Does Novel IL-33 Correlates with TNF- alpha in RA and SLE?

Production of high amounts of inflammatory cytokines plays direct role in disease pathogenesis, including that of systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA]. To investigate whether serum levels of novel IL- 33 and TNF- alpha are higher in Egyptian RA and SLE patients than controls and to compare serum levels of the novel IL-33 with TNF- alpha in RA and SLE with assessing their correlation to clinical disease activity and laboratory findings. 24 SLE, 25 RA and 25 controls were enrolled in this study. Disease activity was evaluated using SLEDAI for SLE patients and DAS 28 for RA patients. IL-33 and TNF- alpha serum levels were determined using sandwich enzyme immunoassay. A significant statistical difference of IL-33 level between SLE and RA groups [P=0.002] and between SLE and control groups existed [P<0.001]. However, a non-significant difference existed between RA and control groups [P=0.340]. There was a significant statistical difference of TNF-alpha level between SLE and control groups [P<0.001] and between RA and control groups [P<0.001], which didn't exist between RA and SLE groups [P=0.070]. A significant positive correlation of serum IL-33 level with serum TNF- alpha level in SLE patients occurred [r=0.505, P=0.012], which was not found in RA [r=-0.023, P=0.912] or in the controls [r=-0.168, P=0.601]. A significant positive correlation was found between TNF- alpha level and SLE patients with high disease activity [r=0.446, P=0.029], which didn't exist with IL-33 [r=0.227, P=0.286]. There was no correlation between serum IL- 33 and DAS 28 [r=0.205, P=0.326], however a negative correlation occurred with TNF- alpha [r=-0.404, P=0.045]. Serum levels of TNF- alpha and novel IL-33 were higher in RA and SLE Egyptian patients than controls. A significant positive correlation occurred between serum IL-33 and serum TNF- alpha in SLE but not in RA patients. Most clinical and laboratory variables in RA and SLE patients did not correlate with either serum IL-33 or TNF- alpha levels

Myocardial perfusion scintigraphy [Gated-SPECT] and coronary disease risk factors in Behcet's disease with metabolic syndrome

Behcet's disease [BD] is a multi-system vasculitis that can have a wide range of effects on the cardiovascular system. To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in asymptomatic BD patients with and with out metabolic syndrome and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography [G-SPECT]. The study population consisted of 20 [17 men and 3 women] patients with BD and 20 healthy controls of age and sex match. Technetium-99m methoxyisobutylisonitrile [Tc-99m MIBI] gated SPECT studies were performed using a 1-day rest-stress protocol. Stress and rest left ventricular ejection fraction [LVEF] were calculated. Using gated SPECT images myocardial perfusion scores [summed stress score [SSS], summed rest score [SRS] and summed difference score [SDS]] were determined. Echocardiography was performed for comparison. Carotid intima-media thickness [1MT] was recorded to detect the macrovascular involvement in BD and to detect if there is any possible correlation with the microvascular myocardial affection. Abnormal myocardial perfusion scintigraphy [MRS] was detected in 15 patients [2 with infarction, 13 with perfusion defects], 5 patients had normal perfusion pattern. Scmiquantitative scores [SSS, SRS and SDS] were significantly higher in the BD patients compared to control [p 0.000]. There was a statistically significant difference between BD patients and control regarding the carotid artery IMT by ultrasonography being increased in the patients. On the other hand, the G-SPECT and echocardiographic LVEF was significantly lower in the BD patients [p 0.001 and p 0.002 respectively]. On comparing the results of the BD patients with and without metabolic syndrome, the studied parameters for coronary risk factors as blood pressure, cholesterol, triglycerides and fasting blood sugar they were significantly higher in the metabolic syndrome group. On the other hand, the HDE was significantly lower in the metabolic syndrome group. Both the disease activity [BDCAF] and the myocardial perfusion gated SPECT [SSS] were significantly higher in those BD patients with metabolic syndrome [p 0.03]. On the contrary, the differences in results of the carotid artery IMT and the echocardiographic LVEF% in BD patients with and without metabolic syndrome did not reach significance. There was a tendency to increased disease duration in BD patients with more severe myocardial perfusion defect. The difference was only significant between patients with perfusion defect and those with old myocardial infarction involving the antero-septal wall [p 0.04]. There was a statistically significant difference among the three myocardial perfusion scan subgroups as regards the level of triglycerides, systolic and diastolic blood pressure [p 0.29, 0.38, 0.13 respectively]. The CRP level was higher in the infarct patients followed by the defective perfusion. A significant difference was only found when comparing the level of those with history of infarction [severe ischemia] with those with normal myocardial perfusion scan [p 0.047]. On comparing the carotid artery IMT, echocardiographic LVEF%, and myocardial perfusion G-SPECT parameters, they were all significantly different among BD patients with infarction, defective and normal myocardial perfusion. A significant positive correlation was present between the SRS and the disease duration [p 0.04]. CRP significantly correlated with both the SSS and SDS [p 0.04 and 0.00 respectively]. Furthermore, the SSS and SRS significantly correlated with the blood pressure, triglycerides and cholesterol levels. The BDCAF significantly correlated with the SSS and SDS [p 0.009 and 0.007 respectively]. Carotid artery IMT significantly correlated only with SRS [0.02]. However, the echocardiographic LVEF% significantly correlated with all the myocardial perfusion gated SPECT parameters. Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD with silent myocardial ischemia [SMI]. Gated SPECT is a non-invasive more reliable method compared to echocardiography that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction in cardio-Behcet. Myocardial perfusion defects increase with increased disease activity and carotid artery IMT. Metabolic syndrome risk factors account for an augmented perfusion defect and should be considered a high risk group in BD patients

