Serum autoantibodies profile and increased levels of circulating intercellular adhesion molecule-1: a reflection of the immunologically mediated systemic vasculopathy in rheumatic diseases?
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Clinical manifestation of systemic vasculitis may be postulated as a consequence of the immune response abnormalities in the course of connective tissue diseases (CTD). The aim of this study was to elucidate the significance of the different autoantibodies and soluble intercellular adhesion molecule 1 (sICAM-1) shedding into the circulation in the diagnosis of vasculitis in rheumatic diseases. Serum of 86 patients with rheumatic diseases (54 with rheumatoid arthritis (RA) and 32 with CTD) were analyzed for the concentrations of sICAM-1 levels by the enzyme linked immunosorbent assay (ELISA). Control sera were obtained from 30 healthy individuals. Anti-nuclear antibodies (ANA), anti-double-stranded antibodies (anti-dsDNA) and anti-proteinase-3 (PR-3) antibodies (anti-neutrophil cytoplasmic autoantibodies cytoplasmic specific, cANCA) were assessed by the ELISA method. Fifty out of 86 patients had the systemic lesions. Pathological picture of the vascular loop in the nailfold capillary microscopy was found in 84 patients. In 19 patients the microvascular changes were advanced, in 35 moderate and in 30 mild. All patients with the articular manifestations had the pathological changes in the capillary microscopy. Patients with advanced changes in the capillary microscopy had the longer disease duration compared to patients with mild intensity of vasculitis. Serum concentration of sICAM-1 was significantly increased in RA and CTD patients compared to 30 controls (in both cases p<0.001). Moreover, RA and CTD patients with the systemic vasculitis showed significantly higher levels of sICAM-1 than those without vascular involvement (respectively p<0.001 and p<0.005). ANA were observed in significantly elevated concentration among RA and CTD patients with the systemic damage compare to patients without organ injury (respectively p<0.001 and p<0.05). Also cANCA level was twice more higher but only among CTD patients with the systemic damage (p<0.05). Serum concentration of sICAM-1 was elevated in studied patients with the presence of ANA antibodies (p<0.05). Significant correlation between ANA level and the disease duration, and hemoglobin concentration were observed. The concentration of cANCA correlated with rheumatoid factor and of dsDNA with patient age. We conclude that the systemic lesions in the course of RA and CTD are accompanied by the microvascular injury in nailfold capillary microscopy. Our data suggest that sICAM-1, ANA and cANCA serum levels may reflect the extent of the vascular involvement in RA and CTD patients.
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A.Kuryliszyn-Moskal, Department of Rheumatology and Internal Diseases, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland