AB0247 LIFE QUALITY AND DEPRESSION LEVEL ASSESSMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Depression is a common and significant rheumatoid arthritis (RA) comorbidity that develops under the influence of severalfactors, the most important being disease activity, pain intensity and degree of disability.

Objectives:

The goal of the investigation was to determine existence of depression and assess life quality in patients living with RA.

Methods:

The study sample comprised of 150 patients of average age 59.2 years, 79.2% of whom were women and 20.8% were men, who have lived with RA for an average of 9.6 years. For determining disease activity level, Disease Activity ScoreDAS28was utilized. Pain intensity and global disease activity were rated using a visual analogue scale ranging from 1 to 100mm. For functional capacity assessments, Health Assessment Questionnaire(HAQ) index was adopted,depressions severity was determined through Back Depression Inventory (BDI), and Serbian version of the health-related quality of life instrument EQ-5Dwas employed to assess patients’ quality of life.

Results:

Average DAS28 score for the sample was4.46±1.32, suggesting moderate RA activity. Pain intensity was on average scored at 53.2±18.6, whereas global disease activity was measured at 49.63±20.2, and theHAQ indexof 1.0±0.70 was obtained. According to theBDI, 21.4% of the patients exhibited no signs of depression, whereas 12.9% had mild, 54.3% moderate, and11.4% severe form of depression.Quality of life, as measured by EQ-5D, was compromised in all life domains, withpain/discomfort, anxiety/depression, inability to partake in usual activities, compromised mobility and self-caremost frequently reported. In patients suffering from moderate and severe depression, high statistically significant positive correlation between depression score and HAQ index was noted.BDIscore was statistically significantly positively correlatedwith the ratings on the EQ-5D scales pertaining to self-care, usual activities, pain/discomfort, and anxiety/depression.

Conclusion:

Depression symptoms are common in patients with RA and can compromise quality of life in all life domains.When assessing disease severity and general status of patients with RA, depression symptoms should also be considered, given their high prevalence and influence on patients’ everyday life.

Acknowledgments:

not

Disclosure of Interests:

None declared

The Aegean in the Early 7th Millennium BC: Maritime Networks and Colonization

The process of Near Eastern neolithization and its westward expansion from the core zone in the Levant and upper Mesopotamia has been broadly discussed in recent decades, and many models have been developed to describe the spread of early farming in terms of its timing, structure, geography and sociocultural impact. Until now, based on recent intensive investigations in northwestern and western Anatolia, the discussion has mainly centred on the importance of Anatolian inland routes for the westward spread of neolithization. This contribution focuses on the potential impact of east Mediterranean and Aegean maritime networks on the spread of the Neolithic lifestyle to the western edge of the Anatolian subcontinent in the earliest phases of sedentism. Employing the longue durée model and the concept of 'social memory', we will discuss the arrival of new groups via established maritime routes. The existence of maritime networks prior to the spread of farming is already indicated by the high mobility of Epipalaeolithic/Mesolithic groups exploring the Aegean and east Mediterranean seas, and reaching, for example, the Cyclades and Cyprus. Successful navigation by these early mobile groups across the open sea is attested by the distribution of Melian obsidian. The potential existence of an additional Pre-Pottery Neolithic (PPN) obsidian network that operated between Cappadocia/Cilicia and Cyprus further hints at the importance of maritime coastal trade. Since both the coastal and the high seas networks were apparently already well established in this early period, we may further assume appropriate knowledge of geographic routes, navigational technology and other aspects of successful seafaring. This Mesolithic/PPN maritime know-how package appears to have been used by later groups, in the early 7th millennium calBC, exploring the centre of the Anatolian Aegean coast, and in time establishing some of the first permanent settlements in that region. In the present paper, we link this background of newcomers to the western edge of Anatolia with new excavation results from Çukuriçi Höyük, which we have analysed in terms of subsistence strategies, materiality, technology and symbolism. Additionally, further detailed studies of nutrition and obsidian procurement shed light on the distinct maritime affinity of the early settlers in our case study, something that, in our view, can hardly be attributed to inland farming societies. We propose a maritime colonization in the 7th millennium via routes from the eastern Mediterranean to the eastern Aegean, based on previously developed sea networks. The pronounced maritime affinity of these farming and herding societies allows us to identify traces of earlier PPN concepts still embedded in the social-cultural memories of the newcomers and incorporated in a new local and regional Neolithic identity.

