Rehabilitation of hypertensive patients with left ventricular diastolic dysfunction

To assess the benefits of exercise training for rehabilitation of hypertensive patients with left ventricular diastolic dysfunction. This study was conducted on 40 hypertensive male patients with left ventricular diastolic dysfunction diagnosed with Doppler echocardiography. They were subjected to full history taking with special emphasis on dyspnea, which was classified according to NYHA classification, clinical examination, and surface ECG. Exercise stress test and Echocardiographic study were done twice for all patients at the start and at the end of the training program. Patients were divided into group-A [exercise group] that included 30 male hypertensive patients who underwent an exercise training program for two months and group-B [control group] that included 10 male age matched hypertensive patients who did not undergo the exercise training program. After the exercise training program group-A achieved longer exercise duration and higher METs as compared to group-B and the pre exercise parameters. Significant reduction of resting HR, BP and DP was noticed in the exercise group. Diastolic function in the form of increased E-wave velocity and reduction ofA-wave velocity, normalization of E/A ratio with reduction of DT and IVRT were noticed in the exercise group as compared to the control group as well as the pertaining data of the exercise group. Rehabilitation training program is beneficial in increasing physical endurance of hypertensive patients and in the control of BP, Diastolic function has improved in trained persons. Exercise training should be considered an integral part of the treatment of hypertensive patients

Anti-Nucleosome antibodies as a diagnostic tool in systemic lupus erythematosus and marker of lupus nephritis

To evaluate the prevalence of anti-nucleosome antibodies [anti-NCS Abs] in systemic lupus erythematosus [SLE], their role in diagnosis, disease activity and lupus nephritis [LN]. The study was conducted on 23 SLE female patients. They were divided into two groups according to the presence or absence of LN. Ten apparently healthy individuals served as a control group. Clinical assessment was done to all patients especially for renal affection. Disease activity was scored with SLEDAI. Anti-NCS and anti-dsDNA antibodies were measured with ELISA. Renal biopsy was performed for patients with LN. The prevalence of anti-NCS Abs was [78.3%] and anti-dsDNA Abs was [56.5%] in SLE. Seventeen patients presented with LN and 6patients without. Among these patients, the prevalence of anti-NCS Abs and anti-dsDNA Abs were [88%-64.7%] and [50%-33.3%] respectively. Anti-NCS Abs were found to be positive in 21.7% of SLE patients lacking anti-dsDNA Abs. The mean anti-NCS and anti-dsDNA Abs tiler in SLE was 250.60 +/- 207.00 and 443.3 +/- 714.3 respectively, showing a highly significant increase compared with healthy controls [12.3 +/- 4.54 and 31.0 +/- 20.11] [p<0.001]. Moreover, in LN and those without LN, the mean anti-NCS Abs showed a highly significant increase [331.41 +/- 179. 73 and 21.67 +/- 8.36] [p<0.001], while there was a significant increase in the mean of anti-ds DNA Abs [574.71 +/- 794.07 and 71.17 +/- 46.99] [p<0.05] respectively. The sensitivity and specificity of anti-NCS Abs in SLE were 82.6% and 100% and in LN were 88.2% and 100% respectively. Anti-NCS Abs showed a positive significant correlation with ESR [r=0.900], SLEDAI [r=0.761] and anti-dsDNA Abs [r=0.681] in LN, but showed a negative significant correlation with disease duration [r=-0.511] and C4 [r=-0.650] in patients without LN. In LN 7 patients hadproliferative glomerular lesion [WHO class III], 6 patients class IV and 4 patients class II on renal biopsy. They were associated with a statistically significant proteinuria, anti-ds DNA and anti-NCS especially in classes II and IV, Anti-NCS Abs could be a useful parameter for diagnosis and assessment of disease activity and LN in SLE, It seems to be a more sensitive marker of SLE than anti-ds DNA especially in patients who are anti-dsDNA antibody negative

Role of anti-annexin V antibodies in peripheral vascular ischemia of systemic sclerosis patients

