Genito-urinary fistula patients at Bugando Medical Centre.

BACKGROUND: Information was collected on 1500 obstetric fistula patients attending Bugando Medical Centre (BMC) in Mwanza, Tanzania. OBJECTIVES: To identify high risk populations of fistula patients treated from 1998-2006. DESIGN: A prospective description study of 1294 patients treated for urine and faecal incontinence at BMC. SETTING: Obstetrics and Gynaecological ward at Bugando Medical Centre. INTERVENTIONS: A total of 1294 patients underwent surgical treatment of incontinence. MAIN OUTCOME MEASURES: Of the 1294 surgical repairs, 84% of the patients were cured, 12% had stress incontinence and 4% failed. CONCLUSIONS: The study shows that low education and poverty were the key factors in the development of fistula. Most obstetric fistulae can be cured, particularly during the first attempt by those properly trained in the skills. Prevention of genital fistula requires raising the education and social status of women including poverty reduction strategies, improving the quality of antenatal care. Increased access to Caesarean section is also needed for prevention of genitourinary fistulas.

[Relationship between the intima-media complex thickness, the risk factors of cardiovascular diseases, and the level of C-reactive protein in gouty patients].

AIM: To estimate a relationship between the intima-media thickness (TIM), cardiovascular risk (CVR) factors, and the level of C-reactive protein (CRP) in gouty patients. SUBJECTS AND METHODS: Eighty-nine patients at an interattack interval were examined. The patients' mean age was 46.0 +/- 11.4 years; the duration of the disease was 5.2 (3.0; 8.9) years. The traditional CVR factors were analyzed. Carotid ultrasound scanning was performed to detect vascular atherosclerotic lesion. The serum CRP concentration was measured by a highly sensitive immunonefelometric assay. RESULTS: According to the TIM, the patients were divided into 2 groups: 1) 37 patients with signs of carotid atherosclerotic lesion (TIM > or = 0.9 mm); 2) 52 patients with a TIM of less than 0.9 mm. The ages at the moment of examination and at the onset of the disease, the duration of the disease, as well as systolic blood pressure, and the risk of myocardial ischemia were greater in Group 1 than those in Group 2. In patients with atherosclerosis, the concentration of CRP was statistically significantly higher than that in patients without this condition. CONCLUSION: By complementing the classical CVR factors, CRP may be a predictor of cardiovascular diseases and their complications in patients with gout at an interattack interval.

[Cardiovascular risk in psoriatic arthritis].

AIM: To evaluate cardiovascular risk in psoriatic arthritis (PA). MATERIAL AND METHODS: The examination covered 61 PA patients (52.9% females) aged 30-55 years and 45 controls without inflammatory and degeneratory diseases matched by gender, age and body mass. Standard cardiovascular risk factors were analysed. C-reactive protein was measured with a highly sensitive method. Carotid arteries were subjected to duplex scanning. RESULTS: PA patients had a high cardiovascular risk. Dyslipidemia manifested with a high total cholesterol, LDLP cholesterol which correlated with inflammation activity. PA was more frequently associated with subclinical atherosclerosis and atherosclerotic plaques. CONCLUSION: Chronic immune inflammation underlying pathogenesis of PA contributes to development of early atherosclerosis and its complications. A high cardiovascular risk is a constituent of PA which had an impact on long-term prognosis of this disease.

[Clinical implication of assessment of heart rate variability in patients with psoriatic arthritis].

AIM: To evaluate clinical significance of heart rate variability (HRV) in patients with psoriatic arthritis (PsA). MATERIAL AND METHODS: HRV was investigated by means of time-domain analysis of 24 h ECG ambulatory recording in 113 PsA (70 female) patients < 55-years-old and 65 age-matched healthy subjects. We assessed the presence of standard cardiovascular risk factors, performed carotid and femoral ultrasound with measurement of intima-medial thickness (IMT) in PsA patients. Inflammatory markers (CRP, fibrinogen) were detected in all the patients. RESULTS: Significantly lower values of HRV parameters adjusted by Mean NN (SDNNn%, SDNNIN%) were detected in PsA men and women when compared to the control group. There was a significant negative correlation between HRV and disease duration, PsA activity (DAS4, Ritchi index), swollen and tender joint counts, femoral IMT, CRP in PsA males (p < 0.05). SDNNin% was lower in PsA male smokers than in non-smokers (p = 0.03). There was a significant negative correlation between HRV and age, systolic blood pressure, dyslipidemia, body mass index, carotid IMT, CRP, fibrinogen in PsA women. CONCLUSION: Reduced HRV reflects sympatho-vagal imbalance in PsA patients associated with the disease duration and activity, smoking, femoral IMT, markers of inflammation (CRP) in males; with standard cardiovascular risk factors, fibrinogen, CRP, carotid IMT in women, and may be identified as a risk factor for cardiovascular morbidity and mortality in further studies.

