predictive value of magnetic resonance imaging for bone erosion progression in rheumatoid arthritis patients

To determine the joint damage progression using magnetic resonance imaging [MRI], and to investigate the predictive value of early MRI in rheumatoid arthritis [RA] patients. We studied forty RA female patients. Their mean age was 42.7 [ +/- 10.6] years. Patients underwent clinical, laboratory and functional assessments over 12 months. Standard plain radiography and MRI of the hands and wrists were done for all patients at baseline and after 12 months. All clinical and laboratory variables reflecting disease activity showed low activity after one year of treatment [p<0.05]. At one year, MRI erosions were found in 62.5% of patients [25 of 40] compared with 42.5% at baseline [p<0.05]. MRI findings reflecting inflammation [bone marrow edema and synovitis] regressed after one year [p<0.05]. We have analyzed baseline variables for prediction of MRI erosions at one year including positive RF, plain radiological erosions, baseline MRI erosion, bone marrow edema and synovitis. Positive RF and synovitis were predictor risk factors for MRI erosive progression at one year [p<0.05]. On the other hand, plain radiological erosions were not statistically significant as predictor risk factor in these patients [p>0.05]. Baseline MRI erosion and bone marrow edema were strong predictors for MRI erosive progression [the odds ratio [95%CI] were 5.92 [3.06-9.03] and 12.85 [3.41-21.22], respectively] [p<0.001]. The results of this study suggest that MRI is a useful tool to investigate disease processes in RA. It can be used in clinical practice in determining the prognosis, and selecting patients who need aggressive therapy to avoid subsequent joint damage

Relationship between electrodiagnostics, MRI findings and clinical picture in lumbar canal stenosis

To study the relationship between the electrodiagnostic and the MRI findings of the lumbar spine and to correlate them to the clinical features in patients with degenerative lumbar spinal stenosis [LSS]. Fifty-six patients diagnosed as having LSS, on the basis of typical clinical features and compatible MRI findings, were included in this study. In addition to history and examination, patients were assessed for disease severity using the maximal walking distance and the visual analogue scale. MRI parameters of lumbar spinal stenosis were assessed. Needle electromyography of the paraspinal muscles and nerve conduction studies including F-wave and H-reflex were performed. Patients were 33 males and 23 females. The body mass index statistically significantly correlated with the patient scores on the visual analogue scale. No significant relation could be detected between age, sex, duration of disease and disease severity. Both of the smallest and the smallest two anteroposterior spinal canal diameters showed no statistical significant correlation with the disease severity. The fibrillations in electromyographic testing statistically highly significantly [p<0.001] negatively correlated with the maximal walking distance and positively correlated with the patient scores on the visual analogue scale. It also statistically highly significantly correlated with the age. MRI findings are related to the diagnosis but not to severity ot the clinical lumbar spinal stenosis. Electrophysiologic studies especially paraspinal muscles denervation potentials seem to be a more sensitive criterion in assessing the severity of symptoms in patients with LSS

Prevalence and risk factors of carotid plaques detected with B-mode ultrasound in rheumatoid arthritis

To determine the prevalence of increased intima-media thickness [IMT] of the carotid arteries and its relationships with classical atherosclerosis risk factors and disease features in patients with rheumatoid arthritis [RA]. Twenty female RA patients were included in the study. All patients were subjected to full history taking, thorough clinical examination and laboratory investigations. In addition, intima-media thickness [IMT] and presence of carotid plaques were assessed using carotid B-mode ultrasound. Presence of traditional cardiovascular [CV] risk factors was also investigated. Plaques could be detected in 40% of our patients. There was a statistically highly significant correlation between the presence of plaques and patients' age, disease duration and deformed joint count [p<0.001]. There was also a statistically significant relationship between the presence of plaques and increased ESR and CRP levels, lower body mass index, presence of diabetes mellitus, hypertension, hypercholesterolemia and higher cumulative glucocorticoid doses [P<0.05]. It did not correlate significantly with tender or swollen joint count, subcutaneous nodules or rheumatoid factor positivity. Increased IMT was statistically significantly correlated with age, disease duration, ESR, diabetes mellitus, hypertension and hypercholesterolemia. RA patients with carotid plaques had significantly longer disease duration, higher deformed joint count, higher ESR, higher levels of CRP and higher cumulative glucocorticoid dose than those without plaque. Increased IMT was correlated with the disease duration and ESR. These findings suggest that there is increased risk of atherosclerosis in patients with rheumatoid arthritis especially those with more severe disease and longer disease duration

