Anti-cyclic citrullinated peptide-2 (CCP2) autoantibodies and extra-articular manifestations in Greek patients with rheumatoid arthritis

The objective of our study was to establish whether there is an association between rheumatoid arthritis with extra-articular manifestations (exRA) and anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies in Greeks. A retrospective study of 220 Greek patients with RA, 95 with exRA and 125 without extra-articular manifestations (cRA). Serum anti-CCP2 antibodies and IgM rheumatoid factor (RF) were measured. CCP2(+) were 65.3% of exRA and 58.4% of cRA patients. RF(+) were 69.5% of exRA and 60.0% of cRA patients. Among exRA patients, 37.9% had high serum anti-CCP2 antibody levels (>100 IU/ml) compared to 21.6% cRA patients (p = 0.008). Serositis and pulmonary fibrosis were found to be associated with high levels of anti-CCP2 antibodies (52.9 vs 26.6%, p = 0.02 and 63.6 vs 26.8%, p = 0.008, respectively). Serum RF levels were 265.0 ± 52.0 IU/ml (mean ± SEM) in exRA and 205.1 ± 40.6 (mean ± SEM) in cRA (NS). High serum RF levels (>268 IU/ml) were more likely to have sicca syndrome. In Greek patients with rheumatoid arthritis (RA), high serum anti-CCP2 antibodies are associated with serositis and pulmonary fibrosis. Therefore, anti-CCP2 antibodies have prognostic significance in patients with RA.     

Coronary surgery in dialysis-dependent patients with end stage renal failure

The number of patients with dialysis-dependent end stage renal failure (ESRF) and coronary heart disease (CAD) has increased in recent years. Coronary artery bypass grafting (CABG) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to increased mortality and morbidity. In a retrospective study we analyzed our clinical results of isolated CABG in 40 dialysis-dependent patients with ESRF (5 female and 35 male, mean age 65+/-8.4 years) and the use of extracorporeal circulation. The perioperative control group comprised 51 patients (10 female and 41 male, mean age 67+/-7.3 years) with normal renal function and isolated CABG. Demographic and preoperative data were comparable in both groups. Hospital mortality was 2.5% in patients with ESRF and 0% in patients with normal renal function. Morbidity was comparable in both groups. The mean number of grafts was 3.1+/-0.9 in the dialysis group and 2.9+/-0.8 in the control group. In the follow-up of the dialysis group (34+/-23 months) 8 patients died. CABG in patients with dialysis-dependent ESRF can be performed with good clinical results and morbidity comparable to patients with normal renal function.     

Ghrelin levels in patients with juvenile idiopathic arthritis: relation to anti-tumor necrosis factor treatment and disease activity

Studies in adults with rheumatoid arthritis reported low serum ghrelin that increased following anti–tumor necrosis factor (TNF) infusion. Data on juvenile idiopathic arthritis (JIA) are lacking. The aim of this pilot study was to explore serum ghrelin levels in patients with JIA and the possible association with anti-TNF treatment, disease activity, and nutritional status. Fifty-two patients with JIA (14/52 on anti-TNF treatment) were studied. Juvenile idiopathic arthritis was inactive in 3 of 14 anti-TNF–treated patients and in 11 of 38 non–anti-TNF-treated patients. The nutritional status, energy intake/requirements, appetite, and fasting serum ghrelin levels were assessed. Ghrelin control values were obtained from 50 individuals with minor illness matched for age, sex, and body mass index. Ghrelin levels in patients with JIA were significantly lower than in controls (P < .001, confidence interval [CI] = −101 to −331). Analysis according to anti-TNF treatment and disease activity showed that ghrelin levels were comparable to control values only in 3 patients with anti-TNF–induced remission. Ghrelin in non–anti-TNF-treated patients in remission was low. Multiple regression analysis showed that disease activity (P = .002, CI = −84.16 to −20.01) and anti-TNF treatment (P = .003, CI = −82.51 to −18.33) were significant independent predictors of ghrelin after adjusting for other potential confounders. Ghrelin did not correlate with nutritional status, energy balance, and appetite. Serum ghrelin is low in patients with JIA and is restored to values similar to those in controls following anti-TNF–induced remission. Our study provides evidence that TNF blockade is independently associated with serum ghrelin, which possibly contributes to anti-TNF–induced remission. These preliminary results could form the basis for future research.     

Entrapped coronary catheter remnants and stents: must they be surgically removed?

Entrapment of catheter components during cardiologic interventions is rare but can cause life-threatening complications and the need for emergency cardiac surgery. We report our surgical series of patients who have experienced entrapped guidewires, Rotablator Systems, and stents after cardiologic interventions. Nine patients were referred for emergency surgery after entrapment of catheter remnants and ensuing acute ischemia. Guidewire fragments persisted in the left anterior descending coronary artery (2 patients) and in the right coronary artery (1 patient); Rotablator Systems lodged in the right coronary artery (2 patients); and stents were entrapped in the left anterior descending coronary artery (3 patients) and in the ramus circumflexus (1 patient). Patients were referred for surgical therapy within 132 +/- 30 min of device entrapment. Surgical procedures included coronary artery bypass grafting and removal of Rotablators or guidewires. Entrapped stents were left in situ, and additional coronary artery bypass grafting was performed. All patients survived. There were no signs of perioperative myocardial infarction. We conclude that surgical strategy has to be individualized in patients with entrapped catheter remnants. The removal of entrapped stents or small fragments of catheter components seems not to be mandatory, if these are contained within small, chronically occluded coronary vessels or within a distal segment.     

Impact of the longitudinal quantitative assessment of juvenile systemic lupus erythematosus severity on the disease outcome

Clinical Rheumatology - This study on juvenile SLE patients aimed to evaluate retrospectively the impact of a tertiary center’s management policy of the disease severity on its long-term...