S u m m a r yO Ob bj je ec ct ti iv ve es s: : To evaluate the concentration of 1,25(OH)2D and 25(OH)D in patients with newly diagnosed juvenile idiopathic arthritis (JIA) determined before starting therapy and attempt to demonstrate the relationship between serum vitamin D metabolites and the activity and subtype of the disease. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : A total of 50 children aged 2-16 years, who were diagnosed with JIA, were enrolled in the study. The control group comprised 28 children with matching age and gender, hospitalized due to circulatory system functional disorder. The level of the active metabolite of vitamin D in the sera was determined using the radioimmunoassay method and the 25(OH)D was tested using an ELISA immunoassay. R Re es su ul lt ts s: : The concentration of 1,25(OH)2D in the serum of children with the disease was statistically significantly lower compared to the children in the control group (34.86 ±17.14 pg/ml vs. 48.47 ±17.99 pg/ml, p = 0.0015 on average, respectively). However, the concentrations of 25(OH)D in both groups were comparable (17.36 ±8.44 ng/ml vs. 17.36 ±16.29 ng/ml on average), but lower than the recommended rate (i.e. < 30 ng/ml ). Higher mean concentrations of the active form of vitamin D in the serum of children with low activity of the disease compared to medium and high activity, but without statistical significance, was found. However, mean concentrations of 25(OH)D were the highest in the group with high disease activity but without statistical significance. Higher mean concentrations of the active form of vitamin D and 25(OH)D in the serum of children with oligoarthritis disease were demonstrated but without statistical significance. C Co on nc cl lu us si io on ns s: : Our results confirm the data on commonly occurring vitamin D deficiency in the developmental age population, which indi-S t r e s z c z e n i e C Ce el l p pr ra ac cy y: : Ocena stężeń: 1,25(OH)2D i 25(OH)D u dzieci z nowo ustalonym rozpoznaniem MIZS, przed rozpoczęciem terapii oraz próba wykazania ewentualnych zależności pomiędzy stężeniami metabolitów witaminy D a aktywnością i postacią choroby. M Ma at te er ri ia ał ł i i m me et to od dy y: : Badaniem objęto 50 dzieci (40 dziewcząt i 10 chłopców) w wieku 2-16 lat, u których ustalono rozpoznanie MIZS na podstawie kryteriów z Edmonton (2001 r.). U wszystkich pacjentów oceniono postać oraz aktywność choroby. Grupę kontrolną stanowiło 28 dzieci zdrowych, odpowiednio dobranych pod względem płci i wieku, hospitalizowanych z powodu czynnościowych zaburzeń układu krążenia. Stężenie aktywnego metabolitu witaminy D [1,25(OH)2D] w surowicy oznaczono z wykorzystaniem metody radioimmunologicznej, a 25(OH)D zbadano za pomocą metody immunoenzymatycznej -ELISA. W Wy yn ni ik ki i: : Stężenie 1,25(OH)2D w surowicy dzieci chorych było istotnie statystycznie mniejsze w porównaniu ze stężeniem u dzieci z grupy kontrolnej (średnio odpowiednio: 34,86 ±17,14 pg/ml vs 48,47 ±17,99 pg/ml, p = 0,0015). Stężenia 25(OH)D w obu grupach...
ObjectivesThe imbalance between Th17 and T regulatory cells (Tregs) may be a key event in development of autoimmunity. The problem is poorly explored in juvenile idiopathic arthritis (JIA) so far. In this study, peripheral blood (PB) and synovial fluid (SF) Tregs and Th17 cells from were assessed in untreated JIA children.Material and methodsIn 50 children with JIA the PB or SF percentages of Tregs and Th17 cells were assessed by flow cytometry, in comparison with PB Tregs and Th17 cells from 28 healthy controls. Additionally, in both groups the levels of proinfammatory cytokines, such as interleukin (IL)-1β, IL -6, IL -17, IL -21, IL -23 and tumor necrosis factor α (TN F-α) were assessed using ELI SA method.ResultsThe proportion of JIA PB Th17 cells was significantly higher than in the controls (p = 0.01). Serum levels of IL -1β, IL -6, IL -17, IL -23 were also significantly higher in JIA (p = 0.011, p = 0.007, p = 0.008 and p = 0.023, respectively). The highest serum IL -6 levels were observed in oligoarthritis JIA (p = 0.031). Synovial fluid IL -21 concentration was distinctly higher in polyarticular JIA. Synovial fluid levels of TN F-α, IL -1β and IL -6 were significantly higher than in JIA PB (p = 0.038, p = 0.013 and p < 0.001, respectively). There was a significant correlation between IL -6 and PB Tregs (p = 0.02).ConclusionsThe results of this comprehensive analysis indicate a role of Th17 cell activation in the pathogenesis of JIA.
