Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage

Objective: To study the value of antibodies to citrullinated proteins/peptides for predicting joint outcomes in patients with recent onset rheumatoid arthritis (RA). Methods: 191 patients with RA onset within the past year were followed up prospectively for five years. Serum samples obtained from 145 patients at baseline before disease modifying antirheumatic drug treatment were examined using three anticitrullinated protein/peptide antibody assays: antiperinuclear factor (APF) by indirect immunofluorescence (IIF), antikeratin antibodies (AKA) by IIF, and anti-cyclic citrullinated peptide (CCP) antibodies by enzyme linked immunosorbent assay (ELISA). Radiographs of the hands and feet taken at baseline and after three and five years were evaluated using Sharp scores modified by van der Heijde. Results:Anti-CCP ELISA was positive in 58.9% of patients. APF/anti-CCP agreement was 77%. The likelihood of a total Sharp score increase after five years was significantly greater among patients with anti-CCP antibodies (67%; odds ratio (OR) 2.5; 95% confidence interval (95% CI) 1.2 to 5.0) or APF (57%; OR 2.4; 95% CI 1.2 to 4.9) but not rheumatoid factor (RF; OR 0.7; 95% CI 0.3 to 1.5). Mean values for radiographic damage, erosion, and joint narrowing scores at the three times were significantly higher in patients with anti-CCP or APF than in those without. AKA did not significantly predict radiographic damage. In separate analyses of patients with and without RF, anti-CCP or APF was better than RF for predicting total joint damage and joint damage progression after five years. Conclusion: Antibodies to citrullinated proteins/peptides determined early in the course of RA by APF IIF or anti-CCP ELISA are good predictors of radiographic joint damage. Further studies of clinical, laboratory, and genetic parameters are needed to improve RA outcome prediction in clinical practice

Low end-tidal CO2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions.

BACKGROUND: Prompt diagnosis of intra-anaesthetic acute hypersensitivity reactions (AHR) is challenging because of the possible absence and/or difficulty in detecting the usual clinical signs and because of the higher prevalence of alternative diagnoses. Delayed epinephrine administration during AHR, because of incorrect/delayed diagnosis, can be associated with poor prognosis. Low end-tidal CO2 (etCO2) is known to be linked to low cardiac output. Yet, its clinical utility during suspected intra-anaesthetic AHR is not well documented. METHODS: Clinical data from the 86 patients of the Neutrophil Activation in Systemic Anaphylaxis (NASA) multicentre study were analysed. Consenting patients with clinical signs consistent with intra-anaesthetic AHR to a neuromuscular blocking agent were included. Severe AHR was defined as a Grade 3-4 of the Ring and Messmer classification. Causes of AHR were explored following recommended guidelines. RESULTS: Among the 86 patients, 50% had severe AHR and 69% had a confirmed/suspected IgE-mediated event. Occurrence and minimum values of arterial hypotension, hypocapnia and hypoxaemia increased significantly with the severity of AHR. Low etCO2 was the only factor able to distinguish mild [median 3.5 (3.2;3.9) kPa] from severe AHR [median 2.4 (1.6;3.0) kPa], without overlap in inter-quartile range values, with an area under the receiver operator characteristic curve of 0.92 [95% confidence interval: 0.79-1.00]. Among the 41% of patients who received epinephrine, only half received it as first-line therapy despite international guidelines. CONCLUSIONS: An etCO2 value below 2.6 kPa (20 mm Hg) could be useful for prompt diagnosis of severe intra-anaesthetic AHR, and could facilitate early treatment with titrated doses of epinephrine. CLINICAL TRIAL REGISTRATION: NCT01637220

Low end-tidal CO2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions.

International audienceBackground:Prompt diagnosis of intra-anaesthetic acute hypersensitivity reactions (AHR) is challenging because of the possible absence and/or difficulty in detecting the usual clinical signs and because of the higher prevalence of alternative diagnoses. Delayed epinephrine administration during AHR, because of incorrect/delayed diagnosis, can be associated with poor prognosis. Low end-tidal CO2 (etCO2) is known to be linked to low cardiac output. Yet, its clinical utility during suspected intra-anaesthetic AHR is not well documented.Methods:Clinical data from the 86 patients of the Neutrophil Activation in Systemic Anaphylaxis (NASA) multicentre study were analysed. Consenting patients with clinical signs consistent with intra-anaesthetic AHR to a neuromuscular blocking agent were included. Severe AHR was defined as a Grade 3-4 of the Ring and Messmer classification. Causes of AHR were explored following recommended guidelines.Results:Among the 86 patients, 50% had severe AHR and 69% had a confirmed/suspected IgE-mediated event. Occurrence and minimum values of arterial hypotension, hypocapnia and hypoxaemia increased significantly with the severity of AHR. Low etCO2 was the only factor able to distinguish mild [median 3.5 (3.2;3.9) kPa] from severe AHR [median 2.4 (1.6;3.0) kPa], without overlap in inter-quartile range values, with an area under the receiver operator characteristic curve of 0.92 [95% confidence interval: 0.79-1.00]. Among the 41% of patients who received epinephrine, only half received it as first-line therapy despite international guidelines.Conclusions:An etCO2 value below 2.6 kPa (20 mm Hg) could be useful for prompt diagnosis of severe intra-anaesthetic AHR, and could facilitate early treatment with titrated doses of epinephrine

