Pattern of young and elderly onset rheumatoid arthritis among a group of Egyptian patients

Rheumatoid arthritis [RA] differs depending on the age of disease onset. The differences between young onset rheumatoid arthritis [YORA] and elderly onset rheumatoid arthritis [EORA] are important because they have clinical and therapeutic implications. The study was conducted on 1185 patients who were ranked after classification according to age at onset of the disease into YORA I, 16-40 years, YORA II, 41-60 years and EORA >60 years. All were compared, based on disease duration [DD], disease activity, severity parameters and drug history. YORA I comprised 298 patients, 28.85% males, age 29.4 +/- 6 and DD 4 +/- 3.3 y, YORA II included 539 patients, 33.77% males, age 49.7 +/- 6.1 y. and DD 6.5 +/- 5.6 y. EORA included 348 RA patients 40.5% males, age 67.1 +/- 6.6 y, DD 9.95 +/- 7.2 y. Activity was increased in EORA compared to YORA I and YORA II, while severity decreased in EORA. ESR, CRP and degree of anemia were higher in EORA. RF titer was higher in YORA. In YORA peripheral joints of the hands and feet were more involved while, large joints in EORA. Rheumatoid nodules were increased in YORA I than EORA p= 0.04. Polymyalgia rheumatica was exclusively present in EORA group 25 patients 7.2%. YORA used methotrexate and its mean dose was higher than EORA. EORA on multiple DMARD 57.9% or biologics 0.8% was significantly lower compared with YORA 186.3% and 1.7%, p= 0.001. EORA has more active and less disabling and affects more males than YORA. The use of biologic therapy and combination DMARD therapy was less in EORA

Bone mineral content and risk of vertebral fractures in ankylosing spondylitis

Osteoporosis and vertebral fractures are encountered in ankylosing spondylitis. This study was undertaken to visualize whether such is due to the disease itself or due to mechanical factors and limited mobility. The study was performed on 26 ankylosing spondylitis patients recruited from the Out-patient Clinic of the Rheumatology and Rehabilitation Departments of Al-Azhar and Al-Menya Universities Hospitals. Sixteen of them had the disease for less than 10 years [G1] and ten had it for more than 10 years [G2]. Twenty-five apparently normal staff members matched in age and sex were taken as a control group. Patients underwent medical history taking, clinical examination, metreological assessment, radiological evaluation according to New York criteria, determination of vertebral fractures according to Black et al. [1991] as well as DEXA examination of the lumbar spine, femoral neck and wrist. There was a reduction of BMC in all of the studied areas lumbar spine, femoral neck and distal forearm in AS patients. Two out of sixteen [12.50%] patients with mild AS [<10 years] had vertebral fractures as compared with three out of twelve [25%] patients with AS [>10 Years] and one out of 25 controls [4%]. No significant correlation was observed between vertebral fractures and BMC in any of the examined areas