[Clinical significance of the assessment of cardiac rhythm variability in patients with rheumatoid arthritis].

The study included 128 patients below 55 years of age with confirmed diagnosis of rheumatoid arthritis (RA) and 30 age and sex-matched healthy volunteer comprising the control group. They were examined for clinical manifestations and severity of RA, cardiovascular risk factors (smoking, body mass index (BMI), blood lipid level), and serum inflammation markers. Intima-media thickness (IMT) was measured in common carotid arteries by duplex scanning. 24 hour ECG monitoring was performed using a three-channel Astrokard monitor, Meditex, with HRV analysis. HRV values in RA patients proved significantly lower than in healthy subjects. The patients showed inverse correlation of HRV with RA duration and severity, HAQ index, X-ray stage, articular dysfunction, and maximum dose of corticosteroids. Also, HRV values negatively correlated with traditional risk factors (age, systolic and diastolic AP, smoking, and IMT. HRV was reduced in AR patients with high and low BMI compared with patients with normal weight. HRV negatively correlated with inflammation markers (leukocytes, ESR, C-reactive protein). It is concluded that concomitant measurement of HRV and inflammation markers in RA patients taking into account severity of the disease and traditional risk factors may be useful for prognosis of cardiovascular death among patients with RA.

Autologous progenitor cell implantation as a novel therapeutic intervention for ischaemic digits in systemic sclerosis.

OBJECTIVES: The effects of local stem cell implantation on clinical and functional characteristics of peripheral vascular disease were studied in two SSc patients with non-healing ischaemic ulcers. METHODS: The local injections of CD34(+) cells from peripheral blood (PB) after mobilization by G-CSF (Case 1) and bone marrow (BM) (Case 2) were used for ischaemic skin ulcers in hands, while mononuclear cells (MNCs) were implanted in lower extremities of the same patients. Ischaemic status was evaluated by measuring ulcer healing, Raynaud's condition score (RCS), visual analogue pain, RP and ulcer scales. To evaluate vasculoprotective action of the implanted cells, we studied weekly the changes in endothelial function, using measurement of flow-mediated brachial artery reactivity by high-resolution ultrasonography, circulating endothelial precursors (CD34(+)VEGFR2(+), CD133(+)VEGFR2(+) CEP) by FACS analysis, cutaneous blood flow (laser Doppler flowmetry), skin surface temperature (thermograph), peripheral arterial diameter and blood flow characteristics by Duplex ultrasonography. RESULTS: CD34(+) cells and MNCs both from BM and PB showed rapid and evident beneficial effect on vascular symptoms resulting in ulcer healing, remarkably decreased daily frequency and duration of RP attacks, RCS, visual analogue scale for RP, ulcers and pain. Physical function and disability measured with HAQ and SHAQ improved. Therapeutic efficacy of stem cell therapy was associated with restoration of endothelial function, augmentation of microcirculatory blood flow and significant increase in circulating CD133(+)VEGFR2(+) progenitors, known as cell effectors of angiogenesis. CONCLUSION: This first open-label pilot study demonstrates the feasibility and short-term safety of local CD34(+) cell therapy for SSc ischaemic complications.

[Subclinical and clinical manifestations of atherosclerosis in antiphospholipid syndrome].