To evaluate the role of a-AXVAbs IgG isotype in SSc and correlate it with peripheral microvascular and macrovascular affection. This study was conducted on 20 SSc female patients and 10 healthy controls. Clinical assessment was performed especially for peripheral vascular affection. ACL [IgG, IgM], Anti Scl-70 and a-AXV Abs were measured by ELISA and AC A by IIP. NFC and Doppler U/S were done. Diffuse SSc found in 11 patients and limited in 9 patients. A-AXV Abs were +ve in 19 patients, mean +/- SD 14.6 +/- 5.2, a highly significant increase compared to controls [t=5.3p<0.001]. There was no significant difference between diffuse and limited SSc [t-1.47 and p>0.05]. Patients were classified into 2 groups according to presence or absence of peripheral vascular affection: Group I, included 12 and Group II 8 patients. There was a highly significant difference between them regarding duration of RP [p<0.001], a significant difference regarding a-AXV Abs [p<0.05], but no such regarding ACL [IgG and IgM], anti-Scl-70 or anti-ACA. Within group I, there was a significant positive correlation between a-AXV Abs and disease duration, RP and ACL [IgG and, IgM] [p<0.05]. NFC showed scleroderma pattern: early 5%, active 75% and late 20%.Comparing a-AXV Abs in them, a highly significant difference in active and late [p<0.001]. Doppler US showed irregular thickening in carotid arteries, stenosis and calcification in ulnar and calcification and irregular thickening in femoral and popliteal arteries. A highly significant increase of a-AXV Abs in ulnar artery stenosis [p<0.001]. Measurement of a-AXV Abs in SSc can discriminate patients with vascular affection from those without it, with specificity 62.5%, and sensitivity 91.7%. Peripheral micro and macrovascular affection should be assessed

Serum YKL-40 in rheumatoid arthritis and its correlation with disease activity

To determine the serum level of YKL-40 in rheumatoid arthritis [RA] patients and to find out its correlation with the disease activity. The study was conducted on 20 RA patients recruited from the Rheumatology and Rehabilitation Department of Ain Shams University Hospitals, as well as 10 apparently healthy individuals who served as a control group. Patients with liver disease, myocardial infarction or malignancies were excluded. Also patients taking slow-acting drugs or had intra-articular injections in the previous month before the study were not included. All the patients and the controls were subjected to complete history taking, thorough clinical examination, radiological and laboratory tests. Serum YKL-40 level was measured in the patients and the controls using ELISA test. Serum YKL-40 level was significantly higher in RA patients as compared to the control group. Serum YKL-40 level showed a positive significant correlation with the disease duration, the parameters of disease activity in RA patients and with the disease severity as assessed with Larsen's radiological score. Measurement of serum YKL-40 level in RA patients is a laboratory test that can be used as a new parameter other than the conventional markers of inflammation, which are ESR and serum CRP level. Also, it helps to asses the disease activity as well as the progression and the destructive effect of the disease on the joints

Tumor necrosis factor alpha expression in iliac bone biopsy and relation to bone histomorphometry in pre- and post- menopausal women

To identify TNF-alpha protein expression in iliac crest bone biopsies and their influence on trabecular microarchitecture in relation to menopausal status. Twenty-four females were classified into Group I: 10 pre-menopausal with mean age 39.9 +/- 5.06 and Group II: 14 post-menopausal with mean age 57.18 +/- 5.01. Serum estradiol and BMD [using DEXA] were assessed. Histomorphometrical study of iliac crest biopsy using H and E stain to evaluate trabecular architecture. Immunohistochemistry with TNF- alpha antibody was done to measure number of bone marrow producing cells and their area% in cells lining bone trabeculae. There was a highly significant difference between 2 groups regarding serum estradiol and BMD at all sites. Histomorphometrical parameters showed a highly significant decrement and significant decrease of Ob.S. TNF- alpha cells number and area% in bone biopsy showed a highly significant increase in group II but no correlation with age or BMI. There was a significant negative correlation of E2 in group /, highly so in group II. BMD, showed a significant negative correlation at the lumbar spine in group II. Bone histomorphometric parameters showed a significant negative correlation with T.Th in group 1 and highly one in group II, a highly significant positive correlation with T.S and with E.S in both groups and a significant positive correlation with T.S in group 1. No significant correlation regarding Ob. S in both groups. TNF- alpha has a critical role in the pathogenesis of post-menopausal osteoporosis. This may have impact on the future therapy, using anti TNF-a drugs already available

