Background and objectivesVascular disorders are a well recognised clinical problem in systemic lupus erythematosus (SLE). This preliminary study was designed to evaluate the association between cerebral circulation changes, carotid arteries involvement as well as nailfold capillaroscopy (NC) abnormalities and immunologic/inflammatory markers, classical atherosclerosis risk factors and organ involvement in SLEpatients.Materials and methodsThe study was performed in 30 SLE patients. Bilateral transcranial doppler (TCD) monitoring over the middle cerebral arteries according to the criteria of the International Consensus Group on Microembolus Detection was performed using two 2-MHz probes of the pulsed Doppler system MultiDop-T Digital (DWL Compumedics). MRI scans of the brain were carried out using a 1.5-T scanner GE Discovery 450 (GE Healthcare). Detection of carotid stenosis was performed using 3D contrast-enhanced MR angiography. Carotid intima-media thickness (cIMT) was measured with B-mode ultrasound. NC was done using Zeiss device.More than 100 variables were taken into account including cytokines, inflammatory markers, autoantibodies, classical risk factors for atherosclerosis and selected organ manifestations.Statistical analysis was performed with chi2 Yates, chi2 Pearson, rank Spearman correlations tests and logistic regression analysis.ResultsFactors which significantly correlated with analysed vascular changes including microemboli in TCD, ischaemic changes in MRI and NC abnormalities, were thrombocytopenia (r = 0.47, p = 0.01), C-reactive protein (CRP) (r = 0.51, p = 0.0039) and antiphospholipid antibodies (aPLs) (r = 0.55, p = 0.0015). There was significant association between vascular endothelial growth factor (VEGF) and IL-6 and high cIMT (r = 0.36, p = 0.0492, r = 0.41, p = 0.0239, respectively) as well as NC abnormalities, especially megacapillaries presence (r = 0.38, p = 0.0415, r = 0.42, p = 0.0226, respectively). Additionally, patients with changes in NC significantly more frequently were dyslipidemic (r = 0.56, p = 0.0015), hypertensive (r = 0.41, p = 0.0252) and unveiled high titers of anti-dsDNA (r = 0.37, p = 0.0492) and cardiac involvement (r = 0.38, p = 0.0441). There was also important positive correlation between cIMT and NC abnormalities (r = 0.40, p = 0.0300) as well as microemboli in TCD (r = 0.44, p = 0.0211). Finally, microemboli in TCD were associated with MRI ischaemic changes (r = 0.45, p = 0.0177).ConclusionsNC and cIMT provide the optimal protocol to screen SLE patients for cardiovascular risk. CRP, VEGF, IL-6, aPLs and anti-dsDNA seem to be crucial pathogenic factors in micro- and macrovascular impairment development in SLE. Patients with higher cIMT and aPLs should undergo TCD for cerebrovascular risk assessment.
Systemic lupus erythematosus (SLE) is a rheumatic disease with unclear pathogenesis. In the course of this disease a dysfunction of the immune system occurs, which involves the production of autoantibodies and the deposition of immune complexes, which contributes to the damage of various organs. The most commonly involved organs include: kidneys, skin, joints, the eye, respiratory system, and the cardiovascular and nervous systems, both central and peripheral. In recent years there have been reports regarding the role of cytokines in the pathogenesis of various organs' involvement. However, until now it has not been entirely clear which cytokines are responsible for either the stimulation or inhibition of the inflammatory response, which could be helpful in establishing a relationship with the clinical picture. In this article reports are summarized regarding Interleukins 4, 7, 10, 18 (IL-4, IL-7, IL-10, IL-18) and their relationship with organ involvement in SLE. Interleukin 4 is indicated as a protective cytokine by its role in preventing the development of an autoimmune response. In the case of IL-7, it has a role in increasing the proliferation of autoreactive T-cell clones and the development of the disease. The IL-10, despite its protective effect, is found in patients with SLE at significantly higher concentrations than in the general population and correlates with the SLEDAI disease activity level scale. Interleukin 18 has a pro-inflammatory effect, contributing to damage to tissues and organs. In the serum of patients with SLE significantly higher levels of IL-18 were found than in the control group; there was also a statistically significant positive correlation between serum IL-18 levels and SLEDAI disease activity level scale and anti-dsDNA antibody titers. Increasing levels of serum IL-18 in SLE patients is associated with an increased risk of cardiovascular disease. In addition, IL-18 has an important role in the involvement of the kidneys and skin in SLE patients. Keywords: systemic lupus erythematosus; organ involvement; cytokines. ABSTRAKTToczeń rumieniowaty układowy (TRU) jest chorobą reumatyczną o nie w pełni poznanej patogenezie. W przebiegu tej choroby występuje dysfunkcja układu immunologicznego polegająca na wytwarzaniu autoprzeciwciał i odkładaniu się kompleksów immunologicznych, które przyczyniają się do uszkodzeń różnych narządów. Najczęściej zajęte narządy to: nerki, skóra, układ ruchu, narząd wzroku, układ oddechowy, układ sercowo--naczyniowy oraz nerwowy, zarówno ośrodkowy, jak i obwodowy. W ostatnich latach pojawiły się doniesienia dotyczące roli cytokin w patogenezie zajęcia różnych narządów. Jednakże do tej pory nie jest w pełni jasne, które cytokiny są odpowiedzialne za nasilenie, a które za zmniejszenie odpowiedzi zapalnej, co mogłoby pomóc w ustaleniu związku z obrazem klinicznym. W artykule zestawione zostały doniesienia dotyczące Interleukin (IL) 4, 7, 10, 18 oraz ich związku z zajęciem narządowym w przebiegu TRU. W przypadku IL-4 wskazuje się na ochronną rolę tej cyt...
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