Parameters Of Inflammatory Activity Research Articles

O impacto da obesidade na atividade da doença em pacientes com espondilite anquilosante

Introduction - Ankylosing spondylitis (AS) or radiographic ankylosing spondylitis is an axial spondyloarthritis with a male predominance, whose symptoms include low back pain associated with morning stiffness that can progress to ankylosis. Its inflammatory etiology is associated with structural changes, which can influence the clinical condition, functionality and response to treatment. Objective: To study body composition and its influence on the inflammatory parameters of AS according to sex. Method: Sixty-seven patients with AS had lean and fat body mass assessed by bioimpedance and Body Mass Index (BMI) assessment. Disease activity was measured by ASDAS PCR and physical function by BASFI. Result: All patients had fat mass above predicted and lean mass below predicted, and the majority had a BMI above normal. There was a positive correlation between BMI and ASDAS PCR only in men, with no correlation in women. Conclusion: Obesity contributed to the increase in inflammatory activity parameters in male AS patients.

O impacto da obesidade nos resultados pós-operatórios de operações abdominais

Introduction: Ankylosing spondylitis or radiographic axial spondylitis is an axial spondyloarthritis with male predominance, whose symptoms include low back pain associated with morning stiffness and may progress to ankylosis. Its inflammatory cause is associated with structural alteration, which may influence clinical presentation, functionality and response to treatment. Objective: To review whether the body composition of patients with ankylosing spondylitis influences inflammatory parameters according to gender. Method: A search was performed in PubMed to identify the available literature. The criteria included the terms “Obesity Paradox”, combined with additional search criteria including the terms “general surgery, abdominal surgery and outcomes” to better define the research. The criteria were restricted to English and Portuguese languages ​​and adult patients. Original articles, systematic reviews and meta-analyses were considered for inclusion. Eligible studies were initially identified by title and abstract. Result: 41 articles were included. Conclusion: Although some groups still require additional studies to prove the real effect of obesity on postoperative results, others already have well-established validity. However, it was demonstrated that obesity contributed to the increase in inflammatory activity parameters in male patients with ankylosing spondylitis.

Dynamics of clinical manifestations and cytokine concentrations in rheumatoid arthritis patients on tofacitinib therapy

Objective - to study the dynamics of clinical and laboratory parameters of inflammatory activity of the disease and cytokines in rheumatoid arthritis (RA) patients on a background of tofacitinib (TOFA) treatment.Material and methods. Ten patients with a reliable diagnosis of RA have been examined: patients' age was 51.0 (48.0; 62.0) years, duration of disease was 7.0 (3.0; 20.0) years. All patients had high disease activity: DAS28 -5.88 (5.53; 5.94), CDAI - 33.0 (29.0; 36.0), SDAI - 33.72 (30.75; 36.85). All patients were treated with TOFA at a dose of 5 mg 2 times a day on a background of methotrexate therapy, non-steroidal anti-inflammatory drugs, and glucocorticoids. Observations were performed before treatment and after 3 and 6 months of therapy. Serum levels of 15 cytokines (IL-1β, IL-4, IL-6, TNF-α, INF-γ, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, sCD40L) were examined using multiplex xMAP technology.After 3 and 6 months of TOFA therapy, there was a significant decrease in DAS28 of 4.55 (3.47; 5.16) and 3.92 (3.80; 4.60); CDAI - 16.5 (11.0; 23.0) and 18.0 (15.0; 19.0); SDAI - 16.6 (11.23; 23.06) and 18.07 (15.06; 19.10); ESR - 19.0 (11.0; 26.0) and 7.0 (4.0; 18.0); CRP - 0.56 (0.50; 1.99) and 0.71 (0.51; 1.1) respectively. IL-6 levels decreased after 3 and 6 months of therapy (p<0.05). The concentration of INF-γ significantly decreased after 3 months (p<0.05), but remained unchanged thereafter. Concentrations of IL-25 and IL-31 decreased after 3 months (p<0.05), and by the 6th month of treatment there was an increase, however, not reaching the initial values.Conclusion. The results of the study show the efficacy of TOFA in RA and create prerequisites for further study of the cytokine-dependent mechanisms of inflammation in this disease.

