Disease Activity Index In Patients Research Articles

Use of the Bath Ankylosing Spondylitis Disease Activity Index in Patients With Psoriatic Arthritis With and Without Axial Disease.

To evaluate whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a responsive instrument in psoriatic arthritis (PsA) and whether it differentiates between axial and peripheral disease activity in PsA. Individuals with PsA initiating therapy in a longitudinal cohort study based in the United States were included. Axial PsA (axPsA), most often also associated with peripheral disease, was defined as fulfillment of the Assessment of Spondyloarthritis international Society axial spondyloarthritis classification criteria or presence of axial disease imaging features. Baseline BASDAI, individual BASDAI items, patient global assessment, patient pain, and Routine Assessment of Patient Index Data 3, and score changes following therapy initiation were descriptively reported. Standardized response means (SRMs) were calculated as the mean change divided by the SD of the change. The mean (SD) baseline BASDAI score at the time of therapy initiation was 5.0 (2.2) among those with axPsA (n = 40) and 4.8 (2.0) among those with peripheral-only disease (n = 79). There was no significant difference in patient-reported outcome scores between the groups. The mean change for BASDAI was similar among axial vs peripheral disease (-0.75 vs -0.83). SRMs were similar across axial vs peripheral disease for BASDAI (-0.37 vs -0.44) and the individual BASDAI items. BASDAI has reasonable responsiveness in PsA but does not differentiate between axPsA and peripheral PsA. (ClinicalTrials.gov: NCT03378336).

Comparative study of the synovial levels of RANKL and OPG in rheumatoid arthritis, spondyloarthritis and osteoarthritis

IntroductionIn chronic arthropathies, there are several mechanisms of joint destruction. In recent years, studies have reported the implication of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) in the process of activation and differentiation of osteoclasts, a key cell in the development of bone erosion. The RANKL/OPG ratio is increased in the serum of patients with malignant diseases and lytic bone disease, as well as rheumatoid arthritis (RA). The objective of this study was to measure and compare the concentrations of OPG and RANKL in the synovial fluid (SF) of patients with rheumatoid arthritis, spondyloarthritis (SpA) and osteoarthritis (OA).MethodsThis was an observational and cross-sectional study with 83 patients, 33 with RA, 32 with SpA and 18 with OA, followed up regularly in the outpatient clinics of the Rheumatology Department of the Clinics Hospital of the Ribeirão Preto Medical School-USP. All patients were assessed for indications for arthrocentesis by the attending physicians at the time of SF collection and were evaluated for demographic variables and medication use. Disease activity was assessed in individuals with RA and SpA. The quantification of SF OPG and RANKL levels was performed by ELISA, and the correlations of the results with clinical, laboratory and radiological parameters were assessed.ResultsWe found no statistically significant difference in the RANKL and OPG levels among the groups. Patients with RA showed a positive correlation between the SF cell count and RANKL level (r = 0.59; p < 0.05) and the RANKL/OPG ratio (r = 0.55; p < 0.05). Patients with OA showed a strong correlation between C-reactive protein (CRP) and the RANKL/OPG ratio (r = 0.82; p < 0.05). There was no correlation between the OPG and RANKL levels and markers of inflammatory activity or the disease activity index in patients with RA or SpA.ConclusionWithin this patient cohort, the RANKL/OPG ratio was correlated with the SF cell count in patients with RA and with serum CRP in patients with OA, which may suggest a relationship with active inflammation and more destructive joint disease.

Associations of Neutrophil/lymphocyte ratio with disease activity indices in patients with ankylosing spondylitis

Background: Axial spondyloarthritis (axSpA) is a painful, inflammatory condition of the spine that usually manifests in young individuals with chronic back pain (less than 45 years of age). It may also be accompanied by extra-articular or periarticular (enthesitis, dactylitis) symptoms (uveitis, psoriasis, inflammatory bowel disease). AxSpA encompasses both ankylosing spondylitis (AS) with radiographic evidence of sacroiliitis and axSpA without radiographic evidence of sacroiliitis. Objective: to assess neutrophil/lymphocyte ratio (NLR) among AS patients and to evaluate its relation to disease activity. Methodology: The present investigation included thirty AS patients and thirty healthy controls. Disease Bath Ankylosing Spondylitis Disease Activity indicators were utilized to assess the disease activity of AS (BASDAI). Analyses were conducted on the relationship between NLR and disease activity. Results: There was a significant positive correlation between NLR and Duration of the disease (r=0.421, P=0.020), ESR (r=0.433, P=0.014), CRP (r=0.700, P< 0.001), BASDAI (r=0.433, P=0.017). There was an insignificant correlation between NLR and age. NLR had increased considerably among AS patients compared to controls (P-value <0.05). NLR can significantly predict AS disease activity (P-value <0.001, at cut off value ≥2.03 with 90% sensitivity, 88.89 % specificity, 94.7% PPV and 80% NPV). Conclusion: In conjunction with acute phase reactants, NLR might be a valuable marker for indicating inflammation.