Metacarpal index phalanx versus dual-energy X-Ray absorptiometry in osteoporosis

Osteoporosis is one of the most common metabolic diseases. It is responsible for considerable morbidity, mortality and costs. Our aim was to evaluate metacarpal index as a diagnostic tool for bone mass measurement as compared with DEXA. The study included 50 males above 60 years of age with a history of osteoporotic fractures as well as 20 apparently healthy males. Their ages ranged from 20-25 years. Metacarpals index had sensitivity of 46%, specificity of 95% positive predictive value 96%, negative predictive value 41% in comparison to DEXA. Metacarpals index can be used as a routine test for exclusion of osteoporosis

Value of anti-cyclic citrullinated peptide antibodies and magnetic resonance imaging in early rheumatoid arthritis

To assess the value of the presence of anti-cyclic citrullinated peptide antibody [anti-CCPAb] as well as magnetic resonance imaging [MRI] in early rheumatoid arthritis [RA]. The study was performed on twenty early RA patients [with disease duration <1 year] diagnosed according to the 1987 ACR classification criteria. They underwent full history taking and thorough clinical examination. Anti-CCPAb was assessed with ELISA technique. MRI study was done for both wrist joints and hands of all patients and evaluated according to the OMERACT 2002 RAMRIS scoring system. Disease activity was assessed with CRP and 28 joint disease activity score [DAS28]. Rheumatoid factor [RF] IgM was analyzed with latex agglutination. We divided the patients according to the presence or absence of anti-CCP antibodies into two groups: Eleven [55%] patients were positive for anti-CCP and 9 [45%] patients were anti-CCP negative. Comparison between the two groups revealed that there was a highly statistical significant difference as regards the CRP level and DAS28 score [p<0.001]. There was a statistically significant difference in the initial presentation between the two groups; in anti-CCP positive patients symptoms started more often in the upper limbs while the anti-CCP negative group they often presented in both upper and lower limbs. Bone marrow edema was more frequent in patients with positive than those with negative anti-CCP-Ab with a highly statistical significant difference [p<0.001]. The highest global scores for bone edema were seen in triquetral and lunate bones. The prevalence and severity of synovitis as well as the MRI scoring of bone erosions did not differ significantly between the two groups [p>0.05]. The highest global score of erosions was located in the same sites in the wrist and MCP joints. Tenosynovitis was observed nearly equally in both groups of patients. Global scores of tenosynovitis in both groups were high in the extensor tendons of the wrist and in the flexor tendons of the MCP joints. The study showed the importance of the presence of positive anti-CCPAb at baseline and its high association with greater disease activity [DAS28], higher levels of CRP, and bone marrow edema as an indicator of future bone erosion in early RA. MRI can be added as a useful tool for evaluation of early RA. This aspect is important because an early diagnosis of RA may modify the therapeutic strategy substantially, suggesting the use of more aggressive pharmacological agents that can delay progression of joint damage and thus substantially change the natural history of the disease

Is acquired total protein s deficiency associated with antiphospholipid antibodies in systemic lupus erythematosus?