Adalimumab in Elderly Patients with Non-Infectious Uveitis. Safety and Efficacy

ABSTRACT Purpose: To assess the efficacy and safety of adalimumab in elderly patients with noninfectious uveitis (NIU). Methods: An observational, retrospective, multicenter study was done. Changes in best-corrected visual acuity (BCVA), inflammatory activity parameters, central retinal thickness (CRT), and the occurrence of adverse events (AE) developed during follow-up were recorded. Results: A total of 82 eyes from 41 patients 60 years of age and older with noninfectious uveitis treated with adalimumab were included. A significant improvement in BCVA (71.5 to 75.4 letters, p = .001) and in CRT (311.1 μm to 265 μm, p = .001) was observed. Moreover, a significant decrease from baseline in the rate of patients with anterior chamber cell (ACC) >0+ (34.6% to 5.7%, p = <0.001) or vitreous haze>0+ (21.3% to 4.3%, p = .002) was determined. AEs were observed in 11 patients (26.8%). Conclusion: Adalimumab can be safe and efficacious for the treatment of NIU in patients 60 years of age and older.

Drug-neutralizing Antibodies againstTNF-α blockers as Biomarkers of Therapy Effect Evaluation.

TNF-α blocker therapy is part of the treatment with biologics used in the management of inflammatory joint diseases. In recent years, drug-induced neutralizing antibodies have been shown to have a negative effect on the course of the disease process. To investigate drug-induced neutralizing antibodies against TNF-α blocking drugs used in patients with inflammatory joint diseases and their effect on the clinical course of the disease. The study included 121 (56.8%) patients with rheumatoid arthritis, 50 (23.5%) patients with ankylosing spondylitis, 42 (19.7%) patients with psoriatic arthritis, and 31 sex and age-matched healthy controls. The patients were monitored at 0, 6, 12, and 24 months after initiation of TNF-α blocker treatment. The demographic data, vital signs and the parameters of inflammatory activity (C-reactive protein, erythrocyte sedimentation rate, and disease activity indices) were analyzed in all patients. Drug-induced anti-TNF-α blockers antibodies (adalimumab and etanercept) were analyzed using ELISA. Statistical analysis was performed with SPSS v. 24. Drug-induced neutralizing antibodies against adalimumab were obtained in 11.57% of patients at 6 month, in 17.64% at 12 month, and in 24.8% at 24 month. Drug-induced neutralizing antibodies to etanercept were not demonstrated in patients followed up at 6 months, at 7.77% at 12 months, and at 9.63% at 24 months. Between the presence of neutralizing antibodies to blockers of TNF-α and indices available for disease activity, there is a strong positive correlation and Pearson Correlation = 0.701, p=0.001. Patients with poor clinical response and available antibodies against adalimumab at 12 months were 82.36% and patients treated with etanercept 71.42%. The difference between the two groups was non-significant (U = 0.527, p> 0.05). Patients with poor clinical response and available anti-adalimumab antibodies at 24 month were 75%, and in patients treated with etanercept - 87.50%, the difference between the two groups not being able to reach significance (U = 0.623, p> 0.05). Drug-induced neutralizing antibodies against TNF-α blockers (adalimumab and etanercept) have a negative effect on the course of inflammatory joint disease and can be used as reliable biomarker to assess the effect of the treatment with these drugs.

