Extra-Articular Symptoms in Constellation with Selected Serum Cytokines and Disease Activity in Spondyloarthritis

Objectives. In this study, we assessed the extra-articular symptoms in constellation with selected serum cytokines and disease activity in spondyloarthritis (SpA). Patients and Methods. We studied 287 SpA patients: 131 had AS, 110 had PsA, and 46 had SAPHO. We assessed extra-articular symptoms in all cases. In 191 SpA patients, we measured serum interleukin-6 (IL-6), interleukin-18 (IL-18), interleukin-23 (IL-23), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). Results. Patients with acute anterior uveitis (AAU) had higher VAS (P=0.0008), BADSDAI (P=0.0001), ASDAS-ESR (P=0.04), CRP (P=0.006), IL-6 (P=0.02), and IL-18 (P=0.03) levels. Patients with inflammatory bowel disease (IBD) had higher VAS (P=0.03), CRP (P=0.0009), and IL-6 (P=0.0003) levels. Patients with skin psoriasis had lower VAS (P=0.001) and BASDAI (P=0.00007) levels. Patients with psoriatic onycholysis had lower VAS (P=0.006), BASDAI (P=0.00001), and CRP (P=0.02) and higher IL-23 (P=0.04) levels. Patients with PPP had lower BASDAI (P=0.04) and higher ET-1 (P=0.001) levels. Conclusions. SpA patients with increased serum IL-18 and decreased serum ET-1 had an increased risk of extra-articular symptoms. In SpA patients, increased disease activity was associated with an increased risk of AAU and IBD and a decreased risk of skin psoriasis, psoriatic onycholysis, and PPP

Echokardiograficzna ocena zmian w układzie sercowo-naczyniowym u pacjentów z zesztywniającym zapaleniem stawów kręgosłupa

Wstęp: Zesztywniające zapalenie stawów kręgosłupa należy do seronegatywnych spondyloartropatii. Proces zapalny obejmuje przede wszystkim przyczepy ścięgniste kręgosłupa oraz stawy obwodowe. Materiał i metody: Do badania włączono 38 chorych z rozpoznanym zesztywniającym zapaleniem stawów kręgosłupa. Grupę kontrolną stanowiło 25 zdrowych osób odpowiadających wiekiem i rozkładem płci grupie badanej. Pomiary echokardiograficzne wykonano według wytycznych i zakresów norm Amerykańskiego Towarzystwa Echokardiograficznego. Oceny funkcji rozkurczowej lewej komory serca dokonano na podstawie następujących wskaźników: prędkość maksymalna wczesnej fazy napełniania (E), prędkość maksymalna przedsionkowej fazy napełniania (A), stosunek E/A i czas rozkurczu izowolumetrycznego (IVRT). Wyniki: Nieprawidłowości w badaniu echokardiograficznym stwierdzono u 67% osób z grupy badanej i u 32% z grupy kontrolnej. Niedomykalność zastawki aortalnej wystąpiła u 21% badanych i u 4% pacjentów z grupy kontrolnej. Frakcja wyrzutowa, frakcja skracania, wymiary jam serca (poza lewym przedsionkiem) nie wykazywały istotnych statystycznie różnic. Wypadanie płatka zastawki mitralnej stwierdzono u 8% osób w badanej grupie, natomiast tętniaka przegrody międzyprzedsionkowej u 13%. Wnioski: U pacjentów z zesztywniającym zapaleniem stawów kręgosłupa często występują zmiany w układzie sercowo-naczyniowym. Charakteryzują się one stałą progresją związaną z czasem trwania choroby. Stopień zaawansowania zmian stwierdzanych w badaniu echokardiograficznym jest niski. Zmiany te nie powodują poważnych następstw klinicznych, ale zaleca się wykonywanie badań kontrolnych i współpracę reumatologa z kardiologiem. (Folia Cardiol. 2005; 12: 221–228

Echokardiograficzna ocena zmian w układzie sercowo-naczyniowym u pacjentów z zesztywniającym zapaleniem stawów kręgosłupa

Wstęp: Zesztywniające zapalenie stawów kręgosłupa należy do seronegatywnych spondyloartropatii. Proces zapalny obejmuje przede wszystkim przyczepy ścięgniste kręgosłupa oraz stawy obwodowe. Materiał i metody: Do badania włączono 38 chorych z rozpoznanym zesztywniającym zapaleniem stawów kręgosłupa. Grupę kontrolną stanowiło 25 zdrowych osób odpowiadających wiekiem i rozkładem płci grupie badanej. Pomiary echokardiograficzne wykonano według wytycznych i zakresów norm Amerykańskiego Towarzystwa Echokardiograficznego. Oceny funkcji rozkurczowej lewej komory serca dokonano na podstawie następujących wskaźników: prędkość maksymalna wczesnej fazy napełniania (E), prędkość maksymalna przedsionkowej fazy napełniania (A), stosunek E/A i czas rozkurczu izowolumetrycznego (IVRT). Wyniki: Nieprawidłowości w badaniu echokardiograficznym stwierdzono u 67% osób z grupy badanej i u 32% z grupy kontrolnej. Niedomykalność zastawki aortalnej wystąpiła u 21% badanych i u 4% pacjentów z grupy kontrolnej. Frakcja wyrzutowa, frakcja skracania, wymiary jam serca (poza lewym przedsionkiem) nie wykazywały istotnych statystycznie różnic. Wypadanie płatka zastawki mitralnej stwierdzono u 8% osób w badanej grupie, natomiast tętniaka przegrody międzyprzedsionkowej u 13%. Wnioski: U pacjentów z zesztywniającym zapaleniem stawów kręgosłupa często występują zmiany w układzie sercowo-naczyniowym. Charakteryzują się one stałą progresją związaną z czasem trwania choroby. Stopień zaawansowania zmian stwierdzanych w badaniu echokardiograficznym jest niski. Zmiany te nie powodują poważnych następstw klinicznych, ale zaleca się wykonywanie badań kontrolnych i współpracę reumatologa z kardiologiem. (Folia Cardiol. 2005; 12: 221–228

