[Show abstract][Hide abstract] ABSTRACT: Systemic sclerosis (Ssc) is an autoimmune disease characterized by cutaneous and visceral fibrosis and its pathogenesis is incompletely understood. T helper cells are key regulators of the immune response and they seem to be involved in Ssc clinical manifestations. The aim of the study is to determine key cytokines secreted by Th1 (IFN-γ), Th2 (IL-6) and Th17 (IL-17) in Ssc patients and correlate them with specific manifestations of Ssc patients.
35 consecutive Ssc patients and 20 age and sex matched controls were recruited. Serum IL-17, IFN-γ and IL-6 were determined using ELISA method.
Serum IL-17 and IL-6 levels were not significantly different in Ssc patients and controls. Serum IFN-γ levels were higher in Ssc patients when compared to controls. Higher serum IFN-γ levels associated with pulmonary hypertension. After adjusting for gender and age, IL-17 levels remained independently associated with some clinical manifestations of Ssc patients (telangiectasia and high activity score of Ssc).
Th17 and Th1 cell responses are active in Ssc patients as their cytokines associated with higher disease activity scores and pulmonary manifestations. Th17 and Th1 specific activity and homing within Ssc patients still needs to be defined and determined in order to target them as potential future therapeutic targets in Ssc patients.
Romanian journal of internal medicine = Revue roumaine de médecine interne 06/2015; 53(1):44-9. DOI:10.1515/rjim-2015-0006
[Show abstract][Hide abstract] ABSTRACT: Background Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), C3 complement (C3), and lymphocyte count are markers of disease activity in patients with systemic lupus erythematosus (SLE).
Objectives Our aim was to identify a prediction tool for SLE disease activity with increased accuracy by combining the afore mentioned parameters, two by two, as ratios.
Methods We prospectively enrolled 130 SLE patients admitted consecutively to our department. Clinical and biological parameters were assessed in each patient. Disease activity was quantified using Systemic Lupus Activity Measure (SLAM) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). For each patient we analyzed ESR/C3, CRP/C3, lymphocyte/ESR and lymphocyte/CRP ratios.
Results The mean age of our study group was 46.58±12.69 years old and 90% were female. SLAM was correlated with ESR/C3 (r=0.549, p<0.01), CRP/C3 (r=0.343, p<0.01) and lymphocyte/ESR ratios (r=-0.240, p=0.01) better than with ESR (r=0.486, p<0.01), CRP (r=0.229, p=0.02), C3 (r=0.175, p=ns) and lymphocyte number (r=-0.235, p=0.01) alone. SLEDAI was correlated with ESR/C3 (r=0.745, p<0.01), CRP/C3 (r=0.342, p<0.01) and lymphocyte/ESR ratios (r=-0.312, p<0.01) better than with ESR (r=0.663, p<0.01), CRP (r=0.235, p=0.01) and lymphocyte number (r=-0.324, p<0.01) alone.
In ROC curve analysis, ESR/C3 ratio predicted SLEDAI>10 with an AUC of 0.779, p<0.01 similar to ESR (AUC 0.782, p<0.01) and SLAM>10 with an AUC of 0.821, p<0.01 less than ESR (AUC 0.909, p<0.01). Lymphocyte/ESR ratio predicted SLEDAI>10 with an AUC of 0.754, p<0.01 and SLAM>10 with an AUC of 0.929, p<0.01.
ESR/C3 ratio was the best predictor for severe disease quantified as SLAM>20 with an AUC 0.998 (p<0.01) compared to the lymphocyte/ESR ratio (AUC 0.983, p<0.01) and ESR (AUC 0.974, p<0.01). Lymphocyte/ESR ratio (AUC 0.890, p<0.01) and ESR (AUC 0.886, p<0.01) were better to predict severe disease using SLEDAI>20 compared to ESR/C3 ratio (AUC 0.850, p<0.01).
Conclusions Lymphocyte/ESR and ESR/C3 ratios correlate with disease activity in SLE patients, possibly with higher accuracy compared to ESR, C3 and lymphocyte number alone.
Acknowledgements This paper is supported by POSDRU/159/1.5/S/137390.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1086.1-1086. DOI:10.1136/annrheumdis-2015-eular.6001 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Glasgow Prognostic Score (GPS) is a simple, systemic inflammation-based prognostic score used mostly in oncology and intensive-care.
Objectives We aimed to investigate the utility of GPS in assessing disease activity in patients with systemic lupus erythematosus (SLE).
Methods Patients admitted consecutively to our department were prospectively enrolled in the study. Clinical and biological parameters were assessed in each participant. Disease activity was quantified using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Systemic Lupus Activity Measure (SLAM) and European Consensus Lupus Activity Measurement (ECLAM). GPS was calculated using 1 point for C reactive protein>10mg/L and 1 point for hypoalbuminemia.
