Cardiovascular diseases represent important complications in rheumatoid arthritis (RA) patients, generated by an accelerated atherosclerosis. The aim of this study is represented by the assessment of the correlations between serum levels of vitamin D, disease activity, and endothelial dysfunction in patients with early RA. Material and Methods. The study was performed on a group of 35 patients with early RA and 35 healthy subjects matched for age and gender, as controls. In all studied subjects, the following were determined: inflammatory markers, insulin resistance, vitamin D levels, and endothelial dysfunction. Statistical analysis were performed using the Student's t-test and the Pearson's test. p values of less than 0.05 were considered statistically significant. Results. The group of patients with RA patients presented inflammation, low levels of vitamin D, elevated insulin resistance, and reduced flow-mediated vasodilation, statistically significant compared to the control group (p < 0.00001). Significant inverse correlations between the levels of 25(OH) vitamin D and DAS28, respective insulin resistance, and significant positive correlation between 25(OH) vitamin D and endothelial function were demonstrated. Conclusion. In early RA patients with moderate and high disease activity, low serum levels of vitamin D were associated with disease activity, increased insulin resistance, and endothelial dysfunction.

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Background:We previously observed an association between systemic lupus erythematosus (SLE) disease activity and heart rate variability (HRV) with a preliminary observation of consistency between these two measures when disease activity changed between two timepoints (1). Objectives: To prospectively test the hypothesis that HRV reflect longitudinal changes in clinical status and patient reported outcomes. Methods: The current project evaluated HRV measurements using a 5 min ECG in SLE patients who completed a minimum of 2 visits in an ongoing clinical trial. HRV parameters were calculated in the time domain (RMSSD and pNN50) and the frequency domain [high frequency (HF) as well as low frequency to high frequency (LF/HF) ratio]. A mixed effects linear model, with generalized estimating equations to account for clustering of visits for each patient, was used to compare changes in HRV between paired visits and to examine linear associations between HRV parameters and clinical scores. All models were adjusted for baseline values of each HRV parameter. Results: Forty nine patients (age 44.9±11.7, 46 female), followed in a total of 413 paired visits (median time between visits 1 month), were included. Global BILAG score was inversely associated with RMSSD (regression coefficient β=-1.39±0.01; p<0.0001). BILAG, SLEDAI and PGA were directly associated with the LF/HF ratio (β=0.96±0.02; p<0.0001, 0.42±0.10; p<0.0001 and 0.83±0.09; p<0.0001, respectively). Changes in BILAG were inversely associated with changes in RMSSD and pNN50 (β=-7.0±1.9; p=0.003 and -1.6±0.04; p<0.0001, respectively). BILAG changes were also directly associated with changes in the LF/HF ratio (β=0.78±0.05; p<0.0001). Categorical improvement, defined as ≥1 letter grade improvement in BILAG and no new BILAG A or B scores, occurred in 77 (19%) visit pairs (group 1) and either no improvement or worsening in 335 (81%) group 2. RMSSD and HF increased in group 1 compared to group 2 (group difference=-33.3±10.1; p=0.001 and -30.9±4.1; p<0.0001, respectively), and the LF/HF ratio decreased in group 1 compared to group 2 (group difference=3.1±0.8; p=0.002). Changes in Physical Component Summary (PCS) of SF36v2 were inversely related to changes in SLEDAI and PGA (β=-0.39±0.14; p=0.006 and -0.19±0.02; p<0.0001, respectively). Changes in Mental Component Summary (MCS) were inversely related to changes in BILAG, SLEDAI and PGA (β=-0.23±0.07; p=0.0001, -0.31±0.10; p=0.002 and -0.08±0.03; p=0.008, respectively). PCS was related to HF (β=0.67±0.28, p=0.01) whereas MCS was inversely related to the LF/HF ratio (β=-0.11±0.03, p=0.0001). Changes in PCS were related to changes in pNN50 (β=0.21±0.05, p=0.0001) and changes in MCS were related to changes in HF (β=1.57±0.18; p<0.0001). Conclusions: Changes in HRV reflect changes in clinical status and patient reported outcomes in patients with SLE. These data suggest that HRV may be a simple non-invasive tool used to gage or predict clinical improvement in SLE.

Six graffiti from the time of the Dacian Kingdom were discovered at Covasna – Cetatea Zânelor (Fairies Fortress). Four vessels with graffiti can be associated with a building having the roof supported by three rows of wooden pillars. Two signs were made before firing and other four after burning, on good quality vessels, preserved in a fragmentary condition. The main issue is whether these graffiti are simple scratches or graphic signs.

Rheumatoid arthritis is a chronic inflammatory disease, in which, besides articular involvement, cardiovascular complications due to premature and accelerated atherosclerosis represent a serious problem. Endothelial dysfunction is the first step in the atherosclerosis development. Rheumatoid arthritis associated inflammation contributes to endothelial dysfunction through direct action of cytokines on endothelium, or via increased insulin resistance. The aim of this study was represented by the assessment of endothelial dysfunction in rheumatoid arthritis patients, and correlation of this with impaired insulin sensitivity. Material and methods. The study was performed on a group of 35 patients with newly diagnosed rheumatoid arthritis. In all patients were assessed: rheumatoid arthritis activity (DAS28), insulin resistance (HOMA-IR) and endothelial dysfunction by means of flow-mediated dilation (FMD). Results. Inflammation was present in all patients, and the disease activity was high (DAS28: 6.41 ± 0.94). The studied patients showed high insulin resistance (HOMA-IR 5.97 ± 1.89) and endothelial dysfunction (FMD 7.94 ± 0.91%). There were significant correlations between endothelial dysfunction and insulin resistance (p = 0.0174), respective disease activity (p = 0.0201). On the other hand, it was shown a correlation between insulin resistance and the disease activity (p = 0.0290). Conclusion. Endothelial dysfunction was present even in newly diagnosed rheumatoid arthritis patients, contributing to the development of later atherosclerotic cardiovascular disease. Insulin resistance represented an important factor involved in endothelial dysfunction appearance.