Is there an association between serum 25-hydroxyvitamin D concentrations and disease activity in rheumatoid arthritis?

BACKGROUND: Recently, it has been recognized that vitamin D not only is important for calcium metabolism and maintenance of bone healthy, but also plays an important role in reducing risk of many chronic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus, insulin-dependent diabetes mellitus, multiple sclerosis, several cancers, heart and infectious diseases. In RA, the role of vitamin D is undefined. METHODS: The objective of this present study was to determine serum 25-hydroxyvitamin D (25(OH)D) concentrations in patients with RA and to establish its correlation with disease activity. This study was performed on fifty-five consecutive patients RA fulfilling the American Collage of Rheumatology (ACR) criteria for the classification of RA and forty-five healthy subjects. Serum 25(OH)D levels were measured using Elecsys 25(OH)D reactive kit. Disease activity was assessed according to DAS28, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The association between serum levels of 25(OH)D and age, gender, disease duration and disease activity parameters were established. RESULTS: The mean serum 25(OH)D levels were significantly decreased in RA patients compared to healthy controls (p < 0.01) and were associated with higher levels of parathyroid hormone. Vitamin D deficiency (i.e. < 30 ng/ml) was found in 50 patients (90.9 %). Serum levels of vitamin D lower than 20 ng/ml were found in 72 % of patients. We did not find the correlation between serum 25(OH)D levels and disease activity parameters. CONCLUSIONS: Our findings have demonstrated that serum 25(OH)D levels is highly prevalent in patient with RA. We believe that it will be helpful to investigate the vitamin D levels in order to determine the osteomalacia risk of RA patients (Tab. 2, Ref. 11).

Can the patient-reported outcome instruments determine disease activity in rheumatoid arthritis?

OBJECTIVES: The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA). METHODS: Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity. RESULTS: HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity. CONCLUSION: It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).

The role of melatonin in rheumatic diseases.

Melatonin is a neurohormone that has attracted a great deal of attention, being frequently investigated in recent years. Due to its wide-spectrum of properties, melatonin has been suggested to be effective with respect to the etiology and treatment of several diseases. Its action on the immune system and antioxidant features has brought interest to this hormone's role in chronic inflammatory diseases. Furthermore, the detection of a correlation between the circadian release of melatonin and the rhythmic symptoms and signs of rheumatoid patients has led scientists to address its involvement in rheumatic diseases. Studies with suitable methodologies and broad perspectives are required in order to determine the functions of this neurohormone, whose effects are dependent on its physiological and pharmacological doses.

Relationship between radiographic grading of osteoarthritis and serum beta-2 microglobulin.

BACKGROUND: Beta-2 microglobulin (B2M) has been shown as a marker for monitoring inflammatory disease activity and it appears likely to have a destructive role in amyloidosis-related arthritis. Whether it has a catabolic role in osteoarthritis (OA) remains unclear. AIMS: To evaluate a possible association between serum B2M and radiographic grading of OA. METHODS: A total of 115 patients with knee OA and 30 controls were divided into subgroups according to Kellgren-Lawrence grading score and their erythrocyte sedimentation rate, C-reactive protein and serum B2M were assessed. RESULTS: B2M levels of patients were significantly higher than the controls (P < 0.01). However, there was no significant difference between OA subgroups and B2M levels had no correlation with the radiological grading. CONCLUSIONS: B2M levels were found to be higher in OA patients than controls, regardless of OA stage. These findings support the studies suggesting that B2M might be involved in the OA pathogenesis.

The effect of regular long term training on antioxidant enzymatic activities.

AIM: It has been reported that exercise induces oxidative stress and causes adaptations in antioxidant defenses. The purpose of the present study was to investigate the effects of regular long term training on antioxidant enzymatic activities consisting of superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) in a group of basketball players engaged in a physical training program. METHODS: SOD, GPX and GST activities were measured as an indicator of antioxidant defenses in long term trained basketball players and compared with non-sporting age matched controls. Independent samples t test was used to compare the data between the two groups. RESULTS: SOD, GPX and GST levels were significantly higher in basketball players than sedentary controls (P < 0.05, P < 0.05 and P < 0.01, respectively). CONCLUSION: Data suggest that regular long term training can induce antioxidant response to the oxidative stress. These results support the possibility that the beneficial effect of physical exercise on oxidative stress might be associated with increased antioxidant defenses.

Correlation between soluble intercellular adhesion molecule 1 level and extracellular superoxide dismutase activity in rheumatoid arthritis: a possible association with disease activity.

