ADAMTS-4 as a possible distinguishing indicator between osteoarthritis and haemophilic arthropathy.

INTRODUCTION: Osteoarthritis (OA) and haemophilic arthropathy (HA) are clinically similar, but pathologically distinct conditions which result in joint pain and loss of function. Distinguishing their disease mechanisms is therefore a key step in the development of curative therapy, as opposed to current symptomatic treatments. A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 4 is a metzincin-family member proteoglycan with known local involvement in OA pathogenesis. AIM: To investigate the potential differences and discriminatory potential of ADAMTS-4 between OA and HA patients. METHODS: We determined ADAMTS-4 plasma concentrations by ELISA in patients with HA and OA. This pilot cross-sectional study included N = 40 male participants equally divided across four subgroups: haemophilia patients with severe or mild HA and control subjects with severe or mild/no OA. RESULTS: Our study showed a striking elevation in plasma ADAMTS-4 expression levels in HA patients as compared to OA, as well as an increase in patients with severe as compared to mild HA. By performing the binomial logistical analysis and fitting the receiver-operator curve (ROC) (cut-off probability .5), ADAMTS-4 had a sensitivity of 95% and specificity of 50% in discriminating between HA and OA among our study participants. CONCLUSION: Uncovering the marked differences in plasma levels of ADAMTS-4 in patients with HA versus OA potentially sheds new light on the mechanisms of HA pathogenesis and could foster more research into the roles ADAMTS-4 and other matrix metalloproteinases (MMPs) play in HA versus OA.

Decrease in handgrip strength in rheumatoid arthritis (RA): is there a sex-related difference?

Rheumatoid arthritis occurs two to three times more often in women than in men and it has been less studied in men. The results of gender influence on clinical course of the disease are contradictory. The aim of this study is to determine the difference in handgrip strength between female and male RA patients in comparison to healthy individuals. The study included 100 RA patients and 100 healthy individuals (50% were male in both groups). Handgrip strength was measured in both hands using a dynamometer. A two-way ANCOVA was used to analyse the data and age was included in the study as covariate. The results show that both male and female RA patients have lower handgrip strength compared to healthy individuals. The analysis of gender and disease interaction has shown that male RA patients have lower handgrip strength than female RA patients in comparison with the healthy group, age adjusted. This interaction is evident and statistically significant in both right hand (F 1, 195) = 14.62; p < 0.01) and left hand (F 1, 195) = 20.54; p < 0.01). The common-language effect size has shown that there is 92% (right hand) and 93% (left hand) chance that male individual will have stronger handgrip than his female counterpart. In RA patients, there is 77% chance for both hands that male will have stronger handgrip. Men and women with RA have significantly lower handgrip strength compared to healthy individuals and the difference is more pronounced in men which was not previously observed in the literature.

Anti-TNF Therapy and the Risk of Malignancies and Infections in Inflammatory Rheumatic Diseases - Our Experience.

BACKGROUND: Early diagnosis is the key to successful treatment of inflammatory rheumatic diseases and the use of conventional disease-modifying antirheumatic drugs (csDMARD) and biologic disease-modifying antirheumatic drugs (bDMARD) or biologics have substantially contributed to better disease control. Biological drugs have been approved for the treatment of rheumatoid arthritis (RA), juvenile arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). SUBJECTS AND METHODS: The study involved 79 adult patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthropathy (USpA) - the last three clinical entities belong to a common group called spondyloarthropathies (SpA); receiving anti-TNF therapy at the department of Rheumatology and Rehabilitation, Clinical Hospital Center Zagreb. The duration of therapy was a minimum of 1 month, with the mean duration of 32.0±24.0 months. The infections recorded were infections that appeared during treatment or soon after the treatment was stopped. RESULTS: During the course of therapy 17 patients (21.5%) experienced an infection, with the total number of 21 infections. This resulted in an overall incidence rate (IR) of 9.9/100 patient-years. Of the patients with RA 76.5% developed an infection, which was significantly higher than for patients with SpA (p<0.001). The IR/100 patient-years for all infections in RA patients was 23.7 compared to 2.8 in patients with SpA. Female gender was associated with a significantly higher infection rate (70.6%, p=0.005). There were 8 infections that were considered serious, yielding an IR of 3.8/100 patient-years. There was only one malignancy case in our study. CONCLUSION: Every fifth patient developed an infection during the course of anti-TNF therapy, and more than one third of all infections were serious. RA and female gender was associated with a significantly increased number of infections.

