Vinit Anand

Abstract

Introduction: Rheumatoid arthritis (RA) is a prototypical inflammatory joint disease of unknown etiology affecting various joints of the body leading to stiffness, swelling, pain, and finally functional inability. Elevated serum alkaline phosphatase (ALP) is a common feature in rheumatoid arthritis (RA) and its origin remains unclear. Inflammatory conditions are more likely to alter mineral status.  Aim of the Study: The aim of this study was to investigate the level of serum ALP, Calcium, Phosphorus & Magnesium levels in Rheumatoid arthritis patients and compare it with healthy subjects.  Materials and Methods: Fifty four RA patients and fifty four age matched healthy controls between 35-65 years were included in the study. Serum Calcium, Phosphorus, Magnesium & ALP activity were measured in all the subjects and correlated.  Results: Serum ALP (145.17±15.87 versus 83.19±17.55 U/L) and phosphorus levels (4.84±0.24 versus 3.84±0.44 mg/dl) were found significantly higher; serum Calcium (7.66±0.34 versus 9.27±0.49) and serum Magnesium levels (1.72±0.24 versus 1.95±0.29 were found to be lower in RA cases as compared to controls and were statistically significant (p Conclusion: Increase in ALP in RA patients when compared to healthy controls suggests the role of serum ALP as a marker of disease activity in RA. The altered mineral status in rheumatoid arthritis, observed in this study reflects on the pathogenesis of RA. Therefore we conclude that serum ALP & mineral estimation can also be used as markers of disease activity in rheumatoid Arthritis. Keywords: Alkaline phosphatase, Serum calcium, Phosphorus, Magnesium, Rheumatoid arthritis.

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Abstract

Introduction and Objectives: Several studies have hypothesized the relation of Blood Urea Nitrogen (BUN) and serum Creatinine level with the severity of coronary artery disease. The basis of this study is to show the prognostic significance of BUN and serum Creatinine levels at admission for assessing the risk of mortality in patients with acute coronary syndromes (ACS). This study also undertakes the comparative prognostic significance of BUN over serum creatinine as an indicator of risk of mortality in patients with ACS. Materials and Methods & Results:This was a prospective study of all patients admitted with suspected (n=1019) and retrospectively confirmed (n=65) Myocardial Infarction (MI) or Unstable Angina. The Receiver-operating characteristic curve analysis established that the area under the curve for BUN was higher than that of Creatinine 0.71 (95% CL 0.65 to 0.78) and 0.63 (95% CL 0.59 to 0.66), respectively (p=0.005). The threshold level was 8.6mmol/L for BUN and 110µmol/L for Creatinine. Sensitivity was 61% and 56% for threshold levels of BUN and Creatinine, and specificity was 84% and 78%, respectively. It is seen only an increase of BUN and a combination of increased BUN and Creatinine levels, as risk factors of mortality with ACS.Isolated increase in creatinine levels was not found to be significant. Separate inclusion of BUN and Creatinine as continuous variables in the regression model showed that both were associated with the risk of mortality. Odds Ratio (OR) 1.18 (95% CL 1.12 to 1.25) and 1.08 (95% CL 1.011 to 1.019) per unit increase (R2 =12.5 and 8.1% respectively). When both were simultaneously included, only the increased BUN level was persistent with the prognosis of ACS: OR after multivariate adjustment 1.14 (95% CL 1.04 to 1.18). Conclusion: An increased level of BUN is a more significant prognostic marker of mortality assessment at admission in ACS than that of serum Creatinine. Keywords: Blood Urea Nitrogen, Serum Creatinine, Acute Coronary Syndrome

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Introduction & Objectives: Rheumatoid arthritis (RA) is a prototypical inflammatory joint disease. The degree of inflammation is reflected in the extent of joint damage, which further has influence on the quality of life of patients with RA. Serum adenosine deaminase (ADA) has been previously proposed to predict disease activity in patients with RA. The aim of this study was to investigate the level of serum ADA, CRP & ALP in Rheumatoid arthritis patients and compare it with healthy subjects. Materials and Methods: Fifty four RA patients and fifty four age matched healthy controls between 35-65 years were included in the study. ADA &ALP activity and CRP levels in serum were measured in all the subjects and correlated. Results: Serum ADA level was found significantly higher among RA subjects with respect to controls (31.37±4.16 versus 11.19±1.802 U/L; P < 0.0001). Serum ALP levels were also increased in RA cases as compared to controls and were statistically significant (145.17±15.86 versus 83.19±17.55 U/L; P < 0.0001). Serum CRP levels were also increased among RA subjects when compared to controls (2.60±1.16 versus 0.283±0.1161). Conclusion: ADA assay can be a reliable, sensitive and specific test. CRP is an important inflammatory marker for rapid diagnosis of rheumatoid arthritis. Increase in ALP in RA patients when compared to healthy controls suggests the role of serum ALP as a marker of disease activity in RA. However, larger and well controlled studies are needed to establish its role as inflammatory marker. Keywords: Adenosine deaminase, Alkaline phosphatase, C-reactive protein, Rheumatoid arthritis.

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