Preliminary study of CD34 stem cells in rheumatoid arthritis patients

To study CD34+ stem cells count in the peripheral blood [PB] of patients with rheumatoid arthritis [RA] and to correlate it with the activity and severity of the disease as a preliminary study for their role in the disease pathogenesis. This study was conducted on 20 RA patients in addition to 10 healthy subjects as a control group. All patients were subjected to full history taking and thorough clinical examination. Assessment was done using modified DAS far disease activity, Speed severity index [SSI] for disease severity, and Larsen score for radiological assessment of the plain x-ray findings of both hands. Assessment of CD34+ stem cells count in the PB was done by using fluorescence-activated cell sorting [FACS]. In this study there was a significantly higher count of CD34+ stem cells in the PB of RA patients compared to the controls. Stem cells absolute count and percentage were significantly negatively correlated with modified DAS, SSI and Larsen score. Bone marrow stem cells [CD34 cells] could play a crucial role in RA. Their level is elevated in the PB of RA patients in comparison with controls. It is suggested that the reduced number of CD34[+] cells in the PB of patients with more severely destructed joints is due to their recruitment to sites of inflammation. Studies are required to further investigate the role of the bone marrow and stem cells in the disease pathogenesis of RA. It could be a future target of treatment in these patients

Serum interleukin-18 level and natural killer cell percentage in systemic lupus erythematosus: clinical correlation

To detect serum interleukin -18 level and natural killer cell percentage in patients with systemic lupus erythematosus and to find out their correlation with disease activity and their role in lupus renal disease. The study included 30 female patients with systemic lupus erythematosus [15 patients with lupus nephritis and 15 patients without renal disease]. 10 apparently healthy females with matched age represent the control group. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using modified systemic lupus erythematosus disease activity index [SLEDAI], laboratory investigations especially serum interleukin-18 level, natural killer [NK] cell percentage, serum urea, serum creatinine and 24 hours urinary protein. Serum level of interleukin-18 [IL-18] was significantly increased and percentage of NK cells was significantly decreased in patients with systemic lupus erythematosus [SLE] when compared to controls. In patients with SLE, increased serum IL-18 level showed significant negative correlation with NK cell percentage while this correlation was significantly positive with SLEDAI. Serum IL-18 level was significantly higher and NK cell percentage was significantly lower in SLE patients with lupus nephritis compared to those with no renal disease. In patients with lupus nephritis, increased serum IL-18 level showed significant positive correlation to serum urea, serum creatinine and 24 hours urinary protein, while reduced percentage of NK cells showed significant negative correlation with serum creatinine. The findings of this study may indicate that increased serum IL-18 levels and reduced NK cell percentage may play a role in pathogenesis and activation of SLE and renal involvement in this disease. Further studies are recommended for IL-18 as a potential target in treatment of autoimmune diseases including SLE

Bone mineral density in premenopausal women with rheumatoid arthritis and systemic lupus erythematosus

Little is known about bone mineral density [BMD], as measured by dual energy x-ray absorptiometry [DEXA], in patients with rheumatoid arthritis [RA] versus matched systemic lupus erythematosus [SLE] and healthy controls at the same time. However, most of these data have been confined to Caucasian population with conflicting results. Also factors controlling bone homeostasis may be different between ethnic groups with lacking data in Orientals. Is to study BMD in premenopausal women with RA and to compare the data of RA patients with matched SLE patients and healthy controls. Moreover, is to evaluate the possible relationship between BMD and disease variables. This study included 60 premenopausal women divided into three equal groups, 20 subjects each, RA patients group, SLE patients group, and healthy controls group. BMD at the lumbar spine [L1-L4] was measured by DEXA. Also, disease variables and biochemical parameters were assessed. Patients with RA and SLE had significantly lower BMD values at lumbar spine compared to healthy controls [p=0.0001]. Similar BMD values were detected in RA and SLE patients. Osteopenia was detected in 40% of RA and SLE patients groups, while osteoporosis [OP] was detected in 40% and 30% of those patients, respectively. There was no correlation between BMD and age of patients, body mass index [BMI], disease activity, as well as disease duration. In contrast, there was an inverse correlation between BMD and dose as well as duration of corticosteroid [CS] therapy [p<0.05]. A high incidence of low BMD at the lumbar spine was found in our premenopausal women with RA and SLE on chronic CS and calcium supplementation compared with healthy controls. In those patients, BMD was related to the dose and duration of CS therapy, but not with disease duration or disease activity

