Acute Phase Inflammatory Markers Research Articles

195. Exploring Associations Between Postpartum Depression, Acute-Phase Inflammatory Markers (CRP and AGP), and Socioeconomic Factors in Mothers at 6 Months Postpartum

195. Exploring Associations Between Postpartum Depression, Acute-Phase Inflammatory Markers (CRP and AGP), and Socioeconomic Factors in Mothers at 6 Months Postpartum

Anaemia of chronic disease among pulmonary tuberculosis patients is associated with inflammatory marker at the start of intensive phase.

Tuberculosis (TB) disrupts iron balance through systemic inflammation. Pulmonary tuberculosis (PTB) is linked to diverse anaemia types, necessitating intricate haematological and biochemical assessments for diagnosis. This study aims to describe the prevalence of anaemia of chronic disease (ACD), iron deficiency anaemia (IDA) among PTB patients and factors associated with these types of anaemia. A cross-sectional analysis was conducted from community-based cohort study involving sputum-positive PTB patients from 2018 to 2020 in urban Puducherry. Participants were enrolled from 10 primary health centres within 2 weeks of initiating anti-tubercular treatment (ATT). Blood samples were collected for assessing haematological and biochemical parameters. The sTfR/log ferritin ratio was used to distinguish between ACD and IDA. Data were captured using Epicollect5 and analysed using STATA V14. Of the 176 PTB patients included, 63.07% (111/176) had anaemia, with ACD being the predominant type (84.6%, 94/111). The C-reactive protein (CRP) levels were higher among the anaemic group [40.77 (16.66-58.51) mg/dl vs 24.65 (14.23-47.26) mg/dl] and higher among the ACD as compared to IDA [46.9 (22.3-61.2) vs 20.8 (13.0-39.1) mg/dl]. Undernourished [adjusted prevalence ratio (APR) =3.43; confidence interval (CI): 1.21-9.69] and patients having low risk of dependence on tobacco [APR = 1.52; CI: 1.10-2.11] had higher risk of ACD. Female patients had higher risk of IDA [APR = 4.95, P < 0.01]. The largest proportion of the PTB participants with anaemia had ACD. Acute-phase reactant and inflammatory marker are increased among newly diagnosed new sputum smear-positive (NSP) PTB participants at the start of ATT. Addressing inflammation is needed for combating anaemia in PTB patients.

Characteristics of the Acute Phase Inflammatory Marker — C-Reactive Protein in Patients with Chronic Bronchial Affections

Chronic lung diseases, particularly those affecting the bronchial tree, are a leading cause of disability and mortality worldwide. This emphasizes the importance of addressing issues related to the prevention, timely detection and treatment of conditions such as chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD) and COPD with bronchiectasis. The use of highly sensitive methods for monitoring likely exacerbations and predicting the development of comorbidities in this patient cohort is justified. Objective — to study the nature and severity of changes in the acute phase inflammatory marker — C-reactive protein (CRP) in patients with chronic lung diseases. Materials and methods. A total of 62 hospitalized patients with CB, COPD and COPD with secondary bronchiectasis were examined. All patients underwent clinical, laboratory and instrumental investigations. The serum CRP level was measured in peripheral blood. A control group comprised 15 practically healthy individuals. Results and discussion. It was found that chronic inflammatory lung diseases were more prevalent in men (in the CB group — 55.0 %, in the COPD group — 86.96 %, in the COPD with secondary bronchiecta­sis group — 93.7 %). The CRP level in peripheral blood serum was elevated in all groups: in the CB group — (5.5 ± ± 0.12) mg/l, in the COPD group — (7.54 ± 0.98) mg/l, in the COPD with secondary bronchiectasis group — (12.93 ± 1.23) mg/l. This indicator was statistically significantly higher by 4.0, 5.6, and 9.6 times, respectively (all p &lt; 0.001) compared to the control group. The proportion of smokers was 60.0 % in the CB group, 73.9 % in the COPD group and 78.94 % in the COPD with secondary bronchiec­tasis group. Conclusions. Harmful habits, especially smoking, contribute significantly to the widespread occurrence of chronic lung diseases. Exacerbations and progression of chronic inflammatory processes in the bronchial tree are associated with an elevated level of CRP. The level of CRP significantly increases with the development of concomitant changes, particularly the presence of secondary bronchiectasis. There is a correlation between smoking and the severity of chronic inflammatory lung diseases, as well as a relation­ship between the severity of COPD and the duration of smoking.