Validation of UVEDAI: An Index for Evaluating the Level of Inflammatory Activity in Uveitis.

Uveitis is the inflammation of the middle layer of the eye, the uvea, and is a major cause of blindness. None of the instruments used in clinical practice are, in themselves, sufficient to evaluate the course of uveitis. Therefore, it is necessary to develop instruments enabling standardized measurement of inflammatory activity. We developed a composite disease activity index for patients with uveitis known as UVEDAI, which considers the overall activity of the eye. The objective of this study was to validate the composite index of ocular inflammation, UVEDAI. A multicenter cross-sectional study involving eight Spanish tertiary hospitals. Sixty-two patients aged ≥ 18years with acute uveitis were recruited. Participants gave informed consent before participating in the study. A full ophthalmological examination was performed by two ophthalmologists to determine inflammatory activity: one used the UVEDAI score and the other used clinical judgment. The ophthalmologists did not share their findings with each other to avoid introducing bias into the analysis. Construct validity was established by means of factor analysis. The criterion validity of the index was determined using an ordinal multivariate regression model, in which the dependent variable was the degree of uveal inflammation (mild, moderate, or high/severe). Cut-off points were determined for the UVEDAI and for the receiver operating characteristic (ROC) curves. Sixty-two patients were included. Total variance with the three components accounted for 80.32% of the construct validity. Each of the three components identified one type of eye involvement. The discriminatory capacity of UVEDAI was 0.867 (95% CI 0.778; 0.955 p < 0.001) for mild versus moderate-high and 0.946 (95% CI 0.879; 1.000 p < 0.001) for high versus mild-moderate. The variables included in UVEDAI enable ocular inflammatory activity to be described with a high degree of accuracy. The index may be used to evaluate and classify this activity with considerable discriminatory power.

Association of NF-κB1/IKKε Gene Expression with Disease Activity Indices in Patients with Early Rheumatoid Arthritis

Association of NF-κB1/IKKε Gene Expression with Disease Activity Indices in Patients with Early Rheumatoid Arthritis

Association of Hypovitaminosis D with Poor Bone Health in Patients of Rheumatoid Arthritis – A Case–Control Study

Abstract Background: Data on correlation between hypovitaminosis D and disease activity indices in patients with rheumatoid arthritis (RA) are varied. In this context, this prospective, case–control study aimed to evaluate the contribution of hypovitaminosis D toward bone health in patients with RA and correlate it with clinical, functional, and radiological disease activity indices. The study objectives were to assess the occurrence of hypovitaminosis D, to determine baseline bone mineral density (BMD), and to evaluate factors likely to contribute to poor bone health in patients of RA. Results: Hypovitaminosis D was observed in 76% of patients of RA with all of them having poor bone health as evident by statistically significant correlation between low Vitamin D levels and poor BMD. Poor bone health was observed in 80% of patients with femoral measurements, exhibiting greater severity of reduced BMD than lumbar spine values. Bivariate analysis revealed significant correlation of low Vitamin D, parathyroid hormone, Modified Sharp Score (MSS), and steroid intake with poor BMD at both spine and femur neck. Furthermore, binary logistic regression analysis among these four variables showed that only MSS had statistically significant association with osteoporosis, and there was a trend towards significance with poor BMD. Conclusions: This study has observed that RA patients indeed have poor bone health. Consequent osteoporosis has multifactorial etiology, and hypovitaminosis D remains one of the prime contributors, yet underappreciated and consequently undertreated.

Research priority setting for paediatric rheumatology in the UK.

