Treatment of ankylosing spondylitis with TNFα inhibitors does not affect serum levels of tryptophan metabolites.

The imbalance between the kynurenine and serotonin pathways can have serious consequences, e.g., depression. One of the factors leading to the imbalance between the pathways of tryptophan metabolism is inflammation. The aim of our study was to assess the impact of treatment with tumor necrosis factor-alpha (TNFα)-inhibitors on tryptophan metabolism in patients with ankylosing spondylitis (AS). Forty patients with AS (twenty-eight males, twelve females; mean age 40 ± 11 years), qualified to receive anti-TNF-α treatment, were prospectively assessed. As a control group, 20 healthy volunteers (7 males and 13 females, mean age 38 ± 5 years) were recruited from the general population. Patients underwent full clinical and biochemical assessment before and after 6 months of therapy. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The presence of depressive disorders was assessed with Beck's Depression Inventory (BDI) scale. Serum concentrations of tryptophan, serotonin, kynurenine, and quinolinic acid were measured. The predominance of the kynurenine pathway in AS patients (compared to the control group) was demonstrated (p < 0.001). Surprisingly, no significant changes in serum levels of tryptophan and its metabolites in AS patients after treatment were found, despite clinical improvement. Moreover, the components of tryptophan metabolism did not correlate significantly with the clinical activity of AS, depression nor laboratory inflammatory markers. Probably some other factors influence the pathways of tryptophan metabolism in patients with ankylosing spondylitis.

[Serum free light chains for monitoring systemic lupus erythematosus activity].

OBJECTIVE: Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease leading to chronic inflammation of numerous tissues and organs. The search for clinically useful markers of its activity is ongoing. At present, it is suggested that serum free light chains (FLC) may be useful in assessing SLE activity. The aim of study: To investigate the relationship between serum levels of free light chains (FLC) and the activity of SLE. PATIENTS AND METHODS: Material and methods: Eighty-four SLE patients (75 female; 9 men) aged 34.9±11.8 years, with the disease duration of 6.2±5.2 years, were included. The disease activity was assessed by: circulating C3 and C4 complement components levels, anti-double-stranded DNA (anti-DNA), SLEDAI-2K scale and levels of FLC. We also assessed the relationship between levels of FLC and clinical manifestations of SLE. RESULTS: Results: Median serum levels of FLC κ and FLC λ were 25.9 ± 15.6mg/L and 21.2 ± 9.4 mg/L in SLE pts, respectively. Serum levels of FLC κ were positive in 60 SLE pts (71.4%) and FLC λ in 20 SLE pts (23.8%). The significant correlations were found between levels of FLC κ, FLC λ and of anti-dsDNA (p=0.01; r=0.27); (p=0.001; r=0.35), C3 complement (p<0.02; r= -0.25); (p<0.004; r= -0.31), C4 complement (p<0.04; r= -0.22); (p<0.006; r= -0.3) and SLEDAI -2K (p<0.009; r=0.28); (p<0.001; r=0.35). The SLE pts with arthritis / myositis and hematologic symptoms had significantly higher FLC levels than those without. CONCLUSION: Conclusion: Measurement of serum levels of FLC can help in the periodical assessment of the disease activity in SLE pts.

ß2-microglobulin as a marker of systemic lupus erythematosus activity.