Angiogenesis in rheumatoid patients: clinical, radiological and histopathological study

To evaluate angiogenesis and cartilage destruction in rheumatoid arthritis [RA] patients. This was performed using power Doppler ultrasonography [PDS] and detection of vascular endothelial growth factor [VEGF] in the serum and immunohistochemically. Eighteen Rheumatoid arthritis patients [group 1] and ten apparently healthy subjects [group 2] participated in this study. Full history taking, thorough clinical examination and routine rheumatological profile investigation were done. Serum VEGF was measured in all patients and controls using ELISA technique. The knee joints were examined with ultrasound and resistance index was measured with spectral ultrasonography. Histological examination for synovial membranes was done with hematoxylin and eosin, factor VIII and VEGF with immunohistochemical staining. There was a highly significant difference between RA patients and controls as regard sVEGF [582.22 +/- 84.89, 176 +/- 20.55 pg/ml], histological score [36.94 +/- 7.83, 2.72 +/- 1.2], factor VIII [3.16 +/- 0.618, 1.2 +/- 0.41], VEGF staining [3.03 +/- 0.89, 0.5 +/- 0.32] and PDS [3.027 +/- 0.58, 0.41 +/- 0.24] [p<0.001 in all parameters]. Also, there was a significant difference between patients and control as regard resistive index [RI] [0.72 +/- 0.19, 1.07 +/- 0.1] and synovial proliferation [3.055 +/- 0.7, 0.25 +/- 0.263] [p<0.05 in both parameters]. RA patients were classified according to VEGF staining into low, moderate and intense staining. There was a highly significant difference between patient subgroups regarding serum VEGF, synovial proliferation, PDS score [p<0.001] and a significant difference regarding histopathological score, factor VIII and RI [p<0.05 in all parameters]. There was a positive correlation between sVEGF and DAS score, synovial proliferation, ESR, PDS, VEGF staining and histological score, and negative correlation with RI. Also, there was a positive correlation between VEGF staining and histological score, sVEGF, PDS, synovial proliferation and negative correlation with RI. VEGF is a potent mediator of endothelial proliferation of angiogenesis, the expression of VEGF depending on the activity and plays a part of pathogenesis of RA and synovitis. PDS is a useful method demonstrating synovial vascularization and monitoring disease activity. RI is an objective tool to estimate the degree of inflammation in RA

Sex hormones in relation to bone mineral density and bone turnover markers in rheumatoid patients

To study the changes in serum and salivary testosterone in rheumatoid arthritis [RA] patients and their implication on bone mineral density [BMD] and bone turnover markers. The above mentioned hormonal levels were measured in fifty post-menopausal RA women [thirty patients with glucocorticoid therapy and twenty treated with other drugs]. Bone turnover markers were also assessed namely Carboxy terminal cross linked telopeptide of type I collagen [ICTP] and carboxy terminal propeptide of type I procollagen [PICP] as well as their relation to BMD was assessed. Although serum and salivary testosterone were higher than controls, there was no significant difference between patients and controls. We observed significantly lower salivary testosterone level in RA on steroids as compared to those not taking steroids. Also salivary testosterone correlated with lumbar BMD and inversely with ICTP

Musculoskeletal pain in obese Egyptians

Obesity is associated with musculoskeletal pain and osteoarthritis. This study compares the prevalence of work-restricting musculoskeletal pain in obese and general population and investigates changes in the incidence of and recovery from musculoskeletal pain after surgical or conventional obesity treatment. A random sample of 50 subjects from the general population was compared with 50 obese subjects. For the obese subjects, information about musculoskeletal pain was also collected 6 and 12 months after obesity surgery or the start of non-surgical treatment. In both sexes, work-restricting pain in the neck and back regions and in the hip, knee and ankle joints was more common in the obese subjects than in the control population. Operated obese women had a lower incidence of work-restricting pain in the knee and ankle joints as compared with the conventionally treated control group over 6 and 12 months. Among subjects reporting symptoms at baseline, the recovery rate for pain in the knee and ankle joints in obese men and pain in the neck and back and in the hip, knee and ankle joints in obese women improved in the surgical group as compared with the control group after 12 months. Obese subjects have more problems with work-restricting musculoskeletal pain than the general population. Surgical obesity treatment reduces the long-term risk of developing work-restricting musculoskeletal pain and increases the likelihood of recovering from such pain

