Samah A. El Bakry

Dysregulation of angiogenic homeostasis in systemic sclerosis.

Systemic sclerosis (SSc) is a connective tissue disorder characterized by tissue hypoxia and excessive fibrosis of skin and internal organs.

Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role?

Background The increase in Rheumatoid arthritis (RA) associated mortality is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis with increased risk of ischemic heart disease about 50% in RA patients compared to controls. Objective To study the pathogenesis of ischemic heart disease in RA, role of inflammatory cytokine interplay, disease activity and rheumatoid factor positivity. Methods Eighty RA patients and 44 healthy controls were included. All subjects were younger than 45 years for females and 55 years for males with exclusion of all traditional risk factors for atherosclerosis. Interleukin (IL) 1, 6 and 18 were assessed in all subjects. RA patients fulfilled ACR/EULAR 2010 criteria and were subjected to Dobutaminestress‐echocardiography, diseases activity assessed by DAS‐28, X‐ray hands for Larsen score and function assessment by HAQ. Results RA patients had significantly higher serum IL 1, 6 and 18 than controls (p = 0.00 in all). Thirty four (42.5%) patients had hypertensive reaction on Dobutamine‐stress‐echocardiography, four of them had ischemic change, and 46 (57.5%) had normal reaction. All patients with hypertensive reaction had positive RF (p = 0.00), 10 had DAS‐28 > 5.1, 20 had DAS‐28 from 3.2 to5.1 and 4 were in remission (p = 0.001). CRP was higher in patients with hypertensive reaction (p = 0.003) while serum levels of IL1, 6 and 18 showed no significant difference. In all patients, serum levels of IL1, 6 and 18 showed significant positive correlation with VAS, HAQ and DAS‐28 (p < 0.001 in all). Only IL18 showed significant positive correlation with X‐ray score in all patients. Conclusion Disease activity and RF positivity play an important risk factor for ischemic heart disease in RA. Serum levels of IL1, 6 and 18 did not help much in detecting patients at risk of ischemic heart disease. Better control of RA disease activity with early remission helps in preventing cardiac complications. More studies on larger number of patients are needed for better understanding of mechanism of ischemic heart disease in RA. HighlightsRheumatoid arthritis.Ischemic heart disease.Interleukins‐1beta, 6 and 18.

Growth Differentiation Factor-15 (GDF-15) Level and Relation to Clinical Manifestations in Egyptian Systemic Sclerosis patients: Preliminary Data

ABSTRACT Aim of the work: This study aims to assess Growth differentiation factor-15 (GDF-15) level in Scleroderma patients and its relation to disease manifestations. Patients and methods: This study included 55 scleroderma patients and 40 age and sex matched healthy volunteers. All patients were subjected to full history taking, thorough clinical examination, and laboratory investigations. GDF-15 serum levels were analyzed in patients and controls using human GDF-15 immunoassay Quantikine ELISA kit. Results: The GDF-15 serum level was significantly higher in Systemic sclerosis (SSc) patients in comparison to healthy control individuals, p-value = 0.004. In addition, the GDF-15 serum levels increased in a significant way in patients with diffuse SSc than those with limited SSc, p = 0.026. Also, we had discovered a significant positive correlation between serum GDF-15 levels and the modified Rodnan score of the SSc patients, r = 0.442, p = 0.001 and a significant association was found between high GDF-15 level and SSc patients with interstitial pulmonary fibrosis (IPF) as compared to healthy controls (p = 0.002). However, no significant difference was found between SSc patients without IPF and healthy subjects regarding GDF-15 level (p = 0.106). Conclusion: GDF-15 serum levels were elevated in patients with SSc and correlated with the extent of skin fibrosis, and it was found to be higher in SSc patients with IPF. Such results may suggest a pivotal role of GDF-15 in fibrotic changes in SSc, and GDF-15 could be a treatment target in SSc patients in future.

Relation of Tumor Necrosis Factor-Alpha with Insulin Resistance in Rheumatoid Arthritis Patients

Background: rheumatoid arthritis (RA) is a chronic inflammatory arthropathic with multiorgan involvement. Increased prevalence of insulin resistance (IR) has been observed in patients with RA. High-grade systemic inflammation is implicated in the development of IR in these patients. Tumor necrosis factor- alpha (TNF-α) is a potent proinflammatory cytokine that plays a role in initiation and progression of inflammation and the mechanisms associated with accelerated atherosclerosis in RA. Aim of the work: this study aimedto investigate the relation between TNF-α and IR in RA patients and its relation to disease activity. Patients and methods: 40 RA patients were included as the patient group and 40 healthy subjects as the control group. Both groups were subjected to full history, clinical examination including body mass index (BMI) and lab investigation, fasting blood glucose, fasting insulin and TNF-α. Results: the sex distribution was the same in patients and the control groups, 82.5% females and 17.5% males. The disease activity (DAS score) was 4.57 ± 1.35. TNF-α median was 240 with IQR 190-510. RA patients had significantly higher serum TNF-α than controls (p value = 0.001). BMI and Waist Circumference among RA patients and controls showed no significant difference. TNF-α has significantly positive correlations with fasting serum insulin, HOMA-IR and disease activity in RA patient group (p value < 0.001). Conclusion: serum TNF-α level was significantly higher in RA patients than the control groups with positive correlation in fasting serum insulin, HOMA score and disease activity.