Anti-oxidant status in patients with Rheumatoid Arthritis after

Spa Therapy

Dr. Mine Karagülle

• Oxygen metabolism has an important role in the pathogenesis of rheumatoid arthritis.

• Reactive oxygen species (ROS) produced in the course of cellular oxidative phosphorylation, and by activated phagocytic cells during oxidative bursts, exceed the physiological buffering capacity and result in oxidative stress.

• The excessive production of ROS can damage protein, lipids, nucleic acids, and matrix components. They also serve as important intracellular signaling molecules that amplify the synovial inflammatory–proliferative response.

Plasma lipid peroxidation and antioxidant levels in patientswith rheumatoid arthritis

A.Kamanlı, M.Nazroğlu, N. Aydilek, C.HacevliyagilCell Biochem Funct 2004; 22: 53–57.

• increased lipid peroxidation and decreased enzymic and non-enzymic antioxidants in RA

• oxidant stress plays a very important role in the pathogenesis of RA.

Antioxidant status & lipid peroxidation in patients withrheumatoid arthritis

F. Karataş, I. Özateş, H. Canatan, I. Halifeoğlu, M. Karatepe, R. ÇolakIndian J Med Res 118, October 2003, pp 178-181

• There was an increased oxidative stress and a low antioxidant status in

patients with RA.

• These changes are probably due to efforts for reducing lipid peroxidation and hence to lower tissue damage.

• This study aims to elucidate plasma oxidant/antioxidant status in patients with rheumatoid arthritis (RA).

• Fasting blood samples were obtained from 24 patients with RA and 20 control subjects.

• Antioxidant potential (AOP) value, nonenzymatic superoxide radical scavenger activity (NSSA), and malondialdehyde (MDA) levels were measured to establish plasma oxidant/antioxidant status in the patient and control groups.

Patients with RA had lower AOP and NSSA but higher MDA levels than those of the control subjects,

These results • could be seen as an indication of reduced

antioxidant capacity and oxidant stress in RA patients

• suggest that the antioxidant system is impaired and peroxidation reactions are accelerated in patients with RA

RA and Oxidation

• The antioxidant defense system is compromised in rheumatoid arthritis patients.

• There is a shift in the oxidant/antioxidant balance in favor of lipid peroxidation, which could lead to the tissue damage observed in the disease.

• Oxygen free radicals have been implicated as mediators of tissue damage in rheumatoid arthritis (RA).

• Therapeutic coadministration of antioxidants along with conventional drugs to such patients has been considered beneficial

Study

• We designed a study to elucidate plasma oxidant/antioxidant status in patients with rheumatoid arthritis (RA) who underwent a 2-week spa therapy course, with the aim of evaluating the antioxidant effects of such therapy

Study

• We included 50 patients with RA (ACR Criteria) who were already receiving conventional treatment and were randomly divided into two groups of 25 each.

Study

• Treatment group received spa therapy for 2 weeks in addition to conventional treatment

• Control group continued rutine conventional treatment

Study

• Fasting blood samples of patients of both groups were collected before and after the spa course for antioxidant potential (AOP) value, nonenzymatic superoxide radical scavenger activity (NSSA), and malondialdehyde (MDA) levels were measured as described by Durak et al.

Malondialdehyde (MDA) (nmol/ml)

• MDA is a product of lipid peroxidation and thereby functions as a marker of oxidative stress.

• The level of MDA in plasma or serum has been reported to be higher in RA patients than in control subjects

• an indication of oxidant stress in these patients.

Antioxidant Defense Potential (AOP) (nmol/ml h)

• To give a more comprehensive evaluation into oxidant/antioxidant status

• Developed by Durak et al (1999)

• expressed as nanomoles/milliliter-hour

• Patients with RA had lower AOP levels

• which is an indication of reduced antioxidant capacity in these patients.

Nonenzymatic Superoxide RadicalScavenger Activity (NSSA) (U/ml)

• To give a more comprehensive evaluation into oxidant/antioxidant status

• Developed by Durak et al (1999)

• expressed as Unites/milliliter

• Patients with RA had lower NSSA levels

• which is an indication of reduced antioxidant capacity in RA patients.

Results

0123456789

MDA NSSA AOP/100

Durak Before

After Healthy

• The levels of MDA, NSSA and AOP in our patients at the begining and after 2 weeks were in accordance with the levels found previous study of Durak et. but were somehow higher

• and lower than the levels of healthy controls (Durak et al)

Results; MDA nmol/mL

0

0,5

1

1,5

2

2,5

3

3,5

4

before after

SPA Control After 2-week spa therapy;

• increased in SPA group, decreased in control group

• No statisticaly significant change intergroup (p=0.5) and beetween group (p=0.2) comparisons

Results; NSSA U/mL

7,6

7,8

8

8,2

8,4

8,6

8,8

before after

SPA Control After 2-week spa therapy;• increased in both groups• Statisticaly significant

increase in SPA group (p<0,05)

• No statisticaly significant change in control group (p=0,5)

• No statisticaly significant difference between the two groups (p=0,7)

Results; AOP U/mL

10

10,5

11

11,5

12

12,5

13

13,5

14

before after

SPA Control After 2-week spa therapy;

• increased in both groups

• No statisticaly significant change intergroup and difference beetween group comparisons

Discussions

• As expected RA patients had higher levels of MDA and lower levels of NSSA and AOP than healthy controls

• Indicating that the antioxidant system is impaired and peroxidation reactions are accelerated in patients with RA

Discussions

• After a 2-week spa therapy period MDA levels increased although not statisticaly significant

• suggesting that peroxidation reactions are accelerated after or during spa therapy

• And spa therapy may cause an extra oxidative stress

Discussions

• After a 2-week spa therapy period

• NSSA (statisticaly significant) and AOP levels increased

• Suggesting that antioxidant potential and activity are improved

Discussions

• Eventhough, a 2-week spa therapy in RA patients when added to rutine conventional therapy seems to cause and acceleration in lipid peroxidation, hence an oxidative stress

• This is contrbalanced with an increase anti-oxidative potential and activity which is already impaired in this patients

Discussions

• Spa therapy complementing conventional therapy in RA patients may exert some beneficial effects on oxidation processes

• These effects may have a therapeutic potential

• But, more studies are required to define the role of antioxidative effects of spa therapy in reported efficacy of this intervention in the management of RA

THANKS FOR YOUR ATTENTİON