Objective: to study the clinical and immunologica features of the manifestation of chronic pain in systemic lupus erythematosus (SLE) patients with neurological symptoms.Methods. We examined 30 healthy individuals and 38 patients with SLE. Beck’s depression questionnaire was used to assess the presence of depressive symptoms. Antibodies to adenosine deaminase (anti-ADA), β2-glycoprotein-I-dependent antibodies to phospholipids of the IgG class (anti-FL) and antibodies to double-stranded DNA (anti-dsDNA) were determined in the serum of patients with SLE. Doppler sonography of the brachiocephalic arteries was performed for all patients with SLE.Results. Complaints about the presence of headaches of varying severity presented 35 people (92.1%). Migraine was recorded in 63.2% patients with SLE. Doppler ultrasound in patients with SLE with chronic headaches in 66.7% of cases showed signs of reduced blood flow in the arteries of the vertebrobasilar basin, which may indicate chronic brain ischemia. Signs of depressive disorder of varying severity were found in 36.8% of patients with SLE, and in patients with neurological disorders, moderate (p = 0.027) and severe (p = 0.041) depression were more often detected. Elevated levels of anti-ADA were found in 36.8%, and anti-FL in 44.7% of patients with SLE. It was noted that “migraine-like” manifestations of chronic pain syndrome were more common in the group of patients with SLE, who had a combined increase in anti-ADA and anti-FL (χ2 = 4.5; p = 0.024). Since a certain part of ADA is concentrated in the plasma membranes of vascular and platelet endothelium cells, it can be assumed that there is a conformational effect of anti-ADA on the β2-glycoprotein-I, leading to increased synthesis of anti-FL and undesirable activation of coagulation cascade in vessels.Conclusion. The combination of severe chronic headache with high levels of anti-ADA and anti-FL can precede the development of stroke and transient ischemic attacks, which emphasizes the need for additional immunological examination of patients with SLE with neurological symptoms.
Министерство науки и высшего образования Российской Федерации Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А.Б. Зборовского» Федеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации
BackgroundAngiopoietin-like protein 4 (ANGPTL4) is actively involved in the processes associated with inflammation, angiogenesis and lipid metabolism in rheumatoid arthritis (RA).ObjectivesTo study of the effect of ANGPTL4 on the features of the inflammatory process in RA.MethodsThe study included 36 RA patients (aged from 33 to 64 years old). A control group (12 people) comprised healthy individuals aged 28 to 52 years old, 28 patients with osteoarthritis (OA) aged 48 to 70 years and 14 people with ankylosing spondylitis (AS) aged 39 to 62 years. Levels of ANGPTL4 in serum were determined by the enzyme immunoassay using the commercial test systems «Human Angiopoietin-like Protein 4 ELISA» from «Bio Vendor» (Czech Republic). Serum C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), rheumatoid factor (RF) titers, and anti-cyclic citrullinated peptide antibody (anti-CCP) were also measured in patients with RA.ResultsThe following results were obtained: the level of ANGPTL4 was significantly higher in patients with RA than in patients with OA, AS, and healthy individuals (p = 0.04, p = 0.021, p = 0.038, respectively). A strong positive correlation was found between the level of ANGPTL4 and the activity of RA according to DAS28 (r = 0.71, p = 0.002). There is no reliable association between ANGPTL4 and anti-CCP (p> 0.05). The ANGPTL4 level in the serum was correlated with levels of ESR (r = 0.42, p = 0.019), CRP (r = 0.49, p = 0.007) and the Sharp score of radiologic change (r = 0.39, p = 0.045) in RA. Hypervascularization rates were significantly correlated with ANGPTL4 in patients with RA (r = 0.38, p = 0.002) according to Doppler data. ANGPTL4 can activate proliferation processes in the synovial membrane by binding to integrin-αvβ3. Besides, the concentration of mast cells is increased in the synovium of affected joints. Mast cells significantly influence angiogenesis through the production of proangiogenic cytokines, including ANGPTL4.ConclusionChanges of the level of ANGPTL4 in the serum of patients with RA may be a potential biomarker of disease activity, severity of neovascularization, inflammation and development of bone erosion.Disclosure of InterestsNone declared