P336 PROCALCITONIN AS PREDICTOR OF IN–HOSPITAL MORTALITY IN A CARDIOGENIC SHOCK POPULATION: A 10–YEARS SINGLE CENTRE RETROSPECTIVE STUDY

Abstract Background Plasmatic procalcitonin (PCT) is an acute–phase inflammatory marker, its value tends to increase during inflammatory conditions such as septic shock, cardiogenic shock (CS) and bacterial infections. Patients with CS complicating acute myocardial infarction (AMI) and signs of systemic inflammatory response syndrome (SIRS) can show increased PCT values but its prognostic role in this setting is still unknown. Purpose: evalute prognostic role of plasmatic PCT in an ischemic CS population. Methods All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study. We evaluated PCT and C reactive protein (CRE) values in blood sample only in patients with clinical signs of SIRS or infection. Microbiological examination were also collected to exclude a bacterial infection. Results We included 167 patients [males 67%; mean age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 (3,1–8,8) mmol/L. All patients required inotropes while 91,1% required mechanical cardiac support (MCS). The overall in–hospital mortality rate was 46%. The PCT values resulted to be an in–hospital mortality predictor at multivariate analysis (p = 0,018) and we observed a generally lower PCT values in surviving CS patients (Fig 1). At the analysis the optimal maximum PCT cut–off value to predict in–hospital mortality was 5,77 ng/l (SE 0,82; SP 0,72, accuracy 0,78) with an area under the receiver operating characteristic curve of 0.80 (Fig 2). Moreover positivity to microbiological examination such as urine colture, blood colture, bronchoalveolar lavage and maximum CPR values were not associated with in–hospital death at univariable analysis. Conclusions in our retrospective study we found that PCT is an in–hospital mortality predictor and values greater than 5,77 ng/ml seem to be a good indicator of patients with poor prognosis in ischemic CS patients. High PCT values could have a role in indentifing CS patients with a intense SIRS or with a septic shock component which is associated with a even higher in–hospital mortality rate. The positivity to microbiological examination and maximum CPR values weren’t death predictors in our sample. Further studies in larger CS population could be advisable to better define prognostic role of PCT and evaluate its role in CICU daily clinical practice.

C- REACTIVE PROTEIN LEVELS AMONG COVID-19 POSITIVE CASES PRESENTING IN GULAB DEVI HOSPITAL LAHORE: A DESCRIPTIVE CROSS-SECTIONAL STUDY

Background &amp; Objectives: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious virus associated with the development of COVID 19. Lack of valid biomarkers makes it difficult to predict disease severity. C-reactive protein (CRP) is an acute phase inflammatory marker that which may predict COVID-19 infection and its severity. The aim of this study was to describe the CRP levels in COVID- 19 positive cases presenting in Gulab Devi hospital Lahore.&#x0D; Methods: In this cross sectional study conducted in Gulab Devi Hospital Lahore for six month, 100 COVID- 19 positive cases were selected using convenient sampling technique. About 3 ml of venous blood was drawn for qualitative and semi-quantitative titration analyses to determine CRP concentration in blood. Descriptive analysis was performed using SPSS version-26 to describe the levels of CRP in relation to clinical features and disease severity.&#x0D; Results: CRP levels were elevated above normal range in 93% COVID-19 positive cases. Patients with severe infection had high levels of CRP (&gt;6mg/L, range: 12-96 mg/L), mildly infected patients had moderate values of CRP and recovering patients of COVID-19 showed lowest value of CRP (&lt;3mg/L ).&#x0D; Conclusion: The serum CRP level was substantially higher in COVID-19 positive cases in this study. CRP is an inexpensive, rapid test available to physicians for early detection of COVID-19 severity. Determining CRP levels can also help physicians to identify patients at higher risk of mortality and complications.

Clinical utility of heparin-binding protein as an acute-phase inflammatory marker in interstitial lung disease.

