Sinem Sag

Levels of serum pentraxin 3, IL-6, fetuin A and insulin in patients with rheumatoid arthritis

OBJECTIVE The aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis. METHODS This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied. RESULTS The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032). CONCLUSION Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

Nailfold videocapillaroscopy results in patients with rheumatoid arthritis

We aimed to analyse the nailfold capillaryscopy findings morphologically and examine their relationship with disease activity and demographic characteristics in patients with rheumatoid arthritis. In accordance with the 2010 ACR/EULAR classification criteria, 201 patients diagnosed with Romatoiad artrit (RA) and 50 healthy controls were included. We analysed capillaroscopic abnormalities such asmegacapillaries, haemorrhages, ramifications and avascular areas in patients affected with rheumatoid arthritis. The findings in our study are as follows: in 45.77% of the RA patients, there were nonspecific capillaryscopy findings. When compared to control group, the incidence of tortuosity, dilated capillary and bushy capillary was higher in RA patients (p values, respectively, 0.110, 0.330, 0.440 and 0.516). In RA patients with Raynaud’s phenomenon, the incidence of nonspecific capillaryscopy findings was higher. While there is a weak relationship between tortuosity and the duration of disease, no significant relation was detected between capillaryscopy findings and parameters such as RF, anti-CCP positivity and disease activity score (DAS28). When compared to controls, we have detected that RA patients have more nonspecific capillaryscopic findings. We could not find a relationship between nonspecific capillaryscopic findings and RA’a clinical findings and laboratory parameters. There is a need for a long-term wider-scale follow-up study to investigate whether there is a capillaryscopic pattern that can be correlated with RA’s clinical findings.

Relationship of hematologic markers with IL-17 and IL-1 beta in patients with rheumatoid arthritis

OBJECTIVES In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

Heberden's nodes and joint capsule fibrosis

The joint cartilage, subchondral bone and synovium are currently thought to be responsible for the different structural changes seen during the evoluation of disease process in osteoarthritis. There is not enough published literature about joint capsule changes in Heberdens nodes, one of the most common manifestations of osteoarthritis. To investigate is possible role of the joint capsule in the pathologic process in the development of Heberdens nodes. We report the histological examination of joint capsule dıstal interphalangeal joints in two patients with Heberdens nodes. We excised V shaped joint capsule parts longitudinally and laterally of distal interphalangial joints of patients with Heberden’s arthritis and aimed to see histopathologic examination of capsule. Histological examination showed the capsule to be composed of hyalinized collagenous stroma containing thickened, closely packed, hypo cellular collagen bundles and small blood vessels and some mature lipocytes groups. The study revealed that fibroblast proliferation and fibrosis occurs in the joint capsule of Heberdens nodes, we postulated those changes are predictive ofosseos proliferation and further research to be established if the joint capsule or soft tissue around the distal interphalangeal joints contribute in the pathological process inosteoarthritis.

AB0751 The differences and similarities between patients and physician global assessment in patients with psoriatic arthritis