Proteomic exploration of potential blood biomarkers in haemophilic arthropathy.

Background and Aims: The pathophysiology of haemophilic arthropathy (HA) is complex and largely undefined. Proteomic analyses provide insights into the intricate mechanisms of the HA.Our study aimed to identify differentially expressed proteins in relation to the severity of HA, explore their pathophysiological roles, and evaluate their potential as HA biomarkers. Methods: Our cross-sectional observational study encompassed 30 HA patients and 15 healthy subjects. Plasma samples were pooled into three groups of 15 samples from those with severe haemophilic arthropathy (sHA), mild haemophilic arthropathy (mHA) and healthy controls. Proteomic analysis was performed using liquid chromatography-mass spectrometry. The severity of HA was assessed using the World Federation of Haemophilia Physical Examination Score and ultrasonography following the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) guidelines. Results: A total of 788 proteins were identified, with 97% of the uniquely identified proteins being expressed in all analysed groups. We identified several up and downregulated proteins across the groups that were mainly related to inflammatory and immunity-modulating processes, as well as joint degeneration. We highlighted ten proteins relevant for the development of HA: cathepsin G, endoplasmic reticulum aminopeptidase 2, S100-A9, insulin-like growth factor I, apolipoprotein (a), osteopontin, pregnancy zone protein, cartilage oligomeric matrix protein, CD44, and cadherin-related family member 2. Conclusion: Our analysis identified several proteins that shed further light on the distinctive pathogenesis of HA and could serve for biomarker research. However, these results need to be validated on a larger patient group.

Measures for achieving recruits' enhanced fitness--a transversal study.

Because of 10.94% frequency in obese recruits in Rijeka in 2005 occupational medicine decided to study causality of that and other most frequent diagnoses: pedes plani, myopia and astigmatism, kyphosis and scoliosis, asthma, hypertension and branch block. Double monitoring of 1,311 recruits was carried out by a transversal study during 2005, 2000 and 1995 and within each year according to location: city, suburbs, islands. The differences in the three periods in the city were obesity (p < 0.05) with highest frequency in 2005, asthenia (p < 0.05) with lowest frequency 0.99% in 2005, and pedes plani (p < 0.05) with highest frequency in 1995. Suburbs showed (p < 0.05) forpedes plani, p = 0.054 for obesity, and the islands obesity (p < 0.05). Myopia and astigmatism frequency went up to 25%, kyphosis to 14.13% and asthma to 5.43%. Hypertension frequency was negligible. Occupational medicine decided to react by measures increasing recruit fitness cooperating with school medicine, teachers and parents, by check-ups, corrections, dieting and physical activities.

[The impact of some bad habits and environmental factors on the somatic status of male adolescents]. / Utjecaj nekih stetnih navika i cimbenika zivotnog okolisa na somatski status muske mladezi.