Features of ankylosing spondylitis at different stages in men and women

The incidence of ankylosing spondylitis (AS) has recently increased with a substantial rise in the proportion of female patients, making this investigation relevant.Objective: to investigate the clinical and laboratory parameters of inflammatory activity and functional status in male and female patients with AS at different stages of the disease.Patients and methods. Examinations were performed in 119 patients (82 men and 37 women) (mean age, 36.4±0.9 years) with AS and 34 patients (24 men and 10 women) (mean age 27.0±1.6 years) with non-radiographic axial spondyloarthritis (nr-axSpA). The investigators used the 1984 modified New York criteria to confirm AS diagnosis and the 2009 ASAS classification criteria for axial spondyloarthritis. They also determined AS activity by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and functional status by the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI). For the calculation of enthesites, the validated index Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used; pain intensity in the last week was estimated using a visual analogue scale (VAS). Laboratory examination included the determination of ESR and HLA-B27 antigen. All the patients underwent a plain film of the pelvic bones; and patients with nr-axSpA had magnetic resonance imaging for sacroiliitis.Results and discussion. In both groups, there was a male preponderance and axial lesions were more common (among the patients with AS, there were 68.9% of the men with sacroiliac joint lesions and 53.7% of those with spinal involvement; among the patients with nr-axSpA, there were 80.0 and 67.6 %, respectively; p&gt;0.05). The HLA-B27 antigen was detected in the majority of patients with AS (86.6% of men and 91.7% of women) and in those with nr-axSpA (91.6 and 80.0%, respectively). Uveitis was more common in women with AS (32.4%), less common in men with AS (17.1%); (p&lt;0.05) and nr-axSpA (8.3%); uveitis was not observed in women with nr-axSpA (p&lt;0.001). The pain according to VAS was more intense in women (48.1±3.4 mm; p&lt;0.01); in the nr-axSpA group, its values were comparable in men and women (p&gt;0.05). The BASDAI and BASFI scores were similar in women at all stages of the disease (p&gt;0.05). The men with nr-axSpA had the best functional status (p&lt;0.01) with the same BASDAI activity (p&gt;0.05) compared with those with AS. The BASMI in patients with AS regardless of gender was higher than in those with nr-axSpA (p&lt;0.01). High BASDAI activity was more frequently detected in women with AS and nr-axSpA than in men (64.9 and 60.0%, respectively; p&lt;0.01). Low activity was not observed in any woman with nr-axSpA. Enthesitis was more common in women in both AS and nr-axSpA (81.0 and 80.0%, respectively; p&lt;0.05).Conclusion. In women, AS and nr-ax-SpA are more severe, starting at their early stage, which is manifested by a higher activity, functional failure, and a higher frequency of extra-axial manifestations.

Pathobiochemical Mechanisms Relating Iron Homeostasis with Parameters of Inflammatory Activity and Autoimmune Disorders in Rheumatoid Arthritis.

To find the correlations between the parameters of iron homeostasis, inflammatory activity and autoimmune disorders in rheumatoid arthritis (RA). The present study included 114 patients with RA and 42 healthy controls. We determined the parameters of iron homeostasis: serum iron, total iron binding capacity (TIBC), ferritin and soluble transferrin receptor (sTfR), the parameters of inflammatory activity: C-reactive protein (CRP), interleukin-6 (IL-6) and prohepcidin, and the parameters of autoimmune disorders: rheumatoid factor (RF), anti-cyclic citrullinated peptide (antiCCP) antibodies and DAS 28. The levels of sTfR, CRP, IL-6 and prohepcidin were significantly higher in RA patients than those in the controls and the level of serum iron was significantly lower in RA than that in the control group. Unlike the controls, in RA, there was a significant positive correlation of sTfR with the parameters of inflammatory activity (IL-6, prohepcidin, ESR) and with the parameters of autoimmune disorders (DAS 28, RF, antiCCP). A negative correlation of serum iron with sTfR was found only in RA patients. Prohepcidin positively correlated with the parameters of inflammation (CRP, ESR) and with the parameters for evaluation of autoimmune disorders (DAS 28 and RF) in the RA group. Our study shows that the simultaneous determination of the two parameters sTfR and prohepcidin is most informative for evaluation of the changes in iron homeostasis in RA. The increase of both parameters provides information for tissue iron deficiency (assessed by the level of sTfR), caused by the inflammation when prohepcidin is expressed.

Immunonutrition in patients with cyctic fibrosis leads to drop of serum amyloid A and increase of oxidative stress.

