Prevalence and impact of chronic hepatitis C virus infection on the clinical manifestations and disease activity among patients suffering from systemic lupus erythematosus

To study the prevalence of anti-HCV antibodies among patients suffering from systemic lupus erythematosus [SLE] as well as to determine the impact of chronic HCV infection on the clinical manifestations and disease activity. Ninety-eight consecutive SLE patients presented to the rheumatology department, Cairo University Hospitals were included in the study. All patients were screened for anti-HCV antibodies using a 3rd generation enzyme-linked immune-sorbent assay [ELISA]. Patients with positive anti-HCV were tested for the presence of HCV-RNA by polymerase chain reaction [PCR]. Patients were classified into two groups; HCV/SLE and non-HCV/SLE according to the presence or absence of anti-HCV antibodies. Twenty/98 patients [20.4%] were positive for HCV antibody. Eight/98 patients [8.2%] had active viremia. SLE patients with positive anti-HCV antibodies tend to be older in age and having a longer SLE duration than non-HCV/SLE Patients. HCV/SLE patients had significantly lower mucocutaneous manifestations [p < 0.05] and higher cardiac manifestations and fundus abnormalities [p < 0.04, p < 0.01 respectively] than non-HCV/SLE patients. There was no statistical difference between the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] score between both groups. Patients with HCV/SLE were less frequently on oral steroids than patients with non-HCV/SLE HCV antibodies and active HCV viremia were found in 20.4% and 8.2% respectively among SLE patients. SLE with positive anti-HCV antibodies tend to be older in age and having longer SLE disease duration, lower mucocutaneous and higher cardiac manifestations and fundus abnormalities. Concomitant chronic HCV infection has no adverse impact on SLEDAI

Ultrasonographic evaluation of lower limb enthesis in patients with early spondyloarthropathies

The enthesopathy of seronegative spondyloarthropathies [SpA] is the hallmark of these diseases, the ultrasound examination of these entheses confirms the frequency of their involvement. To detect entheseal abnormalities with ultrasound [US] in the lower limb of patients with early Spondyloarthropathy [SpA] and to evaluate US as a valuable tool in detecting early enthesis. A total of 45 patients with early disease duration of 11.7 +/- 8.5 months, including 10 patients with psoriatic arthritis [PsA], 10 patients with ankylosing spondylitis [AS], 10 patients with reactive arthritis [ReA], eight patients with ulcerative colitis [UC] and seven patients with Crohn's disease and 20 healthy controls of matched age and sex underwent ultraso-nographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System [GUESS]. On US examination a total of 290/450 [64.4%] of the entheseal sites were abnormal. Mean GUESS score was significantly higher in patients with SpA as compared with controls[p < 0.001], with a higher mean value in patients with PsA, ReA and AS. The mean thickness of all tendons examined was significantly higher in SpA patients than in controls [p < 0.0001] as well as the mean number of enthesophytes and bursitis in all sites examined [p = 0.002, p = 0.003], with a higher prevalence amongst patients with PsA and ReA. The GUESS score was correlated to duration of the disease and the anti-tumour necrosis factor alpha medications. Enthesis involvement occurs early in spondyloarthritis, the enthesis US score appears to be reliable and useful for improving the diagnostic accuracy of early SpA, further studies are needed as US is an evolving technique

Interleukin-27 and its relation to disease parameters in SLE patients

IL-27 exerts profound anti-inflammatory effects in several experimental autoimmune models, suggesting that it may be therapeutically relevant in SLE. To evaluate IL-27 level in SLE patients and its association to clinical manifestations, disease activity parameters and management strategy. We studied 80 SLE patients and 50 controls in a cross sectional study. Demographic, clinical and serological data were evaluated. Systemic lupus erythematosus disease activity index [SLEDAI] and Systemic Lupus International Collaboration Clinics/ACR damage index [SLICC] were assessed. Serum IL-27 was measured by ELISA. There was statistically significant difference in IL-27 level in SLE patients and healthy controls [9.7 +/- 21.9 pg/ml vs 20.2 +/- 47.3 pg/ml in SLE vs controls, respectively] [p = 0.04], also it was found that IL-27 level was statistically significantly lower in SLE patients with lupus nephritis [p = 0.02] and cerebritis [p = 0.03]. Interleukin 27 level had a statistically significant negative correlation with the cumulative dose of hydroxychloroquine and azathioprine [r = -0.3, p = 0.03 and r = -0.3 and p = 0.04, respectively]. IL-27 has anti-inflammatory effect in SLE patients especially those without nephritis or cerebritis and can be therapeutically relevant in SLE. To confirm our results we propose larger scale, multicentre studies with longer evaluation periods

Thrombotic thrombocytopenic purpura associated with chronic HCV infection

Thrombotic thrombocytopenic purpura is a potentially lethal microvascular thrombotic disorder. In this study, we report a 32 years old woman who suffered from undifferentiated vasculitis with marked improvement on steroids and cyclophosphamide. Two years later, hepatitis C virus infection was discovered. Decision for interferon therapy was not recommended at this stage and the patient remained stable for the following 7 years. In January 2009, pegylated interferon and ribavirin were started due to worsening of her hepatitis; the treatment was stopped after 12 weeks due to the absence of any virologic response. Fourteen months later, she developed severe uncontrolled thrombotic thrombocytopenic purpura that led eventually to her death. We report this rare case of thrombotic thrombocytopenic purpura that may directly be related to chronic HCV infection rather than to interferon therapy

