Bo-Ram Koh

C-reactive Protein Is a More Sensitive and Specific Marker for Diagnosing Bacterial Infections in Systemic Lupus Erythematosus Compared to S100A8/A9 and Procalcitonin

Objective. C-reactive protein (CRP), S100A8/A9, and procalcitonin have been suggested as markers of infection in patients with systemic lupus erythematosus (SLE). We investigated the clinical significance of these factors for indication of infection in SLE. Methods. Blood samples were prospectively collected from 34 patients with SLE who had bacterial infections and 39 patients with SLE who had disease flares and no evidence of infection. A second set of serum samples was collected after the infections or flares were resolved. Results. CRP levels of SLE patients with infections were higher than those with flares [5.9 mg/dl (IQR 2.42, 10.53) vs 0.06 mg/dl (IQR 0.03, 0.15), p < 0.001] and decreased after the infection was resolved. S100A8/A9 and procalcitonin levels of SLE patients with infection were also higher [4.69 μg/ml (IQR 2.25, 12.07) vs 1.07 (IQR 0.49, 3.05) (p < 0.001) and 0 ng/ml (IQR 0–0.38) vs 0 (0–0) (p < 0.001), respectively]; these levels were also reduced once the infection disappeared. In the receiver-operating characteristics analysis of CRP, S100A8/A9, and procalcitonin, the area under the curve was 0.966 (95% CI 0.925–1.007), 0.732 (95% CI 0.61–0.854), and 0.667 (95% CI 0.534–0.799), respectively. CRP indicated the presence of an infection with a sensitivity of 100% and a specificity of 90%, with a cutoff value of 1.35 mg/dl. Conclusion. Our data suggest that CRP is the most sensitive and specific marker for diagnosing bacterial infections in SLE.

Carotid subclinical atherosclerosis is associated with disease activity but not vitamin D in Korean systemic lupus erythematosus

Atherosclerosis develops early in systemic lupus erythematosus (SLE) patients and is an important cause of mortality. Vitamin D deficiency is found to be associated with cardiovascular disease and autoimmunity. We evaluated the extent of carotid subclinical atherosclerosis and analyzed its correlation with vitamin D in SLE. One hundred and two female patients with SLE and 52 normal controls (NCs) were recruited. The mean carotid intima-media thickness (IMT) of SLE patients was 0.41 ± 0.08 mm, which was higher than that of NCs (0.32 ± 0.08 mm, p = 0.012). In addition, carotid plaques were more frequent and the plaque index was higher in SLE patients than in NCs (0.68 ± 1.39 vs. 0.26 ± 0.87, p = 0.026). Carotid IMT was correlated with age, body mass index, SLE disease activity index, and aspirin use in SLE patients. The plaque index was correlated with renal involvement. Vitamin 25(OH)D3 level was not correlated with carotid IMT, plaque index or disease activity markers. In SLE, the risk of cardiovascular disease is higher than that in NCs, which may be derived from systemic inflammation. It may be not suitable to assess vitamin D as a marker of disease activity or subclinical atherosclerosis in SLE patients.

Salivary cortisol levels, but not salivary α‐amylase levels, are elevated in patients with rheumatoid arthritis irrespective of depression

Stress is recognized as an important factor in the etiology of rheumatoid arthritis (RA). Therefore, we explored multiple aspects of stress in RA patients.

Induction of Remission is Difficult due to Frequent Relapse during Tapering Steroids in Korean Patients with Polymyalgia Rheumatica

Polymyalgia rheumatica is an inflammatory disease affecting elderly and involving the shoulder and pelvic girdles. No epidemiological study of polymyalgia rheumatica was conducted in Korea. We retrospectively evaluated patients with polymyalgia rheumatica followed up at the rheumatology clinics of 10 tertiary hospitals. In total 51 patients, 36 patients (70.6%) were female. Age at disease onset was 67.4 yr. Twenty-three patients (45.1%) developed polymyalgia rheumatica in winter. Shoulder girdle ache was observed in 45 patients (90%) and elevated erythrocyte sedimentation rate (> 40 mm/h) in 49 patients (96.1%). Initial steroid dose was 23.3 mg/d prednisolone equivalent. Time to normal erythrocyte sedimentation rate was 4.1 months. Only 8 patients (15.7%) achieved remission. Among 41 patients followed up, 28 patients (68.3%) had flare at least once. Number of flares was 1.5 ± 1.6. The frequency of flare was significantly lower in patients with remission (P = 0.02). In Korea, polymyalgia rheumatica commonly develops during winter. Initial response to steroid is fairly good, but the prognosis is not benign because remission is rare with frequent relapse requiring long-term steroid treatment.

