ObjectiveThe aim of this pilot-study was to examine serum calprotectin levels (sCAL) in patients with SLE and determine possible association with disease activity and history of vascular ...events.Methods27 consecutive SLE patients from daily hospital and outpatient rheumatology clinic and 13 healthy volunteers underwent demographic data collection, sCAL assessment (ELISA Buhlmann sCAL diagnostic test), and disease activity assessment by SLEDAI-2K for SLE patients. Patients were divided into two groups, active disease and remission, taking SLEDAI-2K value of 6 as a cut-off, and defined patients who had recent vascular incidents associated with SLE.Results13 patients in active group (38.5% women, median age 50 (35–58), SLE duration 8.85±6.26 years, SLEDAI-2K 14 (7–21)) were compared to 14 patients in remission group (85,7% women, median age 39 (35–53), disease duration 5.21±2.78 years, SLEDAK-2K 3.5 (2–4)) and to 13 control subjects (76,9% women, median age 25 (24–26)). Significantly higher occurrence of neuropsychiatric disease (53.8% vs. 14.3%, P=0.032) and vascular manifestations (76.9% vs. 14.3%, P=0.001) was observed in active patients compared to those in remission. We haven’t observed the difference in occurrence of APS, serositis, dermatologic, constitutional, renal, or hematologic manifestations of SLE between groups. sCAL levels were higher in all patients compared to the control group (1.1 (0.53–1.8) μg/ml vs. 0.7 (0.38–1.1) μg/ml, P=0.02). Moreover, sCAL was higher in the active group compared to remission patients (1.6 (1.1–3.0) μg/ml vs. 0.8 (0.2–1.4) μg/ml, P= 0.02). Patients with a history of recent vascular events had greater sCAL respect other SLE patients (1.7 (1.15–3) μg/ml vs. 1.0 (0.225–1.375) μg/ml, P=0.015). There was a positive correlation between SLEDAI and sCAL in all patients (ρ=0.532, P=0.0043), particularly in active ones (ρ=0.673, P=0.0017). There was no correlation between SLEDAI and sCAL within inactive patients (ρ=0.0678, P=0.818).ConclusionsSLE patients, especially those with active disease, had higher sCAL compared to healthy subjects. We established a positive correlation between vascular manifestations of SLE and sCAL, but also between SLEDAI-2K and sCAL in patients with active disease. Our study was limited due to the small sample size. Further research should confirm these hypotheses on a larger number of subjects.AcknowledgementThe authors declare no conflict of interest. This research was funded by the University of Split, School of Medicine.
Psoriatic arthritis is a chronic, seronegative spondyloarthropathy associated with psoriasis, depending on patient presentation treatment options range from non-pharmacologic measures to NSAIDs, ...DMARDs, and biologics. Secukinumab is a human monoclonal antibody that specifically targets interleukin-17 and has been shown to be highly effective in the treatment of psoriatic arthritis. As the use of IL-17 inhibitors has been approved in the treatment of psoriatic arthritis, clinicians need to be aware of unusual adverse events not previously observed in clinical trials. We report a rare case of Henoch-Schönlein purpura vasculitis induced by secukinumab in a 39-year-old patient. Therefore, using biologic drugs in clinical practice should be aware that cutaneous vasculitis may be triggered by anti-IL17 treatment, and early diagnosis always helps to decrease morbidity and reduce the amount of time to recovery as well as the impact on the quality of life disruption.
Objective
To analyze the correlations of saliva production and pH value with disease activity, disease severity, and oral health-related quality of life in patients with diffuse cutaneous systemic ...sclerosis (dcSSc) without concomitant Sjögren’s syndrome (SS) or SS-related antibodies.
Methods
This cross-sectional study included 28 patients with dcSSc and matching healthy controls. Sialometric assessment and caries status were compared between the two groups. Clinical and laboratory parameters were used to evaluate disease severity, in accordance with the Medsger Severity Scale.
Results
In patients with dsSSc, reduced saliva production and higher pH value were associated with disease activity and severity; moreover, caries status was correlated with SSc disease characteristics, including disease duration and disease severity. Oral health-related quality of life was negatively correlated with mean salivary flow rate.
Conclusions
These findings contradict the existing notion that reduced saliva production in patients with SSc is linked to SS-related antibodies or caused by underlying SS. In addition, patients with dcSSc exhibit elevated risk of cardiovascular disease and invasive dental treatment has been shown to enhance the rates of stroke and heart attack in the general population; therefore, oral health is particularly important in patients with SSc.