The role of heparin-binding protein (HBP) as an acute inflammatory marker in acute exacerbations of interstitial lung disease (AE-ILD) and some stable ILD patients is not well-established. The significance of increasing HBP during an AE-ILD is examined and the first attempt to incorporate HBP into the ILD evaluation system is made. Then, the benefit of HBP in AE-ILD was investigated. ILD patients (n=108) were divided into subgroups based on the phase and severity of the disease. Linear trends of HBP across subgroups were observed, and correlations with common inflammatory markers were examined. Further, the HBP detection was adopted between serum and bronchoalveolar lavage fluid (BALF). Imaging and pathology changes were evaluated using various scoring criteria and compared to HBP. The relationship between HBP with ventilation, fibrosis progression, and changes in arterial oxygen levels and inflammatory markers were investigated to understand the mechanistic pathways. HBP was significantly higher in patients with AE-ILD at the early stage, compared to patients with ILD at the stable phase and its increase was both found in the serum and BALF. With the remission of the disease, there was a linear trend of progressive decline. HBP identified ILD patients who had co-infections. HBP levels increased earlier than CRP, PCT, and SAA. HBP was associated with pulmonary levels of ventilation and lesions by radiology examination, and its levels were significantly worse in AE-ILD patients. However, HBP did not show a correlation to the pathology quantitative evaluation. In conclusion, HBP could potentially evaluate the progression and prognosis of AE-ILD. Because ILD patients are susceptible to infection, and since HBP can identify co-infection, this marker would be of great clinical importance. HBP is possibly predictive of acute exacerbation.

Hyperuricemia Among Egyptian Rheumatoid Arthritis Patients. Is It an Association or an Inflammatory Marker? A Cross-Sectional Observational Study.

ObjectiveTo detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients.MethodsA total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints.ResultsSUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level.ConclusionElevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.

Occupational exposure and markers of genetic damage, systemic inflammation and lung function: a Danish cross-sectional study among air force personnel

Air force ground crew personnel are potentially exposed to fuels and lubricants, as raw materials, vapours and combustion exhaust emissions, during operation and maintenance of aircrafts. This study investigated exposure levels and biomarkers of effects for employees at a Danish air force military base. We enrolled self-reported healthy and non-smoking employees (n = 79) and grouped them by exposure based on job function, considered to be potentially exposed (aircraft engineers, crew chiefs, fuel operators and munition specialists) or as reference group with minimal occupational exposure (avionics and office workers). We measured exposure levels to polycyclic aromatic hydrocarbons (PAHs) and organophosphate esters (OPEs) by silicone bands and skin wipes (PAHs only) as well as urinary excretion of PAH metabolites (OH-PAHs). Additionally, we assessed exposure levels of ultrafine particles (UFPs) in the breathing zone for specific job functions. As biomarkers of effect, we assessed lung function, plasma levels of acute phase inflammatory markers, and genetic damage levels in peripheral blood cells. Exposure levels of total PAHs, OPEs and OH-PAHs did not differ between exposure groups or job functions, with low correlations between PAHs in different matrices. Among the measured job functions, the UFP levels were higher for the crew chiefs. The exposure level of the PAH fluorene was significantly higher for the exposed group than the reference group (15.9 ± 23.7 ng/g per 24 h vs 5.28 ± 7.87 ng/g per 24 h, p = 0.007), as was the OPE triphenyl phosphate (305 ± 606 vs 19.7 ± 33.8 ng/g per 24 h, p = 0.011). The OPE tris(1,3-dichlor-2-propyl)phosphate had a higher mean in the exposed group (60.7 ± 135 ng/g per 24 h) compared to the reference group (8.89 ± 15.7 ng/g per 24 h) but did not reach significance. No evidence of effects for biomarkers of systemic inflammation, genetic damage or lung function was found. Overall, our biomonitoring study show limited evidence of occupational exposure of air force ground crew personnel to UFPs, PAHs and OPEs. Furthermore, the OH-PAHs and the assessed biomarkers of early biological effects did not differ between exposed and reference groups.

Abdominal syndrome in monogenic autoinflammatory disease – is it just a familial Mediterranean fever?

