Alajos Takáts

Elevated Levels of Anti-Helicobacter pylori Antibodies in Henoch–Schönlein Purpura

Objective: Henoch–Schönlein purpura (HSP) is a systemic vasculitis characterized by IgA-containing deposits in the skin, joints, gastrointestinal mucosa and glomeruli. HSP is much rarer in adults than in children. Among a number of other pathogenic factors, Helicobacter pylori (Hp) has recently been implicated in the gastrointestinal and extra-gastrointestinal manifestations underlying HSP. We aimed at studying the occurrence of Hp infections in 11 adult HSP patients with appearance in our clinical practice in the last 5 years. Methods: Eleven adult HSP and 20 healthy adult patients were recruited for this study. Anti-Hp IgG and IgA antibodies were assessed in sera of HSP patients with active (n=5) and remittent disease (n=6) and healthy controls (n=20) in the context of clinical symptoms, endoscopic evaluation, as well as routine and immunolaboratory observations. Concurrent Hp infection was confirmed by urease test and histology. Results: Anti-Hp antibodies were present in 10/11 of HSP patients, and 11/20 of healthy controls. However, only 4/11 HSP patients had concurrent Hp infection as confirmed by urease test and/or histology. In the healthy controls the actual Hp infection was detectable in 9/20 cases. Patients in the acute phase had significantly higher levels of anti-Hp IgG compared to healthy controls (86.0±32.0 versus 25.5±28.5 U/ml, p<0.05). In contrast, anti-Hp IgA/IgG ratios were significantly higher in the remitting phase compared to the control group (3.1±1.8 versus 0.8±0.5 ratio, p<0.05). Among other immunolaboratory markers, serum CRP, circulating IgA and serum tumor necrosis factor-α levels were significantly increased in acute patients compared to healthy group results (45.3±22.7 versus 4.8±3.5 mg/l, p<0,05); (58.9±18.2 versus 25.2±6.4 pg/ml, p<0,05); (5.5±1.1 versus 2.4±1.2 g/l; respectively, p<0.05). Conclusions: Hp infection may be associated with the development and progression of HSP. IgG antibodies to Hp may be present mostly in acute HSP, while IgA antibodies may be involved in sustaining gastrointestinal symptoms underlying the chronic phase of the disease.

Increased mean platelet volume in primary Raynaud's phenomenon

We hypothesized that mean platelet volume (MPV), a reliable marker of platelet activation, might be elevated in primary Raynauds phenomenon (PRP) even if there was no thrombotic complication in our subjects. In this retrospective-cohort study, we examined the clinical value of MPV in 200 patients with PRP and 116 clinical controls, and measured MPV and platelet P-selectin (CD62P) in all study participants. We also evaluated the effect of age, gender, and disease duration on these platelet activation markers in PRP. MPV and CD62 positivities were significantly (p < 0.001) elevated in patients with PRP compared with controls. These differences retained when patients and controls were analyzed according to age, gender, and the disease duration. In logistic regression analysis, MPV (OR: 15.8, 95% CI: 8.14–30.64, p < 0.001) and CD62P (OR: 11.3, 95% CI: 4.85–26.12, p < 0.001) were found to be independently associated with PRP. In conclusion, increased MPV is independently related to PRP, and its level was not influenced by age, gender, and the duration of PRP.

Prothrombotic polymorphisms in patients with Raynaud's phenomenon and migraine

We have investigated the prevalence and possible association of inherited prothrombotic risk factors in patients with primary Raynauds phenomenon (PRP) and migraine. We performed genotypic analysis of FVLeiden, prothrombin G20210A, methyltetrahydrofolate reductase C677T and FXIII-A V34L mutations in these patients. Two hundred patients with primary Raynauds phenomenon of Hungarian origin with migraine (57 female, one male, mean age of 43.8 ± 11.5 years) or without migraine (101 female, 41 male, mean age of 41.8 ± 14.5 years) were included in this study. Duration of PRP among migrainous patients was significantly longer than patients without migraine. The prevalence of methyltetrahydrofolate reductase T677 allele among patients with migraine was significantly higher than in patients without migraine (odds ratio 2.1, 95% CI: 1.4-3.3, p = 0.001). The prevalence of other thrombosis-associated alleles did not differ between patients with or without migraine. FVLeiden mutation, prothrombin G20210A mutation, and FXIII-A V34L polymorphism have no apparent effect on the occurrence of migraine in PRP.

Association of von Willebrand factor and fibrinogen plasma levels with primary Raynaud’s phenomenon in male and female patients

Raynaud’s phenomenon (RP) symptoms include color changes (blanching, cyanosis) and numbness of the fingers, which may be followed by hyperemia, pain, and tingling. Classically ischaemia, deoxygenation and hyperaemia is the sequence of the typical attack. The etiology of primary Raynaud’s phenomenon (PRP) is not completely clarified. Abnormalities in the blood vessel wall, in the neural control of vascular tone, and in circulating mediators were found as part of pathophyisiology of this phenomenon. Several factors contribute to the pathogenesis of PRP and alterations in hemostatic system were documented in these patients [1, 2]. Several studies have examined the association between plasma levels of von Willebrant factor (vWF) and fibrinogen levels in patients with PRP [3–6]. They did not find any association between PRP and vWF and fibrinogen levels. They were not only based on small number of subjects, but also their studies did not investigate this association between men and women separately. We examined the clinical value of plasma levels of vWF and fibrinogen levels in a large group of Hungarian male and female patients with PRP. Two hundred patients (158 female, 42 male, mean age of 42.4 ± 13.7 years) with the diagnosis of PRP were included in the study. We did not include patients with anamnestical occurrence of angina, myocardial infarction, diabetes mellitus, thrombosis, hypertension, or connective tissue disease. We also performed a complete serologic examination to find out any positivity for the presence of connective tissue disease causing secondary RP. All participants provided informed consent, with the approval by ethical committee of Debrecen University. A univariate analysis was done initially, and then variables listed in Table 1 were identified as significantly associated with PRP and included in a multivariate logistic regression model. Fraenkel et al. [7] in a large community-based study but small number of subjects with RP (primary and secondary together), founded a positive association between levels of vWF and RP in men. Table 1 shows some of the clinical characteristics of the patients studied. No differences among groups were seen in vWF levels. Fibrinogen level, moderately but significantly, was elevated in female group. We defined vWF and fibrinogen levels according to tertiles and compared them separately (Fig. 1). We did not find any statistically significant difference of vWF levels among them (data not shown). Fibrinogen level in the lowest tertile was significantly elevated in female group (P = 0.045) compared with male group. We obtained no significant difference of fibrinogen level among other tertiles between male and female groups. vWF level in the upper tertile [ 137.6%, odds ratio (95% confidence interval): 1.022 (0.466–2.239), P = 0.958] did not confer a significant risk of PRP between two groups of men and women. Neither fibrinogen A. T. Takats and A. H. Shemirani contributed equally to this work.

Raynaud’s syndrome, 2011

Raynauds phenomenon is characterized by intense vasospasm of the digital arteries on cold exposure or emotional stress, leading to well-defined colour changes in the skin of the fingers. Behind the clinical manifestations, there is an imbalance between vasoconstrictor and vasodilator factors. It may be primary or secondary to an underlying condition, including autoimmune diseases. Physical examination, nail fold capillaroscopy and immunological tests can differentiate primary forms from secondary ones. The treatment is based on preventing exposure to cold, emotional stress and the administration of certain drugs and, if attacks are present, vasodilators, prostaglandin analogues and anticoagulants may be given. This review focuses on the characteristics of Raynauds phenomenon and the available diagnostic and therapeutic options.