Accelerated atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus

It is important for primary care physicians to recognise rheumatoid arthritis and systemic lupus erythematosus patients as high-risk groups for atherosclerosis, requiring aggressive risk-factor modification. Recent studies suggest that this increased risk is not explained by an excess of traditional risk factors, but rather appears to be related to underlying rheumatic disease activity. Moreover, there is emerging data that aggressive treatment with disease-modifying agents may reduce the incidence of atherosclerosis in these conditions.     

Altered immunoglobulin metabolism in systemic lupus erythematosus and rheumatoid arthritis

IgG and IgM metabolism was evaluated in 10 patients with systemic lupus erythematosus (SLE), 10 patients with rheumatoid arthritis (RA), and in seven normal volunteers. The biological half-lives of purified IgG and IgM, labeled with (131)I and (125)I, respectively, were determined by serial measurements of radioactivity in the blood and urine with a gamma well counter, and by serial counts of total body radioactivity in a total body counting chamber.The mean survival half-life for IgG in patients with SLE was 8.2 days as compared to an average of 18 days in normal controls. An average of 10.1% of total body IgG was catabolized daily compared to a mean of 3.9% in normal controls. Turnover of IgM in patients with SLE was, with very few exceptions, normal. In contrast, patients with rheumatoid arthritis revealed a milder abnormality of IgG metabolism, but markedly abnormal IgM catabolism with a mean half-life averaging 5.9 days as compared to 9.3 days in control subjects. An average of 14.2% of total body IgM was catabolized daily in patients with RA as compared to 8.1% in normal controls.Our data suggest that there are basic differences between patients with RA and SLE in the synthesis and catabolism of IgG and IgM not readily apparent from serum IgG and IgM concentration. Abnormal IgG and IgM metabolism may be related to underlying immunological mechanisms in these diseases. Immunoglobulin turnover studies appear to be an additional means for the characterization of rheumatic diseases.     

系统性红斑狼疮和类风湿性关节炎患者外周循环中APRIL表达水平的检测和意义

目的探讨增殖诱导配体（APRIL）在系统性红斑狼疮（SLE）和类风湿性关节炎（RA）中的表达情况及其与B细胞刺激因子（BLyS）、抗双链DNA抗体（抗dsDNA）及疾病预后的相关性。方法用逆转录-实时定量聚合酶链反应（PCR）检测19例SLE和39例RA患者及20名健康对照者的外周血单个核细胞（PBMC）中A-PRIL和BLyS mRNA的表达,用酶联免疫吸附试验（ELISA）检测血清中APRIL和BLyS蛋白水平。同时,检测血清IgG、IgA、IgM、类风湿因子（RF）和抗dsDNA水平。结果SLE和RA患者未缓解组较对照组、疾病初发组和治疗后缓解组APRIL mRNA水平显著升高,与BLyS mRNA表达水平呈中等程度的相关性。疾病组外周循环中BLyS蛋白显著升高,APRIL蛋白未见升高,APRIL与BLyS无相关性,APRIL蛋白与抗dsDNA和疾病活动度之间无相关性。结论检测APRIL mRNA含量在判断自身免疫病患者病情和疾病预后中有一定价值。     

Frequency of lymphadenopathy in rheumatoid arthritis and systemic lupus erythematosus

This study aimed to assess the frequency of all palpable lymph nodes during active disease and remission in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Hospital records of 100 SLE patients, 100 RA patients, 100 spondyloarthropathy patients, and 150 osteoarthritis patients, treated in our rheumatology department, were evaluated retrospectively. Overall frequencies of enlarged lymph nodes in patients with active RA and SLE were 82% and 69%, respectively. Enlarged lymph nodes associated with RA were mostly located in the axillary region, and in SLE the nodes were smaller and lymphadenopathy was more generalized compared with RA. Palpable lymph nodes disappeared in the majority of patients during remission. Lymphadenopathy was significantly less frequent in patients treated with steroids before admission. Lymph node enlargement is an important physical finding associated with RA and SLE disease activity. Atypical locations and unusually large lymph nodes should raise clinical suspicion of another underlying disease.     