AIM: The aim of the study was to investigate whether some bad habits of sedentary lifestyle influence the occurrence of diagnoses in male adolescents, divided according to their environment into urban, rural and and island groups. PATIENTS AND METHODS: A total of 437 male adolescents underwent physical examination and functional diagnostic tests at Occupational Medicine Clinic in Rijeka, in order to evaluate their fitness for military service. The method of physical examination and anthropologic measurements was used. The results were analyzed by the Stat Soft, Statistics 6.0 software. Pearson chi-squared-test test and correlation matrices were used. RESULTS: The results showed obesity to be present in a relatively high percentage of subjects from urban area (10.94%) and rural area (13.19%), whereas asthenia was more pronounced in islanders (8.69%), yielding a statistically significant between-group difference (p<0.05). In contrast to asthenia, the islanders had the lowest percentage of flatfoot, with a significant difference from the two other groups (p<0.05). Refraction errors, primarily myopia, were not influenced by the place of residence. The incidence of myopia in all three groups was slightly over 20%. Contrary to our expectation, bronchial asthma was most common in the islanders (5.43%), however, there data could not be considered representative because of the rather big rate of migration from the inland to prevent relapses of respiratory diseases. The incidence of mild kyphoscoliosis ranged from 5.55% in the subjectss from rural settings up to 11.95% in the islanders, without a statistically significant between-group difference. DISCUSSION: It is difficult to identify the causes of differences in body weight among adolescents from urban, rural and island settings. It is not so easy to criticize the former for predominantly sedentary life, watching TV, video or Internet. Physical activity cannot be readily performed in towns because of the increasing presence of pollutants in the atmosphere. The prevalence of bronchial asthma was slightly higher than expected, which was explained by the permanent residence of atopics on the islands in order to prevent disease relapses. The lowest incidence of flatfoot among islanders was explained by their free lifestyle, barefoot walking along the rocky seaside, and high level of physical activity. Refraction errors including myopia as the leading diagnosis were equally present in the three groups, exceeding 20%. Besides heredity, the sight is influenced by intensified effects of ultraviolet radiation that causes changes of the eye structure. Also, neon signs and lights as well as too strong night streetlights lead to phototoxic vision damage in adolescents. Study results showed that male adolescents who lead physically inactive life should not to be blamed for the occurrence of the mentioned diagnoses. Like all of us they are daily affected by harmful pollutants that cause damage to the eyes, cardiovascular, respiratory and other organ systems. This study has helped identify the causes of the mentioned diseases in the group of male adolescents, emphasizing the role of occupational medicine. Specialists in occupational medicine should be involved in the monitoring of somatic and other parameters in adolescents from the early school age. In this period, it is still possible to reduce or and even prevent the occurrence of the mentioned diagnoses by examinations, education, exercises and diets. In this way, the candidates for military service would be healthier and fit.

Morphological status of cadets and pilots of the Croatian Air Force.

Results of the analysis of morphological status of cadets and pilots of the Croatian Air Force are presented, in relation to the morphological status of a sample of conscripts of the Croatian Army. The results of the morphological status of body built of the flier potential of the Croatian Air Force, i.e., the potential (cadets) and active fliers (pilots), suggest a process of spontaneous (or possibly systematic) selection of flier candidates based on anthropometric criteria. Based on the obtained anthropometric data, it may be concluded that persons who choose to candidate for and are selected to join the Croatian Air Force as pilots, are of specific personal appearance and body built.

The structure of body measurements for the determination of shoe sizing for young Croatian men.

The determination and promotion of the system of shoe sizing requires accurate knowledge of morphological properties of the foot and lower leg of the tested population. Similarly it is necessary to establish the occurrence and regional distribution of definite sizes in the tested population. Possible regional differences in morphological properties must not be ignored because it has been established by means of anthropological measuring that both foot dimensions and foot shapes differ between populations and within the same population. This has been proven by the investigation of body measures, carried out for the purpose of establishing a system of footwear sizes, which was executed on a randomly selected sample of 4,268 healthy and normally developed males aged 18-22. The investigation was carried out in 1993 on five locations each of which representing a definite region of the Republic of Croatia: Jastrebarsko (central), Koprivnica (northwestern), Pula (southwestern), Sinj (southern) and Pozega (northeastern). The measuring instrument was 31 foot and lower-leg sizes according to the existing ISO standards for footwear. Interregional differences are significant in all body measures. The role and the contribution of individual measures to these differences has been established by means of discriminatory analysis with regions as a priori defined samples. In order to constitute a convenient and purposeful standard for the footwear size system it is necessary to work out a database with referent values for the same system.