AIM: To evaluate intima-media complex (IMC) thickness in patients with antiphospholipid syndrome in terms of clinical-laboratory manifestations and thrombosis risk factors. MATERIAL AND METHODS: The trial included 206 patients (57 males and 149 females, age 16-59, mean age 35.9 years). Of them, 58 (28%) patients had primary antiphospholipid syndrome (PAPS) alone, 148 had documented concomitant systemic lupus erythematosus (SLE). Seventy two (48.6%) SLE patients had antiphospholipid syndrome (APS), 29 (19.6%)--anticardiolipin antibodies (aCL) level above 40 IU in two and more measurements without clinical symptoms of APS. In addition to standard tests, APL (lupus anticoagulant), aCL and antibodies to beta-2 glycoprotein, blood lipids were measured. Thrombosis and atherothrombosis risk factors were evaluated. Ultrasound dopplerography estimated thickness of IMC in the carotid and femoral arteries. The control group consisted of 89 donors free of autoimmune diseases. RESULTS: Mean values of IMC thickness did not differ between the groups. Atherosclerotic plaques (ASP) were detected in 25 (12%) of 206 patients: in 5 (9%) from PAPS group, 10 (14%) from SLE+APS, in 4 (14%) and 6 (13%) from SLE groups aPL+ and aPL-, respectively. Mean age of patients with ASP was 46 +/- 6.9 years (32-55 years). ASP occurrence was associated with older age: ASP were detected in 10 (38%) of 26 patients aged over 51 years (24 plaques), in 10 (20%) of 50 patients aged 41-50 years (18 plaques) and in 5 (10%) of 50 patients aged 41-50 years (18 plaques) and in 5 (10%) of 50 patients aged 31-40 years (9 plaques, p = 0.001). IMC thickness and plaques were associated with prior arterial and venous thromboses and occurred significantly more frequently in patients with myocardial infarction and transient ischemic attacks (p < 0.001). Thrombosis and atherothrombosis risk factors were associated with changed IMC thickness. The level of aPL and their type had no effect on IMC thickness and ASP incidence in the groups studied. CONCLUSION: Increased IMC thickness was associated with age irrespective of APS presence. In SLE, ASP appeared at younger age than in PAPS patients. Atherothrombosis risk factors affect IMC thickness irrespective of the level and type of aPL.

[Endothelial dysfunction in scleroderma systematica: clinicopathogenetic correlations].

AIM: To evaluate disturbances of vascular tonicity regulation in scleroderma systematica (SS) patients using laser Doppler flowmetry (LDF) with calculation of amplitude-frequency blood flow fluctuations (variability) basing on the mathematical model wavelet-transformation. MATERIAL AND METHODS: The trial included 101 patients with verified SS aged 21-60 years (mean 52.3 years, 97 females). In addition, 15 and 10 patients with primary and secondary Raynaud syndrome diagnosed by ACR criteria, respectively, entered the trial. The control group consisted of 20 healthy subjects. Cardiovascular patients were not included in the study. Microcirculation was investigated with laser analyzer of capillary circulation in the tip of left hand finger III and external surface of the left arm. Endothelial motor function was studied in the tests with reactive hyperemia and nitroglycerin. RESULTS: SS patients were found to have a significantly higher variability and endothelial rhythm amplitude index in arm skin, reduced microcirculation, the variation index and high neurogenic tonicity in the hand finger tip. A direct correlation was found between severity and area of skin lesion (of the arm, in particular) and their amplitude of endothelial fluctuations (r = 0.38, p = 0.03) of circulation in the arm skin. Persistent correlations between skin count and LDF values were not registered. There was a significant regression of flow-dependent dilation of the brachial artery in SS patients independent of classic cardiovascular risk factors. CONCLUSION: SS patients have defects in regulation of vascular tonicity both in microcirculation and middle-caliber arteries. Vasomotor activity of the middle-caliber vessels is low in the absence of conventional cardiovascular disease risk factors. LDF detects changes in local regulation in cardiovascular patients confirming the role of neuroendothelial disorders in its pathogenesis. The trend to systemic DE in cardiovascular patients is associated with both disease-mediated vascular lesions (ulcers of finger tips, pulmonary hypertension) and cardiovascular disease markers.

[Soluble CD40 ligand in systemic lupus erythematosus: link with atherosclerotic vascular affection].

