El-Awady Hanaa Mahmoud, El-Wakkad Amany Salah El-Dien, Saleh Maysa Tawheed, Muhammad Saadia Ibraheem, Ghaniema Eiman Mahmoud
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Pak J Biol Sci. 2007 May 1;10(9):1471-6. doi: 10.3923/pjbs.2007.1471.1476.
The study was conducted to investigate the abnormalities in early morning serum melatonin among patients with Juvenile Rheumatoid Arthritis (JRA) and to outline its relation to disease activity and severity. Twenty one patients with JRA and twenty healthy age and sex matched controls were enrolled in the study. Fifteen patients had polyarticular JRA, 3 had oligoarticular and 3 had systemic onset JRA. Evaluation was carried out clinically, functionally and radiologically by using disease activity score, Juvenile Arthritis Functional Assessment Report for Children (JAFAR-C score) and modified Larsen score, respectively. Laboratory investigations included Complete Blood Picture (CBC), The Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), classic IgM Rheumatoid Factor (RF), Anti-nuclear Antibodies (ANA) and melatonin estimation in serum. The serum levels of melatonin were significantly increased in JRA patients (mean +/- SD = 13.9 +/- 8 pg mL(-1)) as compared to healthy controls (mean +/- SD = 8.1 +/- 2.7 pg mL(-1), p < 0.01). A significant positive correlation could link serum melatonin levels to disease activity scores and ESR (r = 0.91, p < 0.001 and r = 0.55, p < 0.01, respectively). No significant correlation was found between melatonin and either Larsen or JAFAR scores (r = 0.19, r = 0.15, respectively). According to melatonin levels, there were 2 groups of patients: Group I with elevated melatonin level (more than 11 pg mL(-1)) (n = 15) and group II with normal melatonin level (less than 11 pg mL(-1)) (n = 6). Patients with elevated melatonin levels had higher ESR (p < 0.05), higher disease activity scores (p < 0.01) and Larsen scores (p < 0.05), than the group of patients with normal serum melatonin. The results of GAFAR scores were comparable between the two groups (p > 0.05). Hence the study conclude that the elevated melatonin levels among JRA patients with active synovitis and its close relation to disease activity rather than disease severity suggests that melatonin might play a promoting role in rheumatoid arthritis. Hence, inhibition of its synthesis and/or action by specific antagonists may be of therapeutic value.
本研究旨在调查幼年类风湿性关节炎（JRA）患者清晨血清褪黑素的异常情况，并概述其与疾病活动度和严重程度的关系。本研究纳入了21例JRA患者以及20名年龄和性别匹配的健康对照者。15例患者为多关节型JRA，3例为少关节型，3例为全身型JRA。分别使用疾病活动评分、儿童幼年关节炎功能评估报告（JAFAR-C评分）和改良拉森评分，从临床、功能和放射学方面进行评估。实验室检查包括全血细胞计数（CBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）、经典IgM类风湿因子（RF）、抗核抗体（ANA）以及血清褪黑素测定。与健康对照者（平均±标准差 = 8.1±2.7 pg/mL(-1)，p < 0.01）相比，JRA患者的血清褪黑素水平显著升高（平均±标准差 = 13.9±8 pg/mL(-1)）。血清褪黑素水平与疾病活动评分和ESR之间存在显著正相关（分别为r = 0.91，p < 0.001和r = 0.55，p < 0.01）。未发现褪黑素与拉森评分或JAFAR评分之间存在显著相关性（分别为r = 0.19，r = 0.15）。根据褪黑素水平，患者分为两组：第I组褪黑素水平升高（超过11 pg/mL(-1)）（n = 15），第II组褪黑素水平正常（低于11 pg/mL(-1)）（n = 6）。褪黑素水平升高的患者ESR更高（p < 0.05），疾病活动评分更高（p < 0.01），拉森评分也更高（p < 0.05），高于血清褪黑素水平正常的患者组。两组的GAFAR评分结果相当（p > 0.05）。因此，该研究得出结论，患有活动性滑膜炎的JRA患者褪黑素水平升高，且其与疾病活动度密切相关而非疾病严重程度，这表明褪黑素可能在类风湿性关节炎中起促进作用。因此，使用特异性拮抗剂抑制其合成和/或作用可能具有治疗价值。