Gastrointestinal (GI) manifestations, such as abdominal pain, nausea, vomiting, and diarrhea, are common autoinflammatory disease (AID) symptoms. The abdominal symptomatology reflecting serositis is one of the most important classification and diagnostic criteria for the classic monogenic AID (MAID) – familial Mediterranean fever (FMF). Failure to timely diagnose FMF frequently leads to unjustified surgical interventions. Other periodic fevers may also present as abdominal symptoms; however, the latter are outside their diagnostic features. These diseases include, first of all, tumor necrosis factor receptor-associated periodic syndrome (TRAPS). Interleukin 1 (IL1) inhibitors serve as the major targeted drugs for the treatment of TRAPS. Russia has registered the IL1 inhibitor canakinumab that prevents the development of organ damages, including those in the GI tract. The paper describes a clinical case of the classic manifestations of TRAPS (fever, rash, periorbital edema, arthritis, and elevated levels of acutephase inflammatory markers) concurrent with severe abdominalgia during attacks and with the development of severe peritoneal adhesions, which led to bowel perforation and emergency surgical intervention. The prolonged persistence of inflammatory attacks before the initiation of therapy, as well as violation of the IL1 inhibitor administration regimen facilitated the development of an urgent exacerbation. Thus, TRAPS should be included in the differential diagnostic circle for patients with severe gastrointestinal manifestations characterized by an attack-like course. These patients need timely prescription of targeted therapy, strict adherence to the dosing and intervals between drug administrations, and careful monitoring to prevent serious complications with the visceral organs, including the gastrointestinal tract, and their immediate correction.

Low-penetrance R92Q (p.Arg121Gln) mutation in the &lt;i&gt;TNFRSF1A&lt;/i&gt; gene: the significance and variants of phenotypes. Successful experience with the interleukin-1 inhibitor canakinumab in a female patient, who is a carrier of R92Q mutation with a severe TRAPS phenotype

The paper is devoted to the assessment of the R92Q (p.Arg121Gln) mutation/polymorphism in the TNFRSF1A gene associated with the monogenic autoinflammatory disease – Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS). It gives data on the frequency of this gene in the general population, which is 1.3% and significantly exceeds the incidence of TRAPS. The authors describe the variants of phenotypes associated with its mutation from asymptomatic carriage to the development of a severe systemic autoinflammatory state with persistent febrile fever and a significant increase in the level of acute-phase inflammatory markers that do not respond to standard antirheumatic therapy. They present a clinical case of the high efficiency of the anti-interleukin 1β monoclonal antibody canakinumab in a female patient with a severe TRAPS phenotype, who had the R92Q mutation and hormonal dependence. Canakinumab therapy led to complete relief from all manifestations of the disease and to discontinuation of glucocorticoids. The authors conclude that the decision to prescribe therapy with biological agents should be made on the basis of the clinical severity of the disease rather than a variant of the mutation that caused it.

Effects of advanced age and pituitary pars intermedia dysfunction on components of the acute phase reaction in horses

Age, neurodegenerative disorders, and dysfunction of insulin secretion may be correlated with increased systemic concentrations of acute phase markers. Thus, the study aimed to determine the effect of age, pituitary pars intermedia dysfunction (PPID), and insulin dysregulation (ID) associated with PPID, on markers of the acute phase reaction. Twenty-nine mix-breed horses of both sexes were classified into groups: (1) healthy adult controls, (2) healthy non-PPID geriatric horses, (3) PPID ID+ horses, and (4) PPID ID− horses. Whole blood proinflammatory cytokine gene expression and serum concentrations of pro- and anti-inflammatory cytokines and acute phase proteins were measured. The data were analyzed using the Mann–Whitney U-test, and correlations between groups of data were assessed using Spearman's correlation coefficient. The tests were statistically significant if P < 0.05. No differences in the whole blood cytokine gene expression, serum cytokine concentrations, or acute phase proteins were noted between the groups. In the PPID ID group, there was a strong correlation between the ACTH concentration after the administration of thyrotropin-releasing hormone and the expression of IL-8 (r = 0.941; P = 0.0321). In the PPID ID+ group, there was a strong correlation between basal insulin concentrations and serum amyloid A (SAA; r = 0.936; P = 0.0083) as well as between postprandial insulin concentrations and SAA (r = 0.965; P = 0.001). These data suggest that neurodegeneration in horses moderately affects circulating markers of inflammation and that ID in horses with PPID influences acute phase inflammatory markers.

