 0.363, p = 0.003), renal SLEDAI (r = 0.479, p < 0.001), urine protein/Cr (r = 0.416, p = 0.001), and ESR (r = 0.347, p = 0.006), but not serum ß2MG (r = 0.245, p = 0.051). Urine ß2MG level was identified as a surrogate for renal involvement (p = 0.009, OR = 1.017, 95% CI 1.004-1.030) and overall disease activity (p = 0.009, OR = 1.020, 95% CI 1.005-1.036). CONCLUSIONS: We demonstrated that urine ß2MG levels are associated with renal involvement and overall clinical disease activity in SLE.

Arterial stiffness and proinflammatory cytokines in fibromyalgia syndrome.

OBJECTIVES: We assessed arterial stiffness and inflammatory cytokine profiles in fibromyalgia syndrome (FMS) patients and analysed the association between them. METHODS: Twenty-seven FMS patients and 29 age-matched premenopausal healthy controls were enrolled in this study. Arterial stiffness was assessed by pulse wave velocity (PWV) and augmentation index (AIx) from pulse waveform analysis. Levels of serum interleukin-1ß (IL-1ß), IL-6, IL-8, and vascular endothelial growth factor (VEGF) were measured by enzyme-linked immunosorbent assay, and a colorimetric assay was used for measurement of serum nitric oxide (NO) metabolites (nitrate and nitrite, NOx) level. Statistical analyses included the Mann-Whitney U-test and Spearman's correlation coefficient analysis. RESULTS: Higher AIx and AIx@HR75 (aortic AIx at a heart rate of 75 beats/min) were noted in FMS compared to those in the controls after adjustment using covariants (p(adj)=0.023 and p(adj)<0.001). However, there were no differences between the three regional PWVs of the two groups at the aorta-femoral, femoral-dorsalis, and aorta-radialis arteries (p(adj)>0.05 for all). FMS subjects had significantly higher serum IL-8 levels than did the healthy controls (327.9±588.7 vs. 76.4±90.5, p(adj)=0.041). However, there were no significant differences in serum IL-1ß, IL-6, VEGF, or NOx levels between the FMS patients and the controls (p(adj)>0.05 of all). Serum IL-8 level did not correlate with PWV and AIx in FMS patients. CONCLUSIONS: This study demonstrates higher AIx and IL-8 levels in FMS subjects compared to those of the controls. However, arterial stiffness including AIx in FMS was not determined by the serum IL-8 level.

Association between the HLA-DRB1 gene and clinical features of systemic sclerosis in Korea.

OBJECTIVE: To determine whether HLA-DR alleles are associated with the development and clinical features of systemic sclerosis (SSc) in Koreans. METHODS: Seventy-nine patients (74 women and five men; 45 diffuse types and 34 limited types; mean age at diagnosis 43.9 years) fulfilling the American College of Rheumatology (ACR) classification criteria for SSc were enrolled. The controls were 144 healthy, disease-free Koreans. HLA-DRB1 genotypes were assessed by the polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. RESULTS: The HLA-DRB1*15 allele was increased in anti-topoisomerase I autoantibody (anti-topo I)-positive SSc patients [p = 0.003, p corrected (p(corr)) = 0.039, odds ratio (OR) = 3.43, 95% confidence interval (CI) 1.45-8.13] compared with controls. The DRB1*11 allele was also observed more frequently in anti-topo I-positive SSc than in controls (13.3% vs. 4.2%) but not statistically significant (p = 0.053, p(corr) = 0.689). In patients with SSc, the DRB1*04 allele was associated with subcutaneous calcinosis (p = 0.048, OR = 4.56, 95% CI 1.07-19.37). Patients with overlap syndrome showed a negative association with the DRB1*04 allele (p = 0.036, OR = 0.26, 95% CI 0.08-0.91). CONCLUSION: The HLA-DRB1*15 allele was associated with the development of anti-topo I-positive SSc in Koreans. In addition, the DRB1*04 allele was associated with certain clinical features in SSc patients.

Cervical spine involvement in longstanding ankylosing spondylitis.

OBJECTIVE: To investigate the degree of ossification and the frequency of ankylosis between the atlas and the dens of the axis in patients with longstanding ankylosing spondylitis (AS), to assess radiological involvement of the cervical spine, and to determine their correlations with structural severity and clinical variables, including neurological abnormalities. METHODS: In 61 AS patients with disease duration over 7 years, the findings of conventional radiographs were graded by the Bath Ankylosing Spondylitis Radiology Index (BASRI), and the ossification levels between the atlas and the dens and the severity of zygapophyseal (ZA) joint lesions were scored using multislice CT. Neurological examinations and somatosensory evoked potentials (SSEP) were performed by neurologists. RESULTS: According to the BASRI, 50 patients (82.0%) had radiological changes of the cervical spine > or = score 1. Thirty-seven patients (60.6%) revealed a certain extent of the atlantodental ossification, and the presence of partial or complete atlantodental ankylosis was seen over 30% of the patients. The BASRI-cervical spine score and the atlantodental ossification levels correlated with disease duration. ZA involvement was observed in 49 patients (80.3%), including 23 with ZA fusion (37.7%). Although 4 of 11 patients with atlantoaxial subluxation showed abnormal SSEP none had significant neurological complications. This might be attributed in part to atlantodental ankylosis and ZA fusion. Finally, ossifications of the anterior and posterior longitudinal ligaments were found 26.2 and 29.5%, respectively. CONCLUSION: Cervical spine involvement and atlantodental ossification or ankylosis appear to be common in patients with longstanding AS, and to be particularly more severe in patients with a longer disease duration.