Stress and Disease Onset in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

OBJECTIVE: To explore the potential contribution of stress as a trigger for disease onset in patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). METHODS: 53 AAV and 85 rheumatoid arthritis (RA) patients as well as 53 healthy controls (HC) were thoroughly asked for the number and impact of stressful life events, coping strategies, and available social support 12 months prior to disease onset. Anxiety, depression, personality dimensions, insomnia, and fatigue were also determined. RESULTS: AAV patients reported higher scoring of the impact of stressful life events compared to the RA and HC group prior to disease onset (2.8 ± 3.1 vs 1.8 ± 2.1 vs 1.7 ± 2.3, p-values: 0.047 and 0.053, respectively). While the number of reported stressful events was found to be significantly higher in AAV vs RA patients but not HC, certain coping strategies and social support features were more commonly implemented by AAV patients compared to HC, but not RA patients. As far as personality and other psychosocial characteristics, AAV patients displayed significantly higher psychoticism traits compared to RA, with no other differences being detected between AAV patients and both RA and HC. After adjusting for potential cofounders, scoring of the impact of stressful life events >3 was independently associated with AAV development compared to both RA and HC [ORs (95% CI): 4.6 (1.6-13.4) and 4.4 (1.0-19.0), respectively]. CONCLUSION: The perceived impact of stressful life events prior to disease onset emerged as a contributing factor for AAV development.

Fatigue in Primary Sjögren's Syndrome: Clinical, Laboratory, Psychometric, and Biologic Associations.

OBJECTIVE: To identify independent contributors of fatigue in primary Sjögren's syndrome (SS) patients, taking into account clinical, laboratory, and psychological features, and to explore the potential role of interferon (IFN)-induced gene indoleamine 2,3-dioxygenase (IDO-1), anti-21-hydroxylase (anti-21[OH]) antibodies, and soluble BAFF. METHODS: Detailed clinical and laboratory characteristics were recorded for 106 primary SS patients. The Functional Assessment of Chronic Illness Therapy-Fatigue, Zung Depression Scale, State-Trait Anxiety Inventory, Eysenck Personality Questionnaire Scale, and Athens Insomnia Scale were adopted to assess fatigue, depression, anxiety, and sleep disturbances, respectively. Peripheral whole blood expression levels of IDO-1, as well as type I and II IFN-induced genes were calculated using quantitative reverse transcriptase-polymerase chain reaction. Serum anti-21(OH) antibodies and soluble BAFF levels were determined by a radioimmunoassay and an enzyme-linked immunosorbent assay, respectively. Univariate and multivariate models were performed to identify determinants of fatigue. RESULTS: Fatigue was detected in 32 of 106 (30.2%) primary SS patients. In univariate analysis, fatigue was associated with arthralgias/myalgias, fibromyalgia hydroxychloroquine therapy, both state and trait anxiety scores, depression, and neuroticism, as well as impaired sleep patterns. Multivariate analysis revealed neuroticism (odds ratio [OR] 6.9, [95% confidence interval (95% CI) 1.7-28.0]), depression (OR 3.0 [95% CI 0.8-11.0]), and fibromyalgia (OR 5.5 [95% CI 1.1-27.7]) as independent fatigue contributors. Soluble BAFF levels, anti-21(OH) autoantibodies, and IDO-1 messenger RNA expression did not significantly differ between fatigued and nonfatigued primary SS patients. CONCLUSION: Depression, neuroticism, and fibromyalgia play a major role in primary SS-associated fatigue and should be addressed in clinical practice, with active collaboration between rheumatologists and mental health professionals. Further studies are warranted in order to explore underlying pathophysiologic pathways that might explain fatigue in the setting of primary SS.

Total nitric oxide and inducible nitric oxide synthase in alcohol-dependent individuals during detoxification therapy.

BACKGROUND: The alterations of total nitric oxide (NO) (through total nitrite/nitrate) and inducible nitric oxide synthase (iNOS) concentrations were determined in a population of alcohol-dependent individuals without liver disease upon admission for detoxification, two weeks later and after completion of detoxification (4-6 weeks in total). MATERIALS AND METHODS: Thirty-eight men and nine women were included in the study. Endogenous nitrite and total nitrite/nitrate concentrations were measured colorimetrically and iNOS concentration was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Endogenous and total nitrite concentrations were found to be diagnostically equally conclusive, whereas iNOS values were not correlated with the other two parameters. All three parameters were significantly higher in alcohol-dependent individuals compared to controls at all time points. CONCLUSION: The preventive therapeutic use of iNOS inhibitors in alcohol-dependent individuals might avoid the injurious effects of chronic alcohol abuse, and should be a matter of further investigation.

Pregabalin augmentation of antidepressants in older patients with comorbid depression and generalized anxiety disorder-an open-label study.

