Background: Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus. Objective: The aim of this review is to analyze the relationship between systemic lupus erythematosus and cardiovascular diseases, with the emphasis on acute myocardial infarction. Results: Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction and development of atherosclerosis at an earlier age. Contributing factor is the cumulative effect of traditional cardiovascular risk factors interaction with disease related characteristics. Myocardial infarction rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3- fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied with immunosuppressive and/or antiinflammatory therapy. There are significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic treatments. Conclusion: Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment. Although Systemic lupus erythematosus per se is a “female” disease, males are at increased cardiovascular risk and worse outcome. Method: We conducted a literature review through PubMed and Cochrane, using key words: SLE, atherosclerosis, atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.
Introduction: Atherosclerosis in young and premenopausal women with systemic lupus erythematosus (SLE) is frequent, premature and progressive. Although asymptomatic or with atypical clinical presentation, the patients are at high risk of cardiac events. Aim of this study is to estimate the risk profile for atherogenesis and the prevalence of myocardial perfusion abnormalities with 99mTc myocardial perfusion scintigraphy (MPS) in young and premenopausal women. Material and methods: Sixty female patients, aged 30-72 years (divided into two subgroups - patients under 45 years of age and patients over 45 years), diagnosed with SLE for over of 5 years, in active phase of the disease were analyzed for disease activity scores (SLEDAI), the immunologic status of the disease (ANA and a-DNA antibodies in the serum), procoagulant tendency (antiphospholipid antibodies-APhL and lupus-anticoagulant-LAC), the activity of the inflammatory process (hsCRP), the anti-SLE therapeutic approach and the presence of traditional risk factors for atherosclerosis (BMI, smoking, hypertension, hyperlipidemia, diabetes, and familial history for the CAD). Using one-day Dipyridamol – Rest 99mTc SPECT Gated MPS SPECT the extent, severity and reversibility of myocardial perfusion abnormalities were estimated, along with summed scores at stress, rest and summed difference scores and left ventricle volumes and ejection fraction. Results: Abnormal MPS SPECT were detected in 27/60 or in 45% of patients, with one vessel affection of 66.7% (18/27pts) of LAD and 14.8% (4/27pts) o RCA and with two vessel disease of LAD/RCA in 2/27 pts (7.4%) and LAD/Cx in 3/27pts (11.1%). Myocardial perfusion abnormalities were equally prevalent in subgroups of patients younger than 45 years (44,4%) and in patients older than 45 years (45.5%) (ns). The subgroups did not differ significantly concerning the extent of perfusion abnormalities (9,8±3.2% of LV myocardial mass vs. 9,8±7.1%,ns), their severity (with predominance of mild perfusion defects, 48,6% vs. 51,3%,ns) and reversibility (reversible in 41.3% and 58.6%, ns). The differences between the summed scores of severity and the extent of ischemia in the two subgroups were statistically nonsignificant. Younger patients had significantly higher end-diastolic, end-systolic and stroke volumes during stress and rest conditions, compared to older patients (p<0,01) although there were no differences in systolic function, which was not affected in either of the groups as expressed threw ejection fraction. Although nonsignificant, younger patients had higher values of hsCRP and higher procoagulant activity (positive aPhL, LAC) while they were with more active disease activity, with higher SLEDAI score compared to older patients (p=0.028). Higher SLEDAI score and LV volumes, especially EDV at stress were identified as predictor of abnormal MPS in younger groups and more aggressive multidrug anti SLE treatment as predictor of normal MPS. Conclusion: The prevalence and characteristics of myocardial perfusion abnormalities in young SLE are equal as the same in older SLE patients, which indicates the presence of premature, accelerated atherosclerosis in young cohort of patients with SLE. Younger SLE patients with pure disease control (higher SLEDAI score, less aggressive treatment, high hsCRP values and pronounced procoagulant tendency) should undergo screening for myocardial perfusion abnormalities s using 99mTc MIBI MPS)
Late Hodgkin disease refers to a recurrence of the disease after a period of remission (absence of disease symptoms). It can occur as a de novo (new) malignant neoplasma or as a relapse of the old disease. In some cases, late Hodgkin disease may be a new disorder that is not related to the original disease. This can occur if the patient was not properly treated for the original disease, or if the patient's immune system was compromised and developed something new. In other cases, late Hodgkin disease may be a relapse of the original disease. This means that the disease has come back after a period of remission.We present a case of a 27-year-old male with HD after 24 years of period of complete remission of the initial disease. This very rare relapse of HD was presented on gingivae like an extranodal involvement which is less commonly found than in other lymphomas. The histopathological analysis of the gingivae during the relapse showed presence of another subtype of Hodgkin disease -nodular lymphocyte predominant (NLPHL) on a rare location.It is important for patients to follow their treatment plan closely and to continue to see their healthcare provider for follow-up care after treatment. Our case illustrates that Hodgkin lymphoma can also appear in soft tissue masses such as gingivae and is more refractory to the standard therapeutical approach.