Hypothesis: protein S [PS] is a vitamin K dependent plasma protein, and it's free from is required for protein C to be functional. Antiphospholipid antibodies [apl] may cause functional PS deficiency by binding free PS. In patients with SLE have increased incidence of apl, which have been associated with thrombotic events

Objective: to determine the level of total protein S and its relation to [apl]

Methodology: 22 SLE patients diagnosed according to ACR revised criteria [Tan et al., 1982] and ten healthy subjects were included in this study. Assays for protein S, IgG, up1 were performed in patients and control groups

Results: the protein S was lower in the patients than the control and the difference was highly significant. There was a highly significant differences between the level of PS in patients with apl+ve compared with apl-ve patients [p<0.01]

Conclusion: this study confirms an association between apl and PS deficiency

Angibgemesis imbalance in systemic sclerosis

Objective: to identify angiogenesis imbalance in systemic sclerosis [SSc] by measuring serum level of the main angiogenic inducer marker [vascular endothelial growth factor VEGF] and the main angiogenic inhibitor marker [endostatin] in order to find out their possible role in the pathogenesis of the disease

Methodology: this study was conducted on twenty five SSc patients, 15 with limited SSc [LSSc] and 10 with diffuse SSc [DSSc]. They were further classified into early LSSc, late LSSc, early DSSc and late DSSc according to Medsger and Steen, 1996, as well as 15 apparently healthy controls participated to this study. Skin involvement was assessed using the modified Rodnan Skin Score, nailfold Video Capillaroscopy [NVC] and pulmonary function tests [PFTs] were done. Serum VEGF and endostatin levels were measured using enzyme linked immunosorbent assay [ELISA]

Results: there was a statistically highly significant increase in the mean values of both serum VEGF and serum endostatin in SSc patients compared to control subjects [p<0.001]. Early DSSc and early LSSc patients had a statistically highly significant increase in the serum levels of VEGF compared to late DSSc and late LSSc patients [p<0.001]. Late LSSc patients had a statistically significant increase in the mean value of serum endostatin compared to early LSSc patients [p<0.01], as well as late DSSc patients had a statistically highly significant increase in the mean value of serum endostatin compared to early DSSc patients [p<0.001]. A highly significant positive correlation was found between serum levels of endostatin and modified Rodnan Skin Score in SSc patients [r=0.69, p<0.001], while no significant correlation was found between serum VEGF and modified Rodnan Skin Score [r=0.293, p>0.05]. SSc patients without ischemic manifestations had a statistically significant higher level of serum VEGF compared to those with ischemic manifestations [p<0.01], while SSc patients with ischemic manifestations had a statistically highly significant increase in the mean value of serum endostatin compared to those without ischemic manifestations [p<0.001]. SSc patients with early NVC pattern had highly significant increase in the mean value of serum VEGF compared to those revealing late NVC pattern [p< 0.001], while SSc patients with late NVC pattern had highly significant increase in the mean value of serum endostatin compared to those revealing early NVC pattern [p<0.001]. SSc patients with restricted PFTs had a statistically significant higher level of serum endostatin in comparison to those without pulmonary affection [p<0.001], while no significant difference regarding mean levels of serum VEGF in patients with or without restricted PFTs [p>0.05]

Conclusion: we may conclude that angiogenic inhibitor [endostatin] is induced and outweighs angiogenic inducer [VEGF] in late disease. Increased serum endostatin level is associated with skin sclerosis severity, ischemic manifestations and pulmonary fibrosis in SSc patients. This angiogenesis inhibitor favors disease progression and it is a good candidate for further evaluation of disease severity and treatment purposes

Prevalence of macrovascular disease in systemic sclerosis

To detect the prevalence of macrovascular disease in systemic sclerosis. Thirty patients with systemic sclerosis and ten normal controls matched in age and sex were included in the study. All subjects were screened for atherosclerosis risk factors and non-invasive vascular assessment as carotid duplex scanning and measurement of ankle brachial blood pressure index. There was no significant difference in risk factors as cigarette smoking, systolic, diastolic blood pressure, cholesterol, triglycerides and glucose levels between patients and controls groups. Twenty three out of 30 patients [76.7%] had carotid artery disease compared to [30%] of normal controls with a highly significant difference. Macrovascular disease is a common finding in systemic sclerosis. Early identification allows early intervention and treatment with better control of high rate of cardiovascular mortality

