Serum prohepcidin concentrations in rheumatoid arthritis and its relation to disease activity

Objectives The aim of this study was to assess the possible relations between serum level of prohepcidin in patients with rheumatoid arthritis (RA) and their rheumatoid anemia profiles and disease activity. Patients and methods A total of 80 patients with RA (34 male and 46 female) were enrolled. Their mean age was 43.3 ± 11.5 years, and the mean duration of the disease was 7.7 ± 7.0 years. RA disease activities were measured using Disease Activity Score 28 (DAS28). Anemia profiles were measured. Serum concentration of prohepcidin, the prohormone of hepcidin, was measured using enzyme-linked immunosorbent assay. Results The patients′ mean concentration of serum prohepcidin was 211.4 ± 5.88 ng/ml, which was significantly higher than in the control group (167 ± 5.2 ng/ml). Serum level of interleukin-6 and tumor necrosis factor-α were significantly higher in RA patients than in the healthy control group (21.11 ± 5.88 vs. 3.36 ± 1.3 pg/ml and 17.8 ± 3.7 vs. 3.7 ± 1.1 pg/ml, respectively). The prohepcidin concentration was correlated with rheumatoid factor, C-reactive protein, erythrocyte sedimentation rate, and DAS28. There was a significant correlation between prohepcidin with tumor necrosis factor-α and interleukin-6. The prohepcidin concentration was significantly higher in the patients with active RA (DAS28 > 5.1) than those with inactive-to-moderate RA (DAS28≤5.1). Serum prohepcidin concentration in patients negatively correlated with serum iron (r = −0.23, P = 0.04). However, the prohepcidin concentration did not correlate with other anemia profiles. There was no difference of prohepcidin concentration between the patients with anemia of chronic disease and those without. Conclusion Serum concentration of prohepcidin reflects the disease activity, regardless of the anemia states in RA patients, and thus prohepcidin could be used as another useful marker for RA disease activity

Magnetic resonance spectroscopy in evaluation of cerebral chemical changes in fibromyalgia patients

Fibromyalgia (FM) is a clinical syndrome defined by the presence of chronic widespread musculoskeletal pain and the presence of at least 11 of 18 body tender points and these features are often accompanied by other symptoms such as fatigue, poor sleep quality, loss of memory, and mood disturbance. The aim of this work was to investigate the role of magnetic resonance spectroscopy (MRS) to detect the differences in cerebral chemical changes between FM patients and control participants. Thirty patients with primary FM (27 females and three males) were selected from the outpatient clinic of the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University Hospitals. Patients with primary FM fulfill the American College of Rheumatology criteria for diagnosis of FM. Ten persons were needed as healthy control participants with the same age and sex as the included patients. 1 H-MRS unit was used to assess N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Our Results showed the following: there was a significant difference in the level of l-hippocampal (NAA) and right hippocampus Cho and the levels of hippocampal glutamate/glutamine (Glx) in the patient group compared with the control group. There is a highly significant difference between the level of Rt and Lt hippocampal Glx in the same patient, highly significant difference in the level of Rt and Lt hippocampal NAA/Cr, NAA/Cho, and left hippocampal Cho/Cr ratios between cases and controls, and there was a negative correlation between the number of tender points and the level of Lt hippocampal Cr. Moreover, there was a significant difference between the number of tender points and the level of Rt hippocampal NAA and Lt hippocampal Ch/Cr ratios, highly significant difference between the level of Rt hippocampal NAA/Cho, NAA/Cr, and Lt NAA/Cr and number of tender points, and a highly significant difference between the level of Rt hippocampal NAA/Cho, Rt NAA/Cr, Lt NAA/Cr, and number of tender points (P < 0.001). There was a highly significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and visual analogue scale, and there was a significant difference between the level of Rt hippocampal NAA/Cho, Lt hippocampal NAA/Cr, and fibromyalgia impact questionnaire. Conclusion These findings outline the possible nature of FM as a systemic disorder that is mainly expressed through sensorineural dysfunction and abnormal neuroendocrine stress responses