Publications (100) View all
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Article: Kynurenic Acid in Synovial Fluid and Serum of Patients with Rheumatoid Arthritis, Spondyloarthropathy, and Osteoarthritis.
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ABSTRACT: OBJECTIVE: Previously we demonstrated that kynurenic acid (KYNA), an endogenous metabolite of kynurenine, is present in the synovial fluid of patients with rheumatoid arthritis (RA). KYNA inhibits proliferation of synoviocytes in vitro. The goal of our study was to compare KYNA concentrations in synovial fluid and blood of patients with RA, inflammatory spondyloarthropathies (SpA), and osteoarthritis (OA). METHODS: Serum and synovial fluid samples were obtained from 189 patients with RA, 56 patients with SpA, and 32 patients with OA. KYNA was separated using a high-performance liquid chromatography system and measured fluorometrically. RESULTS: KYNA concentration in synovial fluid obtained from patients with RA and SpA was significantly lower than that in patients with OA (p < 0.05). The concentration of KYNA in serum of patients with RA, SpA, and OA did not differ among all groups studied. The positive correlation between KYNA content in synovial fluid and serum was found in patients with RA (p < 0.05). Univariate linear regression analysis demonstrated that fibrinogen was significantly associated with KYNA in synovial fluid (p < 0.05), and red blood cell counts, morning stiffness, and pain scores were significantly associated with KYNA level in serum (all p < 0.05). Multivariate regression analysis revealed correlation between the following independent variables: hemoglobin level, hematocrit, red blood cell count in conjunction with age and KYNA content in synovial fluid. A lack of correlation was observed between KYNA content in synovial fluid of patients with RA and other clinical and laboratory measures of disease activity. CONCLUSION: Our data show a local deficit of KYNA in inflammatory states.The Journal of Rheumatology 04/2013; · 3.69 Impact Factor -
Article: Identification of latent tuberculosis infection in rheumatic patients under consideration for treatment with anti-TNF-α agents.
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ABSTRACT: Immunosuppressive therapy with anti-tumour necrosis factor-α (TNF-α) agents in rheumatic patients modulates the immune system and may increase the risk of reactivating infections that are normally maintained in a latent state, such as tuberculosis. The purpose of this study was to analyse the value of QuantiFERON TB Gold In-Tube (QFT IT) and tuberculin skin test (TST) in BCG vaccinated patients with rheumatoid arthritis and ankylosing spondylitis who were qualified to receive TNF-α blockers. Ninety patients with rheumatoid arthritis and ankylosing spondylitis were included in the study. The control group consisted of 20 healthy participants. Chest X-ray, TST and QFT IT were carried out in all persons. In rheumatic patients positive results of QFT IT and TST tests were identified in 15 cases (16.7%) whereas negative results of both tests were detected in 56 cases (62.2%). In the group of examined patients, 11 (12.2%) had QFT IT-/TST+ test results. In patients with QFT IT+/TST- status one active tuberculosis case was detected. In the control group QFT IT positive results were found in 4 cases (20%) and TST positive in 11 cases (55%). Treatment with TNF-α blockers was introduced in 26 rheumatology patients with the following test status: 3 with QFT IT+/TST+; 20 with QFT IT-/TST-; 3 with QFT IT-/TST+. In the BCG vaccinated population the QFT IT assay may potentially improve the identification and selection for therapy for latent TB infection before treatment with anti-TNF agents.Archives of Medical Science 02/2013; 9(1):112-7. · 1.21 Impact Factor -
Article: The prevalence of antiphospholipid antibodies in rheumatoid arthritis patients and relationship with disease activity.
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ABSTRACT: INTRODUCTION: The importance of antiphospholipid antibodies (aPL) occurrence in rheumatoid arthritis (RA) patients remains unclear. OBJECTIVES: The aim of the study was to assess the prevalence of chosen aPL in RA patients, in correlation with the presence of marker for RA antibodies and with disease activity. PATIENTS AND METHODS: The study group consisted of 97 patients with RA, who had never been treated with biological agents. In all patients serum anticardiolipin antibodies (aCL), anti-beta2-glycoprotein I antibodies (a-β2-GPI), lupus anticoagulant (LAC), rheumatoid factor in class IgM (RF-IgM) and anti-cyclic citrullinated peptide antibodies (anti-CCP) were measured and disease activity was estimated. RESULTS: The presence of aPL was found in 27 patients (27.8%), among them aCL in 20 patients (20.6%), a-β2-GPI in 12 patients (12.4%) and LAC in 1 patient (1%). Positive aCL of low or medium levels, were detected in IgM class in 11 patients (11.3%) and in IgG class in 12 patients (12.5%). Positive a-β2-GPI of low/medium levels, were found only in IgM class. The presence of LAC was associated with aCL-IgM and a-β2-GPI-IgM. Significant correlation was found between the presence of anti-CCP and different types of aPL. There were no correlation between aPL and RF-IgM presence nor with disease activity markers. CONCLUSIONS: The prevalence of aPL is relatively high in patients with RA. A relationship exists between aPL and RA serological marker antibodies against cyclic citrullinated peptide while significant correlations between disease activity and aPL presence do not exist.Polskie archiwum medycyny wewnȩtrznej 08/2012; · 1.37 Impact Factor -
Article: Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent?
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ABSTRACT: OBJECTIVES: To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices.METHODS: Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics.RESULTS: Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices.CONCLUSIONS: PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.Annals of the rheumatic diseases 04/2012; · 8.11 Impact Factor -
Article: Coexistence of five autoimmune diseases: diagnostic and therapeutic difficulties
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ABSTRACT: We report the case of coexistence of five autoimmune diseases in a 36-year-old woman, who initially developed psoriasis. Several years later, the patient was diagnosed with a mixed connective tissue disease and primary biliary cirrhosis (PBC). On admission to the Department of Rheumatology and Connective Tissue Diseases, the patient fulfilled classification criteria of an overlap syndrome systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome/systemic sclerosis (SSc)/Sjogren’s syndrome (SS) with coexisting PBC and psoriasis. The SLE symptoms included discoid lupus erythematosus, arthritis, pancytopenia, antinuclear antibodies and anticardiolipin antibodies. Moreover, the patient met the criteria of antiphospholipid syndrome diagnosed based on preterm delivery before week 34, and high values of anticardiolipin antibodies were found at repeated determinations. The SSc symptoms included sclerodactyly, pulmonary fibrosis with pulmonary hypertension and esophageal dysfunction. The SS syndrome involved xerostomia, xerophthalmia, the positive Schirmer’s test and presence of anti-SS antibodies. The literature reports overlap syndromes in various combinations; however, the coexistence of five autoimmune diseases is extremely rare.Rheumatology International 04/2012; 28(9):919-923. · 1.88 Impact Factor
