High atherosclerosis prevalence was found in rheumatoid arthritis (RA), and the von Willebrand factor (vWF) was shown to be a marker for endothelial damage. The aim of this study was to evaluate the association of intima-media thickness of the left common carotid artery with vWF serum levels in rheumatoid arthritis patients without cardiovascular risk factors. We included 55 RA female patients, each with at least 5 years of duration of the disease, and 20 healthy female subjects as members of the control group. The vWF, cholesterol, triglycerides, and the immune variables-rheumatoid factor and reactive C protein-were evaluated. The media thickness and intima-media thickness (IMT) in patients and in the control subjects were assessed by Doppler ultrasound of the left common carotid artery. Although the ages for RA patients and healthy female controls were not different, the IMT of the left common carotid artery (IMT CCA) in rheumatoid arthritis patients was increased in comparison with healthy control measurements, the mean being 0.67 mm (SD 0.18) vs 0.58 mm (SD 0.10) with a p value 0.01. The vWF serum levels showed differences in RA patients from those in control patients, 145.6 (SD 30.08) vs 121.8 (SD 37.17), respectively, with p=0.007. A correlation was also found between vWF with IMT CCA in the RA patients: r=0.390 and p<0.05. We concluded that the measurements of the left common carotid artery intima-media thickness together with the von Willebrand factor serum levels could give valuable information about the artery status and the atherosclerosis process in early stages in patients with rheumatoid arthritis without cardiovascular risk factors.

The current studies were carried out to determine the expression of Fas ligand and Bax in kidneys from lupus nephritis as possible indicators of apoptosis. Twenty-four kidney biopsies from patients with lupus nephritis and 30 normal controls were studied for FasL and Bax gene expression by fluorescent in situ hybridization. Seventy percent of the lupus biopsies displayed FasL or Bax mRNAs. These genes were mainly expressed in biopsies with higher activity indices. In contrast, neither of these mediators was detected in normal glomeruli. These data suggest that FasL and Bax are up-regulated in lupus nephritis and may play a pathogenic role through apoptotic cascades.

Our objective was to try to evaluate lung affection and to correlate an easier and cheaper method with the high-resolution computed tomography (HRCT) findings in patients with RA. Thirty-six RA patients were selected for HRCT lung scan (twelve patients with altered pulmonary function test (PFT) and 24 with normal PFT). The American Thoracic Society criteria were followed for the pulmonary test. Clinical and laboratory variables were recorded. A statistical analysis was done by Kaplan-Meyer survival curve and ROC curve. When HRCT was evaluated in all patients, only sixteen had an HRCT normal and twenty patients showed some radiologic alteration under HRCT such as: pleural thickness, bronchiectasis, interstitial pattern, micro-nodules pattern, ground-glass opacity, and a reticular pattern. A logistic regression showed that methotrexate use, evolution of the disease (beta 0.018), and FEV1 (beta 0.89) were statistically associated with HRCT alterations. A projection of patients, free from event (HRCT lung scan altered), was obtained through a Kaplan-Meyer analysis, using FEV1 as a predictor over time. The curve shows that in the next 240 months (20 years) nearly 40% of the patients with rheumatoid arthritis will have FEV1 values less than 80% of the normal values predicted for the same age and sex. The FEV1 values have demonstrated a good correlation between PFT and HRCT lung scan. Therefore, they provide an accessible tool for tracking early pulmonary alterations. Methotrexate use and time evolution of the disease have been associated with altered FEV1.

The data indicate that functional iNOS activity is present in glomeruli as part of the inflammatory process in the kidney; therefore the products of iNOS could play a role in the pathogenesis of lupus nephritis.

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Objective: The hypothalamic-pituitary-adrenal (HPA) axis evaluation has been conflicting in rheumatoid arthritis (RA) patients. Our aim was to evaluate the HPA axis response to the insulin tolerance test (ITT) in premenopausal female patients with RA before and after anti-tumor necrosis factor therapy (anti-TNF therapy). Design: A comparative cross-sectional analysis. Subjects and methods: Ten females with RA and without previous anti-TNF therapy were included. Five healthy females were included as controls. An ITT was performed before first dose of anti-TNF therapy and then after week 12. Anti-TNF therapy was applied every 14 days for 12 weeks. Cortisol and ACTH levels were measured at 0, 30, 45, and 65 min. Prolactin was measured at 0, 30, 45, 90, 120, and 150 min. Results: The ACTH basal plasma levels at weeks 0 and 12 did not show statistical differences, at 1.26 (0.41-2.12) vs 1.54 (0.60-2.49) respectively (PZ0.68). The controls demonstrated a higher ACTH response than in the RA patients at week 0 before the anti-TNF therapy (349.12 area under curve (AUC)), (PZ0.004) and a similar ACTH response to ITT to those of RA patients at week 12 after the use of the anti-TNF therapy (1087.42 AUC). Serum cortisol levels did not show significant changes when the ITT was performed before and after the anti-TNF therapy.