AIM: To evaluate clinical implications of pCD40L as a marker of atherosclerotic vascular affection in systemic lupus erythematosus (SLE). MATERIAL AND METHODS: The examination of 132 females (mean age 35 years, SLE duration 96 months) assessed classic factors of atherosclerosis risk (AR), total coronary risk (TCR), detected subclinical atherosclerosis with ultrasonic scanning of the carotid arteries. Serum level of pCD40L was measured with enzyme immunoassay (EL4). RESULTS: Concentration of pCD40L in SLE patients was higher than in the control group (7.1 +/- 4.9 and 5.8 +/- 3.1 ng/ml, respectively) but the difference was insignificant (p > 0.05). Upper limit of normal value (M + 2SD) for pCD40L was 12 ng/ml. Elevation of pCD40L level was seen in 21% of SLE patients. Clinical manifestations of atherosclerosis risk were seen in 13% SLE patients, subclinical in 19 and 17% (increased intima-media thickness and atherosclerotic plaques, respectively). No correlations were found between pCD40L level and atherosclerotic symptoms. The pCD40L level was higher in SLE patients with the plaques than in those without them (p = 0.005). A positive correlation exists between a pCD40L concentration and maximal intima-media thickness (r = 0.2; p = 0.02), total cholersterol (r = 0.3; p = 0.002), LDLP cholesterol (r = 0.3; p = 0.004), LDLP cholesterol (r = 0.2; p = 0.04) and age of the patients (r = 0.2; p = 0.03). In patients with TCR > 20% a pCD40L was significantly higher than in patients with TCR < 20% (p = 0.01). CONCLUSION: Elevated pCD40L level is a marker of atherosclerotic affection of the vessels, has an important clinical role for predicting risk of cardiovascular diseases in SLE and elicidation of the role of activation of cell immunity in development of atherosclerosis in this disease.

[Interleukin-18 in systemic lupus erythematosus: link with clinical symptoms and vascular atherosclerosis].

AIM: To examine correlation between IL-18 concentration, SLE manifestations and atherosclerotic vascular affection. MATERIAL AND METHODS: We examined 162 SLE female patients (age 26-43 years, mean age 35 years, duration of SLE 28-204 months, mean duration 96.0 months) and 64 healthy controls (women aged 30.0-45.0 years, mean age 35.5 years). We analysed correlation between IL-18 concentration, SLE symptoms, classic risk factors for cardiovascular diseases, subclinical and clinical signs of atherosclerosis. RESULTS: IL-18 in blood serum of SLE patients was much higher than in the control group (p < 0.00001). A positive correlation exists between IL-concentration and the disease activity by scale SLEDAI-2K, the level of antibodies to IgG cardiolipin, ESR, SLE, titers of antibodies to double-chain DNA, concentration of creatinin, urine, glucocorticoids dose taken by the patients at examination. In SLE patients with stomatitis, hematological, immunological disorders, a positive test for antinuclear factor, IL-18 was much higher than in patients without the above signs. No significant correlation was seen between IL-18 concentration, subclinical and clinical signs of atherosclerosis, Of risk factors, there was a negative correlation between total cholesterol concentration, LDLP and HDLP cholesterol. CONCLUSION: In SLE patients a high IL-18 level reflects activity of the basic disease and is not related with vascular atherosclerosis.

[Significance of bone marrow endothelial progenitor cells in disturbance of angiogenesis and endothelial dysfunction in systemic scleroderma].

The study is aimed to investigate the process of endothelial repair related to endothelial progenitor cells (EPC) in systemic sclerosis (SS), and analyze the role of EPC abnormalities in endothelial dysfunction and impaired angiogenesis. Correlation between EPC circulating levels, measured by flowcytometry, and peripheral vascular manifestations, cardiac involvement, carotid artery disease, Framingham risk factor score, endothelial function and morphological signs of microangiopathy is explored. Our data demonstrate, that EPC reduction with disease progression is closely linked with endothelial dysfunction and destructive microangiopathy, and significantly contribute into development of severe cardiac disease and pulmonary hypertension in SS patients.

Circulating endothelial progenitor cells in systemic sclerosis: relation to impaired angiogenesis and cardiovascular manifestations.