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation and the Polish Society for Rheumatology on the diagnosis and treatment of pulmonary hypertension in patients with connective tissue disease

Systemic connective tissue diseases (CTDs) comprise a large group of diseases that are auto-immune in nature and characterized by the involvement of multiple systems and organs. Pul-monary hypertension (PH) of various etiologies may develop in the course of CTD, including pulmonary arterial hypertension (PAH), PH secondary to the lung disease, postcapillary PH in the course of left heart disease, and chronic thromboembolic pulmonary hypertension (CTEPH). In addition, the different forms of PH may coexist with each other. Among patients with CTD, PAH occurs most commonly in those with systemic sclerosis, where it affects ap-proximately 8%–12% of patients. The prognosis in patients with untreated PAH is very poor. It is particularly important to identify the high-risk CTD-PAH population and to perform effi-cient and accurate diagnostics so that targeted therapy of the pulmonary arteries can be intro-duced. Echocardiography is used to screen for PH, but clinical and echocardiographic suspicion of PH always requires confirmation by right heart catheterization. Confirmation of PAH ena-bles the initiation of life-prolonging pharmacological treatment in this group of patients, which should be administered in referral centers. Drugs available for pharmacological management include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclins

Serum IL-6 and IL-23 Levels and Their Correlation with Angiogenic Cytokines and Disease Activity in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome

Objectives. To assess serum interleukin-6 (IL-6) and interleukin-23 (IL-23) and their correlation with angiogenic cytokines and disease activity in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and SAPHO syndrome. Patients and Methods. We studied 152 spondyloarthritis (SpA) patients: 69 PsA, 61 AS, 22 SAPHO, and 29 controls. We recorded age, sex, disease duration, and treatment. We assessed BASDAI, VAS, and PASI scores. Serum IL-6, IL-23, VEGF, EGF, FGFb, and FGFa levels were determined using ELISA. We estimated ESR and CRP. Results. Serum IL-6 and IL-23 levels were higher in SpA than in control (P<0.00001 and P=0.0004, resp.). There was a positive correlation between serum IL-6 and CRP in AS (P=0.000001), PsA (P=0.000001), and SAPHO (P=0.0003) patients. There was a positive correlation between serum IL-6 and ESR in AS (P=0.000001), PsA (P=0.002), and SAPHO (P=0.02) patients. There was no correlation of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines in SpA. Conclusions. Serum IL-6 but not serum IL-23 correlated with ESR and CRP in SpA. No correlation was found of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines

Serum Interleukin-18, Fetuin-A, Soluble Intercellular Adhesion Molecule-1, and Endothelin-1 in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome

To examine serum interleukin 18 (IL-18), fetuin-A, soluble intercellular adhesion molecule-1 (sICAM-1), and endothelin-1 (ET-1) levels in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and Synovitis Acne Pustulosis Hyperostosis Osteitis syndrome (SAPHO). We studied 81 AS, 76 PsA, and 34 SAPHO patients. We measured serum IL-18, fetuin-A, sICAM-1, ET-1, IL-6, IL-23, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). IL-18 levels were higher in AS (p = 0.001), PsA (p = 0.0003), and SAPHO (p = 0.01) than in controls, and were positively correlated with CRP (p = 0.03), VEGF (p = 0.03), and total cholesterol (TC, p = 0.006) in AS and with IL-6 (p = 0.03) in PsA. Serum fetuin-A levels were lower in AS (p = 0.001) and PsA (p = 0.001) than in controls, and negatively correlated with C-reactive protein (CRP) in AS (p = 0.04) and SAPHO (p = 0.03). sICAM-1 positively correlated with CRP (p = 0.01), erythrocyte sedimentation rate (ESR, p = 0.01), and IL-6 (p = 0.008) in AS, and with IL-6 (p = 0.001) in SAPHO. Serum ET-1 levels were lower in AS (p = 0.0005) than in controls. ET-1 positively correlated with ESR (p = 0.04) and Disease Activity Score 28 (DAS28, p = 0.003) in PsA. In spondyloarthritis, markers of endothelial function correlated with disease activity and TC

Extra-Articular Symptoms in Constellation with Selected Serum Cytokines and Disease Activity in Spondyloarthritis

