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

periodontitis an occult source of recurrent infection in patients with systemic lupus erythematosus?

To determine if periodontitis can be considered as an occult source and septic focus for recurrent infections in patients with Systemic lupus erythematosus [SLE]. The present study was conducted on 60 subjects divided into 4 groups. Group 1: included 30 SLE patients with periodontitis [SLE/P]. They were further subdivided according to the CRP titer into: Group 1A: 20 patients with CRP titer > 6 and Group 1B: 10 patients with CRP titer < 6. Group 2: included 10 SLE patients without periodontitis [SLE/X], Group 3: 10 non SLE subjects with periodontitis [X/P] and lastly Group 4: 10 healthy subjects. SLE disease activity was assessed by SLAM score. Periodontal examination was assessed by periodontal disease index [PDI]. Laboratory investigations: serum [s] and salivary [sal] CRP titre, CBC, ESR and urine analysis. Microbiological examination of plaque specimens was done. Comparative study between Group 1A and Group 3 revealed a highly significant difference as regards PDI and a significant difference as regards WBC count, ESR, s/CRP, sal/CRP titre indicating more severe periodontal disease in patients with SLE. There was a highly significant greater severity of periodontal disease in patients additionally receiving immunosuppressive therapy. The plaque culture showed Streptococci, Klebsiella, Staphylococci, E. coli and Pneumococci. In selected patients from Group 1, there was a highly significant decrease of s/CRP and sal/CRP after periodontal treatment. Periodontitis is an occult infection that can be considered as a septic focus in SLE patients. CRP is a sensitive indicator for the presence of infection in SLE patients. Periodontal examination must be done routinely for all SLE patients

Sympathetic skin response in carpal tunnel syndrome

Sympathetic skin response [SSR] is most frequently used in diagnosing functional impairment of non-myelinated postganglionic sympathetic fibers. Early diagnosis of autonomic dysfunction is important in patients with carpal tunnel syndrome [CTS] as the earlier the diagnosis the more effective the treatment. Aim of this work was to measure the SSR in patients with CTS to detect its relation with possible autonomic dysfunction. This study included 18 patients [23 hands] with CTS, graded according to Bland [2000]. SSR measurement was done, and the latency and amplitude were measured. Clinical manifestations of autonomic dysfunction were present in 6 hands [26%]. There was statistically high significant longer disease duration among patients with autonomic dysfunction in comparison to those without. Among our patients, 3 hands [13%] had no elicited SSR. This was associated with very severe carpal tunnel syndrome, female sex, and long disease duration. There was a statistically high significant difference between patients and controls as regards the latency of SSR with no significant difference as regards the amplitude. There was a statistically high significant positive correlation between the SSR latency and the grading of CTS, and statistically high significant negative correlation between the amplitude of SSR and the grading of CTS. SSR can be used in the electrodiagnostic workup for patients with carpal tunnel syndrome where it can be used as a method for detection of autonomic dysfunction in these patients

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