The aim of the present study is to evaluate of the impact of immunonutrition on parameters of oxidative stress and inflammation in patients with cystic fibrosis and malnutrition. In the 30 patients with cystic fibrosis and long-term enteral nutrition support for malnutrition the effect of standard and immunonutrion sipping on oxidative stress and inflammatory activity parameters was compared. Malonyldialdehyde (MDA) as parameter of oxidative stress and serum amyloid A (SAA), interleukin 1 and 6, hsCRP, IgM, IgA, IgG as parameters of inflammatory activity were examined. Immunonutrition decreased SAA to 17.6 mg/L comparing to 25.6 mg/L when standard nutrition was given (p = 0.014). MDA was 0.66 µM on standard and 0.96 µM on immunonutrition support (p<0.01). The significant negative correlation was recorded between MDA and SAA, hs-CRP, interleukin 6, IgA and IgG. In conclusion, the application of immunonutrition in patients with cystic fibrosis and malnutrition is associated with drop of SAA but with the rise of MDA.

Pathobiochemical Mechanisms Relating Iron Homeostasis to Parameters of Inflammatory Activity and Autoimmune Disorders in Rheumatoid Arthritis.

To find the correlations between the parameters of iron homeostasis, inflammatory activity and autoimmune disorders in rheumatoid arthritis (RA). The present study included 114 patients with RA and 42 healthy controls. We determined the parameters of iron homeostasis: serum iron, total iron binding capacity (TIBC), ferritin and soluble transferrin receptor (sTfR), the parameters of inflammatory activity: C-reactive protein (CRP), interleukin-6 (IL-6) and prohepcidin, and the parameters of autoimmune disorders: rheumatoid factor (RF), anti-cyclic citrullinated peptide (antiCCP) antibodies, and DAS 28. The levels of sTfR, CRP, IL-6 and prohepcidin were significantly higher in RA patients than those in the controls and the level of serum iron was significantly lower in RA than that in the control group. Unlike the controls, in RA, there was a significant positive correlation of sTfR with the parameters of inflammatory activity (IL-6, prohepcidin, ESR) and with the parameters of autoimmune disorders (DAS 28, RF, antiCCP). A negative correlation of serum iron with sTfR was found only in RA patients. Prohepcidin positively correlated with the parameters of inflammation (CRP, ESR) and with the parameters for evaluation of autoimmune disorders (DAS 28 and RF) in the RA group. Our study shows that the simultaneous determination of the two parameters sTfR and prohepcidin is most informative in evaluating the changes in iron homeostasis in RA. The increase of both parameters provides information for tissue iron deficiency (assessed by the level of sTfR), caused by the inflammation when prohepcidin is expressed.

THE CLINICAL SIGNIFICANCE OF MATRIX METALLOPROTEINASES IN RHEUMATOID ARTHRITIS PATIENTS (REVIEW OF THE LITERATURE AND OUR OWN DATA)

Matrix metalloproteinases (MMPs) are a group of over 20 proteolytic enzymes responsible for cleavage of protein components of the extracellular matrix. Three types of MMPs play an important role in the development of joint damage in patients with rheumatoid arthritis (RA): collagenases (MMP1, 8 and 13), stromelysins (MMP3), and gelatinases (MMP9). MMP3 is considered to be one of the key mediators of joint damage. Increased serum level of MMP is not specific for RA and may be registered in other rheumatic diseases (osteoarthritis, psoriatic arthritis, gout, ankylosing spondylitis, systemic lupus erythematosus); however, monitoring of the level of MMP is of particular clinical importance in patients with RA. MMP3 serum level may be a useful marker of disease activity. Several studies have shown a correlation of MMP3 concentration with clinical and laboratorial parameters of inflammatory activity (ESR and C-reactive protein – CRP) in RA patients. The elevated level of MMP3 is associated with radiological changes in joints and can also be a predictor of severe destructive lesions in RA patients. Evaluation of the MMP3 level can also be useful for monitoring the therapy effectiveness using both standard disease-modifying antirheumatic drugs (DMARDs) and genetically engineered biological drugs (GEBD). Thus, evaluation of MMP3 concentration is useful for assessing disease activity and efficacy of treatment with DMARDs and GEBD, as well as for predicting the severity of destructive changes in joints.