OBJECTIVE: Given the essential role of endothelial progenitor cells (EPCs) in endothelial repair and neovascularization, it is likely that insufficient angiogenesis seen in systemic sclerosis (SSc) is related to EPC alterations. The present study was aimed to analyze in SSc the number of circulating EPCs and their contribution into cardiovascular involvement. METHODS: EPC (CD34+VEGF-R2+ and CD133+VEGF-R2+) circulating levels were evaluated in 40 SSc patients and 24 controls by FACS; their correlations with peripheral vascular manifestations, heart involvement, Framingham risk score, carotid artery disease, endothelial function and morphological signs of microangiopathy were studied. RESULTS: Early stage SSc and high disease activity were accompanied by a rise in circulating EPC levels in association with increased membrane expression of Fas (CD95) that correlated positively with severity of peripheral vascular manifestations. EPC reduction with disease progression was linked with endothelial dysfunction and capillary loss, and showed a strong relation to the development of severe internal organ (predominantly cardiac) involvement and pulmonary hypertension. There was a tendency to decreased EPC levels in SSc pts with low HDL values, but no significant correlations were found between EPCs and Framingham risk factor score, carotid artery IMT and traditional cardiovascular risk factors. CONCLUSIONS: In early stage SSc mobilization of EPCs in response to tissue ischemia was preserved, but dropped with disease progression. EPC reduction may contribute to endothelial dysfunction and impaired angiogenesis, leading to the development of severe vascular life-threatening complications of SSc. Traditional cardiovascular risk factors and subclinical atherosclerosis did not influence EPC levels in SSc patients.

[Clinical significance of heart rate variability in patients with systemic lupus erythematosus].

AIM: To evaluate clinical significance of heart rate variability (HRV) in patients with systemic lupus erythematosus (SLE). MATERIAL AND METHODS: HRV was investigated by means of time-domain analysis of 24 hour ambulatory ECG of 122 SLE patients under 55 years of age and 32 age-matched healthy controls. In addition to clinical manifestations and activity of SLE, we assessed the presence of basic conventional cardiovascular risk factors (hypertension, smoking, body mass index, dyslipidemia), performed common carotid duplex scanning with measurement of intima-medial thickness (IMT). Inflammatory markers (ESR, CRP, IL-6) were assessed in all the patients. RESULTS: Significantly lower HRV and the trend to tachycardia were detected in SLE patients when compared to the control group. There was a significant positive correlation between HRV and a cumulative dose of cyclophosphamide, a high density lipoprotein cholesterol level, a negative correlation between HRV and cumulative dose of azathioprine, standard risk factors (hypertension, smoking, body mass index, triglyceride level), markers of inflammation (ESR, CRP, IL-6) and IMT. CONCLUSION: Measurement of HRV in combination with routine cardiovascular risk factors and level of inflammatory markers can be used for identification of subjects at risk for faster progression of atherosclerosis in SLE patients.

[Cardiovascular diseases in rheumatoid arthritis].

AIM: To examine the significance of conventional cardiovascular factors of risk and immunoinflammatory markers in development of vascular atherosclerosis in rheumatoid arthritis (RA). MATERIAL AND METHODS: Conventional cardiovascular risk factors were evaluated in 103 RA patients (85 females and 18 males, mean age 46.3 years, duration of the disease 75 months). Forty six controls (32 females and 14 males) had no rheumatic diseases. Vascular atherosclerosis was diagnosed at ultrasonic scanning of the carotid arteries. Highly sensitive C-reactive protein (hsCRP) concentration in the blood serum was measured with highly sensitive enzyme immunoassay. RESULTS: No differences by the rate of conventional cardiovascular risk factors between the groups were identified except arterial hypertension. Cardiovascular complications (ischemic heart disease, myocardial infarction, transient ischemic attacks) occurred more frequently in RA patients. Intima/media complex (IMC) thickness differences between the groups were not registered. Atherosclerotic plaques were detected more often in RA patients. In RA patients there was a correlation between IMC thickness in the carotid arteries and age (p = 0.00001), systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.01), concentration of blood cholesterol (C) (p = 0.03) and total coronary risk (TCR) (p = 0.003). Correlation between carotid artery IMC thickness, duration and activity of the disease, RA systemic manifestations was not detected (p > 0.05). A mean concentration of hsCRP in RA was higher than in the controls: 2.8 (4.4-25.6) mg/l and 1.3 (0.6-2.7) mg/ml, respectively (p = 0.001). A positive correlation existed between concentration of hsCRP and DAS4 (p = 0.0004) and negative--with C concentration (p = 0.01), LDL C, HDL C (p = 0.02). Increased concentration of hsCRP, IMC thickness in the carotid arteries, existence of atherosclerotic plaques and clinical picture of vascular atherosclerosis related insignificantly. CONCLUSION: RA patients often suffer from cardiovascular pathology. Immunological markers of inflammation, primarily, hsCRP, in addition to conventional cardiovascular risk factors are essential in development of vascular atherosclerosis.