BackgroundAccurate calculation of glomerular filtration rate (GFR) is an important aspect of clinical care for rheumatologic patients [1, 2, 3].ObjectivesTo choose the optimal method of determining the GFR to assess the severity of renal dysfunction in patients with rheumatoid arthritis (RA).MethodsAn open cross-sectional study was performed involving 96 patients with a reliable diagnosis of RA (mean age 54.4±11.6 years, duration of disease 10.7±8.56 years, 57.3% with moderate RA activity).For comparative assessment of renal function, we used the estimated glomerular filtration rate (eGFR) using the CKD-EPI formulas on the National Kidney Foundation website (USA): creatinine-based equation (eGFRcr), cystatin C-based equation (eGFRcyst) and calculated creatinine and cystatin C equation (eGFRcr-cyst). The 2009 CKD-EPI creatinine equation (eGFRcr) was used as a reference for comparative calculations of GFR. Based on the eGFRcr measurements, patients with RA were divided into four groups: I, >90 ml/min/1.73 m2; II, 89-60 ml/min/1.73 m2; III, 45-59 ml/min/1.73 m2; and IV, <45 ml/min/1.73 m2.ResultsThe mean eGFRcr, presented as a reference in this study, was 70.0±18.7 ml/min/1.73 m2. Signs of hyperfiltration using eGFRcr (>90 ml/min/1.73 m2) were observed in 16 (10.1%) patients with RA, mild decrease of renal function (60-89 ml/min/1.73 m2) was registered in 52 (32.9%), moderate/severe decrease (<59 ml/min/1.73 m2) - in 28 (17.8%) patients with RA. Decreased eGFRcr was differentially associated with increased patient age (r=0.46; p=0.003), disease duration (r=0.24; p=0.017), cumulative dose of hormones (r=0.66; p=0.007), lower height (r= 0.35; p=0.001).Analysis of eGFR values demonstrated significant differences using the selected methods (χ2=9.91, p= 0.007). Intergroup differences (in degree of decrease in eGFR) were statistically significant for all variants of eGFR calculation (eGFRcr, eGFRcyst, eGFRcr-cyst; H-test and Median-test, p<0.001). According to the eGFRcr formula, an absolute majority of patients with RA (83.3%) had a decrease in GFR of varying severity (a slight decrease was registered in 54.2% of cases) (Table 1).Table 1.Group distribution of RA patients according to eGFR, n(%)Group IGroup IIGroup IIIGroup IVeGFRcr16 (17.0)52 (54.2)20 (20.8)8 (8.33)eGFRcr-cys22 (22.9)39 (40.6)20 (20.8)15 (15.6)eGFRcyst29 (30.2)29 (30.2)22 (22.9)16 (16.7)The use of eGFRcyst showed that only 12 of 29 people in the first group had optimal (>90 ml/min/1.73 m2) eGFRcr (p=0.031), and 17 patients entered the group with slightly decreased (60-89 ml/min/1.73 m2) eGFRcr. A similar, but less significant situation (12 of 22 people and 10 patients, p=0.02) was also observed with eGFRcr-cyst. In the second group of RA patients 19 patients corresponded to the chosen criteria in determination of eGFRcyst, and 8 patients entered groups (III and IV) with more severe decrease of renal function (2 patients were included into group I) (p=0,011). Significant differences in this group were also noted when comparing the proportions according to eGFRcr with eGFRcr-cyst (p=0.044). A probable decrease in renal filtration function with eGFRcr (compared with the alternative use of eGFRcr-cyst or eGFRcyst) can be observed in 11-18% of RA patients in group 1 (high/optimal renal function) and up to 10% of RA patients in group 2 (slight decrease). No significant differences were found using the three estimated CKD-EPI formulas in RA patients with moderate/significant decrease in GFR (p>0.05).ConclusionCurrently, the overall diagnostic performance of the CKD-EPI equation based on creatinine and cystatin C may be the most optimal (in comparison with other calculated CKD-EPI formulas) in patients with RA, and may also be useful for confirming eGFRcr results >60 ml/min/1.73m2.References[1]Saisho K. et al. Mod Rheumatol. 2016;26(3):331-5.[2]Couderc M. et al. Arthritis Care Res (Hoboken). 2016;68(5):638-44.[3]Aleksandrov V. et al. Ann Rheum Dis. 2021;80(S1):1059. doi:10.1136/annrheumdis-2021-eular.2275.Disclosure of InterestsNone declared
Министерство науки и высшего образования Российской Федерации Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А.Б. Зборовского» Федеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации
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