Advanced glycation end-product (AGE) pentosidine has previously been demonstrated in different tissues and body fluids. It was suggested as a novel marker for evaluating the pathologic activity in rheumatoid arthritis (RA). In this study we analyzed the relation between pentosidine and markers of inflammation, cartilage turnover, immune response, and disease status of RA. Using HPLC, we analyzed pentosidine in serum and synovial fluid from 39 patients with RA and in serum from 38 healthy controls. Cartilage oligomeric matrix protein (COMP) and antibodies to CCP (anti-CCP) were measured by ELISA. Clinical disease status was assessed by Disease Activity Score 28 (DAS 28) and functional status by Health Assessment Questionnaire (HAQ). We demonstrated significantly higher serum levels of pentosidine in RA patients in comparison with controls. Pentosidine in serum significantly correlated with pentosidine in synovial fluid. Serum pentosidine levels were associated with erythrocyte sedimentation rate (p<0.03) but not with CRP, COMP, anti-CCP antibodies, DAS 28, or HAQ. In contrast to previous studies, we could not show any correlation of pentosidine levels with inflammatory status, clinical disease activity, markers of immune response, or cartilage breakdown. However, AGEs can be suggested as important players participating in joint destruction rather than markers of disease activity., L. Šenolt, M. Braun, J. Vencovský, L. Šedová, K. Pavelka., and Obsahuje bibliografii a bibliografické odkazy
Interleukin-21 (IL-21) plays an important role in the pathogenesis of rheumatoid arthritis (RA). The aim of our study was to assess serum levels of IL-21 in patients with recent-onset RA in relation to disease activity and response to treatment. We analyzed serum levels of IL-21 in 51 RA patients, both before and 12 weeks after the initiation of treatment and in 36 healthy individuals. Disease activity was assessed at baseline and at weeks 12 and 24 using the Disease Activity Score for 28 joints, serum levels of C-reactive protein, and the total swollen joint count. We found that IL-21 levels were not increased in patients with recent-onset RA compared with healthy controls, but they had significantly decreased from baseline to week 12 during treatment. Baseline levels of IL-21 significantly correlated with measures of disease activity (p<0.02 for all). Although IL-21 levels did not predict achievement of remission, decrease in IL-21 levels correlated with improvement in disease activity after 12 weeks (p<0.02) and also after 24 weeks (p<0.04) of treatment. Our data suggest that circulating IL-21 levels may serve as a biomarker of disease activity and better outcome in early phase of RA., O. Sglunda, H. F. Mann, H. Hulejová, O. Pecha, L. Pleštilová, O. Růžičková, M. Fojtíková, O. Šléglová, Š. Forejtová, K. Pavelka, J. Vencovský, L. Šenolt., and Obsahuje bibliografii
The aim of our study was to investigate adrenocortical function in the context of disease activity and inflammatory status in premenopausal RA females. Adrenal glucocorticoid and androgen responses to the 1 μg ACTH 1-24 test were investigated in 23 premenopausal RA and in 15 age- and BMI-matched healthy females. Twelve RA patients were on low-dose prednisone (<8.5 mg/day). Patients with DAS28>3.2 had lower (p<0.05) total plasma cortisol, 17-hydroxyprogesterone, dehydroepiandrosterone and androstenedione responses in the ACTH test compared to healthy controls. Patients with DAS28>3.2 had lower (p<0.05) dehydroepiandrosterone response in the ACTH test compared to patients with DAS28≤3.2. C-reactive protein (CRP), DAS28, and interleukin (IL)-6 negatively correlated with androstenedione response to ACTH 1-24. Responses of all measured adrenal steroids were lower (p<0.05) in patients on low-dose glucocorticoids compared to healthy controls. RA patients not treated with glucocorticoids had lower total cortisol response (p=0.038) but did not differ in free plasma cortisol in the ACTH test. The results indicate an association of increased disease activity with a decrease in adrenal androgen production in RA and normal cortisol bioavailability in patients not treated with glucocorticoids., R. Imrich, M. Vlcek, J. Kerlik, M. Vogeser, F. Kirchhoff, A. Penesova, Z. Radikova, J. Lukac, J. Rovensky., and Obsahuje bibliografii
