The objective of this article was to evaluate whether serum uric acid (SUA) correlates with arterial stiffness and inflammation markers in a cohort of women with systemic lupus erythematosus (SLE) without overt atherosclerotic cardiovascular diseases, who attended a community hospital. One hundred and two women with SLE were assessed as part of this cross-sectional study. Carotid-femoral pulse wave velocity (PWV) was measured using an automatic device (Complior). C-reactive protein (CRP), fibrinogen and homocysteine levels as well as other metabolic results were recorded. Duration and activity of SLE, damage accrual and treatments were recorded. SLE women were categorized as having or not having hyperuricaemia (HU) according to SUA levels (greater than or up to 6.2 mg/dl, respectively). A multiple linear regression analysis was used to determine the independent link between SUA levels and other variables. Women with SLE and HU (n = 15, 15%) had a worse cardiovascular risk profile that included ageing, hypertension, obesity, higher total cholesterol levels, renal failure and presence of metabolic syndrome. Also, the duration of SLE was increased and damage accrual was greater. In the unadjusted analysis, SUA levels correlated with PWV, CRP, fibrinogen and homocysteine. However, in a multivariate linear regression analysis, SUA levels independently correlated with the duration of SLE, creatinine, total cholesterol and homocysteine levels but did not correlate with PWV. In conclusion, SUA was associated with arterial stiffness, but not independently of age and homocysteine levels. Nevertheless, SUA might be an ancillary indicator of subclinical atherosclerosis in SLE women without clinically evident atherosclerotic cardiovascular disease.

Paraneoplastic dermatomyositis associated with bladder cancerSir-Dermatomyositis (DM) is an uncommon inflammatory myopathy of unknown aetiology characterized by pain and weakness in the proximal muscles, cutaneous symptoms (Gottron's sign and heliotrope erythema) and compatible electrophysiological and pathological findings. DM is related to an increased risk of cancer (~three-fold with respect to the expected number of cancer cases without DM), often considered as a paraneoplastic syndrome. 1 The malignancies most strongly associated with DM are ovarian, lung, gastrointestinal cancers and non-Hodgkin's lymphoma. 1 However, the association with the bladder cancer (BC) is unusual. A PUBMED search (key words: dermatomyositis, bladder cancer, bladder tumour, bladder neoplasm, bladder carcinoma, transitional cell carcinoma) revealed only 17 cases in which DM was associated with BC. 1-14 We report here a case of DM as the first manifestation of the recurrence of a BC.We describe the case of a 79-year old man with a medical history of hypertension and chronic obstructive pulmonary disease, type 2 diabetes mellitus and dyslipemia. He had a long history of cigarette smoking until two years before being diagnosed with transitional cell carcinoma of the bladder (Grade I). He underwent transurethral resection of the tumour and received intravesical immunotherapy. After one year of follow-up, a programmed transurethral cystoscopy resulted normal. Eight months later, that is, four months previous to DM manifestation, he underwent a routine digital rectal examination and a mild enlargement of the prostate was found, which was confirmed by a urologic sonography. At this time, no lesions in the bladder were observed. Likewise, he denied symptoms of prostatism. Serum total prostatespecific antigen level was 4.8 ng/mL (normal Ͻ6.5 ng/mL). Urine sediment analysis resulted negative for malignancy and haematuria. On the basis of these findings, he received a diagnosis of benign prostatic hyperplasia. The patient remained asymptomatic until that he began to present an erythematosus, inflammatory, desquamative rash affecting his face, forehead, scalp, upper torso and forearms. A periorbital purplish erythema consistent with heliotrope rash and liquenoid papules overlying his metacarpophalangeal joints also appeared. Finally, he developed sub-acute pain and weakness in the proximal muscles of the upper and lower extremities, dysphagia and dysphonia. He denied abdominal pain, burning on urination, gross haematuria, anorexia or a significant weight loss. Laboratory tests revealed: creatine phosphokinase 2227 UI/L, lactate dehydrogenase 636 UI/L, white blood cells count 9.0 ϫ 10 9 /L (77% of neutrophils), hemoglobin 12.6 g/dL, platelet count 139 ϫ 10 9 /L, erythrocyte sedimentation rate 23 mm/hour, C-reactive protein 5 mg/dL. Urinalysis showed microscopic haematuria. Immunological tests (including antinuclear antibodies, anti-double-stranded DNA antibodies, anti-Sm, antiRo/SSA, anti-La/SSB, anti-RNP, anti-Jo 1 and complement levels), serum...

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