The problem of activity in systemic scleroderma

The problem of systemic scleroderma (SSD) activity enters into the view of standardized patient examination and it is important for choosing a therapeutic complex, for determining the dose of drugs, and for monitoring therapy. Great difficulties in the determination of activity in SSD are caused by the pathogenetic and morphogenetic features of the disease. It should be emphasized that there are no clearly defined exacerbation and remission periods. It is difficult to differentiate the potentially reversible inflammatory changes determining the activity of SSD from the irreversible fibrous changes characterizing the severity of the disease. The laboratory parameters of inflammatory activity are also of little informative value. The complicated problem of activity in SSD is to be further investigated both to improve and modify existing indices and to search for a common specific marker and/or key pathogenetically and clinically relevant markers of disease activity.

SAT0080 Early Rheumatoid Arthritis Patients without Treatment: Baseline Asessment of Insulin Resistance and Cytokines

ObjectivesTo analyze insulin resistance (IR), inflammatory cytokines, adipokines and clinical and laboratory characteristics in patients with early rheumatoid arthritis (ERA) who have not received any treatment for their disease.MethodsThis is...

AB0395 Systemic osteoporosis and its relationship with disease activity in patients with early arthritis

BackgroundThe etiopathogenesis of bone loss seen in patients with rheumatoid arthritis (RA) is multifactorial. Factors that are intrinsic to the individual (age, gender), as well as disease- and treatment-related factors...

ASSOCIATION BETWEEN CARDIAC LESION AND OTHER CLINICAL MANIFESTATIONSOF ANKYLOSING SPONDYLITIS

Objective: to study associations between the lesion of the heart and aorta and other clinical manifestations and the characteristics of ankylosing spondylitis (AS). Subjects and methods. Three hundred and forty-four patients under 60 years of age with a valid diagnosis of AS without concomitant heart disease, followed up at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 2005-2008, were examined. Of them, 64 (18.6%) patients had at least one attack of uveitis during the disease; 280 had never uveitis. During the disease, peripheral arthritis occurred in 160 (46.5%) patients; 184 (53.5%) had axial AS. All the patients underwent ECG; 101 had EchoCG (27 with uveitis and 74 without uveitis, 63 with arthritis and 38 without arthritis). Results. Forty-four patients were found to have cardiac conduction disturbances (atrioventricular or left bundle-branch block); of them 14 (31.8%) and 30 (68%) had uveitis and peripheral arthritis, respectively. Out of the 300 individuals without conduction disturbances, 50 (16.7%) and 130 (43%) had the above conditions (p = 0.01 and 0.003, respectively). Cardiac structural changes (aortic thickening/dilatation, subaortic bump, aortic and/or mitral leaflet thickening) were revealed in 45 patients; among them 21 (46.7%) and 34 (75%) had uveitis and arthritis, respectively; of the 56 patients without EchoCG changes, 6 (10.7%) and 29 (51%) had the above conditions (p = 0.0001 and 0.02, respectively). On the other hand, conduction disturbances were noted in 15 (23.4%) of the 64 patients with uveitis and in 29 (10.3%) of the 280 patients without this condition; p = 0.006; in 30 (19%) of the 160 patients with peripheral arthritis and in 14 (7.6%) of the 180 patients without arthritis; p = 0.003. Aortic and valvular changes were detected in 16 (59.2%) of the 27 patients with uveitis and in 28 (37.8%) of 74 without this condition; p = 0.04; in 36 (57%) patients with arthritis and in 9 (23%) of the 38 without arthritis; p = 0.018. There were no significant differences in the parameters of inflammatory activity between the groups. Conclusion. In patients with AS, cardiac lesion was significantly more frequently in the presence of uveitis and peripheral arthritis; uveitis and peripheral arthritis were significantly more common in patients with AS-induced cardiac changes.

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases

The neuroendocrine polypeptide hormone beta-endorphin (beta-END), which is released from various tissues including the anterior pituitary gland and cells of the immune system, has recently been implicated as having an immunoregulatory role. We used a radioimmunoassay to measure beta-END levels in circulating mononuclear leucocytes from normal subjects and patients with various rheumatic diseases. Levels of beta-END in leucocytes from patients were lower than in leucocytes from healthy subjects (P less than 0.001). Whereas levels of beta-END in leucocytes from patients with the various rheumatic disorders were not significantly different, an inverse correlation was found between beta-END levels in leucocytes and expression of rheumatoid factor (P less than 0.025) and erythrocyte sedimentation rate (P less than 0.025). This study demonstrates decreased content of beta-END in cells of the immune system related to parameters of inflammatory activity in rheumatic diseases.

