Introduction : The Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic disease that is usually the most evident and commonly manifested on diarthrosis joints. The initial etiological factors that trigger the immune-inflammatory response still remains unknown. RA is result of the simultaneous influence of genetic risk factors, external factors and changes in immune system. Objective : The goal of this study was to determine the mutual correlation between smoking and RA activities expressed by the quantitative values of laboratory and disease activity parameters. Material and Method : The open clinical retrospective study included 100 RA patients stages from I to IV aged from 21 to 77 ys. There were 85 (85%) females and 15 (15%) males selected by randomization. The study analysed: age, gender, smoking, duration of smoking, sedimentation rate (ESR), rheumatoid factor (RF), C-Reactive Protein (CRP) anti-cyclic citrullinated peptide (anti-CCP) antibodies and X-ray. Statistical analyses was done with SPSS software, Student's t-test and chi-square test. Results : The quantitative values of laboratory parameters are directly related with the smoking period. All inflammatory markers were increased in both groups, but more elevated in smoker's group. The only statistical significance was found in anti-CCP where this test was significantly higher compared to non-smokers. There was no statistical significance in the onset of disease, gender, ESR, CRP, RF, and radiological changes between two groups, although smokers had some more higher values. Conclusion : Smoking plays significant role in RA activity and leads to longer duration of symptoms and increased disability. All inflammatory markers were increased in both groups, but more elevated in smoker's group, with the only significancy in anti-CCP level. The cessation of smoking should be part of disease management proccess.

This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern--concentration in the first measurement is higher than in the second one, and biphasic pattern--concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3 +/- 10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p < 0.001). We found statistically significant real negative correlation (p < 0.05) between BNP concentration and left ventricle ejection fraction (LVEF) with high correlation coefficient (r = -0.684). BNP concentrations were significantly higher among patients in Killip class II and III compared to Killip class I; Killip class I BNP = 226.18 pg/mL vs. Killip class II 622.51 pg/mL vs. Killip class III 1530.28 pg/mL, p < 0.001. BNP concentrations were significantly higher in patients with; (i) myocardial infarction vs. controls; (BNP 835.80 pg/mL vs. 243.03 pg/mL); (ii) in pts with positive major adverse cardiac events (MACE) vs. negative MACE (BNP 779.08 pg/mL vs. 242.28 pg/mL, p < 0.001); (iii) in pts with positive compared to negative left ventricle (LV) remodelling (BNP 840.77 pg/mL vs. 341.41 pg/mL, p < 0.001). Group with biphasic pattern of BNP release had significantly higher BNP concentration compared to monophasic pattern group. In biphasic pattern group we found significant presence of lower LVEF, Killip class II and III, LV remodelling and MACE. We found that BNP is strong marker of adverse cardiac events in patients presenting with a myocardial infarction. In our AMI group we found significant elevation of BNP and it is suspected that second peak secretion is not only due to systolic dysfunction and subsequent remodeling of LV but also due to impact of ischaemia. Patients with biphasic pattern probably have worse prognosis due to severe coronary heart disease. Besides its diagnostic role as a simple blood marker of systolic function, BNP is also important prognostic marker who helps making clinical decision about early invasive vs. conservative management.