Results Our study group included 130 patients with a mean age of 46.58±12.69 years old and 90% female predominance, out of which 17 (13.07%) had a GPS≥1. Median ECLAM score was 2[0-7.5], median SLAM score was 4[0-24] and median SLEDAI score 6[0-48]. Patients with a GPS≥1 had a higher ECLAM score compared to those with a GPS=0 (3[0-10.5] vs. 2[0-7], p=0.007), a higher SLAM score (7[0-22] vs. 4[1-14], p=0.003), a higher SLEDAI score (8[0-48] vs. 4.5[0-30], p=0.006) and a higher erythrocyte sedimentation rate (ESR) (24[10-90] vs. 13.5[2-61], p=0.03). ROC curve analysis identified ECLAM and SLAM scores as predictors of a GPS≥1 with an AUC of 0.825 (95%CI 0.0.686-0.964, p=0.01) and 0.740 (95%CI 0.483-0.998, p=0.07) respectively. Elevated ESR was also associated with a GPS≥1 with an AUC of 0.819 (95%CI 0.693-0.945, p=0.01).
Conclusions GPS was correlated with disease activity in patients with SLE. A simple systemic inflammation score, it could be used as an auxiliary tool for their assessment.
Acknowledgements This paper is supported by POSDRU/159/1.5/S/137390.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):638.2-638. DOI:10.1136/annrheumdis-2015-eular.6081 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Antiphospholipid syndrome (APLS) is classically associated venous or arterial thrombotic events. However, the predictors for occurrence of deep vein thrombosis in patients with APLS and systemic lupus erythematosus (SLE) are incompletely evaluated.
Objectives The aim of this study was to evaluate the impact of systemic inflammation in patients with APLS secondary to SLE.
Methods In 47 patients with APLS secondary to SLE, we performed the evaluation of traditional risk factors associated with DVT. We assessed the inflammation parameters [erythrocyte sedimentation rate (ESR), fibrinogen and C-reactive protein (CRP) levels]. We divided the study group in two subgroups: A- patients with DVT; and B- patients without DVT or any other thrombotic event.
Results In our study group 18 (38.3%) patients were diagnosed with DVT. Mean age, sex distribution, smoking rate, obesity parameters (body mass index, abdominal circumference, wais-to-hip ratio) were similar in both subgroups. ESR (29.76±4.71 vs 19.71±2.63, p=0.05), fibrinogen (375.88±18.26 vs 326.71±12.45, p=0.02), CRP (12.09±3.68 vs 3.35±0.70, p=0.006) were found to have higher values in patients with DVT. However, in multivariate analysis, only CRP was independently associated with DVT (p=0.03).
Conclusions Inflammation seems to be one of the pathogenic pathways in patients with APLS secondary to SLE and DVT. Further studies are required in order to have valid conclusions.
Disclosure of Interest None declared
Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):975-975. DOI:10.1136/annrheumdis-2014-eular.5743 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Behçet's disease presents some similar clinical features with seronegative spondyloarthritides (SpA), raising the question whether a subgroup of patients with Behçet's disease belong in fact to the latter. As the already known inflammatory involvement at the level of the small bowel in SpA patients could not be extrapolated for patients with Behçet's disease associated SpA (BehSpA), the present study aims to investigate and compare it in these diseases.
54 consecutive patients with a form of SpA, and 7 patients with BehSpA were enrolled and submitted to videocapsule endoscopy (VCE) examination. After reviewing the VCE findings, calculation of the score of small bowel mucosal inflammatory change (Lewis) was performed for each patient. The comparison was made with a control group, sex and age-matched to the patients in the study groups.
The Lewis score differed in the groups considered for analysis (mean of 439, 179 and 81 in the SpA, BehSpA and the control group, respectively, with p = 0.04 for the comparison SpA vs. BehSpA and 0.05 for the comparison BehSpA vs. controls). C reactive protein (CRP) level was markedly reduced in the BehSpA group vs. the other SpA group (2.08 and 14.02 mg/L, respectively; p = 0.053).
The significant difference in intestinal inflammatory involvement in BehSpA versus the other SpAs, as well as the significantly lower serum levels of CRP, as revealed by the present study, clearly draw a line between the two disease entities.
