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Objectives: To study the association of systemic and local interleukin-35 (IL-35) levels in rheumatoid arthritis., Methods: 37 patients with treatment naïve early RA, 49 with established RA and 29 control patients with osteoarthritis (OA) were studied. Serum and paired synovial fluid samples were analysed for IL-35. Disease activity of RA patients was assessed according to the 28-Joint Count Disease Activity Score (DAS28)., Results: The levels of serum IL-35 were significantly higher in patients with treatment naïve early RA compared to those with established disease and control OA subjects. In addition, serum levels of IL-35 significantly decreased 12 weeks after initiation of glucocorticoids and conventional synthetic disease modifying antirheumatic drugs in patients with treatment naïve early RA. Synovial fluid IL-35 levels were significantly higher in RA compared to OA patients, were significantly elevated compared to serum counterparts and correlated with synovial fluid leukocyte count (r=0.412; p<0.01), serum CRP levels (r=0.362; p<0.05) and DAS28 (r=0.430, p<0.01)., Conclusion: This is the first study showing elevated circulating levels of IL-35 in treatment naïve early RA, its significant decrease after treatment initiation and positive association between increased synovial fluid IL-35 and disease activity in patients with long-lasting RA.

Objectives: The purpose of this study was to evaluate the prevalence and prognostic importance of lower extremity arterial disease (LEAD) in patients with multivessel coronary artery disease., Background: The presence of clinically evident LEAD increases the risk of death in patients with known coronary artery disease. Because studies have lacked noninvasive measures of subclinical LEAD, the true prognostic importance of lower extremity atherosclerosis in this population has probably been underestimated., Methods: Ankle blood pressures were measured in 405 consecutive patients with angiographically documented multivessel coronary disease from seven Bypass Angioplasty Revascularization Investigation (BARI) sites and a parallel study site within 3 years of enrollment. Lower extremity arterial disease was defined as an ankle/arm systolic blood pressure ratio of 0.90 or less., Results: Among patients studied, 69 (17%) had LEAD. These patients were more likely to be current smokers, treated for diabetes, older and present with unstable angina compared with patients without LEAD. Among patients who underwent coronary arterial bypass grafting, major complications occurred in 2.8% of those without LEAD compared with 20.7% of those with LEAD (p = 0.002). Five-year mortality rates were similar for symptomatic LEAD (14%) and asymptomatic LEAD (14%). Patients without LEAD had a 3% mortality. After adjusting for baseline differences, the relative risk of death was 4.9 times greater for patients with LEAD compared with those without (95% confidence interval [CI]: 1.8, 13.4, p < 0.01)., Conclusions: Patients with LEAD have a significantly higher risk of death than patients without LEAD, regardless of the presence of symptoms. An abnormal ankle/arm index is a strong predictor of mortality and can be used to further stratify risk among patients with multivessel coronary artery disease.

The left ventricle (LV) was catheterized without X-ray control by a thin teflon catheter introduced through the right brachial artery. Shaping of the catheter allowed entering LV in more than 95% of patients and its safe placements in LV cavity without causing ectopic beats or other complications. Pressures in the pulmonary circulation (PAP, PAPd, PCW) do not reflect left ventricular filling pressure (LVEDP) precisely, particularly when the LVEDP is elevated. The assessment of pathological LV filling pressure from the pulmonary arterial pressures shows, that there was high percentage of false negative results at rest, but during exercise the abnormal values of LVEDP could be predicted from the pulmonary artery pressures. However, PCW or PAPd cannot be considered as identical with LVEDP. For the rough assessment of apparent left ventricular failure it is sufficient to measure pressures in the pulmonary artery. However, for the exact study, the LV should be catheterized. The described bed-side method fulfill all requirements: it is simple, convenient and safe; the pressure is recorded accurately; the procedure can be repeated and is therefore recommended for wider use.