BACKGROUND: Systemic lupus erythematosus (SLE) is characterized by alternating periods of activity and remission. A portion of the patients suffers from the chronically active form of the disease. The search for clinically useful markers of its activity is ongoing. At present, it is suggested that ß2-microglobulin (ß2M) may be useful in assessing SLE activity. OBJECTIVES: The objective of the paper was to investigate the relationship between serum ß2M concentration and SLE activity. MATERIAL AND METHODS: The study group consisted of 69 SLE patients (62 women and 7 men), aged 34.5 ±11 years (19-69). Patients with kidney failure and infection were excluded from the study group. The concentration of ß2M was measured using an ELISA test. SLE activity was assessed with Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and by measuring the levels of C3 and C4 complement components, anti-double stranded DNA antibodies (anti-dsDNA antibodies) and ß2M. The relationship between ß2M and the clinical manifestation of SLE was also covered in the study. RESULTS: The study revealed a statistically significant correlation between ß2M concentration and SLEDAI-2K disease activity index (p < 0.05; r = 0.6), anti-dsDNA titer (p < 0.05; r = 0.3), and C4 component serum level (p < 0.05; r = -0.3). ß2M concentration was significantly higher in patients with arthritis and/or myositis (p = 0.005), vasculitis (p = 0.005), and hematological manifestations of SLE (p = 0.02). CONCLUSIONS: Periodical determination of ß2M concentration in SLE patients may prove helpful in assessing the disease activity.

Gastrointestinal involvement in patients with systemic sclerosis.

INTRODUCTION: Gastrointestinal (GI) involvement is a serious complication of systemic sclerosis (SSc). OBJECTIVES: The aim of the study was to determine the incidence of GI manifestations in SSc. PATIENTS AND METHODS: We studied 73 patients with SSc (60 women and 13 men). Diffuse cutaneous SSc (dcSSc) was diagnosed in 30 patients and limited cutaneous SSc (lcSSc) in 43 patients. Upper GI involvement was assessed based on clinical symptoms such as dysphagia and gastroesophageal reflux-related complications. The majority of patients underwent radiographic examination including a barium swallow. Lower GI involvement was evaluated on the basis of such clinical symptoms as constipation and diarrhea. RESULTS: GI symptoms were observed in 54 (74%) SSc patients. Upper GI symptoms were observed in 54 (74%) patients and lower GI symptoms in 22 (30%) patients. The presence of anticentromere antibodies is associated with a lower risk of GI involvement. There are no significant differences in the incidence of pulmonary involvement between SSc patients with and without GI symptoms. CONCLUSIONS: GI involvement is observed in the majority of SSc patients. Clinical symptoms of GI involvement are significantly more common in patients with dcSSc. The incidence of upper GI symptoms is significantly higher than that of lower GI symptoms.

Coexistence of five autoimmune diseases: diagnostic and therapeutic difficulties.

We report the case of coexistence of five autoimmune diseases in a 36-year-old woman, who initially developed psoriasis. Several years later, the patient was diagnosed with a mixed connective tissue disease and primary biliary cirrhosis (PBC). On admission to the Department of Rheumatology and Connective Tissue Diseases, the patient fulfilled classification criteria of an overlap syndrome systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome/systemic sclerosis (SSc)/Sjogren's syndrome (SS) with coexisting PBC and psoriasis. The SLE symptoms included discoid lupus erythematosus, arthritis, pancytopenia, antinuclear antibodies and anticardiolipin antibodies. Moreover, the patient met the criteria of antiphospholipid syndrome diagnosed based on preterm delivery before week 34, and high values of anticardiolipin antibodies were found at repeated determinations. The SSc symptoms included sclerodactyly, pulmonary fibrosis with pulmonary hypertension and esophageal dysfunction. The SS syndrome involved xerostomia, xerophthalmia, the positive Schirmer's test and presence of anti-SS antibodies. The literature reports overlap syndromes in various combinations; however, the coexistence of five autoimmune diseases is extremely rare.

[The overlap of primary Sjögren's syndrome with antiphospholipid syndrome in man: case report]. / Zespól Sjögrena skojarzony z zespolem antyfosfolipidowym u mezczyzny--trudnosci diagnostyczne: opis przypadku.

We describe the case a 63-year-old man with overlap of primary Sjögren syndrome (pSS) and antiphospholipid syndrome (APS). According to literature the presence of antiphospholipid antibodies is observed in about 20% of patients with pSS. The coexistence of pSS and APS should be considered as an infrequent, but not exceptional, event.