Publications (9) View all
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Article: Interleukin 17 as a novel predictor of vascular function in rheumatoid arthritis.
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ABSTRACT: Rheumatoid arthritis (RA) is associated with enhanced cardiovascular (CV) risk and subclinical vascular disease. The proinflammatory milieu has been linked to premature atherosclerosis and endothelial dysfunction in RA. While interleukin 17 (IL-17) is considered pathogenic in RA, its role in determining vascular dysfunction in this disease has not been systematically assessed. To analyse candidate variables that might determine endothelial function in various vascular territories in a cohort of patients with RA receiving treatment with biological agents, with minimal traditional CV risk factors and low disease activity score. Patients with RA (n=50) receiving stable treatment with biological agents underwent measurement of conduit artery endothelial function by brachial artery flow-mediated dilatation; arterial compliance by pulse wave velocity (PWV) assessment; and endothelium-dependent microvascular testing with Endo-Pat2000 device to assess the reactive hyperaemia index (RHI). IL-17 was quantified by ELISA and disease activity was assessed by 28-joint count Disease Activity Score. IL-17 was the main determinant of lower RHI in univariate and multivariate analysis. Traditional and non-traditional CV risk variables determined PWV, with a significant positive association with IL-17 in univariate and multivariate analysis. In contrast, conduit endothelial function was mainly determined by rheumatoid factor titres in univariate and multivariate analysis. Anti-cyclic citrullinated peptide titres, specific disease-modifying antirheumatic drugs or biological agents and disease activity did not determine vascular function. In patients with RA treated with biological agents, IL-17 is a main predictor of microvascular function and arterial compliance. This study suggests that IL-17 may play a significant role in development of endothelial dysfunction and cardiovascular disease in RA.Annals of the rheumatic diseases 09/2011; 70(9):1550-5. · 8.11 Impact Factor -
Article: Coronary artery involvement in idiopathic retroperitoneal fibrosis: computed tomographic findings.
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ABSTRACT: We describe 2 patients with perivascular low-attenuation soft tissue and inflammatory changes surrounding the coronary arteries in the clinical setting of idiopathic retroperitoneal fibrosis. Neither patient had inducible ischemia on cardiac stress testing. The coronary arteries present an additional site of interest as connections between sclerosing diseases--including retroperitoneal fibrosis, fibrosing mediastinitis, autoimmune pancreatitis, sclerosing cholangitis, and other entities--continue to emerge.Journal of thoracic imaging 04/2011; 27(2):W35-7. · 1.42 Impact Factor -
Article: Determinants of vascular function in patients with chronic gout.
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ABSTRACT: Epidemiologic studies have proposed a relationship between hyperuricemia and cardiovascular (CV) risk. However, it is unclear whether uric acid (UA) is an independent risk factor for CV disease (CVD) after controlling for other predisposing conditions. Gout patients might have persistent systemic inflammation, which, in addition to hyperuricemia, may potentiate CVD. This study examined vascular function and markers of CV damage in gout patients when compared with healthy controls. Brachial artery flow-mediated dilatation, arterial compliance, and microvascular function were measured. Circulating apoptotic endothelial cells and endothelial progenitor cells were quantified by FACS and circulating biomarkers of CVD by enzyme-linked immunosorbent assay. Gout patients displayed significant increases in body mass index, C-reactive protein, UA, and triglycerides and decreases in high-density lipoprotein. There were no significant differences in other CV traditional risk factors, adhesion molecules, or chemokines. Gout patients did not differ from controls in vascular function. In univariate and multivariate analysis, UA was not associated with the quantified CV risk parameters. Despite an increase in several CV risk factors, inflammation, and UA, gout patients display normal endothelial function and no increases in biomarkers of CVD. These results do not support the notion that gout is an independent risk factor for premature CVD.Journal of Clinical Hypertension 03/2011; 13(3):178-88. · 1.83 Impact Factor -
Article: Response to "Absence of conclusive evidence for the safety and efficacy of gonadotropin-releasing hormone analogue treatment in protecting against chemotherapy-induced gonadal injury".
The Oncologist 06/2008; 13(5):613-4; author reply 615-7. · 3.91 Impact Factor -
Article: Advances in immunosuppressive therapy.
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ABSTRACT: Despite the intense interest in biological agents, traditional immunosuppressive drugs remain the mainstays of treatment for systemic rheumatic diseases that involve the lung. Herewith, we review the mechanism of action, administration and clinical use of immunosuppressive drugs, including cyclophosphamide, chlorambucil, azathioprine, methotrexate, leflunomide, cyclosporine, and mycophenolate mofetil. Emphasis is placed on the use of sequential therapies, in which cyclophosphamide is used to induce a remission, and then drugs such as methotrexate or azathioprine are used to maintain the remission. In addition, new regimens that avoid the use of cyclophosphamide for severe forms of vasculitis such as Wegener's granulomatosis have been recently described. Finally, significant benefit has been found when interstitial lung disease due to scleroderma is treated with cyclophosphamide. This represents the first evidence that immunosuppressive drugs are efficacious in rheumatic disease-associated interstitial fibrosis and provides a rationale for developing therapeutic regimens that optimize efficacy and safety.Seminars in Respiratory and Critical Care Medicine 09/2007; 28(4):398-417. · 2.43 Impact Factor
