Depression and Smoking Augment the Production of Circulating Autoantibodies against Glycated HSA in Rheumatoid Arthritis Patients.

BACKGROUND: Depression and smoking contribute to the prognosis of autoimmune rheumatoid arthritis (RA). Advanced glycation end products (AGEs) are also detected in RA patients. This study correlates RA in patients with various levels of depression and a history of smoking through the detection of antibodies against AGEs of proteins. METHODS: Sixty RA subjects were selected and divided into 4 groups based on their levels of depression and smoking habits. The division was as follows: group I consisted of RA patients classified as depressed (RA-D); group II consisted of RA patients with a history of smoking (RA-S); group III consisted of RA patients suffering from depression who were also smokers (RA-DS); and group IV consisted of patients with RA alone (RA-A), i.e., not depressed and non-smokers. In vitro human serum albumin (HSA) was modified by glucose, and the modifications were studied by biochemical and biophysical techniques. Glycated (G)-HSA was used as an antigen, and autoantibodies against G-HSA (G-HSA-Abs) were screened in serum samples of different groups of RA subjects. Oxidative stress levels in all patients and healthy individuals were analyzed by protein-bound carbonyl content estimations. RESULTS: Significant biochemical and biophysical changes were detected in G-HSA when compared to native (N)-HSA. All patients and control subjects were screened for circulating G-HSA-Abs and N-HSA-Abs. From the cohort of different samples, serum autoantibodies from RA-DS showed a high recognition of G-HSA-Abs titres compared to RA-D or RA-S. RA-A exhibited the least binding of circulating G-HSA-Abs of all the groups. The oxidative stress marker, the carbonyl content also exhibited highest levels in RA-DS, followed by RA-D and RA-S. Band shift assay showed the highest titres of immunoglobulin G in the serum samples of RA-DS. CONCLUSIONS: Smoking and concomitant depression in RA subjects may lead to enhanced oxidative stress levels responsible for the gradual formation and/or exposing of cryptic epitopes on HSA that induce the production of G-HSA-Abs. Hence, we postulate that by reducing depression and corresponding oxidative stress, it may be possible to control or limit the severity of the precipitation of RA disease activity and improve prognosis.

Percutaneous K-wiring for Gartland type III supracondylar humerus fractures in children.

OBJECTIVE: To assess the ability of closed reduction and percutaneous K-wire fixation, to obtain and maintain an adequate reduction, and thereby achieve satisfactory end results. METHODS: A prospective study conducted on 60 children over 28 months at Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India, from March 2003 to June 2005, in which Gartland type-III supracondylar fracture humerus were treated by closed reduction and percutaneous pinning, either from lateral side only or from medial side also, under image intensifier control. RESULTS: There was no problem in union. Patients were graded by Flynn's criteria with excellent results in 88.88%, good in 4.44%, and fair in 2.24%, and poor in 4.44% cases. Only one patient had developed cubitus varus deformity and one had Iatrogenic Ulnar nerve palsy from medial pin, which recovered subsequently. The Baumann's angle was well with in the normal range of 66-84 degrees [corrected] CONCLUSION: Percutaneous K-wire fixation is a safe and effective method for the management of Gartland type-III supracondylar fractures with minimal hospital stay and without risking vascular compromise.