OBJECTIVE: We investigated serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) and the activity of extracellular superoxide dismutase (EC-SOD) in rheumatoid arthritis (RA). We also considered whether there was a correlation between sICAM-1 and EC-SOD and disease activity. METHODS: Levels of sICAM-1 were measured in serum from 42 patients with active RA and 30 control subjects by enzyme-linked immunosorbent assay (ELISA). EC-SOD activity was determined in sera isolated from patients with active RA and from controls. RESULTS: The serum levels of sICAM-1 were significantly higher in patients with RA than in control subjects (p<0.001). In contrast, the activity of EC-SOD was significantly lower in RA patients than in healthy controls (p<0.001). A significant negative correlation was found between the levels of sICAM-1 and EC-SOD activity (r=-0.39, p<0.01). There was a statistically positive correlation between sICAM-1 levels with Ritchie articular index (RAI) score and C-reactive protein (CRP) (r=0.32, p<0.05; r=0.44, p<0.01, respectively). CONCLUSIONS: These results show that the increased levels of sICAM-1 present in active RA patients might be due to the decreased activity of EC-SOD, and increased levels of sICAM-1 may also reflect disease status or activity.

The effect of individualized diet challenges consisting of allergenic foods on TNF-alpha and IL-1beta levels in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the effect of individualized diet challenges consisting of allergenic foods, defined by the skin prick test (SPT), on tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) levels in patients with rheumatoid arthritis (RA). METHODS: Twenty patients with a positive SPT response for food extracts and 20 with a negative SPT response were enrolled. None of the patients had active disease. All patients were fasted for the most common allergenic foods for 12 days and then allocated to two groups according to SPT results. Food challenges were performed with allergenic foods in the prick-positive group (PPG) and with corn and rice in the prick-negative group (PNG) for a period of 12 days. Then, allergenic foods were excluded from the PPG patients' diet and corn and rice were removed from the PNG patients' diet. Clinical examinations were performed after fasting (baseline), at the end of the challenge phase and at the end of the re-elimination phase. Stiffness, pain, tender and swollen joint counts, health assessment questionnaire (HAQ), Ritchie's articular index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum TNF-alpha and IL-1beta levels were measured. RESULTS: TNF-alpha (P < 0.01), IL-1beta (P < 0.05), ESR (P < 0.05) and CRP (P = 0.001) levels and all of the clinical variables, except HAQ, were increased with food challenges in the PPG. These increases were also recorded after the re-elimination phase. In the PNG, no significant change was seen in any of the variables, except pain (P < 0.05). During the study, important differences were observed for most of the variables between the two groups. Thirteen (72%) patients in the PPG and three (18%) in the PNG experienced disease exacerbation with challenges. This aggravation continued after elimination. CONCLUSIONS: Our results suggest that individualized dietary revisions may regulate TNF-alpha and IL-1beta levels in selected patients with RA.

High frequency of sister chromatid exchanges in lymphocytes of the patients with Behçet's disease.

Behçet's disease (BD) (OMIM 109650) is an immunogenetically based multisystem disease, characterized by iridocyclitis, arthritis, orogenital ulcerations and pustular skin lesions. Viral and autoimmune etiologies have been suggested and HLA-B5 has been found to predominate in BD. The disease is most seen in Turkey and Japan. Although familial cases have been reported, the mode of inheritance is not clear. To determine the genetic instability in BD, sister chromatid exchange (SCE) analysis has been performed on peripheral lymphocytes in 23 patients and 20 healthy controls. We found significantly higher SCE rates in the patient group (p < 0.0001). Our results may indicate that genetic impairment and genetic instability may play an important part in the etiology of BD.

Sister chromatid exchange analysis in the lymphocytes of patients with ankylosing spondylitis.

OBJECTIVE: This study investigated whether any genomic change occurs in DNA level in ankylosing spondylitis (AS) by measuring sister chromatid exchange (SCE) frequency. METHODS: SCE frequency was detected on metaphase chromosomes obtained from peripheral blood lymphocyte cultures in 15 patients diagnosed as having AS. SCE values were also obtained from 15 healthy subjects as a control group. SCE frequencies were detected from metaphases obtained from standard blood cultures by using bromodeoxyuridine and staining by Giemsa. RESULTS: SCE frequencies of AS were statistically higher than those of the control group (p < 0.005). CONCLUSION: These results suggest that genetic factors may play a more important part than realised in the aetiology of AS.