Objectives. In this study, we assessed the extra-articular symptoms in constellation with selected serum cytokines and disease activity in spondyloarthritis (SpA). Patients and Methods. We studied 287 SpA patients: 131 had AS, 110 had PsA, and 46 had SAPHO. We assessed extra-articular symptoms in all cases. In 191 SpA patients, we measured serum interleukin-6 (IL-6), interleukin-18 (IL-18), interleukin-23 (IL-23), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). Results. Patients with acute anterior uveitis (AAU) had higher VAS (P=0.0008), BADSDAI (P=0.0001), ASDAS-ESR (P=0.04), CRP (P=0.006), IL-6 (P=0.02), and IL-18 (P=0.03) levels. Patients with inflammatory bowel disease (IBD) had higher VAS (P=0.03), CRP (P=0.0009), and IL-6 (P=0.0003) levels. Patients with skin psoriasis had lower VAS (P=0.001) and BASDAI (P=0.00007) levels. Patients with psoriatic onycholysis had lower VAS (P=0.006), BASDAI (P=0.00001), and CRP (P=0.02) and higher IL-23 (P=0.04) levels. Patients with PPP had lower BASDAI (P=0.04) and higher ET-1 (P=0.001) levels. Conclusions. SpA patients with increased serum IL-18 and decreased serum ET-1 had an increased risk of extra-articular symptoms. In SpA patients, increased disease activity was associated with an increased risk of AAU and IBD and a decreased risk of skin psoriasis, psoriatic onycholysis, and PPP

Anti-Phosphatidylethanolamine and Anti-Phosphatidylserine Antibodies&mdash;Association with Renal Involvement, Atherosclerosis, Cardiovascular Manifestations, Raynaud Phenomenon and Disease Activity in Polish Patients with Systemic Lupus Erythematosus

Objective. To evaluate the association between anti-phosphatidylethanolamine (aPE) and anti-phosphatidylserine (aPS) antibodies and cardiovascular risk, organ involvement and disease activity in systemic lupus erythematosus (SLE) patients. Methods. We studied 93 SLE patients and 30 controls. We analyzed levels of anti-phospholipid antibodies, including aPS and aPE, the profiles of antinuclear, anti-neutrophil cytoplasmic (ANCA) and anti-endothelial antibodies, carotid intima-media thickness (cITM) and atherosclerotic plaque presence, ankle-brachial and high resistance indices, atherosclerotic risk factors, organ manifestations and treatment. Results. Levels of aPS and aPE were significantly higher in SLE patients in comparison with the controls (p = 0.038 and p = 0.044, respectively). aPS was associated with the risk of Raynaud&rsquo;s phenomenon (p = 0.021) development. aPE increased the risk of renal involvement (p = 0.049), cerebral stroke (p = 0.050), high vlues of cIMT (p = 0.041) development as well as occurrence of selected serological markers associated with activity of the disease such as anti-double stranded DNA (p = 0.021). The long duration of regular smoking (p = 0.021) and the high number of cigarettes/day (p = 0.015) were significantly associated with the risk of aPE occurrence. Conclusions. Patients with aPS and aPE are at risk of vascular involvement. Especially the presence of aPE may significantly increase the risk of thrombotic complications development in SLE patients without classical serological markers of APS. Finally, aPE might be used as a marker of disease activity and risk of renal injury development in this patient group. The classical atherosclerotic markers including lipid indices play an important role in complex analysis of cardiovascular risk in lupus patients and enable to identify patients at the highest risk and implement effective preventive, diagnostic and therapeutic procedures

Serum Interleukin-23 in Polish Patients with Systemic Lupus Erythematosus: Association with Lupus Nephritis, Obesity, and Peripheral Vascular Disease

Objectives. To analyze the correlation between the serum concentration of interleukin- (IL-) 23 and atherosclerotic changes, traditional atherosclerotic risk factors, the autoantibody profile, and involvement of selected organs in systemic lupus erythematosus (SLE) patients. Patients and Methods. We studied 94 SLE patients and 27 controls. We analyzed the IL-23 serum concentration, autoantibodies, carotid intima-media thickness and atherosclerotic plaque, the ankle-brachial index, atherosclerotic risk factors, and organ manifestations. Results. Concentrations of IL-23 significantly differed between SLE patients and the controls (p=0.0015). On the basis of multivariate stepwise analysis, we revealed that high levels of IL-23 were associated with atherosclerotic plaque in common femoral arteries (OR = 12.67; 95% CI: 1.41–113.84), lupus nephritis (OR = 3.69; 95% CI: 1.16–12.22), and obesity (OR = 4.21; 95% CI: 1.40–12.67). Autoantibodies related to IL-23 were anti-phosphatidylethanolamine antibodies (OR = 11.06; 95% CI: 1.24–98.65) and anti-SS-B/La antibodies (OR = 15.43; 95% CI: 1.73–137.25). Conclusions. IL-23 may be involved in lupus nephritis pathogenesis. Through its association with obesity and selected antiphospholipid antibodies, IL-23 might promote a hypercoagulable state contributing to atherothrombosis development in SLE patients