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Background:Active Rheumatoid Arthritis (RA) is associated with considerable changes in body composition, lipids, adipokines and insulin sensitivity. RA is an independent risk factor for CVD. The mechanisms leading to synovial inflammation are similar to those found in unstable atherosclerotic plaque. Irisin is a metabolic hormone and a novel adipomyokine related to insulin resistance and endothelial functions (1).Objectives:To investigate the relationship between serum irisin levels, disease activity and cardiovascular risk in RA patients, and to test its performance in predicting subclinical atherosclerosis in RA patients.Methods:60 RA patients fulfilling the 2010 ACR/EULAR RA Classification Criteria and 30 healthy controls were recruited for serological testing of irisin levels. BMI was calculated. Waist/hip ratio was measured. RA disease activity was assessed by DAS28-ESR. Disability was assessed by HAQ-DI in its Arabic version. Serum ESR, CRP, glycated hemoglobin (HbA1c), lipid profile (serum level of cholesterol, triglyceride, HDL, LDL and cholesterol/ LDL ratio), insulin levels were measured in all patients and controls. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to calculate insulin resistance. Carotid intimal medial thickness (C-IMT), an indicator of atherosclerosis, was measured by carotid doppler ultrasonography. Echocardiography was performed to assess cardiac abnormalities. Our RA patients were classified twice; first, according to cardiovascular abnormalities and second, according to cut-off values of DAS28.Results:Serum irisin levels were significantly lower in RA patients (9.84 ± 10.56)ng/ml compared to controls (20.48±13.82)ng/ml (p<0.001). BMI values were significantly higher in all patients than controls (P= 0.035), while waist/hip ratio in female patients only were significantly higher (P= 0.007).We found a negative correlation between serum irisin and DAS28-ESR (r = -0.455, P-value 0.005)& HAQ-DI (r = -0.309, P-value 0.016). There was a negative correlation between serum irisin level and parameters of cardiovascular risk including anthropometric measurements (BMI and waist/hip ratio), HOMA-IR (r=−0.371, p=0.009) and C-IMT (r=−0.511, p<0.001). No correlation could be detected between irisin and lipid profile. The frequency of cardiovascular (CV) involvement in RA patients was 45% (27 patients) (11.6 % with echocardiographic abnormalities and 40% having increased C-IMT). Patients with CV involvement showed lower serum irisin level, increased disease activity assessed by DAS28 and increased disease disability assessed by HAQ-DI with statistically significant difference (P < 0.001, P < 0.05 and P < 0.001 respectively). Classifying the patients based on cut-off values of DAS28 into 3 groups (low disease activity, moderate and high disease activity), we found a statistically significant difference between the irisin levels of the 3 groups, being lowest among highly active patients (P= 0.014). c-IMT values were significantly higher in highly active patients (P= 0.04). Assessing the biomarker’s performance as an independent indicator of subclinical atherosclerosis in RA patients using ROC curve, it showed an excellent ability (AUC 0.8, P <0.001). As regarding its ability to differentiate patients with high disease activity, it showed a very good performance (AUC 0.73, P <0.001).Conclusion:In RA patients, serum irisin level was significantly lower and perform better than traditional yardsticks in identifying disease activity. It may act as an independent indicator of subclinical atherosclerosis in RA patients. Serum irisin level may be responsible for increased cardiovascular risk in those patients.References:[1]Chen JQ, Huang YY, Gusdon AM, Qu S.Irisin: a new molecular marker and target in metabolic disorder. Lipids Health Dis. 2015 Jan 14; 14:2.Disclosure of Interests:None declared

Background Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that affects predominantly adolescents and young adults. Oral isotretinoin is a highly effective treatment agent for patients with nodulocystic acne and moderate to severe acne resistant to conventional therapy, isotretinoin might have side effects of oxidative stress and lipid peroxidation. . Malondialdehyde is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Objective The purpose of this study to estimate malondialdehyde level in patients on Isotretinoin treatment for moderate to severe acne and compare them with healthy control group. Patients and Methods The case-control study was conducted at Ain. Shams University Faculty of Medicine, Egypt, from October 2017 to April 2017, and comprised male or non-pregnant female patients more than 18 years of age. 88 participants were included in the study; 44 cases, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne in comparison to equal healthy matching group. Isotretinoin was started in a dosage of 0.5mg/kg/day, and1.0mg/kg/day in patients with moderate and severe acne vulgaris respectively. Malondialdehyde, liver function tests, lipid profile and CBC were tested at the baseline for all participants and after 3 months for the patients who started isotretnoin therapy. Results In the current study, the mean baseline level malondialdehyde among all cases was 141.39 µmo1/m1±88.90, (range: 34.5 -360) and in controls it was 40 [µmo1/m1 ±11.3, (range: 9.5-90.4) this difference was statistically highly significant (P = 0.001). There was highly significant difference in malondialdehyde serum level (p = 0.0001) among all cases after 3 months of isotretnoin therapy, also there was a significant increase in MDA serum level among moderate cases (p = 0.021) and highly significant increase of MDA in severe cases (p=.001).ALP, ALT, serum cholesterol and triglyceride significant increases were seen in all cases. Conclusion low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and Malondialdehyde serum levels than high dose.

Background: chronic inflammatory disorders such as rheumatoid arthritis are associated especially active disease are associated with disturbed glucose and lipid metabolism, this underlying metabolic disorders such as insulin resistance. Objectives: The aim of this study was to determine insulin resistance and its relation to disease activity in patients with RA. Methods: Sixty RA patients fulfilling the 2010 ACR/EULAR RA Classification Criteria were included in the study. Thirty ageand sex-matched healthy volunteers were enrolled as the control group. All subjects underwent full history taking, clinical examination. BMI was calculated. Waist/hip ratio was measured. RA disease activity was assessed by DAS28-ESR. The following laboratory investigations were done for all patients and control: HbA1c, lipid profile and insulin. Insulin resistance was assessed with the HOMA Index. Echocardiography for cardiac abnormalities. Results: The frequency of cardiovascular (CV) involvement in our RA patients was 11.6% with echocardiography. Patients had higher insulin resistance than controls with no statistically significant difference. RA patients with CV involvement showed increased disease activity in comparison with patients without CV involvement, and no significant difference in insulin levels nor resistance between them. Conclusions: Rheumatoid arthritis has higher insulin resistance than controls, with no correlation to disease activity.