[Soluble receptors of TNF-alpha: association with atherosclerotic vascular affection in systemic lupus erythematosus in males].

AIM: To study association between concentration of soluble receptors of TNF-alpha (sTNFa-R1) and atherosclerotic vascular affection in systemic lupus erythematosus (SLE) in men. MATERIAL AND METHODS: The examination covered 75 patients (mean age 34.76 +/- 11.8 years), duration of the disease 126 +/- 110 months. Standard cardiovascular risk factors were analysed. SLE activity was estimated by SLEDAI and ECLAM scales, SLICC/ACR index was calculated. Atherosclerotic vascular affection was studied with ultrasonic scanning of the carotid arteries. sTNFa-RI concentration in blood serum was determined with enzyme immunoassay technique in 73 SLE patients and 20 healthy donors. RESULTS: By sTNFa-R1 concentration, the patients were divided into two groups. Group 1 consisted of patients with sTNFa-R1 < or = 2.87 ng/ml, group 2 > 2.87 ng/ml. Higher concentrations of the receptors were associated with higher mean values of the damage index and proteinuria occurrence, with older age and higher body mass, with signs of vascular atherosclerotic affection (atherosclerotic plaques and intima-media thickness > 0.9 mm. CONCLUSION: Concentration of sTNFa-R1 can be considered as a laboratory marker of atherosclerotic vascular lesions.

[Soluble CD40 ligand in systemic lupus erythematosus and antiphospholipid syndrome].

AIM: To investigate a clinical role of soluble (s) CD40 ligand in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). MATERIAL AND METHODS: A serum concentration of sCD40 ligand was measured with enzyme immunoassay (Bender Medsystems, Austria) in 21 patients with primary antiphospholipid syndrome (PAPS), in 25 patients with secondary APS (SAPS) associated with SLE, in 92 SLE patients and in 16 healthy donors. RESULTS: A sCD40 ligand concentration in sera of SAPS and SLE patients was significantly higher than in donors. Significant differences by the ligand level between the above patients were not seen. In PAPS sCD40 ligand concentration was normal. Elevated serum concentration of the ligand was observed in 9.5% patients with PAPS, 54.0%--with SAPS, 73.9%--with SLE. This rise in SLE and SAPS was not related with the disease activity or renal damage. Hyperexpression of the ligand in APS was associated neither with thromboses nor with a high concentration of IgG/IgM antibodies to cardiolipin. A direct correlation occurred between sCD40 ligand level and platelet count. In SLE and SAPS elevation of the ligand level correlated with increased thickness of carotid artery intima-media complex, hypercholesterinemia and diastolic dysfunction of left ventricular myocardium. CONCLUSION: Hyperexpression of sCD40L in SLE and SAPS is associated with developing cardiovascular diseases and atherosclerosis.

[Atheroscleotic vascular lesion in systemic lupus erythematosus and antiphospholipid syndrome in men].

The aim of the study was to determine the prevalence of various clinical and subclinical manifestations of atherosclerosis (AS) in men with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APLS), as well as to evaluate correlations between vascular atherosclerotic lesions, risk factors, and the levels of C-reactive protein (CRP) and cardiolipin antibodies (CLA). The subjects of the study were 62 patients (mean age 35.7 +/- 11.6 years, disease duration 129 +/- 102 months). Conventional and disease-related risk factors were analyzed. Carotic ultrasonography (CU) was performed in order to reveal vascular atherosclerotic lesions. Serum CRP levels were measured by the high-sensitive immunonephelometric technique. IgG and IgM CLA were studied by solid-phase immunoenzyme assay. CU found carotic arterial involvement in 58% of the patients; clinical manifestations of AS were revealed in 42% of the patients. The patients were divided into two groups: group I included 19 patients with APLS signs, group II consisted of 43 patients without APLS symptoms. The disease duration and lesion index were higher in group I. The study revealed a significant correlation between CRP level and intima-media complex (IMC) thickness in patients suffering from SLE with or without APLS (p < 0.05). Patients with AS displayed higher levels of IgG CLA, although the difference was insignificant. The study demonstrates that men suffering from SLE with or without APLS have a high risk of AS. An increase in CRP level is associated with an increase in IMC thickness.

