Hypovitaminosis D in recent onset rheumatoid arthritis is predictive of reduced response to treatment and increased disease activity: a 12 month follow-up study.

BACKGROUND: Vitamin D displays immunomodulatory activities and has been proposed as a potential player in the pathogenesis of rheumatoid arthritis (RA). A negative association between serum 25(OH) vitamin D levels and RA activity was demonstrated but longitudinal studies investigating the role of vitamin D levels in predicting RA activity and response to treatment are lacking. Therefore, this study was designed to test the hypothesis of an association between serum 25(OH) vitamin D levels at RA diagnosis and disease activity evaluated by clinimetric, laboratory and ultrasound (US) parameters and to detect the prevalence of remission and response to treatment after 12 months follow-up. METHODS: This is a longitudinal, retrospective study on data obtained from thirty-seven patients with early RA treatment-naïve. Serum inflammatory markers, auto-antibodies and 25(OH) vitamin D levels were obtained at baseline. Hypovitaminosis D was diagnosed for 25(OH) vitamin D levels < 20 ng/ml. Tender joint count (TJCs), swollen joint count (SJCs), Visual Analog Scales (VAS), Disease Activity Score (DAS) 28 score were assessed at baseline and 12 months after diagnosis. Joints synovitis and power-Doppler were evaluated at baseline and 12 months later. RESULTS: At baseline mean 25(OH) vitamin D levels were 24.4 ± 11.9 ng/ml; 35% of study subjects had hypovitaminosis D which strongly associated with higher RA activity and lower prevalence of remission and response to treatment (all p-values < 0.001). The percentage of patients not presenting a reduction of the US synovitis score after 12 months from diagnosis was significantly higher among patients with hypovitaminosis D than in those with normal serum 25(OH) vitamin D at baseline. CONCLUSIONS: In patients with early RA and basal hypovitaminosis D after 12 months follow-up reduction of disease activity and percentage of remission and response to treatment were significantly lower than those observed in patients with normal vitamin D levels. These results provide further support to the immunomodulatory action of vitamin D in RA and suggest a role of basal vitamin D status in the prediction of disease evolution. Vitamin D measurement and possibly vitamin D supplementation should be considered an additional option in the management of early RA patients

An investigation into the effect of MLSS on the effluent quality and sludge settleability in an aerobic-anoxic sequencing batch reactor (AASBR)

The aim of this study is to enhance the effluent quality and improve the sludge settleability by determining the effects of the mixed liquor suspended solids (MLSS) on the solid’s settling behaviour and the treatment efficiency in an aerobic-anoxic sequencing batch reactor (AASBR). The results obtained from this study revealed that raising the MLSS concentration from 2 to 3 g/l improved the chemical oxygen demand (COD), ammonia-nitrogen (NH3-N) and nitrate-nitrogen NO3-N removal efficiency, and led to an increase in the sludge volume index (SVI) value. Moreover, increasing the MLSS concentration from 3 to 4 g/l did not significantly affect the COD, NH3-N and NO3-N removal rates or the solid’s settling behaviour. However, increasing the MLSS concentration from 4 to 6 g/l significantly reduced the COD and nitrate removal efficiency and the sludge settling rate slowed down. The results proved that the optimal MLSS concentration for COD, NH3-N and NO3-N removal is between 3 and 4 g/l. In this range the removal rates for COD, NH3-N and NO3-N were 93%, 95% and 96% respectively, and the effluent quality was 35 mg/l, 0.43 mg/l and 0.75 mg/l for COD, NH3-N and NO3-N respectively. In addition, a good solid separation occurred during that range with SVI value of 81 ml/g; this finding was supported by a morphological study along with scanning electron microscopy (SEM)