Influence of prolactin and estrogen on disease activity in patients with systemic lupus erythematosus

Objective The objective of this paper is to evaluate the role of prolactin and estrogen levels on disease activity in patients with systemic lupus erythematosus (SLE). Patients and methods This study included 60 female patients with SLE, with a mean age of 33.5±13.12 years. It was conducted between November 2014 and October 2015. Disease activity was defined according to Systemic Lupus Erythematosus Activity Index; score of at least 6 was considered as an active disease. Prolactin (PRL) and estrogen levels and other serological markers of lupus disease activity, namely, complement 3,4 (C3 and C4), erythrocyte sedimentation rate, C-reactive protein, and anti-double-stranded DNA (anti-dsDNA) titer were calculated. Results Hyperprolactinemia was present in 25.0% of patients, and low estrogen level was present in 33.3% of patients. There was no significant correlation between either of estrogen or prolactin levels and all clinical and laboratory features, except for a significant positive correlation between anti-dsDNA and hyperprolactinemia. Conclusion There was no significant correlation between either of PRL or estrogen levels and Systemic Lupus Erythematosus Activity Index score. Overall, 80.0% of patients with hyperprolactinemia and 80.0% with low estrogen level had SLE activity. There was a significant difference in the frequency of further indicators of disease activity in SLE such as raised erythrocyte sedimentation rate, raised C-reactive protein, or decrease in complement factors with high serum PRL and low estrogen level

Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

Background Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with probable autoimmune aetiology. RA has many secondary complications and a variety of neuropsychological consequences. Aim The aim of this study was to estimate the frequencies of neuropsychiatric disorders in RA patients and their relationship with the duration and activity of disease. Patients and methods Seventy-four consecutive female RA patients were recruited and compared with 25 age-matched and education status-matched female healthy volunteers. All eligible participants underwent clinical, laboratory and electrophysiological examinations (motor and sensory nerve conduction study, F-wave of four limbs, P300 event-related potential and electroencephalography). The Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 3rd ed., Revised (DSM-III-R) Axis I Disorders (SCID-I) for diagnosis of psychiatric illness and the Wechsler Adult Intelligence Scale, 3rd ed. (WAIS-III) with assessment of total scale, verbal and performance intelligence quotients (IQ) were administered to all participants. Results Fourteen (18.9%) patients had evidence of symptomatic peripheral neuropathy and radiculopathy, whereas 60.8% had psychiatric disorders. Depression was the most prevalent psychiatric disorder (45%), followed by anxiety (27%) and comorbid anxiety with depression (21.6%). Low IQ scores were recorded in 54% of patients. P300 latency was significantly prolonged (P = 0.0001), and seven (9.5%) RA patients recorded abnormal P300 latency (>mean ± 2 SD) compared with control values. Abnormal electroencephalography findings were observed in 48.6%. Visual analogue scale pain score was significantly higher among patients with psychiatric disorders versus patients without psychiatric disorders (P = 0.0001). Significant negative correlation was recorded between Disease Activity Score and total IQ score (P = 0.01), whereas no significant association was seen between Disease Activity Score and the presence of neuropathy or psychiatric disorders. Conclusion Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients′ health-related quality of life