BackgroundMyostatin is expressed in skeletal muscles and exerts a negative feedback in myogenesis. Chronic inflammation has been associated with increased serum myostatin levels (Baig MH, Front Physiol. 2022).ObjectivesThe calculation of serum myostatin levels in patients with rheumatoid arthritis (RA) and association with disease parameters.MethodsA cross-sectional study of 30 post-menopausal women with RA, classified according to the 1987 ACR criteria. Blood samples were collected and inflammatory markers (erythrocyte sedimentation rate, ESR, and C-reactive protein, CRP) were calculated. Serum myostatin levels were assessed using the ELISA method. Seropositive disease was defined according to a positive history of antibodies against rheumatoid factor (RF) or against citrullinated proteins (ACPA). Disease activity and patient functionality were expressed by using the DAS28 (ESR) and the HAQ-DI scores respectively.ResultsIn our cohort, 47% (n=14) had seropositive disease. Mean values for ESR, CRP, DAS28 (ESR) and HAQ-DI were 29 ± 20 mm, 1.6 ± 2.6 mg/dl, 3.9 ± 1.7 and 0.9 ± 0.6 respectively. The mean serum myostatin levels were 5.9 ± 1.3 μg/ml. According to the DAS28 (ESR) score, 17% (n=5) patients were in disease remission, 20% (n=6) had low disease activity, 40% (n=12) had medium disease activity and 23% (n=8) had high disease activity. Serum myostatin was not associated with disease activity (p=0.32), patient functionality (p=0.08) or the inflammatory burden attributed to active disease (p=0.67 for ESR and p=0.83 for CRP). Seropositive disease did not correlate with serum myostatin levels (p=0.08).ConclusionIn post-menopausal women with rheumatoid arthritis, serum myostatin levels are independent of disease activity, patient functionality, inflammatory burden, RF or ACPA seropositivity. Except for inflammation per se, other disease parameters associated with RA influence the regulation of myostatin.Reference[1]Baig MH, Ahmad K, Moon JS, Park SY, Ho Lim J, Chun HJ, Qadri AF, Hwang YC, Jan AT, Ahmad SS, Ali S, Shaikh S, Lee EJ, Choi I. Myostatin and its Regulation: A Comprehensive Review of Myostatin Inhibiting Strategies. Front Physiol. 2022 Jun 23;13:876078. doi: 10.3389/fphys.2022.876078.Table 1.Association of serum myostatin with disease parameters in RA patients (statistical significance: p<0.05)ParameterCoefficientpAge0.0840.658BMI-0.1560.412Disease duration0.1310.492Seropositive disease-0.8090.084ESR-0.0810.672CRP0.0410.830DAS28 (ESR)-0.1900.315HAQ-DI-0.3220.083Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundHematological manifestations are common in systemic lupus erythematosus (SLE), and are thought to result from immune-mediated peripheral cell destruction or bone marrow failure(1,2).ObjectivesTo assess the clinical characteristics and outcomes of severe hematological disease in a large cohort of lupus patients.MethodsRetrospective analysis of the “Attikon” lupus cohort (over 800 patients total) (3) for the identification of patients with a history of severe hematological manifestation. The latter were defined as: thrombocytopenia with a platelet count <30.000/mm3, hemolytic anemia with an hemoglobin <8 g/dL, neutropenia with less than 500 neutrophils/mm3, history of thrombotic microangiopathy (TMA) or macrophage activation syndrome (MAS). Treatments and long-term outcomes (relapses, mortality) were recorded.ResultsAmong 300 patients with hematologic manifestations, 40 patients had severe disease. Most of them were women (75%). Mean age at SLE diagnosis was 41,1 years and mean disease duration at diagnosis of cytopenia was 3.8 years. Hematologic manifestation preceded SLE diagnosis in 13 patients (32,5%).Autoimmune thrombocytopenia was the most common (57,5%), followed by hemolytic anemia (17.5%), TMA (12.5%) and Evans syndrome (7,5%). All patients received glucocorticoids (GC). Rituximab (15%) and cyclophosphamide (12,5%) were the most frequently used GC-sparing agents during the first episode. Nine patients (22,5%) received intravenous immunoglobulin (IVIg). Relapse occurred in 23 patients (57,5%), most of which (N=17, 73,9%) were treated with GC alone or in combination with IVIg or plasma exchange at initial presentation, without the use of GC-sparing agents. Most of the flares (60,8%) were severe. No deaths were observed.ConclusionHematological disease in SLE is treatment-responsive. GC remain the mainstay of treatment, but the high relapse rates underscore the need for more efficient GC-sparing agents.References[1]Fayyaz A, Igoe A, Kurien BT, Danda D, James JA, Stafford HA, Scofield RH. Haematological manifestations of lupus. Lupus Sci Med. 2015 Mar 3;2(1):e000078.[2]Hepburn AL, Narat S, Mason JC. The management of peripheral blood cytopenias in systemic lupus erythematosus. Rheumatology (Oxford). 2010 Dec;49(12):2243-54[3]Nikolopoulos D, Kostopoulou M, Pieta A, Karageorgas T, Tseronis D, Chavatza K, Flouda S, Rapsomaniki P, Banos A, Kremasmenou E, Tzavara V, Katsimbri P, Fanouriakis A, Boumpas DT. Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort. Lupus. 2020 Apr;29(5):514-522.Table 1.Characteristics of patients with hematological manifestationsAge at diagnosis, mean (years)41,1Women N(%)30(75)Mean disease duration at cytopenia diagnosis (years)3,8Thrombocytopenia, N=23, (mean platelet count,/mm3)11682Hemolytic anemia,N=7 (mean Hb,g/dL)6,75Neutropenia N=1,(mean neutrophil count)450Evans syndrome, N=3 (mean Hb, g, mean platelet count)7 /46600TMA,N=5, (mean platelet count)8750MAS, N=1Immunosuppressive treatment at initial presentationAzathioprine (N,%) 4(10) Corticosteroids (N,%) 40 (100) Cyclophosphamide (N,%) 5(12,5) IgIV (N,%) 9 (22,5) Mycophenolate mofetil (N,%) 2(5) Rituximab (N,%) 6(15)Relapse N(%)23(57,5)Severe relapse (N,%)14(60,8)Non responder to corticosteroids/IgIV (N,%)1(2,5)Disclosure of InterestsNone declared
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