The evidence base that underlies the management of children and young people with paediatric rheumatic diseases is deficient. In this field, there are many crucial unanswered questions. The UK Paediatric Rheumatology Clinical Studies Group, supported by UK National Institute for Health Research Clinical Research Network: children and Versus Arthritis, elicited ideas for research priorities from paediatric rheumatologists, trainees, allied health-care professionals, nurse specialists, patients, parents of patients, carers, and charities. These ideas were collected through online surveys and face-to-face meetings. A modified Delphi process was used, which included online research priority ranking surveys and a consensus workshop. A longlist of 55 disease-specific research priorities and 37 general research priorities were voted on in the first survey. A list of 11 top general research priorities was produced. The top ten disease-specific research priorities were discussed in depth at a Delphi workshop to determine their final ranking. This Health Policy paper will help to guide clinicians, academics, and funding bodies to prioritise research in paediatric rheumatic diseases, specifically in areas of unmet patient needs.

Intravoxel incoherent motion diffusion-weighted imaging as a quantitative tool for evaluating disease activity in patients with axial spondyloarthritis

To determine the correlations between four quantitative magnetic resonance imaging (MRI) parameters derived from intravoxel incoherent motion diffusion-weighted images (IVIM DWI) and the semi-quantitative Spondyloarthritis Research Consortium of Canada (SPARCC) score of the sacroiliac joint (SIJ) and five clinical activity indices in patients with axial spondyloarthritis (axSpA). A total of 75 patients with axSpA and complete clinical activity indices and SIJ MRI were enrolled to this prospective study. Univariable and multivariable linear regression analyses were performed to evaluate correlations between MRI parameters and clinical activity indices after controlling for confounders. All data were further analysed using Pearson's correlation coefficients (r). Only pure diffusion coefficient (D) and incoherent perfusion related microcirculation (D∗) were found to be independently positively correlated with several clinical activity indices (all p<0.05). Positive correlations were observed between D and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), extent of influence of pain, with r of 0.605, 0.402, 0.319, and 0.485 (all p<0.0125). D∗ correlated positively with BASDAI, BASFI, and PGA (r=0.436, 0.356, 0.301, respectively; all p<0.0125). D and D∗ derived from IVIM DWI could be associated with some disease activity indices in patients with axSpA; apparent diffusion coefficient (ADC) and SPARCC scores were not correlated with these indices. IVIM DWI may be a useful tool for the quantitative assessment of disease activity in patients with axSpA.

Evaluation of neutrophyl/lymphocyte ratio, platelet/lymphocyte ratio and mean platelet volume according to the disease activity index in patients of ankylosing spondylitis

Objective: To determine the relationship between neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) and mean platelet volume (MPV) with acute phase reactants in patients with ankylosing spondylitis (AS) and to show the usability of these parameters in the activation periods and follow-up of the disease.&#x0D; Material and Method: The demographic data (age, gender) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of 70 patients who had been followed regularly for at least 1 year and whose diagnosis of AS was definite were recorded. The control group consists of 70 people who do not have any disease. Among the laboratory parameters, neutrophil, platelet, lymphocyte count, C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), NLR, PLR and MPV values were retrospectively checked and recorded.&#x0D; Results: In our study, a statistically significant difference was found between the AS patients and the control group in MPV, NLR and PLR values. In addition, these values were found to be statistically significantly different between the groups with low disease activity and high disease activity in the AS patient group. There was a weak negative correlation between MPV value and BASDAI, ESR and CRP values. There was no statistically significant correlation between NLR value and ESR and CRP. There was no correlation between PLR value and ESR and CRP.&#x0D; Conclusion: As a result of our study, NLR, PLR and MPV values are seen as simple, easy and inexpensive markers that can be used to determine disease activity in AS patients.

Serum matrix metalloproteinase-9 concentration as a marker of disease activity in patients with inflammatory bowel disease.

