Glukokortikoid receptor gén polimorfizmusok és a primer és szekunder osteoporosis összefüggéseinek vizsgálata = Association between glucocorticoid receptor gene polymorphisms and primary and secondary osteoporosis

A glükokortikoid receptor gén három polimorfizmusának összefüggését vizsgáltuk az osteoporosisos hajlammal normál populációban valamint szteroid-indukált osteoporosisos betegekben. Kidolgoztunk két új allélspecifikus PCR módszert (J Steroid Biochem Mol Biol., 92:465-8 és J Steroid Biochem Mol Biol., 100:161-6). Eredményül azt találtuk, hogy a normál populációt reprezentáló 241 személyben, akiknek anamnézisében a csontot befolyásoló betegség vagy kezelés nem szerepelt, az N363S variáns hordozása a csont metabolizmus lebontás irányba való eltolódásával járt (p=0,042; r=0,73). A csont denzitásra az N363S polimorfizmus nem volt szignifikáns hatással, feltehetően a vizsgált betegcsoport széles korösszetétele miatt. A BclI és ER22/23EK polimorfizmusok nem befolyásolták sem a csontanyagcserét, sem a csont ásványi anyag tartalmát (ezen eredményeinket közlő kézirat jelenleg elkészítés alatt van). A 36 szteroid-indukált osteoporosisos betegben a polimorfizmusok előfordulása nem tért el szignifikánsan az egészségesektől, azonban megjegyzendő, hogy az N363S variáns allélfrekvenciája háromszor magasabb volt a normál populációban mértnél (0,09 vs. 0,03, p=0,097), így tervezzük ennek a tendenciának további vizsgálatát. Eredményeink azt mutatják, hogy a glükokortikoid receptor érzékenységét növelő N363S polimorfizmus a normál populációban intenzívebb csont lebontásra hajlamosít. Ez hosszú távon a csont minőségének romlásához és osteoporosis kialakulásához vezethet. | We investigated the role of three polymorphisms of the glucocorticoid receptor gene in osteoporotic tendency of normal subjects and patients with steroid-induced osteoporosis. We elaborated two new methods based on allele-specific PCR (J Steroid Biochem Mol Biol., 92:465-8 and 100:161-6). We found that among the 241 patients who have never had any disease or medication influencing bone health, the N363S variant was associated with an increased rate of bone resorption (p=0,042; r=0,73). The N363S polymorphism did not influence bone mineral density in these subjects, possibly due to the wide age range of the studied population. The BclI and ER22/23EK polymorphisms did not influence neither bone metabolism, nor bone mineral density (our manuscript publishing these results is in preparation). In the 34 patients with steroid-induced osteoporosis, the frequency of the three polymorphisms did not differ significantly from the normal population. Nevertheless, allele frequency of the N363S variant was three times higher in steroid-induced osteoporotic patients than in healthy subjects (0,09 vs. 0,03, p=0,097), and we plan further studies to investigate this tendency. In conclusion, our results suggest that the N363S polymorphism of the glucocorticoid receptor gene is associated with an increased rate of bone resorption in the normal population. This increased bone resorption could lead on the long-term to the impairment of bone quality and a tendency to osteoporosis

Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA Study

Introduction Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA). Methods The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents. Results Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P LT 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P LT 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies. Conclusions In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself