Effects of menopausal status and disease activity on biochemical markers of bone metabolism in female patients with rheumatoid arthritis

The effect of menopause and disease activity on bone metabolism was studied in 60 female patients with RA, [30 pre-menopausal and 30 post -menopausal] and 30 control subjects [15 pre-menopausal and 15 post-menopausal]. This was done using biochemical markers of bone metabolism [osteocalcin] [OC], bone alkaline phosphatase [BAP] pyridinoline [PYD] and deoxypyridinoline, [DPD] compared with the results of bone mineral density measured by dual-energy X-ray absorptiometry [DEXA] in both patients and control groups. The results of the study showed that, there were elevated levels of bone formation marker OC and BAP in RA group than in controls and in post-menopausal than in premenopausal groups, while there were no significant differences in OC levels in pre- and pos-tmenopausal RA. The bone resorption marker, PYD levels showed highly significant difference between post and pre-menopausal groups in both patients and controls, and OPD levels showed only significant differences between both groups. Also there were significant correlation between levels of all bone markers and different grades of disease activity. There were highly significant difference in bone mineral density [BMD] and T -score between patients and control. By comparing the results of DEXA and bone markers levels, the study showed high significant negative correlation between BMD and T-score in both lumbar spine and femoral neck and levels of OC and PYD. DEXA results were more sensitive and specific than the levels of bone markers in detecting systemic bone loss in patients with RA

diagnosis of carpal tunnel syndrome, sensitivity of the various electrophysiological tests

The results of eight electrophysiological tests of 50 successive carpal tunnel syndrome in 42 patients are reported prospectively to evaluate the sensitivity of these tests and thresholds for diagnosis of Proportions of cases of abnormal findings were 45% for needle study; 50% for distal motor latency; 62% for digit -to-wrist orthodromic sensory conduction velocity; 76% for palm-to-wrist orthodromic sensory conduction velocity. 24%had normal findings for these conventional parameters, among them 6 had a double peak after global fourth digit stimulation, 20 had a fourth digit median-ulnar latency difference of 0.40 m/sec, or more, and all the 24 had abnormal centimetrric test [short segment stimulation SSS]. Although these results highlight the value of palm-to-wrist orthodromic sensory conduction velocity and fourth digit median-ulnar latency difference measurements in diagnosis of [CTS]. The centimetric test is the most valuable for the assessment of the mildest form of C.T.S.

Is beta2-microglobulin a marker of bone remodling in postmenopausal osteoporosis?

Beta[2]-microglobulin plays a role as a bone-derived growth factor regulating both osteoblast and osteoclast cell activity. Serum beta[2] -microglobulin has been proposed as a bone remodeling biological marker in high bone turnover conditions. Osteoclastic activity is, enhanced in postmenopausal osteoporosis, suggesting that beta[2] microglobulin concentration may also be increased in this disease. In this study, beta[2]- microglobulin concentration was found to be raised [P< 0.001] in 30 women with postmenopausal osteoporosis as compared with 30 normal women of similar age; tartrate - resistant acid phosphatase concentration also was raised [P< 0.001]. Linear regression analysis revealed a highly negative correlation result between total body bone mineral content and beta[2] - microglobulin [r = 0.577, P < 0.001], and positive correlation result between beta[2] - microglobulin and tartrate - resistant acid phosphatase concentration [r2 = 0.806, P< 0.00 I]. These findings, and the stimulatory effect of beta[2] microglobulin on osteoclastic and osteoblastic activity suggest that beta[2]- microglobulin may play an important role as a local regulator factor in the pathogenesis of postmenopausal osteoprosis