Low vitamin D status in systemic sclerosis and the impact on disease phenotype.

OBJECTIVE: Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis. MATERIAL AND METHODS: Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. RESULTS: The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29). CONCLUSION: Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.

Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy.

AIMS: To investigate by ultrasonography (US) in a cohort of active RA patients starting biologic therapy the responsiveness of tenosynovitis of wrist and hands compared to the responsiveness of synovitis in a 6 month period follow-up, to compare the responsiveness of finger flexor tenosynovitis with the responsiveness of wrist extensor tenosynovitis and to describe the subclinical synovitis and tenosynovitis in RA patients in clinical remission. MATERIAL AND METHODS: Fifty seven patients with active RA starting biologic therapy were included. Clinical, laboratory, and US evaluations were performed at baseline, 1, and 6 months. US evaluation included wrist and MCPs 2-5 joints, bilaterally for synovitis and extensor tendons compartments 2, 4, and 6 and finger flexors 2-5 for tenosynovitis. Eighteen US scores based on semiquantitative or binary grades were calculated at each visit. Responsiveness of synovitis and tenosynovitis scores was calculated using the standardized response mean (SRM). RESULTS: The responsiveness of US tenosynovitis was lower comparing with the responsiveness of US synovitis but both showed large effect of therapy. Furthermore, tenosynovitis responsiveness was similar to CRP responsiveness (SRM -0.90). Finger flexors tenosynovitis showed a higher responsiveness than extensor tenosynovitis on GS (-0.94 compared to -0.63) and a lower SRM on PD (-0.56 compared to -0.85). Tenosynovitis scores remission was overlapping clinical remission according to CDAI and SDAI in 100% of cases. Overall there was less subclinical tenosynovitis than subclinical synovitis at final visit according to clinical activity indices. CONCLUSION: Tenosynovitis US scoring in RA may be as good as synovitis scoring for characterization of disease activity and responsiveness.

[Comparative study on Chinese medicine and western medicine for treatment of osteoarthritis of the knee in Caucasian patients].

OBJECTIVE: To compare the efficacy, safety and tolerability of different therapies in Caucasian patients with osteoarthritis (QA) of the knee. METHODS: Seventy-five cases (90 knee joints) of osteoarthritis were randomly divided into 3 groups, western medicine group, traditional Chinese medicine (TCM) group, integrated Chinese and western medicine group. The western medicine group were treated with oral administration of Glucosamine Sulfate, oral administration and external application of non-steroid anti-inflammatory agent, ultrasound physiotherapy, etc. The TCM group were treated with oral administration of J uanbi Decoction, acupuncture and moxibustion, cupping, massage of acupoint and ear acupuncture. The integrated Chinese and western medicine group were treated with oral administration of Glucosamine Sulfate, oral administration and external application of non-steroid anti-inflammatory agent, acupuncture and moxibustion, cupping, massage of acupoint and ear acupuncture. The intensity of knee joint pain on walking, resting and standing, the nocturnal pain, stiffness, the maximum walking distance and the daily living ability were monitored after 30 days, 60 days and 90 days of treatment. RESULTS: After 90 days of treatment, the integrated Chinese and western medicine group was better than other two groups in improvement of percentages in self pain assessment with visual analog scale (VAS), pain and stiffness measured by WOMAC scale, pain and maximum walking distance measured by Lequesne scale (P < 0.05 or P < 0.01). There were no significant differences in the therapeutic effects between the TCM group and the western medicine group. All of these three treatments were well tolerated, and no severe adverse events were found. CONCLUSION: Combined TCM and western medicine treatment has rapid and definite therapeutic effect in reducing pain and improving mobility of knee joints and daily living ability in Caucasian patients of knee osteoarthritis.