Journal of gastrointestinal and liver diseases: JGLD 12/2013; 22(4):405-11. · 2.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hepatitis C virus (HCV) is one of the most important etiologic agents of postransfusional hepatitis and a common cause of chronic hepatitis, cirrhosis and hepatocarcinoma. T helper (Th)17 cells are a newly discovered Th cell subset with implications in both host defense and autoimmunity. Th17 implications in chronic HCV infection are not well characterized. Given the important role in multiple other immune and inflammatory conditions, they are of obvious interest. Specific HCV-Th17 cells are implicated in immune response modulation, correlated with fibrosis severity and intrahepatic inflammatory status. Serum IL-17 levels are higher in chronic HCV infected patients and Th17 cytokines are modulated within the therapeutic response at anti-viral treatment. However, novel intriguing data indicate that Th17 boost could be associated with spontaneous HCV clearance. It is possible that Th17 could play a dual role (both beneficial and harmful) and that an unbalance of regulating factors (chemokines, transcription factors, receptor expression, etc.) rather than the lymphocyte itself could tip the Th17 immune response one way or another. The role of Th17 cells in host anti HCV defense is beginning to emerge and one has to focus upon its potential beneficial aspects and not only on its destructive potential.
Romanian journal of internal medicine = Revue roumaine de médecine interne 07/2012; 50(1):13-8.
[Show abstract][Hide abstract] ABSTRACT: To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions.
Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to a video capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed.
The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients.
The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part.
World Journal of Gastroenterology 02/2011; 17(8):1030-5. DOI:10.3748/wjg.v17.i8.1030 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report two cases of neuromyelitis optica (NMO) associated with primary Sjögren's syndrome (pSS), comparing the clinical and laboratory features of these predominant neurological patients and reporting their different outcome. NMO - a severe demyelinating disorder of the central nervous system - primarily affects the spinal cord and optic nerves, resulting in longitudinally extensive transverse myelitis and/or optic neuritis. Our patients had a late pSS diagnosis, due to the absence of sicca syndrome and specific Sjögren serology in the early stages of their diseases, when the neurological symptoms prevailed. Many NMO patients have an accompanying autoimmune disease, most commonly Sjögren syndrome and systemic lupus erythematosus or a related profile of non-organ-specific autoantibodies. Neurologic involvement occurs in approximately 20% of patients with pSS, usually preceding the diagnosis (in 75-80% of the cases) [1,2]. The frequency of both neurologic manifestations (revealing pSS) and negative autoimmune serology, especially in the event of CNS involvement, could explain why underlying pSS is misdiagnosed [3,4]. Screening for pSS should be systematically performed in cases of acute or chronic myelopathy and/or cranial nerve involvement, mainly because these patients have a severe outcome. The presence of the anti-aquaporin4 antibodies, besides anti-Ro and anti-La, in both reported cases, is intriguing and raises the question of whether we are facing two distinct diseases or the NMO is just complicating an unusually less expressive Sjögren's syndrome subtype.
Romanian journal of internal medicine = Revue roumaine de médecine interne 01/2011; 49(4):295-300.
[Show abstract][Hide abstract] ABSTRACT: HCV (hepatitis C virus) chronic hepatitis has become one the most expensive diseases for public health systems all over the world in the past 10-20 years, a real epidemic, the second most frequent, after hepatitis B virus infection. Due to the complex manifestations, one may consider HCV infection as a "systemic" disease. Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of HCV infection, but cryoglobulinemic vasculitis (CV) is considered to be relatively sparse although prevalence studies are needed. Presence of serum cryoglobulins is essential for MC diagnosis, but serum levels do not correlate with the disease activity or prognosis. MC can be defined as a B lymphocyte proliferation disease being characterized by polyclonal activation and antibody synthesis. Evolution to lymphoma should be considered continuous but also other infectious, environmental or genetic factors could be involved. The t (14.18) translocation and Bcl-2 activation in B lymphocytes, B cell-activating factor (BAFF), E2-CD81 interaction, immunoregulatory T CD4+CD25(high) + lymphocytes and type III IFNs might play an important role in MC and lymphoma evolution in HCV patients.
Romanian journal of internal medicine = Revue roumaine de médecine interne 01/2011; 49(1):3-10.
[Show abstract][Hide abstract] ABSTRACT: Lupus erythematosus (LE) is an autoimmune inflammatory disease that involves many organs and systems. Immunological factors seem to play a key-role in LE pathogenesis. LE patients have T lymphocytes dysfunctions.Th17 is implicated in the pathogenesis of various autoimmune diseases like psoriasis, multiple sclerosis or rheumatoid arthritis. The purpose of this study was to evaluate the circulating Th17 cell population in LE patients.
A total of 15 LE patients were recruited and divided into three groups: systemic lupus erythematosus (SLE), discoid lupus (DLE) and subacute lupus (SCLE). Serum IL-17A, IL-17F and IL-23 were detected. Th17 circulating cells were evaluated by flow cytometry.
Serum IL-17A and IL-17F levels were higher in SLE, DLE and SCLE patients compared to healthy controls. The number of Th17 cells were higher in SLE and DLE patients (p<0.05). the number of CD3+IL-17+ cells were higher in SLE, DLE and SCLE patients (p<0.05).