[Etanercept therapy in rheumatoid arthritis: efficacy and safety]

INTRODUCTION

Etanercept, tumor necrosis factor (TNF-alpha) antagonist, lowers the disease activity level in patients with rheumatoid arthritis (RA), reduces joint destruction saving physical functions and improving life quality.

OBJECTIVE

The aim of this study was to establish efficacy and safety of etanercept in combination with disease modifying antirheumatic drugs (DMARDs) in the treatment of RA.

METHODS

To patients with active RA, who were on therapy with DMARD, etanercept was introduced in weekly doses of 50 mg, with continuation of DMARD. Efficacy of this form of treatment was evaluated in the 12th week. Maintenance of the effect of treatment was also evaluated during 24, 48 and 96 weeks. Long-term evaluation of etanercept safety was assessed by registering all unwanted events during a two-year period.

RESULTS

After 12 weeks of treatment with etanercept, 80% of patients had ACR20 response, while 85% showed clinically significant decrease of DAS28 index. We achieved remission in five patients (12.5%) and low activity of RA in 17 patients (42.5%). During a 96-week of follow-up period, achieved therapy effects were maintained. In four patients (10%) etanercept therapy was interrupted after 24 weeks because of inadequate response. In one of them (2.5%) we recorded a cardiovascular incident. Acute infections were registered in 47 cases. Four of those were severe infections. Neither cases of malignancy development were noted, nor were there any lethal disease outcomes.

CONCLUSION

Etanercept in combination with DMARD shows a high level of efficacy in the treatment of RA. The safety profile of the drug is satisfactory.

[Therapy of lupus nephritis with mycophenolate mofetil]

INTRODUCTION

Mycophenolate mofetil is an immunosupressive agent used in transplantation and subsequently in a variety of autoimmune conditions. It inhibits both B and T lymphocyte proliferation, and also has nonimmune effects on the kidney. The major experience in systemic lupus erythematosus has focused on proliferative lupus nephritis.

MATERIALS AND METHODS

In our study we treated 8 female patients with proliferative lupus nefritis with combination therapy of prednisone (1 mg/kg body weight) and mycophenolate mofetil (2 g per day). Complete remission was defined as a value for urinary protein excretion that was less than 0.5 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration and improved or stable serum creatinine. Partial remission was defined as a daily proteinuria below 2 g in a previously nephrotic patient or minimum 30% from starting values, with normal urinary sediment, serum albumin of minimum 30 g/L and stable serum creatinine.

RESULTS

Two patients had a complete remission after 7 and 2 months respectively. Five patients had a partial remission after 5.2+/-4.3 months of therapy. One patient did not react on therapy. There were no side effects during the course of therapy.

DISCUSSION

Considering the fact that 7/8 patients have had nephrotic range proteinuria and that 50% of patients were refractory on standard induction therapy, results of this study are good indicator of value of mycophenolate mofetil in the terapy of proliferative forms of lupus nephritis.

CONCLUSION

Mycophenolate mofetil gives satisfactory results in the treatment of proliferative forms of lupus nephritis with minimal side effects.

[Correlation between sera levels of sICAM-1 and sVCAM-1 and severity of kidney lesions in patients with lupus nephritis]

INTRODUCTION

Adhesion molecules are essential for cellular interactions and are important in the activation and adhesion of cells. Studies have shown that elevated levels of solubile ICAM and VCAM are related to disease activity in patients with various acute and chronic inflammatory diseases. Our aim was to investigate the correlation between the levels of sICAM-1 anti sVCAM-1 and the degree of disease activity and severity of lupus nephritis.

MATERIAL AND METHODS

Using the ELISA procedure, we determined the sera levels of sVCAM-1 and sICAM-1 in 80 patients with SLE and in group of 27 healthy volunteers.

RESULTS

Patients with SLE had significantly higher sera levels of adhesion molecules comparing to the controls (p<0.001). There was a high positive correlation between the sera levels of sVCAM-1 and concentration of anti-ds DNA antibodies in patients with SLE (p<0.001), and there was also a negative correlation between the sera levels of sVCAM-1 and concentration of C3 and C4 component of complement (r=-0.64, r=-0.58). In the group of patients with lupus nephritis, significantly higher sera concentrations of sVCAM-1 were detected compared patients without nephritis. Patients with class III and IV kidney changes had significantly higher levels of sVCAM-1 compared to the patients with class II kidney changes. In the group of patients with activity index of kidney changes (AI) over 4 sVCAM-1 the sera levels were significantly higher compared to the group with AI <4.

