Serum melatonin in juvenile rheumatoid arthritis: correlation with disease activity

Objective: To investigate the abnormalities in early morning serum melatonin among patients with juvenile rheumatoid arthritis [JRA] and to outline its relation to disease activity and severity

Methodology: Twenty one patients with IRA and twenty health age and sex matched controls were enrolled in the study. Fifteen patients had polyarticular JRA, 3 had oligoarticular JRA and 3 had systemic onset JRA. Evaluation was carried out clinically, functionally and radiologically by using disease activity score, Juvenile Arthritis Functional Assessment Report for Children [JAFAR-C score] and modified Larsen score respectively. Laboratory investigations included CBC, ESR, CRP, classic IgM RF [latex agglutination], ANA [indirect imniunofluorescence] and melatonin estimation by Enzyme Linked Immunosorbent Assay [ ELISA]

Results: The serum levels of melatonin were significantly increased in JRA patients [13.9 +/- 8 pg/ml] as compared to healthy controls [8.1 +/- 2.7 pg/ml] [p<0.01]. A significant positive correlation could link serum melatonin levels to disease activity scores and ESR [r = 0.91, p<0.001 and r = 0.55, p < 0.01 respectively]. No significant correlation was found between melatonin and either Larsen or JAFAR scores [r = 0.19, p>0.05, r = 0.15, p>0.05 respectively]. According to melatonin levels, there was 2 groups of patients: group I with elevated melatonin level [more than 11 pg/ml] [n = 15] and group 2 with normal melatonin level [less than 11 pg/ml] [n = 6]. Patients with elevated melatonin levels had higher ESR [p<0.05], higher disease activity scores [p<0.01] and Larsen scores [p<0.05], than the group of patients with normal serum melatonin. The results of GAFAR scores were comparable between the two groups [p>0.05]

Conclusion: The elevated melatonin levels among JRA patients with active synovitis and its close relation to disease activity rather than disease severity suggests that melatonin may play a promoting role in rheumatoid arthritis. Hence, inhibition of its synthesis and/or action by specific antagonists may be of therapeutic value. Serum Melatonin in Juvenile Rheumatoid Arthritis: Correlation with Disease Activity

Serum growth-regulated oncogene-alpha chemokine and its correlation with pulmonary fibrosis in systemic sclerosis

To determine serum levels of Growth-Regulated Onchogene-alpha [GRO-alpha] in systemic sclerosis [SSc] patients and correlate these levels with the presence and extent of pulmonary fibrosis detected by pulmonary function tests [% DLCO] and high resolution CT scan of lungs [HRCT]. The study included 23 SSc patients [8 limited and 15 diffuse] and 15 age and sex-matched healthy controls. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, manometry, chest X-ray, spirometry to calculate the diffusing capacity of the lung for carbon monoxide [DLCO] and high resolution CT lung scan. Serum levels of GRO-alpha, anticentromere [ACA] and antitopoisomerase I [anti-top.I] antibodies were detected by enzyme linked immunosorbent assay [ELISA technique]. Serum levels of GRO-alpha were significantly higher in SSc patients [21.6 +/- 10.98 pg/ml] than in healthy controls [8 +/- 1.13 pg/ml] [p<0.001]. While there was no statistically significant difference between diffuse and limited SSc as regards GRO-alpha level [p>0.05], SSc patients with high serum GRO-alpha level had significantly increased frequency of decreased% DLCO [p<0.01] and the presence of anti-top I [p<0.01] compared to those with normal GRO-alpha level. In contrast, SSc patients with normal GRO-alpha level had increased frequency of ACA [p<0.001]. There was statistically significant association between elevated level of GRO-alpha and severity of lung function detected by decreased% DLCO [p<0.01] and high resolution lung CTscan [p<0.001]. Also, a highly significant negative correlation existed between serum GRO-alpha and decreased% DLCO [r= -0. 768, p<0.001]. Our results suggest that elevated serum level of GRO-alpha in SSc patients is correlated with pulmonary affection and may reflect the severity of lung fibrosis. Repeated and sequential analysis of GRO-alpha may clarify their usefulness as a serological marker for the severity of lung injury and enable us to better understand the pathogenesis of pulmonary fibrosis in SSc

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

Effects of physical exercise on HCV chronic active hepatitis patients

Infection with HCV shows a high prevalence in our country and often becomes chronic and proceeds to a state of chronic active hepatitis, a condition which is not easy to treat and almost always end up in liver cirrhosis as well as a high risk of hepatocellular carcinoma. The aim of the this work was to study the effect of regular physical exercise over a period of 6 weeks on some parameters usually used to evaluate the liver condition and the activity of the disease. Patients were randomized into 3 groups; Group I: 20 patients with chronic active hepatitis due to infection with HCV and showed a significant reduction in ALT and AST levels over the period of the exercise program. Group II: 20 patients with decompensated liver condition due to HCV infection with at least one of the manifestations of liver cell failure and exhibited a bad exercise tolerance with non-significant changes in their laboratory data. Group III: 20 patients with compensated HCV liver disease were not included in the exercise program and were considered as a control group. It was concluded that physical exercise was well tolerated by HCV chronic active hepatitis patients and may be of benefit while in decompensated patients physical exercise should be restricted as much as possible