Neutrophil to lymphocyte ratio in the diagnosis of viscero-visceral cardioneuropathy in patients with gallbladder disorders

Summary. Neutrophils to lymphocytes ratio (NLR) reflects the activity of systemic nonspecific inflammation and immune system answer. NLR can be influenced by the change of gallbladder condition. It’s a pity, but the diagnostic and prognostic opportunities of NLR are not properly used in routine clinical practice. The aim of this paper was to estimate the NLR value in the assessment of heart condition in the diagnostics of viscero-visceral cardioneuropathy in dependence of gallbladder condition in patients with cardiorheumatic disorders. We analyzed data of 506 inpatients with cardiorheumatic diseases, which were divided into groups according to gallbladder condition: intact gallbladder; sludge, polips and cholesterosis; various deformations of gallbladder body; gallbladder neck deformations and sonographic signs of past cholecystitis; cholelithiasis; anamnesis of cholecystectomy. It was established that NLR levels, revealed in this study, exceeded the levels of healthy people according to our previous studies (1.8±0.46) and literature data (1.65-1.86). NLR was dependent of gallbladder condition: maximal levels always accompanied pathological changes of the latter. On the background of active inflammatory phase of rheumatic diseases NLR was higher, than in case of stable and acute forms of ischemic heart disease. NLR correlations depended on gallbladder condition, and were the most numerous in case of intact gallbladder. NLR was associated with age, heart rate, acute phase inflammatory markers, parameters of endogenous intoxication, cytolysis and structural heart parameters (sizes of chambers, thicknesses of walls, ejection fraction). Ranking analysis of NLR of all included patients showed that its levels were maximal in case of cholecystitis in anamnesis and in patients after cholecystectomy. All other values can be clearly divided into 2 groups: intact gallbladder plus bent gallbladder body and, apart of it, other pathological conditions (sludge, signs of cholecystitis in anamnesis, cholelithiasis and cholecystectomy in anamnesis). Conclusions: NLR was the highest in case of active inflammatory process in hemorrhagic vasculitis (3.66) and rheumatic fever (3.24) than in the stable ischemic heart disease (2.47) and myocardial infarction (1.85), all р&lt;0.05. Regardless of the disorder, NLR was dependent on the gallbladder condition and reached the maximal values in case of gallbladder changes. Taking into account the big amount of NLR correlations with clinical and laboratory parameters, and the results of instrumental diagnostics methods, we can say that NLR may be used in the diagnostics of viscero-visceral cardioneuropathy.

Administration of the Interleukin-1 Inhibitor Canakinumab in Children with Autoinflammatory Diseases and Systemic Juvenile Arthritis: the Report for Case Series

In Russia, the interleukin-1 inhibitor canakinumab (fully human monoclonal antibodies to interleukin-1) is increasingly used for treating autoinflammatory diseases and systemic juvenile arthritis (sJIA). The article describes the experience of administering canakinumab in patients with autoinflammatory diseases (n = 12) and sJIA (n = 7), the efficacy and tolerability of the drug are analyzed. Canakinumab was prescribed subcutaneously in a dose of 2–6 mg/kg (maximum 300 mg) once in 4–8 weeks. The therapy duration ranged from 3 months to 4 years. All patients had a rapid clinical improvement, relief of systemic manifestations, normalization of the level of acutephase inflammatory markers. In 4 patients with sJIA we failed to achieve the relief of arthritis symptoms. While administering the drug, no serious adverse events were registered. Thus, the experience of administering canakinumab in patients with autoinflammatory diseases and sJIA showed the high efficacy and good tolerability of the drug. The canakinumab administration at sJIA can be effective in the early disease stages in patients with systemic and initial articular changes.

Serum calgranulin C is a highly sensitive autoinflammation activity indicator in patients with familial periodic fevers

