Leptin is a peptide hormone that has an essential role in the regulation of body weight by inhibiting food intake and stimulating energy expenditure. The role of leptin in the modulation of the immune response and inflammation has been regarded as important. In rheumatoid arthritis (RA) patients it was reported that fasting leads to an improvement of clinical and biological measures of disease activity, which was associated with a marked decrease in serum leptin. These features suggest that leptin may also influence the inflammatory mechanisms of arthritis in humans. In this study we assessed serum leptin levels in RA and osteoarthritis (OA) patients and found a correlation between serum leptin level and other markers as well as bone mass density changes, activity of disease, disease duration and the age of the patients. The blood was collected from 30 RA and 30 OA patients who constituted the control group. Serum leptin level was determined using the DRG Leptin ELISA Kit-a solid phase enzyme-linked immunosorbent assay based on the sandwich principle. The serum level of leptin in RA patients ranged from 1.8 to 81.1 ng/ml and median value was 11.2. There was a positive correlation between body mass index (BMI) of RA patients and serum level of leptin (correlation coefficients Spearman's r = 0.81). According to correlation coefficients, serum leptin level is independent of age of RA patients, stage of disease, number of painful and swollen joints, duration of morning stiffness, disease duration as well as value of titre of the Waaler-Rose, disease activity score (DAS 28) value and presence of rheumatoid nodules. There was a negative correlation between serum leptin level and glomerular filtration rate (GFR). No correlation between the serum leptin level and T-score was found. An influence of steroid treatment on the serum leptin level was not shown. The median serum leptin level in OA patients was 9.2 ng/ml. There was a positive correlation between body mass index of OA patients and serum level of leptin (correlation coefficients Spearman's r = 0.57). No correlation was found between serum leptin level and patient's age, duration of disease and value of laboratory data. There were no correlations between serum leptin level and visual analogue pain scale (VAS) for the lower-limb afflicted patients as well as stage of disease according to Kellgren and Lawrence's score in OA patients. There was a negative correlation between serum leptin level and T-score value in OA patients (r = -0.58, P < 0.05). No statistically significant differences were found between serum leptin levels for RA and OA patients.

The results of some epidemiological studies point to the presence of an increased risk of cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) in rheumatoid arthritis (RA). At least 50% of abnormalities remained asymptomatic. Pathological conditions contributing to myocardial dysfunction such as high serum levels of IL-6, C-reactive protein (CRP) and TNF alpha are present both in RA and CHF patients. The most common pathological mechanism leading to the development of heart failure is left ventricular (LV) diastolic dysfunction, which remains clinically asymptomatic for a long time. The aim of this study was to assess the systolic and diastolic functions of the LV in RA patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Our purpose was also to estimate whether there is a correlation between the duration and severity of RA and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the RA group and control group, which constituted healthy volunteers. Left ventricular mass index in RA group was significantly greater than in the control group (105.2 +/- 32.6 vs. 87.9 +/- 16.8; p < 0.05) so were the interventricular septum end-diastolic thickness (1.01 +/- 0.33 vs. 0.86 +/- 0.12; p < 0.05), the LV posterior wall end-diastolic thickness (0.94 +/- 0.08 vs. 0.83 +/- 0.11; p < 0.0001) and the aortic root diameter (3.18 +/- 0.31 vs. 3.10 +/- 0.63, p < 0.001). The ejection fraction in RA group was significantly lower than in the control group (64.4 +/- 1.3 vs. 66.3 +/- 1.3; p < 0.0001). The assessment of diastolic function parameters revealed significantly longer isovolumetrc relaxation time (IVRT) and shorter deceleration time (DT) in RA patients compared to the control group. Patients in stage II or III revealed significantly lower LV mass index (99 +/- 17 vs. 131 +/- 42; p < 0.05) and the interventricular septum end-diastolic thickness (0.94 +/- 0.10 vs. 1.28 +/- 0.5; p < 0.05) than those in stage IV. Mean aortic diameter was significantly greater in individuals in stages III and IV (3.73 +/- 0.28) than in the stage II of the disease (2.77 +/- 0.21), p < 0.05. No differences in echocardiographic parameters' values were observed between seropositive, seronegative, nodule-present and nodule-absent persons. Echocardiographic examination revealed valvular heart disease in 24 (80%) RA and 6 (20%) control patients (p < 0.0001).