IntroductionAntiphospholipid syndrome is a multisystem autoimmune disease characterized by arterial and/or venous thrombosis and persistent presence of antiphospholipid antibodies. It can be a primary disease or secondary when associated with other autoimmune diseases.Case presentationWe present a case of a 16-year-old Caucasian boy with a massive arterial and venous thrombosis in his lower limbs as well as in his central nervous system with clinical symptoms such as headaches and chorea. He did not present any clinical or laboratory signs of a systemic inflammatory connective tissue disease, including systemic lupus erythematosus. Based on the clinical picture and results of the diagnostic tests (positive antibodies against β2-glycoprotein and a high titre of anticardiolipin antibodies) we finally diagnosed primary antiphospholipid syndrome. During a 9-month follow up after the acute phase of the disease, he was treated with low-molecular-weight heparin. Neurological symptoms were relieved. Features of recanalization in the vessels of his lower limbs were observed. After a subsequent 6 months, because of the failure of preventive treatment – an incident of thrombosis of the vessels of his testis – treatment was modified and heparin was replaced with warfarin.ConclusionAlthough the preventive treatment with warfarin in our patient has continued for 1 year of follow up without new symptoms, further observation is needed.
Scientific Abstracts corticosteroid dose was higher in the first year (0.14 mg/kg/day compared with 0.05 mg/kg/day in the second year), mean height velocities in the first and second years of the study were comparable at 6.7 and 7.1 cm/y, respectively. During TCZ treatment, a significant increase in insulin-like growth factor 1 (IGF-1) levels was observed, suggesting a normalisation of growth hormone axis function (mean baseline IGF-1 SDS of -0.9 [n = 70] compared with year 2 mean IGF-1 SDS of -0.2 [n = 56]; p = 0.0015, paired t-test on n = 56). The osteocalcin/c-telopeptide of type 1 collagen (OC/CTX-1) ratio increased significantly (p = 0.0082, paired t-test), suggesting an increase in osteoblast activity relative to osteoclast activity. At year 1, JADAS-71 score correlated with height velocity during that year (Spearman rank r = -0.36, p = 0.0010; [n = 81]). Image/graph: Conclusions: TCZ therapy for sJIA resulted in catch-up growth of study patients. Additionally, TCZ therapy resulted in increased IGF-1 levels and OC/ CTX-1 ratios, suggesting beneficial effects on the growth hormone axis and on bone metabolism. Improvement in JADAS scores correlated with increased height velocity. Continued data collection (for a total of 5 years) will allow a comprehensive analysis of growth outcomes in the TENDER study.Background: Imbalance between cells secreting IL-17 (Th17) and regulatory T lymphocytes (Tregs) may be a key pathogenic event in development of autoimmnune diseases. Recent studies suggest that vitamin D may have a significant impact on the development of autoimmunity, but the problem has been poorly explored in juvenile idiopathic arthritis (JIA) so far. Objectives: In this study we assessed correlation between Tregs, Th17 cells, as well as some immunological parameters and vitamin D metabolites in de novo JIA patients. Methods: Fifty freshly diagnozed JIA children were evaluated. The control group comprised 28 children free from inflammatory conditions. Subpopulations of Tregs and Th17 cells in peripheral blood (PB) (JIA, controls) and in JIA synovial fluid (SF), were determined by flow cytometry. Serum concentrations of IL-1β, IL-6, IL-17, IL-21, IL-23 and TNF-α cytokines were assessed by ELISA. 1,25(OH) 2 D and 25(OH)D levels were determined by radioimmunoassay and ELISA, respectively. The potential correlation of the results with clinical (JIA activity, type of onset) and laboratory parameters were examined. Results: The proportion of JIA PB Th17 cells was significantly higher than in healthy children (p=0.01). There was no relationship between Treg and Th17 frequency and JIA activity. In JIA PB, but no in SF, a significant relationship between Tregs and platelet levels was observed (p=0.028). Serum levels of IL-1β, IL-6, IL-17, IL-23 were found significantly higher in JIA than in controls (p=0.011, p=0.007, p=0.008 and p=0.023, respectively). The highest serum IL-6 levels were observed in JIA oligoarthritis (p=0,031). In turn, SF IL-21 concentration was distinctly higher in polyarticular subtype of the d...
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