الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 235 |  |  |
| | | from | 235 | | |
Abstract
The present work was undertaken in order to assess the prevalence of anti-chromatin and anti-histone antibodies in patients with systemic lupus erythematosus and to correlate serum levels of these antibodies with clinical features of the disease. This study was carried out on sixty eight patients. All were selected from the outpatient clinics of Rheumatology and Rehabilitation Department Mansoura University Hospital. Fifteen apparently healthy subjects of matching age and sex served as control group. These participants were divided into four groups: Group I: It included 38 female patients with SLE . They were fulfilling the American Rheumatism Association (ARA) revised criteria for the classification of SLE (Tan et al., 1982). Group II: It included 15 female patients with RA . They were fulfilling the American Rheumatism Association Criteria for the classification of RA (Arnett et al., 1988). Group III: It included 15 female patients with SSc. They were fulfilling American Rheumatism Association Criteria for the classification of SSc (Masi et al ., 1980). Group IV: It included 15 apparently healthy females. All patients were subjected to full history and clinical examination as vital signs , body weight, complexion , eye examination, skin examination, musculoskeletal examination : for joint , tenderness, warmth , swelling or deformity and muscle for tenderness , neuropsychiatric examination, abdominal examination , chest examination and cardiovascular examination. The following investigations were done: Plain x-ray, chest x-ray, ECG, EMG and NCV,fundus examination,renal biopsy, complete blood picture, erythrocyte sedimentation rate, C-reactive protein, complete urine analysis, 24 hours proteinuria , serum creatinine , liver function tests, RF, anti-dsDNA, complement components, antinuclear antibody, anti-chromatin and anti-histone antibodies. The following results were obtained: Among clinical manifestations of the disease in our SLE patients, malar rash was the most common feature (60.5%) while descoid lesion affected only one patient (2.6%). Haemoglobin concentration was significantly lower in SLE patients than in controls while ESR was higher in SLE patients than in controls. Increased levels of anti-chromatin antibodies (>20 IU/ml) were detected in 34 SLE patients(89.5%) and in 0(0%) among control group. Increased levels of anti-histone antibodies (>1IU/ml) were detected in 35 SLE patients(92.1%) and in 0(0%) among control group. Increased levels of anti-chromatin antibodies (>20 IU/ml) were detected in 5 RA patients(33.3%), while 10 patients (66.7%) have anti-chromatin antibodies levels below this value and considered to have normal levels. Increased levels of anti-histone antibodies (>1IU/ml) were detected in 3RA patients(20.0%) while 12 patients (80.0%) have anti-histone antibodies levels below this value and considered to have normal levels. Increased levels of anti-chromatin antibodies (>20 IU/ml) were detected in 4 SSc patients (26.7%), while 11 patients (73.3%) have anti-chromatin antibodies levels below this value and considered to have normal levels. Increased levels of anti-histone antibodies (>1IU/ml) were detected in 5 SSc patients(33.3%), while 10 patients (66.7%) have anti-histone antibodies levels below this value and considered to have normal levels. The blood level of anti-chromatin and anti-histone tend to be significantly higher in SLE (G I) rather than those in RA,SSc and control groups. This difference was significant in all groups. No significant difference were observed between blood level of anti-chromatin and anti-histone antibodies among G II, G III and G IV. Sensitivity of anti-chromatin antibodies in SLE patients p was 89.5% and specificity was 80.0% ,while sensitivity of anti-histone antibodies was 92.1% and specificity was 82.2%. Serum levels of anti-chromatin and anti-histone antibodies were significantly correlated in SLE patients. Insignificant correlations were observed between age, disease duration and anti-chromatin , anti-histone antibodies among all groups. The incidence of anti-chromatin and anti-histone antibodies was significantly higher (P<0.01) than that of anti-dsDNA antibodies in the initial stage of the disease. There was significant correlation (p<0.05) between the level of anti-chromatin titer and arthritis ,malar rash ,oral ulcer and pulmonary affection .There was no significant correlation between anti-chromatin antibodies and other clinical manifestations. There was significant correlation between the level of anti-histone titer and fatigue(P=<0.05).There was insignificant correlation between anti-histone antibody titer and other clinical manifestations. SLEDAI scores of SLE patients were positively correlated with serum levels of anti-chromatin antibodies (P=<0.001),and insignificantly correlated with serum levels of anti-histone antibodies(P=>0.05). No significant correlations were observed between anti-chromatin & anti-histone antibodies and laboratory parameters in SLE patients. Patients with renal involvements showed significantly higher serum levels of anti-chromatin antibodies (P=<0.01) than patients without nephritis. No significant difference was observed between serum levels of anti-histone antibodies in patients with and without renal involvement. There was significant correlation between serum levels of anti-chromatin antibodies (P=<0.01) and renal biopsy grade.There was no significant correlation between serum levels of anti-histone antibodies and renal biopsy grade. No significant association was found between various drug users regarding serum levels of anti-chromatin and anti-histone antibodies. No significant association was observed between the level of anti-chromatin and anti-histone titers and parameters of disease activity and severity in RA patients. No significant correlation was observed between anti-chromatin and anti-histone antibodies and parameters of disease activity and severity in SSc patients. Conclusion: Anti-chromatin and anti-histone antibodies could be a useful addition to the laboratory tests that can help in the diagnosis and follow up of treatment in SLE. Determination of anti-chromatin and anti-histone antibodies could be useful parameters for early diagnosis of SLE patients. Anti-chromatin and anti-histone antibodies were useful markers to help diagnosis of SLE patients with negative anti-dsDNA. Anti-chromatin antibody seem to be a promising marker which was useful in assessment of disease activity in SLE patients. The increased titer of anti-chromatin antibodies appears to be a sensitive marker for identifying patients with lupus nephritis. Recommendations: Anti-chromatin and anti-histone antibodies have proved to be useful in diagnosing patients with SLE , perhaps a positive anti-chromatin and anti-histone antibodies test should be included as one of the ARA criteria for diagnosing SLE (Cacoub et al.,1997). Chromatin and histones appear to be the prime autoantigen that are generated through apoptosis(Agrawal,2000).Further understanding the processes involved in the pathogenesis could guide development of new therapeutic interventions.