Leczenie dny moczanowej u pacjentów po przeszczepieniu narząduTreatment of gout in patients after organ transplantation B Bo oż że en na a J Ja as sz zc cz zy yk k, , M Ma ał łg go or rz za at ta a W Wi is sł ło ow ws sk ka a Klinika Reumatologii i Chorób Wewnętrznych, Centralny Szpital Kliniczny MSW w Warszawie S Sł ło ow wa a k kl lu uc cz zo ow we e: : dna moczanowa, hiperurykemia, kwas moczowy, transplantacja.K Ke ey y w wo or rd ds s: : gout, hyperuricemia, uric acid, transplantation.Reu ma to lo gia 2013; 51, 3: 215-220

BackgroundZoledronic acid (ZA) is approved to prevent or treat osteoporosis in women after menopause (PO), men, secondary osteoporosis, especially glicocorticoid-inducted one (GC). Causes of osteoporosis in patients with connective tissue diseases (CTD) are much more complicated than in patients with postmenopausal osteoporosis.ObjectivesThe aim of this study was to evaluate the safety and efficacy of ZA in the treatment of glicocorticoid-inducted osteoporosis in the course of connective tissue disease (GC/CTD) in comparison with postmenopausal osteoporosis (PO).MethodsThis study included a total of 196 patients in a period of 5 years (2010-2014). Among this group was 75 patients with GC osteoporosis in the course of CTD and 103 with PO. They had been treated with ZA at a dose of 5 mg given iv. once a year with adequate calcium and vitamin D supplementation. All patients included into the study fulfilled the osteoporosis densitometric criteria according to WHO and had contraindications to the use of oral bisphosphonates. The primary endpoint was the number of complications observed in GC patients after ZA administration compared to those noted in patients with PO. The second endpoint was the number of new fractures during 5-year treatment of ZA.ResultsIn both groups there were no statistically significant differences in terms of the mean age, T-score result before the first administration and during the tratment of zoledronic acid and mean number of osteoporotic fractures. The number of complications in patients with GC/CPD was distinctly higher (12% - 9 in 75 patients) than in patients with postmenopausal osteoporosis (3,88% - 4 in 103 patients). Furthermore in patients with PO the only side effect observed were flu-like symptoms (fever, myalgia, arthralgia) whereas in patients with GC/CPD disease more severe complications were noted such as renal function deterioration-4 cases, trombocytopaenia-1 or osteonecrosis of the jaw-1. No significant difference between a number of bone fractures was noted in the course of observation:8% - 6 fractures in GC/CPD and 7,77% - 8 fractures in PO group.ConclusionsThe analysis suggests that the treatment of ZA in 5-years observation in PO is as effective as in GS/CPD subjects. The number of complications was significantly higher and they were more severe in patients who had glicocorticosteroid-inducted osteoporosis associated to CTD as compared to subjects with postmenopausal osteoporosis. The safety and efficacy of a annual dose 5 mg intravenous infusion of zoledronic acid should be further investigated.ReferencesZoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Reid DM, Devogelaer JP, et al., HORIZON investigators. Lancet. 2009,11;373:1253-63.The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). Black DM, Reid IR, at al. J Bone Miner Res. 2012,27:243-54....

Background Causes of osteoporosis in patients with connective tissue diseases (CTD) are more complex than in patients with postmenopausal osteoporosis (PO). None of the studies published so far examined the safety and efficacy of once-yearly intravenous zoledronic acid 5 mg administration in CTD patients. Objectives The aim of the study was to assess safety of the zoledronic acid administration in patients with osteoporosis in the course of CTD and compare it to patients with PO. Methods We investigated 160 patients with osteoporosis including those without CTD or PO who received in total 278 infusions of intravenous zoledronic acid 5 mg in the period 2010-2012. Two subgroups of patients were identified: 47 with osteoporosis in the course of CTD including 33 with rheumatoid arthritis and 91 with PO. All patients included into the study fulfilled the osteoporosis densitometric criteria according to WHO and had contraindications to the use of oral bisphosphonates. The primary endpoint was the number of complications observed in CTD patients after the zoledronic acid administration compared to the number of complications registered in patients with PO. Results Both PO and CTD patients groups showed no statistically significant differences in terms of the mean age (73 vs. 70,66 years), T score result before the first administration of zoledronic acid (-2,91 vs. -2,81) and mean number of osteoporotic fractures (1,8 vs. 1,69). The number of complications in patients with CTD was significantly higher (14,89% - 7 patients) than in patients with PO (3,29% - 3 patients) (p<0,03). Furthermore in patients with PO the only observed type of adverse reaction were flu-like symptoms whereas in patients with osteoporosis associated with CTD also more severe complications were registered such as the renal function impairment (3 cases) and osteonecrosis of the jaw (1 case). Conclusions The safety and efficacy of a single 5 mg intravenous infusion of zoledronic acid should be further investigated as our retrospective analysis suggests that in patients with CTD treated with zoledronic acid the number of complications is significantly higher and they are more severe as compared to patients with PO. Disclosure of Interest None Declared