Diagnosing inflammatory bowel disease (IBD), determining the appropriate treatment and follow-up of patients rely mainly on endoscopy and biopsy. Finding a sensitive, specific, cost-effective and less-invasive biomarker is the focus of much of the current research in this field. The aim was to investigate the relation between serum matrix metalloproteinase-9 (MMP-9) levels and disease activity in patients with IBD, correlating with clinical and endoscopic indices of disease activity and with treatment received. Sixty patients (30 with ulcerative colitis, 30 with Crohn's disease) and 20 controls were included. Serum MMP-9 levels were measured for all patients and controls by ELISA. Clinical activity was determined by partial Mayo score for patients with ulcerative colitis and Crohn's Disease Activity Index for patients with Crohn's disease, and endoscopic activity was assessed using Ulcerative Colitis Endoscopic Index of Severity for patients with ulcerative colitis and Simple Endoscopic Score of Crohn's disease for patients with Crohn's disease. Serum MMP-9 was higher in patients with active ulcerative colitis than in patients with inactive disease and the control group. Serum MMP-9 was also higher in patients with active Crohn's disease than in patients with inactive disease and the control group. In both ulcerative colitis and Crohn's disease groups, there was a significant difference between serum MMP-9 levels in patients receiving conventional treatment and those on biological treatment, with lower levels of the marker detected in the sera of patients subgroups receiving biologics. Serum MMP-9 can be used to differentiate between active and inactive IBD (including both ulcerative colitis and Crohn's disease).

OP16 Characterization of the Clinical Features and Outcomes of Paediatric Patients with Isolated Colonic Crohn’s Disease: A Multi-center Study from the Porto Group of ESPGHAN

Abstract Background Isolated colonic (L2) Crohn’s disease (CD) in adults is thought to have unique clinical and genetic features compared with ileal (L1) CD and ulcerative colitis (UC). Similar studies in paediatrics are scarce. Our goal was to characterize the clinical features of paediatric patients with isolated colonic CD and compare them to patients with ileo-cecal CD and those with UC. Methods This was a multi-center retrospective study including 21 sites affiliated with the Porto IBD group and IBD interest group of ESPGHAN. Data of paediatric patients diagnosed between 2014–2017 with L1 or L2 CD, or with UC, was collected, including information on demographic, clinical and laboratory parameters at diagnosis, end of induction, 1 year and 3 years after diagnosis (or at last follow-up). Results Data was collected on 300 children (102 L1, 94 L2, 104 UC) with similar demographic features. At diagnosis, bloody stools were identified in 45% of L2 patients, compared with 15% and 95% of L1 and UC patients, respectively (P&amp;lt;0.001), while fever was documented in 27% of L2 patients, compared to 13% and 3% of L1 and UC patients, respectively (P&amp;lt;0.001). At the time of diagnosis, the median pediatric Crohn’s disease activity index for patients with L1 and L2 was 25 (IQR 17.5–37) and 27.5 (20–40), respectively, while the median pediatric ulcerative colitis activity index was 40 (30–55) for patients with UC. C-reactive protein levels were significantly higher among CD patients (both L1 and L2), compared to patients with UC, and calprotectin values were comparable. ASCA was positive in 55%, 25% and 2% (P&amp;lt;0.001) and pANCA in 2%, 17% and 53% (P&amp;lt;0.001) in L1, L2 and UC patients, respectively. Granulomas were identified in 36% of L2 patients, similar to patients with L1 (33%). For induction therapy, exclusive enteral nutrition, oral steroids and mesalazine were used in 50%, 45% and 38% of patients with L2 CD, compared with 72%, 28% and 9%, and 0%, 52% and 75% of L1 and UC patients, respectively (P&amp;lt;0.001). Steroid-free clinical remission at the end of induction was overall similar between groups, around 55%. At 1-year post-diagnosis, 62%, 68% and 40% were on an immunomodulator (P=0.03) and 41%, 26% and 22% were receiving anti-TNFα agent (P=0.01), of patients with L1, L2 and UC, respectively. While time to initiation of an anti-TNFα agent was significantly shorter in L1 patients compared with L2 and UC (P=0.03), time to admission and time to surgery were similar. Conclusion Paediatric patients with isolated colonic CD exhibit several clinical features which differentiate them from ileo-cecal CD and UC. Prospective studies are required to understand the pathogenesis of this unique entity and define short- and long-term outcomes.

Evaluation of the modified Crohn's disease activity index in patients with Crohn disease with enterostomy: A single-center observational study.