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, axial involvement, enthesitis, dactylitis and uveitis. The differences and similarities between patients global assessment (PtGA) and physicians global assessment (PhGA) were not assessed clearly in PsA. Objectives The aim of this study was to assess differences and similarities between patients and physicians perspective of global assessment in patients with PsA. Methods Patients with PsA over the age of 18-year-old who met the CASPAR classification criteria were underwent clinical and laboratory evaluation by using standardized protocol and case report form, from two universities outpatients clinics. PtGA and PhGA, VAS-pain, fatigue, BASDAI, BASFI, health-related QoL were recorded at baseline visit. Pearson correlation coefficient were calculated for PtGA and PhGA. Linear regression model were used to asses relationship between global assessments and clinical finding. Results A total 144 patients with PsA (male 51, female 93) were included. Symptom duration (7.8±7.5 vs 11.3±11.2), VAS-pain (4.4±2.6 vs 4.9±2.6), PtGA (4.7±2.5 vs 5.0±2.4) and PhGA (4.0±2.2 vs 4.4±2.2) were similar between male and female patients with PsA (p>0.05). VAS-fatigue was higher in female patients with PsA than male ones (5.9±2.7 vs 4.4±2.8, p=0.001). Disease activity measurements such as, tender and swollen joint count, DAS28, BASDAI and acute phase reactant were similar for both sex. Correlation coefficient of Physicians global assessment was higher than PtGA in various clinical findings. The highest correlation coefficient was observed in VAS-pain (r=0.784) and followed by SF36-bodily pain (r=-0.613), BASDAI (r=0.587), NHP-physical activity (r=0.584), VAS-fatigue (r=0.555), BASFI question 5 (r=0.551) for PhGA (p<0.0001). However the highest correlation coefficient was observed in VAS-pain (r=0.690) and followed by NHP-physical activity (r=0.536), BASFI question 10 (r=0.512), BASDAI (r=0.499), SF36 (r=-0.490) and BASFI total score (r=0.484) for PtGA (p<0.0001). Statistically significant positive linear relation was observed between global assessment and clinical parameters (VAS-pain, fatigue, BASDAI, BASFI, DAS28, NHP-physical activity) by using simple linear regression model. VAS-pain and BASDAI question 1 explained 83.3% of PtGA as a predictor in multiple linear regression model. However, VAS-pain and DAS28 explained 68.4% of PhGA as a predictor in multiple linear regression model (table 1).Table 1. Results of multiple linear regression of PtGA and PhGA R2 B SE t p Patients global assessment  Constant 0.833 0.597 0.311 1.920 0.060  VAS-pain 0.665 0.061 10.939 ?0.0001  BASDAI-1 How would you describe the overall level of fatigue/tiredness you have experienced in the past week? 0.205 0.063 3.243 0.002 Physicians global assessment  Constant 0.684 0.399 0.310 1.285 0.201  VAS-pain 0.587 0.050 11.846 ?0.0001  DAS 28 0.332 0.096 3.453 0.001 Conclusions Assessment of disease activity as well as clinical parameters is considered to be complex in PsA. Patients and physicians have different perspective of disease activity. Severity of pain and fatigue may be predictor of PtGA whereas; pain and objective disease activity measurement may be predictor of PhGA in patient with PsA. Disclosure of Interest None declared

THU0051 The Levels of Serum Pentraxin 3, IL 6, Fetuin A and Insulin in Patients with Rheumatoid Arthritis

Background The pathogenesis of RA is not well understood, but genetic, environmental and immunologic factors are known to be involved in the development of the disease. The long pentraxin, pentraxin-3 (PTX-3), is an inflammatory marker and a member of pentraxin superfamily which contains CRP and serum amyloid P. There are some published studies showing the relationship between RA and PTX-3. (1–3). We investigated that PTX3, IL 6, fetuin- A, insulin and HOMA-IR might also have a role in the pathogenesis of RA. Objectives The aim of this study was to evaluate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6,insulin and HOMA-IR levels in patients with rheumatoid arthritis. Methods This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were determined. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). Quality of life was evaluated by the use of the Health Assessment Questionnaire disability index. Results The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were elevated than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively) A positive correlation was evident between the DAS 28 score and IL6 levels (r =0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels was positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032). In addition, DAS-28 score values were not in correlation with insulin, fetuin-A, HOMA-IR, IL-6 and pentraxin-3 levels (p>0.05). Conclusions Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of IL-6, fetuin-A, insulin HOMA-IR, pentraxin -3, CRP, ESR concentrations were not associated with clinical severity of the RA. References Dessein PH, Norton GR, Woodiwiss AJ, Joffe BI, Solomon A. Independent role of conventional cardiovascular risk factors as predictors of C-reactive protein concentrations in rheumatoid arthritis. J Rheumatol 2007;34:681–8. Hollan I, Nebuloni M, Bottazzi B, Mikkelsen K, Førre OT, Almdahl SM, Mantovani A, Fagerland MW, Aukrust P, Meroni PL; Feiring Heart Biopsy Study Group.Group. Pentraxin 3, a novel cardiovascular biomarker, is expressed in aortic specimens of patients with coronary artery disease with and without rheumatoid arthritis. Cardiovasc Pathol 2013 Sep-Oct;22(5):324–31. Klimek E, Skalska A, Kwaśny-Krochin B, Surdacki A, Sulicka J, Korkosz M, et al. Differential associations of inflammatory and endothelial biomarkers with disease activity in rheumatoid arthritis of short duration. Mediators Inflamm 2014;2014:681635. Disclosure of Interest None declared