relationship between post stroke urinary incontinence and functional outcome

To identify the risk factors for urinary incontinence [UI] and compare the functional outcome of continent and incontinent stroke patients, in order to determine f UI has any influence on functional outcome after stroke. One hundred patients with stroke, admitted to the hospital, were divided into two groups according to their continence status. Comparative study was done between incontinent [group 1] and continent [group 2] patients. Both groups were subjected to detailed history taking, clinical examination and functional assessment, using the functional independence measure motor scale [M-FIM,] on admission and urodynamic evaluation was done for incontinent patients. Functional assessment of both groups and urodynamic evaluation for the incontinence status were repeated six months later. There was a 52% prevalence of urinary incontinence [UI] on admission and 32% at discharge. 20 out of 52 patients became continent. Predictor risk factors of post-stroke urinary incontinence in this study were age, hypertension, diabetes mellitus, hyperlipideinia, atrial fibrillation, transient ischemic attack and previous stroke. Previous stroke was strong predictor risk factor in the incontinent group of patients. At six months, compared with continent patients, incontinent patients had greater disability measured by M-FIM scales [median [range] of 31.5 [2 7-42] versus 78 [68-85]; p<0.001]. UI is a common and distressing problem after stroke and it is a strong predictor of functional outcome. This study showed that UI on admission had a negative impact on functional outcome at six months. So, early recognition of the risk factors may assist in rehabilitation management of stroke patient particularly for appropriate treatment setting and improvement of their long-term outcome

relation between inflammatory markers, lipid parameters and antioxidant vitamins in rheumatoid arthritis patients

The association between rheumatoid arthritis and increased risk of atherosclerosis and coronary heart disease is well recognized. The role of chronic inflammation, dyslipoproteinemia, lipid peroxidation and low levels of antioxidant vitamins [vitamin A and E] in the development of atherosclerosis and coronary heart disease is being established. To study the relationship between lipid profile abnormalities, antioxidant vitamins and inflammatory markers in rheumatoid arthritis patients. Thirty rheumatoid arthritis patients and twenty apparently healthy volunteers as a control group were studied .The following parameters were measured for all included subjects: markers of inflammation; CRP, RF, ESR, and VCAM [Vascular Cell Adhesion Molecule], lipid parameters; total cholesterol, triglycerides, direct HDL and LDL cholesterol and Lp [a] and antioxidant vitamins A and E. The inflammatory markers [CRP, ESR and VCAM] were significantly higher in patients compared to controls [p<0.01]. Total cholesterol and LDL cholesterol in rheumatoid arthritis patients were significantly higher compared to the controls [p<0.05]. Also Lipoprotein [a] was significantly higher in rheumatoid arthritis patients compared to the controls [p<0.01]. Vitamins A and E were significantly lower in rheumatoid arthritis patients compared to the control group [p<0.01]. A significant positive correlation was found between total cholesterol, LDL-C, lipoprotein [a] and VCAM [p<0.001, and p<0.01 and p<0.01] respectively. A significant negative correlation between the antioxidant vitamins E and A and VCAM [p<0.05 and p<0.05] in rheumatoid arthritis patients was also observed. A significant negative correlation was also found between lipoprotein [a] and both vitamins [E and A] [p<0.01 and p<0.001] respectively. The association of VCAM with high lipid parameters and low levels of antioxidant vitamins, might explain the association of chronic inflammatory processes with atherosclerosis and the high risk of cardiovascular disease in rheumatoid arthritis patients

possible prognostic role of VCAM-1 in stroke patients

The vascular endothelium promotes inflammation through the up-regulation of inflammatory leukocyte-endothelial cell adhesion molecules such as intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1] and E-selectin. These molecules bind to circulating leucocytes and facilitate their migration into the Central Nervous system CNS. In the CNS, these cells produce a number of cytotoxic molecules that may facilitate cell death and increase the infarct volume. To define the extent of expression of VCAM-1 in correlation to the clinical disability and outcome in stroke patients. Complete lipid profile, fibrinogen assay, lipoprotein [a] and FIM were determined in 25 recent stroke patients at the time of admission and compared with 15 matched apparently healthy control subjects. The difference between the mean total cholesterol [TC] level of patients and controls was not significant. However, high density lipoprotein [HDL] was significantly lower in patients as compared to controls but low density lipoprotein LDL was significantly higher. The concentration of Lp [a] and fibrinogen level, were significantly higher in the patients' group than controls. The concentration of VCAM-1 was significantly higher in stroke patients as compared to controls. Multiple regression analysis was performed to assign the predictors for functional independence measures [FIM] as a clinical outcome for the functional disability. The independent parameters were the duration of stroke as well as the laboratory tests [lipid profile, Lp [a], fibrinogen and VCAM-1]. The duration of stroke and VCAM-1 level negatively correlated with FIM, meaning that patients with high VCAM-1 level demonstrated more functional disability as manifested by low FIM score. The most sensitive parameters that can predict FIM were the duration of stroke and VCAM-1 level. Further research on the role of inflammatory CAMs in the pathogenesis of ischemic cerebrovascular disorders should lead to new diagnostic and therapeutic strategies in an attempt to reduce leukocyte-induced damage in stroke

