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Rheumatoid arthritis (RA) and osteoarthritis (OA) may cause rapid joint destruction and chronic disability. The main pathological feature of RA is chronic synovitis, resulting in bone resorption due to TNF-a-RANKL-DKK-1 mechanism. The main pathological feature of OA is increased osteophyte formation governed by members of the TGF/BMP protein family, as well as by the group of Wingless (Wnt) proteins. The renin-angiotensin-adosterone system has been identified as an important regulator of fibrosis and is being investigated as a potential target for antifibrotic drugs. Experimental evidence also indicates that aldosterone directly contributes to accelerate damage by sustaining cell growth, inflammation and fibrosis reactions. This occurs through production of growth factors including TGF-b. The objective of this study was to investigate serum sodium/potassium ratio (SSPR) as an indicator of aldosterone function in patients with OA and RA. Retrospective analysis of SSPR of patients aged 40-70 with active RA (n=50 patients) and OA (n=30) was performed as of medical records from the in-patient clinic. These findings were compared with the data of SSPR of healthy controls (n=30). SSPR of patients with RA, OA and healthy controls was within the recognized normal range (27-40). The lowest SSPR was found in healthy controls: 30.9±2.4. Significantly higher values were found in the RA group (32.9±2.9; P less then 0.001) and OA patients (34.3±2.1; P less then 0.001). The SSPR was significantly higher in the OA group compared to RA (P=0.004). No correlation was observed between SSPR and age (P=0.534). We conclude that patients with OA had relatively increased SSPR, indirectly indicating increased aldosterone function compared with controls and patients with RA.

The prognostic significance of finding vegetations by M-mode echocardiography in patients with infective endocarditis remains controversial because many such patients are referred for early surgery. We detected vegetations in 7 of 25 consecutive subjects with active infective endocarditis (28.1 %) studied by M-mode echocardiography. 11 patients died within 1 year and only 1 underwent surgery. Patients with vegetations had a higher likelihood of developing serious complications such as death, congestive heart failure or ‘severe congestive heart failure’ when compared with patients without vegetation. This study validates previously reported series including a high percentage of patients ‘requiring surgery’ and points to the serious prognostic implication of finding a vegetation by M-mode echocardiography.