To determine the possibility of using the serum proinflammatory calcium-binding protein, or calgranulin C (S100A12), to assess activity and therapeutic efficiency in patients with periodic disease (PD) and other familial periodic fevers (FPFs). Thirty-five patients with PD and other FPDs, which were verified by molecular genetic study, were examined. In accordance with the disease activity, the patients were divided into 2 groups. The investigators determined the concentration of S100A12 by solid-phase enzyme immunoassay and that of other acute-phase inflammatory markers (erythrocyte sedimentation rate (ERT), neutrophil counts, and fibrinogen and C-reactive protein (CRP) concentrations). The serum concentration of S100A12 in the stage of disease activity was 466.7 (265.22--851.7) ng/ml, which was significantly higher than in remission (244.29 (118.93--409.85) ng/ml (p=0.000002). The highest S100A12 concentrations were noted in the patients with PD; these were 758.95 (434.80--1035.95) ng/ml; the S100A12 level in the majority of PD patients even during remission remained moderately higher. An investigation of the relationship of A100A12 to genetic variants found no differences between the patients homozygous for M694V and those with other genotypes (p=0.37). Estimation of the time course of therapy-induced changes in the serum S100A12 concentration revealed its considerable reduction (р=0.0018). However, normalization of S100A12 levels was not achieved in PD. The remaining increased S100A12 concentration in these patients may be suggestive of the activity of PD despite the absence of its clinical manifestations. S100A12 as a highly sensitive marker allows more exact evaluation of the anti-inflammatory effect of therapy. The S100A12 identification of the subclinical activity of autoinflammatory diseases made all the more important since traditional inflammatory markers, such as ERT, CRP, fibrinogen, and leukocyte counts, are less sensitive for these purposes. In our study, these markers were within the reference range in remission. No differences were found in the S100A12 levels between the groups with and without amyloidosis (p=0.62). S100A12 is a highly sensitive marker for the activity of autoinflammatory diseases and the efficiency of their therapy. The serum level of S100A12 in PD may be used to diagnose the subclinical activity of inflammation, which is of importance in monitoring the risk of amyloidosis.

A familial case of TRAPS in a Russian population

Tumor necrosis factor (TNF) receptor-1-associated periodic syndrome (TRAPS) is a classical autoinflammatory syndrome (AIS). The paper describes repeated cases of TRAPS in an ethnic Russian family. Molecular genetic examination of a 9-year-old boy, his mother and his grandmother has revealed the heterozygous mutation of c151C<T in exon 2 of the TNFRSF1 gene, which gives rise to amino acid substitution in pHis51Tyr protein sequencing. It is interesting that this mutation has been described in a North American population, but it has been encountered in only 2% of the patients with TRAPS in the European Registry (EuroTRAPS). This case alludes to the fact that in the Russian population there are families with TRAPS, which may have atypical mutations in the TNFRSF1A gene. Curiously, his mother and his grandmother were diagnosed with TRAPS only after its identification in the child (i. e. 34 and 45 years after the onset of the disease, respectively). Moreover, maternal blood tests permanently showed a pronounced increase in the acute-phase inflammatory markers missed by their local doctors. With each further generation, the family has exhibited an early onset of TRAPS and its progressively severer course with more time taken for its attacks. But if his mother and his grandmother had symptoms as erythema centrifugum, fasciitis, myalgias, and transient joint contractures, which are a distinguishing feature of this syndrome, the manifestations of the disease in the child were more non-specific. In the patient’s mother, the abovementioned characteristic symptoms of TRAPS occurred not at the onset of the disease, but just in adolescence. It is not inconceivable that if her son had not been adequately treated, he could also develop these symptoms with time. It is intriguing that the child was observed to have clinical hemorrhagic vasculitis, a condition associated with a number of AISs, primarily with familial Mediterranean fever. In this case, all the manifestations of the disease, including hemorrhagic vasculitis, were completely abolished in the child treated with the interleukin 1 inhibitor canakinumab.

Acute–Phase Inflammatory Response in Patients with Pulmonary Tuberculosis

Summary The main issue in patients with pulmonary tuberculosis (PTB) represents the impossibility of the host immune response to express bactericidal function and the sterilization of lesions depends exclusively on the specific antimicrobial chemotherapy. In order to investigate the value of acute-phase inflammatory response markers in patients with newly confirmed extensive PTB, there was designed a clinical study with 80 patients, of whom 40 had active disease (experimental group), while other 40 had inactive sequellar disease without comorbidity (control group). The examined groups were homogenous with respect to the patient’s general demographic characteristics. In the experimental group, 20.0% of the patients had an initial bacterial infection of the lower respiratory tract, while their average value of acute-phase systemic inflammatory markers was initially, before the antituberculosis treatment, significantly elevated compared to the control group. At the end of the treatment, values of erythrocyte sedimentation rate in the first hour (SE) and serum C-reactive protein (CRP) significantly decreased (SE-p &lt;0.001, CRP-p&lt;0.001), together with the value of the leukocyte count (Le) and serum fibrinogen (Le-p&lt;0.001, fibrinogen-p&lt;0.001). Multivariate linear regression analysis proved a significant correlation between baseline serum fibrinogen level with positive history of contact with active TB patient and initial radiological extent of PTB lung lesions. The values of the acute-phase inflammatory response markers in active PTB have its clinical significance in the assessment of unfavourable course of disease in extensive disseminated form of PTB as well as in the occurrence of complications associated with low respiratory tract bacterial superinfection.