Mast cells in rheumatoid synovial tissue with electron microscopy

The aim of this study was to search for the presence of mast cells in the synovial tissues of rheumatoid arthritis [RA] with electron microscopy in a trial to understand the pathogenesis of the disease. Synovial tissues were obtained from 10 RA patients. The presence of mast cells was examined with electron microscopy. The presence of mast cells was not demonstrated in the synovial tissues of RA with electron microscopy. Electron microscopy is not a suitable method for demonstrating the presence of mast cells in the synovial tissue of RA patients

Thermography and its use in diagnosis of active sacroiliac ankylosing spondylitis

The objective of this study was to investigate the value of sacroiliac thermography in the assessment of disease activity in ankylosing spondylitis [AS]. The clinical, laboratory and sacroiliac thermographic indices were done for 27 patients with AS. Clinical disease activity was demonstrated in 13 patients, while the other 14 were inactive. The mean sacroiliac thermographic index was significantly higher in active ankylosing spondylitis group than either the inactive or the control group. Furthermore, significant correlations were observed between the thermographic indices and other parameters of the disease activity

Anti-neutrophil cytoplasmic antibodies in juvenile chronic arthritis and rheumatoid arthritis

To assess the incidence and clinical significance of ANCA in RA and JCA patients, and to study the relation between ANCA and granulocyte specific ANA. Serum antineutrophil cytoplasmic antibodies were determined with indirect immunofluoresescent [IIF] technique in 20 RA and 12 JCA patients. ANCA was detected in sera from 10 RA patients [50%] and their titer ranged from 110-350 and JCA patients [25%], their titer ranged from 70-230. ANCA titer was not correlated with RF, disease duration and the presence of ANA. p-ANCA were found in 25% RA patients and 8% of JCA patients, c- ANCA were seen in 25% of RA patients and 17% of JCA patients. The laboratory and histologically proven nephropathy were seen in 25% of RA patients 8% of JCA patients, they were associated with p- ANCA. We concluded that early diagnosis of ANCA associated vasculitides is a key to prevent renal failure, and to measure the serum ANCA titer not only for the diagnosis the clinical course, but also to early treatment of renal affection

Validity of radiological methods in early detection of rheumatoid shoulder synovitis and correlation with disease activity

This study was carried out on 34 active rheumatoid arthritis [RA] patients. All studied cases were subjected to careful history, clinical and joint examination, routine laboratory investigations and Interleukin -1beta [IL-1beta] level determination. Twenty-seven patients who had painful shoulders were radiologically examined with PR, US, CT and MRI with quantitative evaluation of bone erosions and joint space narrowing to assess disease activity. Positive correlations were found between IL-1beta and Ritchie articular index [RAI], ESR, disease activity score [DAS] and RF in all patients [p=0.007, <0.05, = 0.007 and <0.001 respectively]. Radiologically, glenohumeral erosions were detected with PR in 15-patients [55.5%], with US in 21 patients [77.7%], with CT in 15 patients [55.5%] and with MRI in 19 patients [70.3%]. US was the most sensitive in detecting erosion of the glenohumeral articulations [77.7%] while MRI was more sensitive in acromioclavicular erosions, as well as major and minor tuberosities [81.4% and 88.8% respectively]. Grading of these erosions was done with the 4 modalities effusion and rotator cuff tear was detected with US in 25.9% and with MRI in 33.3%. Pannus was only detected with MRI. Total scores for bone erosions and joint space narrowing showed significantly positive correlations with serum levels of IL-1beta in our patients. [p<0.001 and 0.005 respectively]. All four radiological modalities are complementary in the diagnosis and monitoring of rheumatoid shoulder patients and there is a positive correlation between these radiographic scoring methods and the clinical and laboratory parameters of disease activity