The aim of the study was to evaluate the clinical significance of serum (S) and synovial fluid (SF) interleukin (IL)-18, IL-15, IL-12 and the tumor necrosis factor alpha (TNF-alpha) measurements in relation to laboratory and clinical measures of disease activity of patients with active rheumatoid arthritis (RA). Sixty-four patients with RA and 25 patients with osteoarthritis (OA) were included in this study. RA activity was determined using the Disease Activity Score (DAS) 28 index. Concentrations of IL-18, IL-15, IL-12 and TNF-alpha were measured by ELISA. Serum C-reactive protein (CRP) levels were also determined. Cross-sectional correlations between S and SF levels of cytokines and values of DAS 28 index were calculated. The results have shown that IL-18, IL-15, IL-12 and TNF-alpha levels in S and SF of patients with RA were significantly higher than the levels obtain from patients with OA (p<0.01). Significantly higher levels of IL-18, IL-15 and TNF-alpha were found in the SF compared to the S of patients with RA (p<0.01). Significantly higher S and SF levels of all four cytokines and serum CRP values were found in RA patients with high disease activity (DAS 28>5.1) compared to those with mild (DAS 28>3.2) and low disease activity (DAS 28>2.6) (p<0.01). Serum and SF concentrations of all four cytokines positively correlated with DAS 28 index values, i.e., disease activity. A poor correlation was found for S and SF IL-12 whereas the highest coefficient of correlation was found for SF IL-18 (r=0.879, p<0.01), and SF TNF-alpha (r=0.827, p<0.01) and disease activity in this study. Strong correlation was found between SF TNF-alpha and SF IL-18 levels (r=0.732, p<0.01). In conclusion, SF IL-18 and TNF-alpha levels in RA patients are good indicators of disease activity. The results obtained support the use of the DAS in clinical practice as a reliable method in assessing disease activity in RA patients.
Takayasu's arteritis (TA) is a rare vasculitis that affects the aorta and its primary branches. Heterogeneous clinical manifestations have been described in different geographical areas. We aimed to evaluate demographic, clinical, and angiographic features and the outcome in 16 TA patients who were followed in a single center in Serbia. TA was diagnosed according to the 1990 American College of Rheumatology criteria with median delay of 2 years. The majority of patients (81%) experienced one or more disease relapses and long-term remission was achieved in 94%. Five-year survival rate was 94%. Common systemic manifestations at disease onset included fever (69%), arthralgia (25%), weight loss (19%) and vascular symptoms, arm claudication (100%), headaches (69%), dizziness (56%), and hypertension (37%). All patients had multiple arterial bruits with diminished/absent left arm pulse in 88%. The raised erythrocyte sedimentation rate and C-reactive protein levels were found in 63% and 80%, respectively. Angiography revealed stenotic or occlusive sites of multiple arterial involvement. Stenosis of the left subclavian artery was the most frequent lesion (88%). The angiographic classification was as follows, 50% type I, 19% type IIa, and 31% type V arteritis, suggesting relatively favorable vascular lesions and infrequent serious complications. Glucocorticoids were the main initial therapy for active disease; however, treatment with additional immunosuppressive agents was required in two-thirds of the patients. Seven patients (44%) underwent one or multiple surgical interventions. The main indications for surgery were cerebral hypoperfusion, severe limb claudication, and gangrenous infection. The demographic and angiographic disease patterns in our cohort were similar to American, Italian, Japanese, and Korean cohorts in terms of frequent involvement of the branches of aortic arch and differed from cohorts from other Asian countries in which abdominal aorta and renal artery involvement prevailed.
Cytokines concentrations could be good indicators of the degree of the general activity of RA. This research could contribute to the interpretation of insufficiently well known views of the pathogenesis role and significance of citokines in an active disease.
Ibandronate manifested significant improvement of the BMD after 12 months of treatment of patients with decreased BMD, with good tolerance and excellent treatment compliance.
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