OXIDANT-ANTIOXIDANT PARADOX OF SERUM URIC ACID AND ITS RESPONSE TO DEXAMETHASONE CYCLOPHOSPHAMIDE PULSE THERAPY IN PATIENTS WITH PEMPHIGUS VULGARIS. A HOSPITAL BASED STUDY.

Peerzada Sajad*, Iffat Hassan, Syed Mubashir, Reyaz Bhat, Waseem qureshi, Gousia sheikh, Hamid Bashir and Aresalan Malik

ABSTRACT

Background: Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucus membranes in which increased production of reactive oxygen species(ROS) leading to a decline of antioxidants in plasma and red blood cells and hence oxidative stress is one of the proposed mechanisms in pathogenesis. There are very scarce studies regarding the role of antioxidants in pemphigus vulgaris. The role of serum uric acid which can act both an antioxidant as well as an oxidant and its response to DCP therapy was evaluated in this study. Aim and objectives: To evaluate the serum level of uric acid in patients with pemphigus vulgaris and its response to dexamethasone –cyclophosphamide pulse therapy. Material and Methods: This was a prospective hospital based study conducted in the department of Dermatology and Biochemistry, Government medical college Srinagar in which new(freshly diagnosed )cases of pemphigus vulgaris were recruited and the serum levels of uric acid was determined by calorimetric method. The level of uric acid was then again determined after the achievement of clinical remission with DCP therapy. Results: A total of 15 successively admitted patients were recruited in the study. The serum level of uric acid was elevated in three patients, decreased in one patient only and the rest had uric acid levels within normal limits. However the levels returned to normal with DCP therapy following the achievement of clinical remission in patients with both elevated and decreased uric acid levels. Conclusion: The decreased levels of uric acid in pemphigus vulgaris as found in some previous studies was found in only one patient in our study and the rest had normal to elevated levels,thus explaining the oxidant-antioxidant paradox of uric acid. However larger studies are needed to establish the role of uric acid (antioxidant or oxidant) in pemphigus vulgaris.

Keywords: ROS-Reactive oxygen species; Antioxidant system; Oxidative stress; uric acid, pemphigus vulgaris, DCP-Dexamethasone-cyclophosphamide pulse therapy.