Increased neopterin level and chitotriosidase activity in pregnant women with threatened preterm labor

Objectives: To determine whether the cellular inflammatory markers of activated macrophages, neopterin (NEO), chitotriosidase activity and the acute-phase inflammatory marker C-reactive protein (CRP) are elevated in pregnancy with threatened preterm labor (TPL).Methods: Thirty-two pregnant women with TPL and 32 women with uncomplicated pregnancy (UP) were included this study. The primary aim was to compare the NEO, chitotriosidase activity and CRP levels between women with TPL and women with UP.Results: NEO levels were all significantly elevated in patients with TPL compared to UP (median 25–75%; 9.61 [8.47–12.29] versus 4.46 [3.59–6.92], respectively; p < 0.001). Chitotriosidase activity was significantly elevated in pregnant women with TPL compared to UP (median 25–75%; 59.00 [38.00–87.25] versus 43.50 [23.25–65.25], respectively; p = 0.036). However, CRP levels were not different in women with TPL compared to UP (p = 0.573). Furthermore, a significant moderate negative correlation was found between delivery week and NEO level (r = −0.557, p = 0.001). However, a significant correlation was not seen between delivery week and chitotriosidase activity (r = −0.042, p = 0.741).Conclusions: Inflammatory markers such as NEO and chitotriosidase activity, which are markers of macrophages, are more elevated in pregnant women with TPL than in women with UP. These data suggest that there are striking increases in inflammation and cellular immune activation in TPL.

Characterization of the inflammatory response to anthelmintic treatment of ponies with cyathostominosis

Cyathostomins can cause a severe inflammation of equine large intestine characterized by substantial ventral edema and pronounced protein loss. Anthelmintic treatment of horses can result in a localized inflammatory response in the colonic mucosa of clinically normal horses. The aim of this study was to evaluate the systemic inflammatory response of ponies naturally infected with cyathostomins to single dose representatives of three anthelmintic drug classes, namely, oxibendazole, pyrantel pamoate, and moxidectin. Thirty ponies aged between 1 and 18years of age were allocated to one of three anthelmintic treatments groups. Anthelmintic efficacy was evaluated using the fecal egg count reduction test performed weekly between 2 and 8weeks post-treatment. Inflammatory responses were evaluated on days 0, 1, 3, 5, and 14 after treatment using hematology, measurement of the acute phase inflammatory markers serum amyloid A, fibrinogen, haptoglobin, and iron, and real-time PCR measurement of expression of the genes for interleukins 1-β and −10, tumor necrosis factor-α, and interferon-γ.There were subtle inflammatory responses to treatment, but cytokine expression was significantly associated with the interaction term between treatment group and anthelmintic efficacy (P<0.05). Of the acute phase markers, only fibrinogen associated with treatment group. The findings suggest that systemic inflammatory responses subsequent to anthelmintic treatment of cyathostomin infection are minimal. It is possible that this response is ‘buffered’ by anti-inflammatory products of the parasites and/or the anti-inflammatory effects of the macrocyclic lactones.

SAT0014 Correlation of CRP haplotypes with response to anti-TNF therapy in UK patients – results from the BRAGGSS cohort

BackgroundAnti-TNF medication is the most effective treatment method in patients with RA and reduces inflammation by blocking the TNF pathway. However, this treatment is expensive, costing ∼£10,000 per patient, per...

THU0007 Investigation of CRP Gene Polymorphisms as Predictors of Cardiovascular Mortality in Inflammatory Polyarthritis – Results from the Norfolk Arthritis Register

BackgroundPatients with rheumatoid arthritis (RA) and inflammatory polyarthritis (IP) are at increased risk of premature death compared to the general population, with cardiovascular disease (CVD) forming the primary cause. C-reactive...