Various connective tissue diseases tend to affect specific organs, lungs being the organ with the most serious repercussions and consequences. The diagnosis of interstitial lung disease makes the ...treatment more difficult and worsens long-term prognosis and overall survival. Positive results from the registration studies of nintedanib led to approval of the drug for the treatment of idiopathic pulmonary fibrosis and chronic fibrosing interstitial lung diseases in connective tissue diseases. After registration, real-world data on the use of nintedanib are being collected in everyday clinical practise. The objective of the study was to collect and analyse real world experience gathered after the registration of nintedanib for the treatment of CTD-ILD and to show if the positive results collected from a homogeneous and “representative” study population can be applied to everyday clinical practice. We are presenting a retrospective observational case-series study of patients treated with nintedanib from the three largest Croatian centers specialised in the treatment of connective tissue diseases with interstitial lung diseases. Stabilisation or improved of lung function tests was reported in 68% of patients when changes in predicted FVC were observed and in 72% of patients when changes in DLco were analysed. Almost all of the reported patients (98%) were treated with nintedanib as an add-on drug to immunosuppressants. The most common side-effects were gastrointestinal symptoms and abnormal liver function tests in less extent. Our real-world data confirm the tolerability, efficacy and similar side-effects of nintedanib as reported in pivotal trials.
Key Points
•
Interstitial lung disease is a common manifestation of several connective tissue diseases and its progressive fibrosing phenotype contributes to high mortality rate and many unmet needs regarding the treatment remain.
•
Registration studies of nintedanib obtained sufficient data and positive results to support approval of the drug.
•
Real-world evidence from our CTD-ILD centres confirm the clinical trial data regarding efficacy, tolerability and safety of nintedanib.
Objective
This study was performed to identify a possible association of the clinical parameters of systemic sclerosis (SSc) and the socioeconomic status (SES) with oral health-related quality of ...life (OHrQoL) as measured by the Oral Health Impact Profile 49 (OHIP 49), taking into account the effect of educational level (as a proxy of SES) on oral health.
Methods
Subjects were recruited from the Croatian SSc Center of Excellence cohort. Detailed dental and clinical examinations were performed according to standardized protocols. The associations of OHrQoL with disease characteristics and socioeconomic status were examined.
Results
Thirty-one consecutive patients with SSc were enrolled (29 women; mean age, 56.45 ± 13.60 years). OHIP 49 scores were significantly correlated with disease activity and severity. Furthermore, OHrQoL was positively correlated with skin involvement as evaluated by the modified Rodnan skin score. Impaired OHrQoL was positively correlated with the severity of general, skin, gastrointestinal, and joint/tendon involvement. The OHIP 49 score differed between patients who were positive and negative for anti-topoisomerase I antibody. Higher OHIP 49 scores were detected in patients with lower SES (primary school educational level).
Conclusion
Collaboration between rheumatologists and dental professionals is required to improve dental care and oral health outcomes of SSc.
Catestatin (CST) is an important peptide that influences various inflammatory diseases. Our goal was to investigate CST concentrations in patients with RA compared to healthy subjects. This ...cross-sectional observational study included 80 patients with RA and 80 healthy control subjects. Demographic characteristics and laboratory parameters were recorded. Serum CST levels were determined by an enzyme-linked immunosorbent assay (ELISA). Serum CST levels were significantly higher in RA patients than in the control group (10.53 ± 3.90 vs 5.24 ± 2.37 ng/mL, p < 0.001). In RA patients, there was a statistically significant correlation between CST and patient age (r = 0.418, p < 0.001) and both DAS28 (r = 0.469, p < 0.001) and HAQ scores (r = 0.483, p < 0.001). There was a statistically significant correlation between serum CST levels and RA duration (r = 0.583, p < 0.001). Multiple linear regression analysis showed that serum CST levels retained a significant association with RA duration (β ± SE, 0.13 ± 0.04, p = 0.002) and DAS28 score (0.94 ± 0.45, p = 0.039) after model adjustment for age, body mass index (BMI) and HAQ score, with serum CST levels as a dependent variable. These findings imply that CST is possibly associated with RA complex pathophysiology and disease activity. However, future larger multicentric longitudinal studies are necessary to define the role of CST in RA.