Undersøkelser av krepsdyr og fisk i fem regulerte og reguleringspåvirkede innsjøer i Mandalsvassdraget høsten 2014

Denne rapporten omhandler vannkvalitet, krepsdyr og fisk i Store Kvernevatn og Langevatn-magsinet (Langestølstjern, Roddeivsvatn, Sandvatn og Langevatn), og i tre reguleringspåvirk-ede innsjøer; Lisle Kvernevatn (nedstrøms Store Kvernevatn), Tjørni (nedstrøms Langevatn-magasinet) og Tjønnæ (nestrøms Ljoslandsvatn). Alle de fem innsjøene er lokalisert i øvre deler av Mandalsvassdraget i Åseral kommune, Vest-Agder. Langevatn og Store Kvernevatn har reguleringshøyder på henholdsvis 16,8 og 25,8 m. Innsjøene ble prøvefisket med Nordisk oversiktsgarn, og utbyttet uttrykkes som antall individ pr. 100 m2 garnareal (Cpue). Fiskens vertikalfordeling ble undersøkt ved å sette garna på standard dyp; 0-3, 3-6, 6-12 og 12-20 m. Fiskebestandene i Langevatn og Store Kvernevatn ble også undersøkt i 2003 og 2009. Dette ble foretatt på de samme stasjonene og med samme garninnsats som i 2014. Krepsdyrunder-søkelsene er begrenset til Store Kvernevatn og Langevatn. For Langevatn og Store Kvernevatn er det fastsatt utsettingspålegg tidligere. I de tre siste årene (2012-2014) har det vært satt ut henholdsvis 1000 og 2000 énsomrig aure pr. år. I Lisle Kvernevatn og Tjørni ble utsettingene satt i gang i 2011, og siden er det satt ut henholdsvis 250 og 500 individ pr. år. I Tjønnæ blir det ikke satt ut fisk. Settefisken er fettfinneklippet for å skille den fra naturlig rekruttert fisk. Settefiskproduksjonen ble fra 2014 lagt til Syrtveit Fiskeanlegg i Evje og Hornnes. Innsjøene i øvre deler av Mandalsvassdraget er fremdeles påvirket av forsuring. Men i seinere år har vannkvaliteten i enkelte lokaliteter bedret seg noe, som i tilløpsbekkene til Store Kvernevatn. Her varierte pH i 2003 og 2014 mellom henholdsvis 4,91-5,16 og 5,03-5,38. Også innholdet av labilt og giftig aluminium (Ali) har avtatt noe i løpet av de siste 10 årene, fra 17-72 μg/L i 2003 til 11-27 μg/L i 2014. ANCmod (syrenøytraliserende kapasitet) er fremdeles negativ i alle lokaliteter, fra -3 til -8 μekv/L. Lisle Kvernevatn har en liknede vannkvalitet som Store Kvernevatn. Blant tilløpsbekkene til Langevatn er den til Langestølstjern surest, med pH 4,99. Tilløpene til Sandvatn og Roddeivsvatn hadde noe høyere pH-verdier, med henholdsvis 5,30 og 5,40. Innholdet av Ali er i dag moderat med 20-26 μg/L. I selve magasinet, basert på en prøve nær dammen, er vannkvaliteten omtrent den samme som i innløpselvene, med pH=5,27-5,35 og Ali=16-33 μg/L (2003-2014). ANCmod var pr. 2014 noe lavere i Langevatn med tilløpsbekker enn i Store Kvernevatn, med -3 til +1 μekv/L. Tjørni hadde en svært dårlig vannkvalitet med pH= 4,64, Ali=49 μg/L og ANCmod = - 9 μekv/L. Dette skyldes trolig tilførsel av surt vann fra tilløpsbekkene i øst (fra Falkefjellet og Geitheii). Tjønnæ har en noe bedre vannkvalitet både mht pH (5,27), Ali (18 μg/L) og ANCmod (-1 μekv/L). Langevatn og Store Kvernevatn har svært artsfattige krepsdyrsamfunn. I Langevatn ble det funnet 9 arter (4 arter vannlopper og 5 arter hoppekreps), mens Store Kvernevatn hadde 14 arter (9 arter vannlopper og 5 arter hoppekreps). Alonella excisa var den eneste av artene i Langevatn som ikke ble funnet i Store Kvernevatn. Selv om begge insjøene har artsfattige krepssamfunn, er det indikasjoner på at situasjonen for ferskvannsfaunaen er noe bedre i sistnevnte lokalitet. Dette er basert på funn av flere arter, men også at den svakt forsuringsfølsomme hoppekrepsen C. scutifer er mer vanlig. Mandalsvassdraget, Vest-Agder, vannkvalitet, krepsdyr, fisk(aure), utsettinger, vassdragsreguleringer, etterundersøkelse