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

Serum and synovial fluid levels of vascular endothelial growth factor in rheumatoid arthritis: correlation with disease activity

To study serum and synovial fluid levels of vascular endothelial growth factor [VEGF] in Rheumatoid arthritis [RA] and to investigate its association with clinical and laboratory parameters in order to assess its value as a marker of disease activity and development of joint synovitis. Measurement of VEGF levels in serum of 40 RA patients, synovial fluid obtained from 15 patients of them and 10 healthy age and sex matched subjects taken as controls using enzyme linked immunosorbent assay [ELISA] technique. Subjects underwent thorough clinical examination, assessment of disease activity using disease activity score [DAS] and radiological evaluation using the Larsen scale. Serum VEGF levels in RA patients [436.5 +/- 286.3 pg/ml] and that in synovial fluid [640.7 +/- 305.4 pg/ml] were significantly higher than in controls [252.0 +/- 51.6 and 276.0 +/- 48.8 pg/ml] respectively [p<0.001]. Twenty two RA patients out of 40 [55%] had increased serum VEGF while 14 RA patients out of 15 [93.3%] had increased synovial fluid VEGF There was a highly significant difference between serum VEGF [590.9 +/- 303.2 pg/ml] and synovial fluid VEGF [756.0 +/- 313.8 pg/ml] of RA patients [p<0.001]. Moreover, there was a statistically significant positive correlation between serum and synovial fluid VEGF [p<0.05] of RA patients. Also, there was a highly significant difference [p<0.001] and a significant positive correlation [<0.05] between serum VEGF and 28 swollen joint count, ESR, DAS score and Larsen grades. Again, there was a statistically significant difference [p<0.05] and significant positive correlation [p<0.05] between serum VEGF and age and 28 tender joint count while there was a significant negative correlation with Hb level [p<0.05]. Serum and synovial fluid VEGF levels were increased in RA patients and reflect the extent of joint disease severity. So VEGF levels can be a reliable marker in assessment of early active joint destruction in RA patients and evaluate the antiangiogenic therapy especially with VEGF inhibitors, which can represent a novel therapy for RA in the future

Role of placental growth factor and high resolution ultrasound in evaluation of hypervascularity in psoriatic arthritis

To measure the levels of placental growth factor [PIGF] in the serum and synovial fluid of in psoriatic arthritis [PsA] patients. Also, to evaluate any possible role of high resolution US in the angiogenesis observed in this disease. The study was conducted on 25 PsA patients and 10 apparently healthy age and sex matched subjects who served as controls. All subjects were subjected to thorough clinical and laboratory examination. PIGF levels were measured in the serum of all of them with ELISA technique. This was confirmed with Western blotting for PIGF in synovial fluid. Assessment of vascularity of the small joints of the hands and other affected knee joints with high resolution US was performed. The mean value of serum PIGF level in the serum of PsA patients was [66.52 +/- 12.44 pg/ml] and that in the synovial fluid was 79.82 +/- 14.92]. There was a highly statistical significant difference between them and serum/synovial fluid levels in controls [16.20 +/- 7.33 and 19.44 +/- 8.79 pg/ml] respectively [p<0.001]. Moreover, there was a highly significant association [p<0.001] and a statistically significant positive correlation [p<0.05] between serum and synovial fluid levels of PIGF in PsA patients. There was a statistically significant difference between PsA patients and controls as regard Hb levels, ESR and serum uric acid [p<0.05]. Also, there was a significant positive correlation between synovial fluid PIGF levels and the onset of joint affection [p<0.05]. High resolution US can measure the synovial thickness in the small joints of the hands as well as knee joints in PsA patient. It can also detect increased blood flow in joints, so can measure the resistive index and can detect effusion. Our results showed that there was a highly statistical significant difference between PsA patients and controls as regard synovial thickness [p<0.001]. Also, there was a significant negative correlation between serum PIGF and resistive index of PsA patients Angiogenesis plays an important role in the pathogenesis of PsA. This is confirmed by the presence of higher PIGF levels in both serum and synovial fluid. Inhibition of PIGF and its receptor [Flt-1] constitute potential candidates for therapeutic modulation of angiogenesis and inflammatory joint destruction in arthritis. High resolution ultrasound can be very useful to detect early hypervascularization and joint inflammation which guide treatment towards an early or more aggressive therapy