Clinical significance of serum TNFalpha and -308 G/A promoter polymorphism and serum Il-6 and -174 G/C promoter polymorphism in systemic lupus erythematosus patients

Systemic lupus erythematosus [SLE] is a disorder of immune regulation where cytokine imbalance and genetic factors are implicated in its pathogenesis. To evaluate the clinical significance of serum levels of tumor necrosis factor alpha [TNFalpha] and its -308 G/A promoter polymorphism as well as the IL-6 and -174 promoter polymorphism in SLE patients and find any association to the clinical and laboratory features as well as to the disease activity and severity. We studied 37 female SLE patients and age and gender matched healthy control. Demographic, clinical and serological data were evaluated and the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] and the Systemic Lupus International Collaboration Clinics/ACR Damage Index [SLICC] were assessed. Serum TNF-alpha and IL-6 levels were measured using enzyme-linked immunosorbent assay [ELISA] and DNA genotyped for TNF-alpha promoter [-308 G/A] and IL-6 promoter [-174 G/C] by polymerase-chain reaction-restriction fragment-length polymorphism [PCR-RFLP] analysis. Serum TNF-alpha and IL-6 levels were significantly higher in the SLE patients compared to control. Regarding IL-6, there was a statistically significant difference between the levels in the three groups according to the promoter polymorphisms. Patients with constitutional symptoms showed higher level of IL-6 while the TNF-alpha level was significantly lower in those with pulmonary manifestations. There was a tendency to a higher TNF-alpha and IL-6 level in those with neuropsychiatric manifestations. Serum TNF-alpha, -308 G/A promoter polymorphism, IL-6 and -174 G/C were higher in SLE patients than in healthy controls. To confirm our results we propose that larger scale, multicenter studies with longer evaluation periods are needed

Comparative study of kidney affection in SLE patients with and without antiphospholipid syndrome

To evaluate the incidence, clinical associations and outcome of APS nephropathy in SLE patients with 2[ry] APS. We studied 64 female SLE patients with nephritis; 32 of them had 2[ry] APS [group 1] and the rest without 2[ry] APS [group 2]. Demographic, clinical and serological data were prospectively evaluated. Systemic lupus erythematosus disease activity index [SLEDAI] and Systemic Lupus International Collaboration Clinics/ACR damage index [SLICC] were assessed. Renal duplex, renal [99m]Tc-dimercaptosuccinic] scan [DMSA scan] and renal magnetic resonance angiography [MRA] were all used to detect renal vascular affection. There were statistically significant differences between the two examined groups regarding damage index [p = 0.000], hypertension [p = 0.02], thrombocytopenia [p = 0.000], LDL [p = 0.008], C3 [p = 0.01] and TMA [p = 0.04]. In group 1: MR angiography detected 7 patients with RAS: 5 patients with renal artery thrombosis that showed a significant association with TMA and proteinuria [p = 0.002, p = 0.004: p < 0.001, p = 0.02, respectively]. Patients with RAS had DBP, s.creatinine and TGs [p = 0.004, p = 0.005 and p = 0.0003, respectively]. Renal DMSA detected 6 patients with cortical scar which showed a significant association with TMA, proteinuria, livedoreticularis and arthritis [p = 0.001, p = 0.01, p = 0.04 and p = 0.03, respectively] those patients had DBP and RI [p = 0.000 and p = 0.006, respectively]. aPL testing should become a routine investigation in patients evaluated for RAS or renal infarctions especially with hypertension and unexplainable deteriorating renal function. To confirm our results we propose that larger scale, multicentre studies with longer evaluation periods

25-Hydroxy vitamin D levels and its relation to disease activity and cardiovascular risk factors in women with systemic lupus erythematosus

To evaluate the associations of serum 25 hydroxy [OH] vitamin D [25[OH]D] levels with cardiovascular risk factors as well as disease activity in women with SLE. Fifty women with SLE as well as 30 controls were included in our study. Data collected included, demographics, SLE activity and damage assessments, cardiovascular risk factors, medications and laboratory assessment of inflammatory markers and 25[OH]D levels. Stepwise logistic regression analysis were used to estimate the association of 25[OH]D levels with cardiovascular risk factors. A significant lower 25[OH]D levels was found in SLE patients compared to controls [P < 0.001]. A positive correlation was found between 25[OH]D and diastolic blood pressure, fasting blood sugar, cholesterol, triglycerides, LDL, BMI, as well as proteinuria and C3 levels. Furthermore, a significant positive correlation was found between 25[OH]D and the RT carotid artery stenosis and RT carotid artery plaque and the intima media thickness of both left and right carotid arteries. Lower 25[OH]D levels were also significantly associated with higher SLE disease activity and damage scores and steroid cumulative dose. Stepwise logistic regression analysis showed that higher BMI, diastolic blood pressure, cholesterol, triglycerides, LDL and diabetes mellitus act as predictors of lower 25[OH]D levels. Our study found an association between lower 25[OH]D levels and increased cardiovascular disease [CVD] risk factors, as well as increased SLE disease activity and damage indices. Future studies are needed to determine relation of 25[OH]D and cardiovascular risk factors in patients with lupus