Purpose: e risk of atherosclerosis is increased in several rheumatological disorders, but any such risk remains unproven for ankylosing spondylitis. Since carotid intima-media thickness is an indicator of early atherosclerosis, and the paraoxonase (PON1) enzyme has antioxidant activity to prevent LDL oxidation, we aimed to identify: 1) the relationship between carotid intima-media thickness (CIMT) and serum paraoxonase (PON1) activity in ankylosing spondylitis (AS) patients; and 2) the possible di erences in CIMT in AS patients versus age-matched, healthy controls.Methods: Forty-ve AS patients (36.8±9.8 years, 36 males, 9 females) and 30 controls (35.9±10.2 years, 23 males, 7 females) were recruited consecutively. Serum PON1 activity and CIMT were measured. e Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to identify relationships between these clinical indices and levels of CIMT and PON1.Results: Mean CIMT was signi cantly increased in AS patients relative to controls (0.49±0.06 mm vs. 0.59±0.07 mm; p < 0.0001). Conversely, serum PON1 activity was decreased (199.1±60.3 U/L vs. 96.7±29 U/L; p < 0.0001). PON1 activity was negatively correlated with CIMT (r = -0.557, p = 0.0001). Disease duration was positively correlated with CIMT (r = 0.542, p = 0.0001) and negatively correlated with PON1 (r = -0.649, p = 0.0001). On multivariate analysis, disease duration and serum PON1 activity were found to be independent predictors of CIMT (R 2 = 0.687, p = 0.0001).
Conclusions:In conclusion, signi cantly increased CIMT and decreased PON1 activity suggest a relationship between atherosclerosis and AS: a relationship that is strongly correlated with disease duration.
Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. This study investigated the relationships of clinical stage with epidemiological and magnetic resonance imaging (MRI) findings in SSPE by retrospective review of 76 cases (57 male) diagnosed by typical periodic electroencephalographic features, clinical symptoms and elevated measles antibody titre in cerebrospinal fluid. Clinical stage at diagnosis was I or II in 48 patients, III in 25 and IV in three. Prominent findings at presentation were atonic/myoclonic seizures (57.9%) and mental deterioration with behaviour alteration (30.3%). Frequent MRI findings (13 - 32 patients) were subcortical, periventricular and cortical involvement and brain atrophy; the corpus callosum, basal ganglia, cerebellum and brainstem were less frequently involved. Five patients had pseudotumour cerebri. Cranial MRI at initial diagnosis was normal in 21 patients (19 stage I/II, two stage III/IV). Abnormal MRI findings were significantly more frequent in the later stages, thus a normal initial cranial MRI does not exclude SSPE, which should, therefore, be kept in mind in childhood demyelinating diseases even when the presentation is unusual.
When sensitive echocardiographic Doppler techniques such as MPI, TDI-derived MPI, and PW-TDI are utilized, DD can be detected in a significant proportion of patients with AS without cardiovascular (CV) disease which may contribute CV mortality in these patients.
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