Although the Crohn's Disease Activity Index (CDAI) is often used to evaluate the disease activity in Crohn's disease (CD), the number of liquid or soft stools cannot be precisely evaluated, and thus accurate scores cannot be calculated, in patients with enterostomy. Therefore, we created the modified CDAI (mCDAI), without the defecation frequency item from the CDAI, and examined its usefulness.Study participants comprised 9 patients with CD with enterostomy and 20 patients with CD without enterostomy. Correlations between the mCDAI and serum albumin (Alb) levels or C-reactive protein (CRP) levels were examined using regression analysis. Additionally, regression analyses were conducted in patients with CD without enterostomy to determine the Alb and CRP levels corresponding to the CDAI at its cutoff value for remission status (150). The obtained values were applied to the mCDAI regression equations to determine the equivalent mCDAI cutoff value.mCDAI and Alb levels were significantly negatively correlated (P < .0001). The mCDAI had a significant positive correlation with the CRP level and erythrocyte sedimentation rate (P = .0061 and P = .0133, respectively). From the regression analysis of patients with CD without enterostomy, the Alb and CRP levels equivalent to a CDAI of 150 were 3.85 g/dL and 0.62 mg/dL, respectively. When applying these values to the mCDAI regression formulas, the values of 113.8 and 115.2, respectively, were obtained. Thus, the cutoff value of the mCDAI indicating disease activity was estimated as 115.The mCDAI fully reflects the nutritional status and inflammatory response, and is convenient and useful for assessing disease activity over time, in patients with CD with enterostomy. A mCDAI score ≥ 115 indicates disease activity.

Vitamin D is not useful as a biomarker for disease activity in rheumatoid arthritis

ObjectiveTo determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis (RA). MethodAn analytical, retrospective, cross-sectional study was performed at the Hospital Luis Vernaza (HLV) and Center for Rheumatology and Rehabilitation (CERER). We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria, and with a 25-hydroxyvitamin D (25 [OH] D) test within the last 3 months. The activity of the disease was assessed with the 28-joint Disease Activity Score (DAS 28) and C-reactive protein (CRP) as an acute-phase reactant. Spearman's rank correlation coefficient was used to establish association between the variables. ResultsA total of 100 RA patients were studied. The mean vitamin D levels were 32.9 ± 11.5 ng/mL. In all, 45% showed insufficient 25 (OH) D and 55% had normal levels; no deficient vitamin D values were found. According to the DAS28-CRP, patients with low, moderate and high activity had an average vitamin D level of 30.4 ± 10.7, 31.9 ± 10.7, and 31.8 ± 12.1 ng/mL, respectively. There were no significant correlations between the disease activity and the serum vitamin D level (P = .60). ConclusionIn our group of RA patients, there was no statistically significant correlation between the levels of vitamin D and the activity of the disease, nor were other determining variables associated with vitamin D levels

The Effect of the Presence of Fibromyalgia on Common Clinical Disease Activity Indices in Patients with Psoriatic Arthritis: A Cross-sectional Study.

The Effect of the Presence of Fibromyalgia on Common Clinical Disease Activity Indices in Patients with Psoriatic Arthritis: A Cross-sectional Study.

The relationship between the symptom of fatigue and the functioning of patients with inflammatory bowel diseases after surgery.

IntroductionThe occurrence of fatigue in patients suffering from inflammatory bowel diseases (IBD) is influenced by pain, frequent bowel movements, stress associated with symptoms and time of their occurrence reaction of surroundings, fear for their own health, sleep disturbances, side effects of pharmacological treatment, physical and mental exhaustion, hindered social contacts and difficulties at work.AimTo evaluate the fatigue and the assessment of functioning of patients with IBD, who were treated surgically.Material and methodsTo evaluate the functioning of patients, a Polish version of the Inflammatory Bowel Disease Questionnaire was used. To evaluate the occurrence of fatigue in studied subjects, a Polish version of the Functional Assessment of Chronic Illness Therapy – Fatigue Scale was used. The activity of disease was evaluated with the use of the Crohn’s Disease Activity Index for patients with Crohn’s disease (CD) and the Clinical Activity Index for patients with ulcerative colitis (UC).ResultsBefore surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (28.76 for CD and 28.76 for UC, p = 0.72). Also, after surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (14.8 for CD and 16.0 for UC, p = 0.71). The IBD patients who underwent surgery for CD and UC had significantly lower FACIT-F scores compared to the patients before the surgery (p = 0.001 and p = 0.0001, respectively). IBD patients who underwent surgery for CD and UC had significantly better functioning and higher IBDQ total scores compared to the patients before the surgery.ConclusionsSurgical treatment significantly reduces the fatigue symptom in patients with IBD. The severity of fatigue correlates with disease activity and functioning in the respective areas.