Autoantibodies to C-reactive protein in incomplete lupus and systemic lupus erythematosus.

Objective Anti-C-reactive protein (CRP) antibodies have been described in patients with systemic lupus erythematosus (SLE). We investigated the potential of the anti-CRP antibody as a marker for disease activity in SLE patients and as a predictor of progression to SLE in patients with incomplete lupus. Methods Immunoglobulin G anti-CRP antibody levels were measured using an enzyme-linked immunosorbent assay. Results Patients with incomplete lupus exhibited clinical and immunologic characteristics different from those in SLE patients: no serositis and alopecia, more common oral ulcers and arthritis, lower disease activity index, lower positivity for antinuclear and anti–double-strand DNA antibodies, and higher complement levels. Anti-CRP antibody levels were higher in SLE patients (35.6 [35.1] AU) than in patients with incomplete lupus (23.1 [25.8] AU, P = 0.016) and normal controls (21.0 [14.3] AU, P < 0.001). Anti-CRP antibody was significantly higher in SLE patients with arthritis and correlated with disease activity markers, including antichromatin antibody. However, no difference in anti-CRP antibody levels was observed between patients with incomplete lupus that progressed to SLE and those whose did not. Conclusion These data suggest that anti-CRP antibodies can neither be used as biomarkers in SLE nor predict SLE progression in patients with incomplete lupus.

AB0406 Vitamin d cannot predict carotid subclinical atherosclerosis in sle

Background Atherosclerosis in patients with systemic lupus erythematosus (SLE) develops earlier and is one of the important causes in mortality. Vitamin D was revealed to affect many systems including cardiovascular and immune system, and several data suggested vitamin D deficiency contributed cardiovascular disease and immune dysregulation in SLE. Objectives We planned to analyze correlations between vitamin D levels and carotid subclinical atherosclerosis in patients with SLE. Methods One-hundred-two female patients with SLE and 52 female normal controls were recruited. The carotid artery intima-media thickness (cIMT) and plague were assessed by B-mode ultrasound at the carotid artery level. Vitamin 25(OH)D levels were checked by immunoradiometric assay using the Bio-Line 25(OH)D3-Ria CT kit (Bio-Line S.A., Belgium). Disease activity markers were checked at the time of enrollment. Results The cIMT of SLE is 0.41 ± 0.08 mm, which is higher than normal control (0.32 ± 0.08, p < 0.001). The carotid plague was detected in 26 patients of SLE (25.4%), and the mean of plaque index (PI) was 1.45 ± 0.14. The cIMT was correlated with age (r2 = 0.458, p < 0.001), SLEDAI (r2 = 0.272, p = 0.028), taking aspirin or not (r2 = 0.237, p = 0.033) in patients with SLE. The complement 3 (r2 = 0.400, p = 0.010) and complement 4 (r2 = -0.359, p = 0.020) were correlated with PI. The 25(OH)D levels in patients with SLE were 12.06 ± 7.56 ng/mL and 46 patients of SLE (45%) had vitamin D deficiency. The 25(OH)D levels of SLE patients were not correlated with cIMT or PI. When the patients were divided at 12 ng/mL of 25(OH)D level, only complement 4 was different significantly (18.95 ± 7.34 vs 22.27 ± 9.09, p = 0.047), and there was no difference in cIMT or PI between two groups. Conclusions In patients with SLE, the risk of cardiovascular disease estimated by cIMT and carotid artery plaque was higher than normal control, which was correlated with disease activity. However, vitamin D levels were not showed significant correlations with carotid subclinical atherosclerosis. To our disappointment, vitamin D level was considered inappropriate to assess predisposition to cardiovascular disease in SLE. References Wu PW, Rhew EY, Dyer AR, et al. 25-hydroxyvitamin D and cardiovascular risk factors in women with systemic lupus erythematosus. Arthritis Rheum. 2009;61:1387-95. Disclosure of Interest None Declared