[The significance of cardiovascular risk factors and C-reactive protein to the development of atherosclerosis in women with systemic lupus erythematosus].

Compared with general population, women suffering from systemic lupus erythematosus (SLE) have signs of coronary artery disease (CAD) five to eight times more often, especially in young age. Early development of atherosclerosis in patients with SLE is caused by conventional cardiovascular risk factors and specific ones, associated with the disease and its therapy. A slight increase in such an inflammatory marker as C-reactive protein (CRP) is thought to reflect the presence of subclinical inflammation in the vascular wall, connected with atherosclerotic process. The authors analyzed the frequency of clinical and subclinical (an increase in the thickness of intima-media complex (IMC)) atherosclerotic manifestations, the summary coronary risk, the prevalence of conventional risk factors, and CRP level in 133 female patients with SLE and in 50 healthy donors. Compared to the control group, SLE patients were younger, developed cardiovascular diseases (CAD, stenocardia, myocardial infarction, and cerebral stroke (p = 0.05) as well as arterial hypertension more often, had higher levels of hs-CRP and triglycerides, and lower levels of high density lipoprotein cholesterol (HDLC). There was a positive correlation between hs-CRP level and the activity of the disease according to ECLAM score, ES value, IgG and IgM levels, hematological disturbances (anemia, leucopenia, and/or thrombocytopenia) , and a negative correlation with total cholesterol level, HDLC there was a moderate correlation between hs-CRP and a maximal IMC value.

[Atherosclerotic lesion of the vessels in systemic lupus erythematosus in males: relations with concentration of C-reactive protein].

AIM: To elicit prevalence of clinical and subclinical manifestations of atherosclerosis in men with systemic lupus erythematosus (SLE), to assess correlation between vascular atherosclerosis, risk factors and concentration of C-reactive protein (CRP). MATERIAL AND METHODS: Analysis of conventional and disease-related factors of risk, ultrasonic scanning of the carotid arteries, high-performance enzyme immunoassay for CRP were made in 37 patients (mean age 36.9 +/- 10.7 years, duration of the disease 130.2 +/- 108.2 months). RESULTS: Clinical symptoms of atherosclerosis were seen in 35% patients. By thickness of the intimamedia complex (IMC), the patients were divided into 2 groups. Group 1 consisted of 21 patients with vascular atherosclerosis (IMC > 0.9 mm), group 2--of 16 patients with IMC < 0.9 mm. Mean age, age of the disease onset, body mass index were greater in group 1. A mean CRP concentration in patients with athrosclerosis was significantly higher than in the group without vascular atherosclerosis (p = 0.004). CONCLUSION: SLE men comprise a group of high atherosclerosis risk. An elevated CRP level is associated with thicker IMC.

[Vascular symptoms of Behcet's disease].

AIM: To characterize vascular symptoms of Behcet's disease (BD) in patients treated for the last 10 years in the Institute of Rheumatology. MATERIAL AND METHODS: Vascular symptoms of BD were studied in 151 patients with BD (mean age 33.5 +/- 9.5 years, duration of the disease 14.0 +/- 10.1 years, 104 males and 47 females, 67.4% carried HLA B51(5) antigen). Duplex vascular scanning was made to detect venous thrombosis. RESULTS: Thrombotic complications were found in 37 of 151 (24.5%) patients with BD (30 males and 7 females, mean age 37.1 +/- 9.1 years, mean duration of the disease 7.3 +/- 9.7 years). Venous thromboses prevailed (36 patients). Four males (2.6%) had arterial lesions: aneurysms of the iliac arteries (n = 1), thrombosis of the iliac artery (n = 1), pulmonary infarction and thrombosis of the pulmonary arteries (n = 2). Combination of venous and arterial manifestations occurred in 3 patients. One patient had thrombosis of the venous sinus, occlusion of the retinal vessels was diagnosed in 7 patients. CONCLUSION: Incidence of vascular disorders was observed in 1/4 of the patients. This corresponds to those observed worldwide and concerns venous thrombosis and other thromboses. Among the examinees, vascular disorders were associated with a young age, earlier development of thrombotic complications in males than in females.