Vitamin A supplementation decreases disease activity index in patients with ulcerative colitis: A randomized controlled clinical trial

IntroductionConsidering the link between vitamin A deficiency and disease activity in ulcerative colitis (UC) and also the association between dietary intake of vitamin A and gastrointestinal symptoms in these patients, this study aimed to investigate the effect of vitamin A supplementation on disease activity in patients with UC. MethodIn the present double-blind randomized controlled clinical trial, one hundred and fifty patients with Mayo score of 6–12 were randomly assigned to receive 25,000 IU/day vitamin A supplements or placebo for two months. The disease activity was calculated by the Mayo clinic score. Within groups and between groups comparisons were performed using paired sample t-test and one-way ANCOVA respectively. For measuring the treatment effect, the response ratio and number needed to treat (NNT) was calculated for the rate of clinical response and mucosal healing. ResultsOne hundred and forty three patients completed the study. After two months of supplementation, significant decreases in Mayo clinic score (p < 0.001) and subscores (p < 0.001) was observed in the intervention group. There were significant differences between the two groups regarding Mayo clinic score and subscores after adjusting for age, sex, BMI, disease duration and baseline values (P < 0.05). Moreover, there were significant differences between two groups regarding clinical response ratio (P < 0.001) and mucosal healing ratio (P < 0.001). The NNT [95%CI] values for the clinical response was 3 [2–40] and for the mucosal healing was 5 [2.90–10.4]. ConclusionAlthough according to the results, daily dose of 25,000 IU vitamin A had positive clinical and endoscopic effects, considering the limitations, further studies with longer duration and larger sample size and considering dietary intake are needed to confirm these preliminary results.

Vitamin D is not useful as a biomarker for disease activity in rheumatoid arthritis.

To determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis (RA). An analytical, retrospective, cross-sectional study was performed at the Hospital Luis Vernaza and Center for Rheumatology and Rehabilitation. We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria, and with a 25-hydroxyvitamin D (25 [OH] D) test within the last 3 months. The activity of the disease was assessed with the 28-joint Disease Activity Score (DAS28) and C-reactive protein (CRP) as an acute-phase reactant. Spearman's rank correlation coefficient was used to establish association between the variables. A total of 100 RA patients were studied. The mean vitamin D levels were 32.9 ± 11.5 ng/mL. In all, 45% showed insufficient 25 (OH) D and 55% had normal levels; no deficient vitamin D values were found. According to the DAS28-CRP, patients with low, moderate and high activity had an average vitamin D level of 30.4 ± 10.7, 31.9 ± 10.7, and 31.8 ± 12.1 ng/mL, respectively. There were no significant correlations between the disease activity and the serum vitamin D level (P=.60). In our group of RA patients, there was no statistically significant correlation between the levels of vitamin D and the activity of the disease, nor were other determining variables associated with vitamin D levels.

Assessing the Correlation of Fecal Calprotectin and the Clinical Disease Activity Index in Patients With Ulcerative Colitis.

It has been shown that fecal calprotectin can be used to evaluate mucosal inflammation better than using clinical indices and serum markers. The aim of this study was to assess the use of fecal calprotectin for evaluating the disease activity in 2 groups of patients with ulcerative colitis and a control group. The study population consisted of 30 patients with active-phase ulcerative colitis, 30 remission-phase patients, and 30 healthy control patients. After obtaining informed consent, we took blood and fecal samples. Fecal calprotectin was assessed by the enzyme-linked immunosorbent assay method; levels of more than 200 μg/g were considered abnormal. The Simple Clinical Colitis Activity Index was used to evaluate disease activity. A one-way analysis of variance test and a Pearson correlation test were used to analyze the results. The means ±SD of the disease activity index were 4 ± 2.8, 6 ± 1.9, and 2.7 ± 2.5 in patients with active-phase and remission-phase ulcerative colitis, respectively (p < .001). Fecal calprotectin (μg/g) values (mean ±SD) for active-phase patients, remission-phase patients, and the control group patients were significantly different: 711.7 ± 228, 517 ± 328.2, and 304 ± 297.5, respectively. There was a significant correlation between fecal calprotectin and the disease activity index values (r = .41; p = .004). Fecal calprotectin could be a useful tool in assessing the bowel disease activity in patients with ulcerative colitis.