Th17 lymphocytes are implicated in LE pathogenesis. Our findings suggest that IL-17 is implicated not only in SLE but also in DLE and SCLE immunopathogenesis.
Romanian journal of internal medicine = Revue roumaine de médecine interne 01/2010; 48(3):255-9.
[Show abstract][Hide abstract] ABSTRACT: Both Hashimoto encephalopathy (HE) and epilepsia partialis continua (EPC) are neurological entities less encountered by the clinician. Nevertheless, they imply diagnostic and therapeutic challenges. We report the case of a 42-year old woman with HE and EPC. Diffi culties of diagnosis and management of HE and EPC are discussed.
Romanian Journal of Neurology/ Revista Romana de Neurologie 01/2010; 9(3).
[Show abstract][Hide abstract] ABSTRACT: A 27-year-old male with a 2 year history of ankylosing spondylitis (AS) was investigated for intermittent episodes of diarrhea and found to have granulomatous ileitis. Differential diagnosis, discussions regarding similarities in immune alterations in both AS and Crohn's disease and therapeutic options are presented in this paper.
Romanian journal of internal medicine = Revue roumaine de médecine interne 01/2010; 48(4):347-53.
[Show abstract][Hide abstract] ABSTRACT: Ischemic stoke is a major cause of death and an important source of disability in industrialized countries. Since there is no ideal treatment for cerebral ischemia, any approach aiming to limit the devastating consequences of the ischemic process is justified. Concerning immune responses, it has become clear in the latest years that actors of the immune system are involved in multiple and various neurobiological processes such as cerebral ischemia, neurodegeneration, neuroprotection and neuroregeneration. An immunological approach to cerebral ischemia can distinguish, besides the implication of inflammation in the developing of atherothrombosis thus leading to stroke, the clear involvement of immune cells and mediators in processes continuing the initial stage of ischemia, having consequences on recovery or lesion extent. Cerebral infarctions develop within minutes to hours of cessation of the cerebral blood flow, but may expand over subsequent days. There is increasing evidence that leukocytes, cytokines, cell adhesion molecules, and other immune mediators contribute to secondary infarction growth, but inflammatory cytokines are also involved in signaling pathways leading to neuroprotection related to ischemic pre-conditioning. The aim of this review is to show some aspects concerning the complex and diverse functions of immune modifications occurring in cerebral ischemia. This first part will focus on the involvement of immune cells, adhesion molecules and immunological transcription factors in the development of ischemic lesion.
Romanian journal of internal medicine = Revue roumaine de médecine interne 02/2008; 46(1):3-8.
[Show abstract][Hide abstract] ABSTRACT: At the crossover of specialties, the osmotic demyelination syndromes are under-diagnosed clinical entities. Even if the knowledge and the management of these entities have evolved in the latest years, many issues are still unsolved. Initially described as diseases affecting alcoholics and malnourished and considered affecting solely the pons, it is now known that osmotic demyelination can produce extrapontine lesions (extrapontine myelinolysis). Rapid correction of sodium in hyponatremic patients is pathogenically involved in the genesis of central pontine and extrapontine myelinolysis. The aim of this review is to focus on the main characteristics of the disease, which can represent a challenge for the clinicians in respect to its recognition and treatment.
Romanian journal of internal medicine = Revue roumaine de médecine interne 02/2008; 46(3):199-205.
[Show abstract][Hide abstract] ABSTRACT: The antiphospholipid syndrome (APS) is defined by the presence of antiphospholipid antibodies (aPL), associated with thrombosis or recurrent spontaneous abortions. APS can occur alone or secondary to other conditions, especially associated to inflammatory systemic autoimmune diseases. Among the neurological manifestations associated with aPL, only ischemic stroke is recognized by the actual classification criteria for APS. Other neurological manifestations have been, however, repeatedly reported in case studies of APS patients. Headache, and especially migraine, was commonly reported in APS patients and is one of the classical features described by Hughes as related to aPL, but studies failed to confirm this association. We studied retrospectively the association between headache syndromes and aPL in 428 patients with inflammatory connective tissue diseases admitted in the Neurology and Internal Medicine Departments of Colentina Hospital-Bucharest. We found that migraine alone, not headache of all types, is significantly associated with aPL in patients with systemic immune disease. We studied the presence of cerebral ischemia in patients with headache and aPL. In SLE patients, headache (all types) is significantly associated with positive titers of aPL, and cerebral ischemic lesions are significantly encountered. Even if both migraine and aPL are conditions with high frequency in patients with immune systemic disease and their association may be coincidental, the presence of ischemic lesions in patients showing this association suggests the need to define a sub-group at risk, for whom headache can be a marker and anticoagulants can be discussed.
Romanian journal of internal medicine = Revue roumaine de médecine interne 02/2007; 45(4):355-63.