CONCLUSION

The sera level of sVCAM-1 is a reliable parameter to evaluate the autoreactivity degree in SLE. In the same time, sVCAM-1 sera level can be used as a reliable marker to evaluate the renal lesion extensivity in SLE.

Blood pressure and electrocardiographic changes elicited by the glare pressor test

The glare and cold pressor tests with blood pressure and ECG recording were administered to 47 young, healthy men. Both stimuli increased mean systolic and diastolic blood pressure significantly. However, cold was more powerful than glare as a diastolic pressor stimulus. Heart rate and corrected QT interval increased significantly during both tests. Professional and nonprofessional drivers who drove at night showed significantly greater diastolic BP responses to the glare pressor test than did non-driver subjects. Ventricular extrasystoles (VES) were recorded exclusively during the glare pressor test in two of six professional drivers with night driving exposure. The heart rate and QT responses reflect the individual's reactivity to sensory stress, regardless of modality or glare exposure. On the other hand, the greater diastolic response and appearance of VES in night driving subgroups during glare suggest a greater sensitivity to the glare pressor test in these subjects.

Age-dependent resistance to the toxic effects of paraquat in relation to superoxide dismutase activity in rat lung

Young rats are much more resistant to the toxic effects of orally-administered paraquat than are older rats. The possible relation of this phenomenon to the activity of superoxide dismutase in lung is discussed.

Copper-zinc containing and manganese containing superoxide dismutase in the ground squirrel/Citellus citellus/--the effect of hibernation

The distribution of Copper-Zinc containing and Manganese-containing superoxide dismutase in the liver, kidney, interscapular brown adipose tissue (IBAT) and brain of the ground squirrel, as well as the effect of hibernation, was studied. Activity of both forms of SOD was highest in the liver and lowest in the brain. Activity of the Mn SOD in relation to total SOD was higher in the liver and kidney of the ground squirrel as compared with results reported for other rodents. The highest activity of Mn SOD in relation to total SOD was found in the IBAT and brain (36% and 49%, respectively). Total SOD activity per mg proteins and per g wet mass in IBAT and brain of hibernating animals was increased: for IBAT, p less than 0.05 and p less than 0.025, respectively; for brain, p less than 0.01 and p less than 0.025, respectively. Protein content in hibernating ground squirrel was not significantly changed. In the hibernating ground squirrel CuZn SOD activity in IBAT and brain was higher as compared with the active animal (p less than 0.025 and p less than 0.005, respectively). In the liver and kidney CuZn SOD was not significantly changed during the hibernation. In the liver and brain of the hibernating animals a lower Mn SOD activity was found (p less than 0.005 and p less than 0.05, respectively).

Distribution of superoxide dismutase in the ground squirrel (Citellus citellus): effect of the hibernation and arousal

The activity of superoxide dismutase (SOD) was studied in the liver, kidney, interscapular brown adipose tissue (IBAT), lung, heart and spleen of the active and hibernating ground squirrel (Citellus citellus). One group was examined immediately after the arousal from the hibernation. A considerable activity of this enzyme was found in homogenates of all tissues studied except the lung. This activity was lower in the liver and lung of the ground squirrel than in the rat (P less than 0.01). In the other tissues studied the enzyme activity was about the same level in both animals. In the ground squirrel hibernation didn't produce the significant change in SOD activity, as compared with the active state, except in the spleen. Tested immediately after the arousal, SOD activity was significantly higher in all tissues studied except in the IBAT, as compared with the hibernating ones (P less than 0.01).

Biosynthesis of mitochondrial protein components in the liver of cold exposed or adapted rats

Liver mitochondria of rats exposed or adapted to cold were fractionated after labelling in vivo with radioactive amino acid mixture. Specific activity (Cpm/mg proteins) of unfractionated proteins from the whole mitochondria, water soluble proteins and cytochrome c after the animals exposure to 4 degrees C for 3, 6, 12 and 24 hr was higher as compared with the controls adapted to 24 degrees C; specific activity of contractile and structural proteins was not changed. In rats exposed to cold for 7, 14 and 21 days the labelling of all fractions studied was at the level of controls. The liver weight was increased in cold adapted rats (21 days). If expressed per total liver mass, radioactivity of all fractions was higher in cold adapted rats than in controls.