Safety, and Humoral and Cell-mediated Immune Responses to Herpes Zoster Vaccine in Patients with Rheumatoid Arthritis.

To examine humoral and cellular immune responses induced by a live attenuated herpes zoster (HZ) vaccine in patients with rheumatoid arthritis (RA) compared with osteoarthritis (OA) patients. This was an observational study of a live attenuated HZ vaccine in 41 patients with RA receiving conventional disease-modifying antirheumatic drugs (cDMARD) and/or low-dose glucocorticoids (GC) and in 28 patients with OA. Blood samples were obtained before and at 12 weeks after HZ vaccination. Immunogenicity was assessed using varicella zoster virus (VZV)-specific interferon gamma ELISA and an in-house ELISA. Clinical outcomes, including adverse events, HZ occurrence, and RA flares, were analyzed. No patients developed vaccination-induced HZ during the followup period (median = 1.6 yrs). The HZ vaccine induced a significant increase in the VZV-specific enzyme-linked immunospot spot-forming units and anti-VZV immunoglobulin G antibodies in patients with RA and OA. The number of spot-forming units was lower in patients with RA than in patients with OA both at baseline and at 12 weeks after vaccination. The disease activity index for patients with RA was similar at baseline and at 12 weeks after vaccination. However, 6 patients with RA (14.6%) experienced a flare during the 12 weeks. Overall, 17 (24.6%) participants reported a mild adverse event such as an injection site reaction (11.6%). The HZ vaccine induced VZV-specific cellular and humoral responses in patients with RA. Although patients with RA showed a weaker vaccine-induced VZV-specific cellular immune response than patients with OA, the vaccine may be considered in patients with RA receiving cDMARD and/or low dose GC.

The Expression of Migration Inhibitory Factor mRNA in Peripheral Blood of Children with Systemic Lupus Erythematosus

Aim: This study was aiming at evaluation of the importance and the change in the level of macrophage migration inhibitory factor (MIF) in serum studied by ELISA and in peripheral blood mononuclear cell (PMBC) through the expression of mRNA of MIF studied by reverse PCR and its correlation with disease activity index in patients with systemic lupus erythematosus (SLE). Also, the relationship of MIF with the treatment by corticosteroids and renal involvement was taken into consideration.Material and methods: For this purpose, twenty lupus patients, regularly attending the Pediatric Allergy and Immunology Clinic, Children Hospital, Ain Shams University and fulfilling the American Rheumatism Association Revised Criteria for diagnosis of SLE, were studied in comparison to thirty-five healthy subjects as normal controls. According to the presence or absence of clinical renal involvement, lupus patients were divided into two groups: Group Ia: included 10 patients with clinical renal involvement and Group Ib: comprised 10 patients without clinical renal involvement. Full history taking and clinical examination were done and the SLEDAI was assessed. Also, the following laboratory investigations were performed ESR, routine microscopic urine analysis, 24 hours urine proteins, serum ANA, C3, serum anti-DNA, serum creatinine, serum MIF by ELISA and MIF gene expression through the mRNA in PBMC by rPCR.Results: The results of the present study showed that the MIF in serum and in PBMC were significantly higher among lupus patients as compared to normal controls. In addition, both were significantly higher among lupus patients with clinically evident nephritis than those without. Serum MIF and MIF gene expression were both significantly higher among lupus patients who suffered from symptoms suggestive of lupus nephritis as edema, hematuria, hypertension and positive anti DNA levels than other patients who did not experience these symptoms. In our study, different correlation analysis were done with serum MIF and MIF gene expression and proved to be significantly positive with SLEDAI score, ESR, cumulative dose of steroids, serum creatinine, 24 hour urinary protein and duration of illness in all lupus patients.Conclusions: In conclusion, MIF both in the serum and MIF gene expression by reverse PCR in macrophages were significantly higher in all lupus patients in comparison to healthy controls being significantly higher in those lupus patients with clinically evident nephritis than those without. Also MIF had a significant positive correlation to SLEDAI score and ESR indicating its correlation with disease activity.