Endothelin-1 and ocular involvement in behcet's disease

To detect plasma Endothelin-1 [ET-1] in Behcet's disease [BD] and to assess if ET-1 is associated with ocular BD. 20 BD patients [12 with ocular and 8 without ocular disease] and 10 healthy control subjects were included in the study. The plasma level of Endothelin-1 was measured with Enzyme Immunometric Assay [EIA]. Plasma ET-1 levels were significantly higher in patients with BD than in the control subjects. Among patients with ocular BD, the mean plasma ET-1 levels were significantly increased when compared with non ocular disease and control subjects. Elevated plasma Endothelin-1 may play a role in ocular involvement of BD

Detection of human retrovirus-5 in rheumatoid arthritis patients

This study was carried out to detect the possible association of human retroviruse-5 [HRV-5] with RA and its correlation with disease activity and severity in a trial to detect its possible role as an etiologic factor. We conducted our study on 31 RA patients and 15 apparently healthy subjects serving as a control group. All patients were subjected to complete history taking, thorough clinical examination, radiological and laboratory tests. Nested PCR was done to detect the presence or absence of HRV-5 in the blood of all patients and controls as well as nine synovial fluid samples from RA patients. There was a significant presence of HRV-5 in the blood of RA patients and in four synovial fluid samples out of nine. The four patients whose synovial fluid samples were HRV-5 positive also showed HRV-5 positive blood. There was a statistically significant higher alkaline phosphatase mean in cases with HRV-5 positive blood, which may reveal Liver damage that might be caused by the virus itself. There was no statistically significant difference in the activity or severity grades in HRV-5 positive blood and synovial fluid compared to HRV-5 negative cases. The presence of HRV-5 in a significant percent in our RA patients [25.8%] should be taken into consideration since it may have a role as an etiologic factor in the pathogenesis of this disease

H-reflex in the diagnosis of lumbosacral radiculopathy

This work comprised fifteen patients suspected of having unilateral fifth lumbar root [L[5]] and/or first sacral root [S[1]] radiculopathy secondary to spinal nerve compression. Ten healthy subjects matched in age, sex and height served as controls. Diagnosis was confirmed clinically and with radiographic assessment. H-reflex was done bilaterally to both symptomatic and asymptomatic sides from both soleus and gastrocneumius muscles according to Shahani [1986]. Peak to peak amplitude and latency was recorded. On the symptomatic side a significant prolongation was found in the latency of the H-reflex as elicited from both soleus and gastrocneumius muscles on the symptomatic side of patients versus the asymptomatic side or the control group p<0.05. There was a highly significant reduction p<0.001 of the amplitude of the motor evoked response from both muscles as well. However, abnormal H-reflex was also encountered in the non-symptomatic side. The H-reflex recorded from the soleus was more sensitive than from the gastrocnemius muscle. All patients with neurological deficit showed prolonged latency and reduced amplitude. Both techniques, measuring H-reflex from soleus or gastrocnemius are complementary to each other and the positive results of any of them could be enough for the diagnosis of radiculopathy

Risk factors for flat foot in preparatory school children: clinical and electrophysiological studies