Serum collagenase-like peptidase activity in rheumatoid arthritis and systemic lupus erythematosus

Collagenase-like (CL) peptidase activity in serum, which was measured using a newly synthesized substrate, (succinyl-Gly-Pro-Leu-Gly-Pro)-4-methylcoumaryl-7-amide, was significantly lower in patients with advanced rheumatoid arthritis or with systemic lupus erythematosus than that in normal controls. Decrease of the serum enzyme activity was more pronounced in systemic lupus erythematosus. No significant change in serum CL-peptidase activity was found in other connective tissue diseases such as mixed connective tissue disease and Sj?gren's syndrome.     

Pro- and antioxidant blood system in patients with rheumatoid arthritis and systemic lupus erythematosus

AIM: To estimate the levels of prooxidants (malonic dialdehyde-MDA and nitric oxide-NO), Zn, activity of antioxidant enzymes (superoxide dismutase--SOD and glutathione peroxidase--GPO) in the blood of patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). MATERIAL AND METHODS: Pro- and antioxidant system was assessed in 45 RA patients and 32 SLE patients by content of MDA estimated by reaction with thiobarbituric acid, NO (Boehringer Manheim kits, Germany), Zn (Unicam SP 190/191, Great Britain), activity of SOD and GPO (kits Ransod, Ransel; Randox, Great Britain). RA activity was evaluated by DAS index, SLE--by SLEDAI. RESULTS: MDA and NO concentrations were found elevated while SOD and GPO activity low in RA and SLE. The level of Zn was subnormal in RA. The activity of RA and SLE did not influence the above indices significantly. CONCLUSION: RA and SLE patients have high levels of prooxidants (MDA and NO) whereas their antioxidant enzymes (SOD and GPO) activity was low. This may promote oxidant stress.     

Spontaneous secretion of antinuclear factors in systemic lupus erythematosus, rheumatoid arthritis and rheumatism

The authors studied the ability of non-stimulated short-term cultures of peripheral lymphocytes of SLE, RA and rheumatic fever patients to spontaneously produce antibodies to DNA and other antinuclear factors. To demonstrate antibodies to DNA, use was made of the radioimmunoassay and the passive hemagglutination test. ANF-test of indirect immunofluorescence. The nosological and clinical features of secretory ANF were explored in the diseases in question. It was established that patients with the main rheumatic diseases are different as regards the rate of demonstration, level and spectrum of secretory ANF. They also differ from the group of donors in terms of the same characteristics. The culture of peripheral lymphocytes of SLE patients has the greatest ability to secrete antibodies to DNA and ANF of the primarily marginal and homogenous types of fluorescence. This characteristic correlates with SLE activity before the disease onset and over time as well as with lupus nephritis. In RA and rheumatic fever, this characteristics correlates with the disease activity, the presence of visceritis in RA. The clinicopathogenetic importance of secretory ANF in rheumatic diseases is discussed.     

Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus

Although peripheral and central nervous system involvement havebeen well recognized in patients with rheumatoid arthritis (RA)and systemic lupus erythematosus (SLE), autonomic nervous system(ANS) involvement has rarely been studied, and has shown conflictingresults. We performed cardiovascular ANS assessment in 34 RAand 37 SLE patients, using standard cardiovascular reflex tests.The results in each patient were compared with age- and sex-matchedhealthy controls. Forty-seven percent of the RA patients and19% of the SLE patients had symptoms suggesting ANS dysfunction.The heart rate variation in response to deep breathing was significantlydecreased in both the RA and SLE patients (p=0.001). This diminishedheart rate response showed no correlation with the disease duration,the number of swollen joints, the Ritchie articular index, ESR,or rheumatoid factor in the RA group, or the disease duration,the SLEDAI score or ESR in the SLE group. The clinical significanceof the diminished cardiovascular ANS response needs to be investigated.     

Serum glycylproline p-nitroanilidase activity in rheumatoid arthritis and systemic lupus erythematosus

Glycylproline p-nitroanilidase activity in serum of patients with advanced rheumatoid arthritis or with systemic lupus erythematosus but with normal hepatic function was found to be significantly lower than that of normal adult controls. Decrease of this enzyme's serum activity was more pronounced in systemic lupus erythematosus. A significant inverse correlation was observed between the enzyme activity and the duration of rheumatoid arthritis.