Serum matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase-1 [TIMP-1] in rheumatoid arthritis, psoriatic arthritic and osteoarthritis

To investigate whether serum levels of MMPs and TIMPs are specifically elevated in rheumatoid arthritis as compared to other inflammatory and degenerative joint diseases. We compared serum levels of matrix metalloproteinases [MMP-3, MMP-9] and tissue inhibitor of metalloproteinase [TIMP-1] of RA with psoriatic arthritis [PsA] and osteoarthritis [OA]. Serum samples were obtained from 30 RA, 20 psoriatic arthritis and 30 knee osteoarthritis patients. Serum concentration of stromelysin-1 [MMP-3], gelatinase B [MMP-9] and TIMP-1 were measured with quantitative sandwich enzyme-linked immunosorbent assay [ELISA] technique. Clinical examination and assessment of disease activity in RA using disease activity score [DAS] were carried out. Radiological evaluation in RA patients using the Larsen scale and in OA patients using the Kellgren and Lawrence scale were also done. Unique serum profiles of MMPs and TIMP-1 were identified in the two inflammatory arthritis groups [RA and PsA]. The serum concentrations of MMP-3 and MMP-9 were significantly higher in RA patients than in OA patients used as a control groups [p<0.001]. These two MMPs dominated in the serum of RA patients than PsA patients [p<0.001]. The analysis of the serum concentrations of TIMP-1 was also elevated in RA patients as compared with OA knee patients [p<0.001]. Also TIMP-1 was found in a significantly higher concentration in the serum of RA patients than PsA patients [p<0.05]. MMP-3 and MMP-9 correlate significantly with disease activity [DAS] in RA patients and with radiological scores. Serum levels of MMP-3, MMP-9, and TIMP-1 were significantly higher in RA and PsA than OA patients. MMP-3 and MMP-9 could be specific markers of joint inflammation and destruction. These variables are neither specific for RA nor for diseases in which bone erosions occur. These markers were correlated with the clinical activity of the disease. Early detection of these markers may herald progressive course and modulate the lines of treatment

Clinical significance of serum thrombomodulin level in rheumatoid arthritis patients

To determine the soluble thrombomodulin [TM] level in sera of rheumatoid arthritis [RA] patients and to evaluate its relationship to disease activity in those patients. Twenty rheumatoid arthritis patients were included in this study. They were 18 females and 2 males. Their age ranged from 25 to 62 years. The Disease Activity Score [DAS] was used for the assessment of disease activity in the patients. The DAS was divided into 3 categories: 2.4 and 3.7 [high disease activity]. Ten age and sex-matched healthy subjects were included as a control group. The soluble thrombomodulin level was measured with a solid phase sandwish-Enzyme-Linked-Immuno-Sorbent Assay [ELISA] in the sera of the twenty RA patients and ten controls. The relationship between serum TM levels and disease activity in the patients was assessed. The frequency of patients with high serum TM levels [> 5.33 ng/ml] was 7/20 [35%]. Serum TM levels in the patients were significantly higher than those in the control group [p < 0.05] and there was a significant positive correlation between serum TM levels and the DAS [p < 0.05]. Comparison between patients with different categories of the DAS and controls regarding serum TM level showed that patients with high disease activity [DAS > 3.7] had a highly significant higher serum TM levels than the control group [p < 0.001]. Patients with moderate disease activity [DAS > 2.4 and 0.05]. Serum TM levels were elevated in RA patients and correlated with the disease activity score. These results may indicate that serum TM measurement may be valuable in the evaluation of the RA disease activity

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