Primary Sjögren's syndrome (pSS) patients have higher prevalence of endothelial dysfunction and premature atherosclerosis. Recent studies investigated adropin, a secretory protein that can regulate ...lipid metabolism and insulin resistance and protect endothelial cells' function and that has an anti-inflammatory effect. The aim of this study was to determine adropin levels in pSS patients compared to healthy controls. Additional goals were exploring the correlation between adropin and several metabolic and immunological parameters in pSS, including disease specific antibodies, EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), and Sjögren's Syndrome Disease Damage Index (SSDDI). This research included 52 pSS patients and 52 healthy controls. pSS patients have significantly higher adropin levels compared to the control group (3.76 ± 0.68 vs. 3.14 ± 0.69 ng/mL,
< 0.001). Correlation analysis showed that adropin levels in pSS patients have positive correlation with high-density lipoprotein (HDL) (r = 0.290,
= 0.036) and anti SSA/Ro52 antibodies (r = 0.307,
= 0.026) and negative correlation with SSDDI (r = -0.401,
= 0.003). Multivariant linear regression showed that adropin levels are independently associated with HDL (β ± SE, 0.903 ± 0.283,
= 0.002) and SSDDI (β ± SE, -0.202 ± 0.073,
= 0.008). Our findings imply that adropin could be involved in the pathophysiology of pSS, yet it remains to be elucidated in future studies whether adropin has a protective or detrimental role in this setting.
: The most prominent feature of systemic sclerosis (SSc), besides vasculopathy and autoimmune disorders, is excessive fibrosis. Serotonin affects hemostasis and can induce vasoconstriction, which is ...presumed to be one of the pathophysiological patterns in SSc that leads to fibrosis. Our aim was to explore the possible association of serotonin with some of the clinical features of SSc in our cohort of patients.
: We measured serotonin levels in sera of 29 female SSc patients. Patients were 41-79 years old, their average disease duration was 9 years. Serotonin values were analyzed in correlation with clinical and laboratory parameters, such as modified Rodnan skin score (mRSS), digital ulcers (DU), and spirometry parameters-forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and lung diffusion capacity of carbon monoxide (DLCO). Statistical analyses were performed using statistical software Statistica.
: We found correlation of serotonin level with mRSS (r = 0.388,
= 0.038). The highest values of serotonin were documented in patients with refractory DU, but this was not statistically significant. We also found a negative correlation between serotonin and FVC (r = -0.397), although it did not reach the level of significance (
= 0.114).
: Our study suggests that levels of serum serotonin could affect the course of skin fibrosis and partially restrictive pulmonary dysfunction in patients with SSc. We assume that serotonin might have influence on several features of SSc, but more studies are needed to reveal those relations.
To determine salivary flow rate, oral and periodontal status, oral health-related quality of life (OHRQoL), objective and subjective indexes, and serum antibody reactivity in patients with primary ...Sjögren's disease (pSD). Thirty-one patients with pSD and 31 control subjects participated in this cross-sectional, single-center study. The unstimulated whole salivary flow rate (UWSFR) and stimulated whole salivary flow rate (SWSFR), salivary pH, DMFT index (DMFT = D-decayed, M-missing, F-filled tooth), periodontal pocket depth (PPD), clinical attachment level (CAL), interincisal distance, OHRQoL, objective European League Against Rheumatism (EULAR) SS Disease Activity Index (ESSDAI) and subjective (EULAR SS Patient Reported Index (ESSPRI), 6-items-VAS-SS (Visual Analog Scale), Profile of Fatigue) indexes were analyzed. The patients with pSD had a blood sample taken in the morning between 7 and 10 a.m. for comprehensive laboratory analysis. Patients with pSD had statistically significant lower UWSFR (0.20 vs. 0.90 mL/min) and SWSFR (0.56 vs. 1.64 mL/min) values compared with control subjects (
< 0.001, Mann-Withney U test). Salivary pH value of pSD patients was significantly lower compared with control subjects (6.00 vs. 7.00;
< 0.001, Mann-Whitney U test). The mean DMFT index of patients with pSD compared to control subjects was not statistically significant (23.74 ± 7.28 vs. 20.77 ± 5.73;
= 0.08,
-test). Interincisal distance was significantly decreased in the pSD group compared with control subjects (43.80 ± 0.38 vs. 47.60 ± 0.50;
= 0.003,
-test). The prevalence of periodontitis was similar in patients with pSD and control subjects (83.9% vs. 77.4%;
= 0.35, λ
test). The mean Oral Health Impact Profile (OHIP-49) total score was statistically significantly higher in pSD patients compared with control subjects (32.00 vs. 8.00;
< 0.001, Mann-Whitney U test). Patients with pSD have decreased salivary flow and salivary pH, poor oral health, decreased interincisal distance, high prevalence of periodontitis, and worse OHRQoL. These findings highlight the need for a multidisciplinary approach to the management of patients with pSD that includes physical and psychological aspects of the disease.
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