Carotid atherosclerosis is not associated with lower bone mineral density and vertebral fractures in patients with systemic lupus erythematosus.

BACKGROUND: Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). METHODS: We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. RESULTS: Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p = 0.001), have a higher body mass index (p = 0.008), and exhibit dyslipidemia at study entry (p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). CONCLUSIONS: In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

[Antibodies against extracellular products of group A Streptococcus. Diagnostic importance in acute rheumatic fever]. / Anticuerpos contra productos extracelulares del estreptococo grupo A. Importancia diagnóstica en la fiebre reumática aguda.

Streptococcal throat infection is a sine qua non for the development of rheumatic fever (RF) in genetically susceptible people. Demonstration of such infection is not easy. In overt RF less than 10% of patients still carry streptococci in their throat and immunologic methods are required to identify antibodies against streptococcal products (SP). Humoral response against SP was studied in children and adults with and without RF. Antistreptolysin O (ASO) showed a non-gaussian distribution, and reference value was established as percentile. Adults have a 97 percentile of 227, in children 90 percentile was 451. When RF was present all cases, except one, showed higher values. When antibodies against SP besides ASO were sought by an agglutination test (Streptozyme tm), people below 15 years of age showed low titers in 15 out of 28 cases. In contrast, high titers were the rule in children suffering RF. High ASO titer correlated with high Streptozyme value. These methods are capable to recognize an specific immune response against Group A Beta hemolytic streptococci, and are valuable tools in the diagnosis of RF.