Mirjana Veselinovic

Clinical Benefits of n-3 PUFA and ɤ-Linolenic Acid in Patients with Rheumatoid Arthritis

(1) Background: Marine n-3 polyunsaturated fatty acids (PUFA) and ɤ-linolenic acid (GLA) are well-known anti-inflammatory agents that may help in the treatment of inflammatory disorders. Their effects were examined in patients with rheumatoid arthritis; (2) Methods: Sixty patients with active rheumatoid arthritis were involved in a prospective, randomized trial of a 12 week supplementation with fish oil (group I), fish oil with primrose evening oil (group II), or with no supplementation (group III). Clinical and laboratory evaluations were done at the beginning and at the end of the study; (3) Results: The Disease Activity Score 28 (DAS 28 score), number of tender joints and visual analogue scale (VAS) score decreased notably after supplementation in groups I and II (p < 0.001). In plasma phospholipids the n-6/n-3 fatty acids ratio declined from 15.47 ± 5.51 to 10.62 ± 5.07 (p = 0.005), and from 18.15 ± 5.04 to 13.50 ± 4.81 (p = 0.005) in groups I and II respectively. The combination of n-3 PUFA and GLA (group II) increased ɤ-linolenic acid (0.00 ± 0.00 to 0.13 ± 0.11, p < 0.001), which was undetectable in all groups before the treatments; (4) Conclusion: Daily supplementation with n-3 fatty acids alone or in combination with GLA exerted significant clinical benefits and certain changes in disease activity.

Copper and zinc concentrations in atherosclerotic plaque and serum in relation to lipid metabolism in patients with carotid atherosclerosis.

BACKGROUND/AIM Some oligoelements are now investigated as possibly having a role in atherosclerosis. The aim of this study was to compare the concentrations of copper and zinc in the serum and carotid plaque and parameters of lipid metabolism in patients with different morphology of carotid atherosclerotic plaque. METHODS Carotid endarterectomy due to the significant atherosclerotic stenosis was performed in 91 patients (mean age 64 ± 7). The control group consisted of 27 patients (mean age 58 ± 9), without carotid atherosclerosis. Atheroscletoric plaques were divided into four morphological groups, according to ultrasonic and intraoperative characteristics. Copper and zinc concentrations in the plaque, carotid artery and serum were measured by atomic absorption spectrophotometry. RESULTS Serum copper concentrations were statistically significantly higher in the patients with hemorrhagic in comparison to those with calcified plaque (1.2 ± 0.9 µmol/L vs 0.7 ± 0.2 µmol/L, respectively; p = 0.021). Zinc concentrations were statistically significantly lower in plaques of the patients with fibrolipid in comparison to those with calcified plaques (22.1 ± 16.3 g/g vs 38.4 ± 25.8 µg/g, respectively; p = 0.024). A negative significant correlation was found for zinc and triglycerides in the serum in all the patients (r = -0.52, p = 0.025). In the control group we also demonstrated a positive significant correlation for low-density lipoprotein cholesterol and copper in the serum (r = 0.54, p = 0.04). CONCLUSION The data obtained in the current study are consistent with the hypothesis that high copper and lower zinc levels may contribute to atherosclerosis and its sequelae as factors in a multifactorial disease. Further studies are necessary in order to conclude whether high concentration of copper and zinc in the serum could be risk factors for atherosclesrosis.

Plasma Homocysteine Concentrations In Patients With Rheumatoid Arthritis

Abstract In this study, we investigated the concentration of serum homocysteine (Hcy) in patients with rheumatoid arthritis (RA) compared with the control group and the connection between homocysteine and parameters of inflammation and disease activity. Sixty RA patients and 20 healthy controls were included in the study, and clinical examination and investigation were performed during which disease activity was assessed. Peripheral blood samples were used for all of the assays. Levels of Hcy were 33% higher in the RA patients than in the control subjects (mean +/− SD 11.79±3.72 μmol/L versus 8.90±1.38 μmol/L; p< 0.01). A significant correlation was found between parameters of inflammation (C-reactive protein) and homocysteine in patients (r=0.322, p=0.012). Patients with high disease activity had a significantly greater increase in homocysteine (p<0.05). An increase in plasma homocysteine in RA patients is related to the parameters of inflammation and disease activity. Elevated Hcy levels occur commonly in patients with RA and may explain some of the increased cardiovascular mortality seen in RA patients.

DIFFICULTIES IN THE DIAGNOSIS OF INCLUSION BODY MYOSITIS- CASE REPORT

Abstract Inclusion body myositis belongs to the group of idiopathic inflammatory myopathies. Two processes, one autoimmune and the other degenerative, appear to occur in parallel. There are two forms of inclusion body myositis, hereditary and sporadic. Case report: 47-year-old woman with muscle weakness and atrophy of the distal and proximal muscles, and involvement of quadriceps and deep finger flexors was admitted for neuromuscular evaluation. These changes have been started gradually and insidiously over three years. Electromyography findings were nonspecific and for this reason in the beginning of the disease it was misdiagnosed as demyelization peripheral neuropathy. Muscle biopsy, with the presence of characteristic structures such as rimmed vacuoles and amyloid deposits definitely confirmed the diagnosis of inclusion body myositis. Conclusion: There are several difficulties in the diagnosis of inclusion body myositis as nonspecific EMG findings and overreliance on electrophysiology and lack of the cardinal histological features in muscle biopsy. Although this disease is rare and incurable, making the correct diagnosis is crucial to directing the patient to physical therapy for weakness and occupational therapy to improve a patient’s ability in activities of daily living.