Cíl. Zjistit, zda je možné pomocí ultrazvukového vyšetření s kontrastní látkou, odlišení zánětlivého postižení charakterizovaného angiogenezí (revmatoidní artritidy) od změn degenerativních. Zjistit, zda aplikace kontrastní látky pomůže odlišit aktivní fázi od změn chronických u již stanovené revmatoidní artritidy (RA). Metoda. Vyšetření probíhala na přístroji Philips iu22 s povrchovou lineární sondou 12-17 MHz, kontrastní látka (k.l.) použitá v této práci byl sulfurhexafluorid (SonoVue®, Bracco) v množství 5 ml. První skupina (odlišení revmatoidní artritidy od degenerativních změn) zahrnovala 63 pacientů, druhá skupina pacientů (stanovení aktivní fáze revmatoidní artritidy) obsahovala vyšetření 55 pacientů. Všichni pacienti byli sledováni revmatologem, byla provedena zvyklá laboratorní vyšetření, u pacientů s revmatoidní artritidou bylo stanoveno DAS28 skóre. Výsledky. Při statistickém zpracování byla senzitivita odlišení degenerativních změn od revmatoidní artritidy 75%, specificita 83,7%, u druhého cíle byla senzitivita aktivní fáze RA 80,6 %, specifkita 66,7% při DAS skóre vyšším jak 5. Na hladině významnosti a = 0,05 byl shledán statisticky významný rozdíl v DAS skóre mezi pacienty s negativním a pozitivním výsledkem ultrazvuku (p < 0,001). Závěr. Senzitivita a specificita vyšetření ultrazvukového vyšetření s kontrastní látkou při odlišení zánětu od změn degenerativních může přispět v diferenciální diagnostice u zánětů, které jsou charakterizovány angiogenezí. U stanovení aktivní fáze RA byla shledána vysoká senzitivita a nižší specificita při ultrazvukovém vyšetření. V obou případech by se však tato metoda mohla stát součástí algoritmu vyšetření., Aim. The aim of this work was to determine whether the contrast enhanced ultrasound examination would be useful in differentiation between inflammatory joint disease (characterized by angiogenesis) and degenerative disease and to determine whether this method could help to distinguish the active phase of chronic rheumatoid arthritis (RA). Method. All patients were examined on the ultrasound device Philips iu22 using linear probe 12-17 MHz, the applied contrast agent was sulfurhexafluorid (SonoVue®, Bracco) in quantities of 5 ml. The first group (differentiation between RA and degenerative changes) includes 63 patients, a second group (determination of the active phase of RA) includes 55 patients. All the patients underwent also clinical examination performed by rheumatologist and laboratory examination, in patients with RA the DAS28 score was established. Results. The sensitivity for the differential diagnosis between the degenerative disease and RA was 75%, specificity 83.7%. For the determination of RA active phase the sensitivity was 80.6%, specificity 66.7%. For the correlations we used the cut-off DAS score 5 to identify the active RA patients. We found statistically significant difference in DAS score between RA patients with negative and positive findings on ultrasound (p < 0,001). Conclusion. We found that contrast enhanced ultrasound provides clinically acceptable sensitivity and specificity for differentiation between RA and degenerative disease, high sensitivity and comparatively lower specificity for the RA active phase identiffication. This method thus may become a valuable part of the diagnostic algorithm in patients with inflammatory joint disease., Andrea Šprláková-Puková, Alena Štouračová, Miloš Keřkovský, Zdeněk Fojtík, Monika Obrovská, Tomáš Pavlík, and Literatura
Osteoporosis in chronic diseases is very frequent and pathogenetically varied. It complicates the course of the underlying disease by the occurrence of fractures, which aggravate the quality of life and increase the mortality of patients from the underlying disease. The secondary deterioration of bone quality in chronic diseases, such as diabetes of type 1 and type 2 and/or other endocrine and metabolic disorders, as well as inflammatory diseases, including rheumatoid arthritis - are mostly associated with structural changes to collagen, altered bone turnover, increased cortical porosity and damage to the trabecular and cortical microarchitecture. Mechanisms of development of osteoporosis in some inborn or acquired disorders are discussed., I. Zofkova, P. Nemcikova., and Obsahuje bibliografii