Four hundred preparatory school children aged from eleven to fifteen years were enrolled in this study. Bilateral static footprints were taken to evaluate the configuration of the medial longitudinal arch and the occurrence of flat foot [FF] in them. Risk factors that might influence the development of the medial arch were studied [body mass index [BMI], hypermobility, standing and walking hours and the type of foot wear]. Moreover, the distal motor latencies, conduction velocities and amplitude of the M responses of the posterior tibial nerve were measured to establish if pes plans may cause tension in the posterior tibial nerve. Also electromyographic [EMG] interference pattern [IP] of the evertors and invertors of the foot as turns in relation to mean amplitude to elicit the normal cloud in controls and compare it -with the data points of case was performed. Flat foot occurred in 20% and 28% of the male and female groups respectively. Again, the incidence of hypermobility was 12% and 8% in the female and male groups respectively. There -was a +ve correlation between the occurrence and degree of FF and BMI and ligamentous laxity. The electrophysiological studies of the posterior tibial nerve were within normal range. But on comparing both groups [subjects with flat foot and normal foot] there were significant differences in the distal motor latencies of the posterior tibial nerve. There was no statistically significant difference in the mean amplitude of motor units and number of turns between cases of FF and controls. However, data points [MA/T] revealed that 40% were abnormal i.e. placed above and to the left in relation to the normal cloud. The presented data clarify the importance of paying attention to the problem of flat foot and factors that might influence its occurrence. Proper strategies should be taken to decrease the incidence of flat foot in school children

role and clinical implications of ANCA and Its subspecificities in some rheumatic disorders

Antineutrophil cytoplasmic antibodies [ANCA] and their sub specificity for target antigens: elastase, cathepsin G [CG] and lactoferrin [LF] have been detected in patients with rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc]. We aimed at finding out the prevalence of ANCA, their target antigens and their clinical implications in Egyptian patients. Serum samples were collected from sixty-one patients. Thirty-two had rheumatoid arthritis [RA], sixteen had systemic lupus erythematosus [SLE] and thirteen had systemic sclerosis [SSc]. Samples were examined for ANCA with the indirect immunofluorescence technique [IIF]. Antibodies directed against elastase, CG and LF were determined using the solid phase enzyme immunometric assay [ELISA]. Statistical studies were used to associate clinical findings to the presence of ANCA sub specificities. In our sample of Egyptian patients, the prevalence of ANCA in RA was 50%, in SLE 42.8% and in SSc it was 55%. The probability of occurrence of antibodies against elastase was 22.3%, CG 13.8% and LF 16.6% in RA patients. The most recognized antigen in SLE patients was anti-elastase 62.5%, CG 25% and LF 18.7%. In RA patients, the presence of anti-elastase antibodies was associated with a long duration of the disease. The presence of CG was associated with the presence of renal affection and erosive changes in X-rays. Skin vasculitic lesions were associated with the presence of LF. In SLE patients, the presence of CG was associated with lupus nephropathy. Positivity for anti-elastase was associated with digital vasculitis and arthropathies. The presence of serositis in SLE patients was not associated with any of the target antigens. In RA patients, serum ANCA sub specificities [anti-elastase, LF] were significantly increased in cases than controls. In SLE patients serum anti-elastase level and anti-Cathepsin G were significantly higher in cases than controls. In SSc patients, only serum anti-elastase was significantly higher in cases than in controls. The prevalence of ANCA in different rheumatic disorders indicates severe disease with increased inflammatory activity. The antibodies directed against target antigens may act as a marker for disease subsets

Effect of estrogen agonist antagonist on bone mineral density in postmenopausal breast cancer

Tamoxifen is an estrogen agonist/ antagonist, which has its effect not only on breast cancer cells but also on the liver and bone. In this study we tried to study the effect of long-term treatment with that drug on bone metabolism. Twenty-five postmenopausal women with stage I or II breast cancer receiving 30 mg tamoxifen daily together with twenty-five postmenopausal age-matched normal controls were included in this study. Measurements of bone mineral density using dual energy X-ray absorptiometry [DEXA] at the lumbar spine, femoral neck and forearms were done after the operation, at the start of the study and after 12 months of tamoxifen administration. They were compared with those of normal controls. Bone mineral density increased in the tamoxifen treated group as compared to the control group. A decrement in bone mineral density in the age-matched group [Z score] was statistically significant [p<0.05]. Also, there was a significant reduction in serum cholesterol in the tamoxifen treated group. These results indicate that tamoxifen has estrogen-like effects on bone metabolism in post-menopausal women. This results in an increase and stabilization of bone mineral density in the axial skeleton and a stabilization of bone mineral content in the appendicular skeleton