Chemiluminescence in inflammatory bowel disease patients: a parameter of inflammatory activity

Background: Reactive oxygen species (ROS) are produced in excess in the inflamed mucosa and peripheral blood of patients with inflammatory bowel disease. These species have emerged as a common pathway of tissue injury in a wide variety of inflammatory and other disease processes. The present study was conducted to assess ROS production and to correlate this with parameters of inflammatory activity. Methods: In 25 patients with Crohn's disease (CD), 20 patients with ulcerative colitis (UC) and 65 age- and sex-matched healthy volunteers ROS production was measured using the whole blood luminol enhanced chemiluminescence assay (LECA). Disease activity was assessed using the Crohn's disease activity index and the Ulcerative Colitis Symptoms Score (UCSS) for CD and UC, respectively. Furthermore, the effect of various scavengers, enzymes and enzyme inhibitors on LECA was studied to assess the contribution of different ROS. Results: LECA was significantly higher in CD and UC patients compared with healthy controls (7.1±4.7 and 9.8±6 vs. 5.2±2.8×10 3 counts per minute (cpm), p<0.05 and <0.001). In CD, relative LECA (patient/control) was correlated with the Crohn's disease activity index and C-reactive protein (CRP) ( r=0.54, p=0.001 and r=0.51, p=0.01). In UC, CRP but not LECA was correlated with the Ulcerative Colitis Symptoms Score (C-reactive protein: r=0.42, p=0.01). Addition of azide, superoxide dismutase, deferoxamine and dimethylthiourea resulted in a decrease of LECA values. Conclusion: Whole blood LECA is increased in patients with CD and UC. This parameter is correlated with disease activity in CD. The observed chemiluminescence is probably due to generation of superoxide and the hydroxyl radical.

Objective and Subjective Sleep Disturbances in Patients with Rheumatoid Arthritis

To assess objective and subjective evidence of sleep disturbances in patients with rheumatoid arthritis (RA) and to examine correlations between parameters of inflammatory activity and sleep pathology. Nineteen RA patients and 19 age-matched healthy control subjects underwent all-night polysomnography on 2 consecutive nights. RA patients were also evaluated for daytime sleepiness by mean sleep latency test and responded to a self-report questionnaire on their first night. Whereas normal sleep architecture is conserved in RA, we confirmed former findings of severe sleep fragmentation and an enhanced presence of primary sleep disorders. No correlation exists between RA activity and the sleep disorders. Subjective assessment was not consistent with the objective evidence of sleep disruption, unlike the findings in patients with fibrositis. Sleep is severely disturbed in patients with RA, regardless of the inflammatory disease activity. The specificity of the sleep disorders assessed needs confirmation, as does specific sleep therapy for these patients.

Thrombocytosis in active rheumatoid arthritis. Relation to other parameters of inflammatory activity and confounding effect of automated cell counting.

The magnitude of thrombocytosis and the possible confounding effect of platelet clumping, an in vitro artifact resulting in spuriously low platelet counts, in active rheumatoid arthritis (RA) was evaluated by a prospective survey of 57 consecutive patients, 60% of whom had thrombocytosis. Five cases (9%) of platelet clumping, assessed by H6000 pictures, were found. A low-grade platelet loss in many of the samples anticoagulated by EDTA was suggested by comparison with platelet counts obtained in parallel blood samples anticoagulated by citrate. Thus, the possibility of spuriously low platelet counts due to laboratory artifacts must always be taken into consideration in RA patients. The relation between thrombocytosis and other estimates of disease activity was also studied. The platelet count in citrated blood in active RA was significantly correlated with ESR, acute phase plasma proteins, and neutrophil, basophil and monocyte counts. In a multivariate regression model, however, only the correlation with haptoglobin (p = 0.06) approached significance.