OBJECTIVE: The objective of this 12-week open-label study was to evaluate the efficacy, safety, and tolerability of pregabalin as an adjunctive treatment to antidepressants in older patients suffering from depression and comorbid generalized anxiety disorder (GAD). METHODS: The initial sample of this open-label study consisted of 94 older patients fulfilling criteria for depression with comorbid GAD who were treated with antidepressants. Twenty of them who had received antidepressant monotherapy for an adequate time and shown partial response to the antidepressant prescribed, in terms of either anxiety or depressive symptomatology, followed the next phase. During the 12-week study period, pregabalin was gradually added to the previously prescribed antidepressant, reaching 225 mg/day over 4 weeks. Depression and anxiety scores as well as side effects were monitored. Within groups, differences of depression and anxiety scores at baseline and during the following 12 weeks of treatment were estimated with repeated-measure analysis of variance. RESULTS: A statistical significant reduction in depression scores was observed after the 4th week of treatment (p < 0.01), which further improved between the 8th and 12th weeks (p < 0.01). Concerning overall anxiety scores, a statistically significant improvement was noted between the 2nd and 4th weeks (p < 0.01), which further continued throughout the 8th (p < 0.05) and 12th weeks (p < 0.05). CONCLUSIONS: The present study demonstrated a good therapeutic response to pregabalin in patients with depression comorbid with GAD after a 12-week treatment period. Both anxiety and depressive symptomatology significantly improved, and minimal side effects were observed.

Duloxetine versus citalopram and sertraline in the treatment of poststroke depression, anxiety, and fatigue.

The authors sought to determine the relative efficacy and tolerability of duloxetine versus citalopram and sertraline in the treatment of poststroke depression (PSD), anxiety, and fatigue. A group of 60 patients with PSD were assigned to receive duloxetine, citalopram, or sertraline and were assessed over a 3-month period for depression, anxiety, and fatigue. Improvement of depression and anxiety, but not fatigue, was observed in all study groups. Duloxetine was well tolerated and significantly more effective than citalopram and sertraline for the treatment of anxiety symptoms in PSD patients. None of the antidepressants used was effective for reducing symptoms of fatigue.

Psychopathological and personality features in primary Sjogren's syndrome--associations with autoantibodies to neuropeptides.

OBJECTIVES: To determine the spectrum of personality and psychopathology features of patients with primary SS (pSS) and explore whether they are linked to disease characteristics as well as the presence of autoantibodies (autoAbs) against neuropeptides. METHODS: Personality and psychopathological variables were determined in 103 pSS patients and 110 healthy controls (HCs). AutoAbs against hypothalamic and pituitary neuropeptides were measured by ELISA in 25 pSS patients and 25 HCs. Data analysis was performed by univariate and multivariate logistic regression models and by comparison with regression models. RESULTS: A higher number of pSS patients reported distinct personality traits (neuroticism, psychoticism and obsessiveness) and psychological distress compared with HCs. After adjustment for personality characteristics and demographics, only hypochondriasis was the main psychopathology feature associated with pSS, suggesting that psychopathological manifestations in the setting of pSS are primarily dependent on premorbid personality characteristics. Although no differences were detected between serum levels of neuropeptide autoAbs in pSS cases and controls, levels of autoAbs against alpha-melanocyte-stimulating hormone (alpha-MSH) correlated with anxiety scores in both groups examined but with higher intercept in pSS subjects. Significant correlations between anxiety score and autoAbs directed against oxytocin and vasopressin were also detected in the pSS patients. CONCLUSIONS: pSS patients exhibit a distinct pattern of personality traits and high levels of psychological distress compared with HCs, which seems to be determined by premorbid personality characteristics. Correlations between anxiety and alpha-MSH autoAbs suggest their potential involvement in anxiety development in both pSS and HCs.

Alteration of biological markers in alcohol-dependent individuals without liver disease during the detoxification therapy.

BACKGROUND/AIM: The need for sensitive biological markers to detect and prove recent drinking has been the focus of many research groups. The aim of our study was to investigate the alterations of biological markers in a population of alcohol dependent individuals during the detoxification period. PATIENTS AND METHODS: Fifty-two alcohol-dependent individuals were admitted for alcohol detoxification on an inpatient basis. Carbohydrate-deficient transferrin (CDT), gamma-glutamyl transpeptidase (gamma-GT), interleukin-6 (IL-6), mean corpuscular volume (MCV), aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) were obtained at admission and on a 15-day basis. Comparisons between measures were made with t-test. RESULTS: All biochemical parameters associated with alcoholism, with the exception of MCV, were statistically significantly decreased during the detoxification process (p<0.05). CONCLUSION: CDT is an excellent marker of alcohol overconsumption during evaluation, as well as during the detoxification treatment. IL-6 could serve as an additional marker to CDT, a point needing further investigation.