Radiographic evaluation is still the most important tool for assessing structural damage to joints and the skeleton. The progression of the radiographic damage to the joints in the hands and feet is an important and objective variable for assessing the disease's activity as well as predicting the outcomes of treatment.In this study, radiographic assessment of the hand joints, acute phase reactants (ESR and CRP), and ACPA autoantibodies were used to assess the disease activity in RA patients treated with methotrexate therapy. Their roles as prognostic indicators of disease outcome were also examined.The serum of 70 participants (35 in the untreated RA group and 35 in the control group) was tested using the ELISA method DIA-STATTM Anti-CCP (Axis-Shield Diagnostics). In the same participants, RF was determined using the agglutination test (Latex RF test). Patients were treated with methotrexate at an average dose of 10 mg once weekly. For clinical evaluation of disease activity in every patient's radiographic index (RI), sedimentation, CRP, and RF were analyzed at certain time intervals (baseline, after 6, 9, and 12 months).The dynamic changes in the mean values of the RI score, sedimentation, CRP, and RF were used to assess RA. RI showed an increased radiographic progression of hand joint damage at time intervals between baseline and 9 months (p = 0.0167) and between baseline and 12 months (p = 0.0089). Statistical analysis showed statistically significant differences among the mean values of ESR in the four time intervals (p = 0.00002). Also, statistically significant differences were shown in the mean values of CRP in the four time intervals (p = 0.0488) (standard deviations showed great variations). At baseline, progression was seen in 3 (10%) patients, after 6 months in 13, and after 9 and 12 months RI progression was seen in 15. It was also observed that most patients had increased values of RF and CRP.Despite the methotrexate therapy, progression of the radiographic damage followed, especially in patients with increased values of sedimentation, CRP, and RF with persistence of previous hand joint erosions, as predictors of the aggressive course of disease.
The autoimmune hemolytic anemias antibody can be hot or cold, have an incidence of 70 to 80% may be idiopathic in 50 to 60% and the rest of the cases secondary to lymphoproliferative disorders, collagen disease, drugs, solid tumors, infections and inflammatory bowel disease.RA may result in the reduced lifespan of red blood cells. This could lead to anemia if the body is unable to produce new red blood cells at a sufficient rate. Understanding these links between RA and anemia is crucial.Anemia is a common comorbidity in individuals with rheumatoid arthritis (RA). In fact, anemia of the type characterized by low serum iron concentrations in conjunction with adequate iron stores is frequently associated with RA and has served as a model for anemia of chronic disease. Rheumatoid vasculitis can affect blood vessels in many parts of your body. For this reason, it can cause many different symptoms.It most often damages blood vessels to the skin, fingers and toes, nerves, eyes, and heart. This reduces blood flow to these areas and damages them.Rheumatoid arthritis (RA) may be associated with a range of extraarticular manifestations, with hematologic complications including anemia and other conditions with hematologic abnormalities, such as Felty syndrome and lymphoproliferative disorders, particularly lymphoma and large granular lymphocyte (LGL) leukemia.
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