Accelerated rehabilitation after anterior cruciate ligament reconstruction: comparison of closed kinetic chain [CKC] versus open kinetic [OKC] exercises

Anterior cruciate ligament [ACL] is one of the most commonly injured ligaments of the knee. ACL reconstruction [ACL-R] is the treatment of choice in cases of severe knee instability to avoid recurrent knee injuries and subsequent degenerative changes. Accelerated rehabilitation after ACL-R greatly affects the healing response and significantly helps patients to gain dynamic stability in the knee joint. Much debate surrounds the difference between open kinetic chain [OKC] and closed kinetic chain [CKC] exercises during ACL-R rehabilitation. It was the aim of this study to compare the effects of a comprehensive rehabilitation program with quadriceps strengthening in closed kinetic chain [CKC] exercises with the same rehabilitation program with quadriceps strengthening in open kinetic chain [OKC] exercises in patients with ACL reconstruction and to evaluate the effects on knee function. Forty consecutive patients with ACL reconstruction for isolated in injury were included ACL this study. They were subjected to a rehabilitation program for 4 months supplemented with OKC exercises in one group and CKC exercises in the second group. Patients in CKC exercise group showed at the end of the four months' rehabilitation programs, a statistically significant increase in passive range of motion [PROM] [p < 0.001], in Lysholm score [p = 0.002] and a significant decrease in number of patients with extension deficit >/= 5° [p = 0.008], all indicating improvement in knee functions, while OKC group only showed improvement in PROM as regards knee functions [p = 0.049]. Comparing both groups-as regards the outcome of rehabilitation program on knee functions showed that there was a non significant difference between the two groups concerning PROM, Lysholm score or improvement of extension deficit and thigh atrophy [p = 0.463, p = 0.757, p = 0.085, p = 0.430 respectively]. At the end of the 4 months, there was statistically significant more improvement of knee pain in CKC group than OKC groups [p = 0.018] and more number of patients who gave a response of "satisfied" in CKC group than OKC groups [p=0.027]. We conclude that both CKC and OKC exercises appear to be suitable for rehabilitation after ACL reconstruction; however, CKC exercises showed better outcome after rehabilitation than OKC exercises as regards knee function, knee pain and patient satisfaction

Multifrequency tympanometry in rheumatoid arthritis patients

To assess the value of the multifrequency tympanometry [MFT] in rheumatoid arthritis [RA] patients. 56 patients with RA, and 54 well-matched controls. MFT was used to measure admittance, conductance, susceptance and phase angle at different probe frequencies and resonant frequency. The RA group had a mild sensouneural hearing loss [SNHL] in the high frequencies with an average of 26.52 dBHL at 4kHz and 34.55dBHL at 8kHz which suggests inner ear affection. However, there was no statistically significant difference between the two groups as regards the air conduction pure tone average. Our RA group showed a higher mean resonant frequency [1038Hz +/- 251.18] than the control group [927.78Hz +/- 126.14] and this difference was statistically significant [p<0.05]. This suggests increased middle ear stiffness in RA, through a chronic inflammation that may involve the incudo-malleolar and/or incudo-stapedial diarthroidal joints. There was a correlation between resonant frequency and different disease parameters: The positivity of the rheumatoid factor, mean grade of disease activity, drug therapy and the presence of extra-articular manifestations. There was a direct correlation between resonant frequency and Erythrocyte sedimentation rate, rheumatoid factor, articular index and morning stiffness; and there was an inverse correlation between resonant frequency and grip strength of the patients. However, there was no correlation between resonant frequency and age of the patient, age of onset nor duration of the disease. MFT is more sensitive than single-frequency tympanometry to detect small changes in the mechanics of the tympano-ossicular chain in RA patients which can be used for the staging of RA, in addition to the traditional rheumatological parameters