Moderate-to-high levels of anticardiolipin antibodies are associated with preeclampsia, but there is insufficient evidence to use anticardiolipin antibodies as predictors of preeclampsia in clinical practice.
Mean platelet volume (MPV), measured using automated blood analysers, has been appraised as a potential biomarker in cardiovascular disease, diabetes mellitus, and cancer. The test, a useful tool in differentiation of thrombocytopenic states, has now been carried out for autoimmune disorders, but data are yet scarce. Controversial results have been obtained in systemic and organ-specific autoimmune disorders. Another test, the immature platelet fraction (IPF) reflects the amount of young, reticulated platelets. IPF is calculated by automated hematology analysis or flow cytometry, and it is usually high in patients with rapid platelet destruction. For both MPV and IPF, standardization of cutoff is a major need. In this review, we focus the current applicability of MPV and IPF as biomarkers in patients with autoimmune diseases.
-One third of cases of cerebral ischemia have no clear etiology. A humoral response to the atherosclerotic plaques components beta2-glycoprotein I (beta2-gpI) and heat-shock proteins (Hsp) might be involved in the pathogenesis of stroke. This case-control study includes a complete profile of anti-beta2-gpI antibodies and testing of IgG antibodies to the 60/65 kilodaltons (kDa) Hsp in stroke patients. Ninety-three patients with acute ischemic stroke and 93 controls were evaluated for age, sex, race, hypertension, smoking, previous cardiopathy, diabetes mellitus, hypercholesterolemia and previous history of cerebral ischemia. IgG/ IgM/IgA anticardiolipin (aCL) and anti-beta2-gpI antibodies, as well as IgG antibodies to human 60 kDa Hsp and to Mycobacterium bovis 65 kDa Hsp, were detected by immunoassay. Adjusted odds ratios (OR) were calculated by logistic regression. The adjusted OR for IgA anti-beta2-gpI antibodies was 4.6 (90%CI 1.5 to 14.3; p = 0.025). The non-adjusted OR for IgG antibodies to Hsp 60 was 26.1. The adjusted OR for IgG antibodies to Hsp 65 was 3.2 (90%CI 1.2 to 8.3; p = 0.044). The adjusted OR for IgG to any Hsp (60 or 65) was 4.8 (90%CI 1.9 to 12.1; p = 0.006). This study demonstrates that elevated IgA anti-beta2-gpI and IgG antiHsp 60/65 antibodies are associated with increased risk of ischemic stroke. The association occurred independently of other risk factors. This humoral response might link autoimmunity, thrombophilia and atherosclerosis in stroke patients.KEY WORDS: anti-beta2-gpI antibodies, anti-Hsp 60/65 antibodies, acute cerebral ischemia.Anticorpos contra os componentes da placa aterosclerótica beta2-glicoproteína I e proteínas de choque Anticorpos contra os componentes da placa aterosclerótica beta2-glicoproteína I e proteínas de choque Anticorpos contra os componentes da placa aterosclerótica beta2-glicoproteína I e proteínas de choque Anticorpos contra os componentes da placa aterosclerótica beta2-glicoproteína I e proteínas de choque Anticorpos contra os componentes da placa aterosclerótica beta2-glicoproteína I e proteínas de choque térmico como fatores de risco para isquemia cerebral aguda térmico como fatores de risco para isquemia cerebral aguda térmico como fatores de risco para isquemia cerebral aguda térmico como fatores de risco para isquemia cerebral aguda térmico como fatores de risco para isquemia cerebral aguda RESUMO -Um terço dos casos de isquemia cerebral não apresenta etiologia clara. Uma resposta humoral contra os componentes da placa aterosclerótica beta2-glicoproteína I (beta2-gpI) e proteínas de choque térmico ("heat-shock proteins", Hsp) pode estar envolvida na patogênese do infarto cerebral. Este estudo de caso-controles inclui um perfil completo de anticorpos anti-beta2-gpI e a testagem de IgG anti-Hsp de 60/65 kilodaltons (kDa) em pacientes com isquemia cerebral. Noventa e três pacientes com isquemia cerebral aguda e 93 controles foram avaliados quanto a idade, sexo, raça, hipertensão arterial, tabagismo, cardiopatia prévia, diabete mellitus, hip...
To compare the diagnostic powers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) in a population selected for its high statistical relevance, over a 6-month period, an informed consent to test for anti-CCP was obtained from 1,025 consecutive patients for whom RF was ordered at a University laboratory. Within 1 year, a diagnosis was obtained without informing the physician about the anti-CCP result. Extensive statistical analyses were performed. A total of 768 patients satisfied the inclusion criteria, and 132 were classified as having RA, yielding a pre-test probability of RA of 17%. The sensitivities for anti-CCP and RF were 62 and 64% (P = 0.83), and the specificities were 97 and 90% (P < 0.001), respectively. The positive predictive value (PPV) was 79% for anti-CCP and 56% for RF (P < 0.001), whereas the negative predictive value was 92% for both. The likelihood ratio (LR) was 17.9 for anti-CCP and 6.2 for RF (P < 0.005). Forty RA patients were diagnosed with RA of less than 2 years length, and the same significant statistic differences between anti-CCP and RF were observed. Placing the results of both tests together, or using different cutoff points, increased the diagnostic utility of the tests. The anti-CCP test has statistically shown significant higher specificity, PPV, and LR for RA than the RF test in a clinically diverse population. If new criteria are to be devised to help diagnose early RA, anti-CCP should be included because it has a greater diagnostic impact than RF.
High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.
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