Vitamin D deficiency in patients with active systemic lupus erythematosus.

UNLABELLED: We investigated the effects of disease activity on bone metabolism in 36 patients with systemic lupus erythematosus (SLE). Changes in bone remodeling were not explained by corticosteroid use. A high prevalence of 25OHD deficiency in SLE patients indicates the need for vitamin D replacement, mainly during high disease activity periods. INTRODUCTION: We investigated the effects of SLE disease activity on bone metabolism, their relation to inflammatory cytokines and vitamin D levels. METHODS: We performed a cross-sectional analysis of 36 SLE patients classified according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in high activity (group I: 12 patients, mean age 29.6 years) or in minimal activity (group II: 24 patients, mean age 30.0 years), and compared them to normal controls (group III: 26 women, 32.8 years). Serum calcium, phosphorus, parathyroid and sex hormones, bone remodeling markers, interleukin (IL)-6, soluble IL-6 receptor (sIL-6R), IL-1, tumor necrosis factor-alpha (TNF), 25-hydroxivitamin D (25OHD), and 1,25-dihydroxyvitamin D3 were measured, plus bone mineral density. RESULTS: All cytokines were significantly higher in SLE groups; IL-6 could differentiate SLE patients from controls. In group I, 25OHD levels were lower (P < 0.05), which was related to the SLEDAI (R = -0.65, P < 0.001). In multiple regression analysis, the 25OHD level was associated with SLEDAI, osteocalcin and bone-specific alkaline phosphatase. The SLEDAI score was positively correlated with all measured cytokines and especially TNF (R = 0.75, P < 0.001). CONCLUSIONS: SLE patients demonstrated changes in bone remodeling strongly related to disease activity. A high prevalence of 25OHD deficiency was observed in SLE patients, indicating the need for vitamin D replacement.

Increased frequency of the C4A*6 rare allele in rheumatic heart disease.

The aim of the present investigation was to determine whether the alleles of the MHC class III complement proteins BF, C2 and C4 (C4A and C4B) could be markers for RHD in the Brazilian population. Forty-nine patients with chronic RHD were studied. The controls included 65 healthy unrelated individuals, matched with the patients according to sex, age and ethnical background. BF, C2, C4A and C4B allotypes were determined by standard technologies including Western blots for C2 and C4 variants with monoclonal and policlonal antibodies. The results showed a significantly elevated presence of the C4A*6 rare allele (p = 0.003 RR = 11.85) and a decrease of C4A*3 in the patients. In addition, C4 null and BF and C4 rare alleles were more frequent in patients than in the controls. Considering that in this investigation only RHD patients were included, further studies are necessary in order to clarify whether C4A6 is a marker for the cardiac form or for the disease itself.

Diagnostico atual do lupus eritematoso sistemico. / Current diagnosis of systemic lupus erythematosus

Os autores fazem uma revisao dos achados clinicos e laboratoriais de LES que permitem induzir o diagnostico. Analisam o valor do Band Test e os novos criterios da ARA para o diagnostico. Terminam sugerindo uma pequena modificacao na utilizacao desses criterios, tornando-os melhor aplicaveis no nosso meio

Lupus eritematoso sistemico "curado": consideracoes sobre prognostico do LES. / Cured systemic lupus erythematosus:considerations on the prognosis of SLE

Os autores, tendo por motivo a apresentacao de um caso curado de LES com glomerulonefrite, tecem consideracoes sobre o prognostico dessa doenca. Analisam tambem trabalhos de autores focalizando o assunt

Condrocalcinose e artropatia neurogenica. / Chondrocalcinosis and neurogenic arthropathy

Os autores apresentam um caso de condrocalcinose em joelhos, cujo aspecto clinico e radiologico poderia sugerir uma artropatia neurogenica. Fazem revisao da literatura e discutem a importancia da existencia ou nao de uma artropatia neurologica em razao das possibilidades terapeuticas

Plasmaferese. / Plasmapheresis

Os autores estudaram a aplicacao da plasmaferese em 15 casos de artrite reumatoide definida. Por facilidade tecnica, opinaram pela remocao diaria de 500ml de sangue com a reposicao dos elementos figurados. O metodo nao exige reposicao de plasma, e relativemente inocuo e apresentou resultados satisfatorios a curto e medio prazo