The diagnostic value of combined risk factor analysis and radiological imaging in determining osteoporosis in post-menopausal women.

AIM: To determine the diagnostic value of risk factor analysis (age, duration of menopause, body mass index and physical activities) and radiological imaging (Singh index and cortical index of the femoral neck) in diagnosing osteoporosis in post-menopausal women. METHODS: The study was cross sectional on 64 post-menopausal women without secondary risk factor for osteoporosis. They were classified proportionally using the Singh index. Bone density was measured using DEXA (dual x-ray absorptiometry) on the femoral neck and lumbal 2-4 spine areas. The Singh index and cortical index of the femoral neck were evaluated using femoral neck antero-posterior x-ray. Physical activities were measured using a Historical leisure activity questionnaire. Bivariat statistical analysis was conducted using the t-test and chi-square, whereas multivariate analysis was conducted using multinomial logistic regression. RESULTS: There was a significant association (p<0.05) between bone density and age, body weight, height, body mass index, duration of menopause and Singh index. With multinomial logistic regression analysis, it was demonstrated that only Singh index, the duration of menopause and body mass index had the highest sensitivity and specificity. The score system algorithm could be utilized in two steps, the first was to diagnose osteoporosis and the second was to distinguish between osteopenia and normal bone. This score system had a sensitivity of 91.4% and a specificity of 89.6%, a positive prediction value of 91.4% in determining osteoporosis, and a sensitivity of 66.7%, a specificity of 89.1% and a positive prediction value of 70.6% in determining osteopenia, whereas the negative prediction value was 75%. CONCLUSION: The score system algorithm is the best method for determining osteoporosis in post-menopausal women. If there is osteopenia, evaluation using DEXA is then required. The score system algorithm cannot be used to follow up the therapy.

Use of anti-citrullinated peptide (Anti –CCP) antibodies in distinguishing patients with systemic lupus erythematosus and rheumatoid arthritis.

Diagnosis of Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) can be confused in their initial stages. The joints, especially the hands, are commonly affected in both disorders, many patients with SLE are initially misdiagnosed as having RA Given that the outcome for the two diseases is diverse, it would be helpful to have serological marker to distinguish between them at onset. Anti-citrullinated peptide antibodies (anti-CCP) have recently been described as highly specific for RA. The objective of this study is to confirm the specificity of anti-CCP antibodies and to determine whether they might distinguish patients with RA from those with SLE. This study is a cross sectional study on a group of patients with RA (n=27), SLE with arthritis (n=20), other autoimmune diseases (non-rheumatic diseases, n = 8), and healthy adults (n=20). Anti-CCP was determined by a commercial Elisa test and Rheumatoid factor (RF) was determined by the standard slide latex test. The sensitivity and specificity of anti-CCP for the diagnosis of RA was 63.0% and 97.9% respectively, comparing with RF for RA that was 40.7 % and 85.4 %. Only 1 healthy adult was anti-CCP+, no anti-CCP was detected from SLE and other autoimmune disease. The mean of titer anti CCP in normal healthy adult, other autoimmune diseases, SLE and RA was 1.35 ± 2.04, 0.63 ± 0.59, 0.75 ± 0.59, and 38.17± 44.22 RU/ml, respectively. There was a highly significant difference between the mean of titer anti CCP for RA with others diseases (p <0.001). We conclude that detection of anti-CCP is very useful for the diagnosis of RA and distinguishing RA from SLE.

Comparison of urinary excretion of Deoxypiridinoline and value of serum Osteocalcin within the Knee Osteoarthritis grading.

The identification of molecular markers, which reflects differences in disease progression rates in Osteoarthritis (OA), would greatly facilitate clinical studies. Urinary Deoxypyridinoline (UDPD) and serum osteocalcin (OC) had been widely used for marker of bone metabolism, but the use for molecular marker in OA was lack of data. Recent studies show that there were conflicted results between urinary excretion of DPD and serum OC value within knee OA grading. The aim of this study is to compare of urinary excretion of DPD and the level of serum OC as destructive parameter of cartilage within the knee OA grading. This cross sectional study comprise of 69 patients with OA of knee joints. Kellgren and Lawrence scale was use for grading of OA. Group of patients with knee OA grade 2 call as group of early OA and group of patients with knee OA grade 3 and 4 calls as group of late OA. DPD in urine was measured using Immuno-chemilunescence, serum osteocalcin was measured using Elisa method. The mean value of urinary concentrations of DPD in OA patients was higher than normal value (9.79 ± 7.28 nM DPD/mM Creatinin), and the mean value of serum OC within normal value (8.49 ± 4.68 ng/mL). There were no significant differences of age, body mass index (BMI), duration of illness, urinary excretion of UDPD and serum OC level between early and late OA. In conclusion, there is no significant difference of urinary excretion of DPD and serum OC level within knee OA grading. The use of urinary DPD and serum OC as molecular markers of progression of OA needed to be explored by other longitudinal study.

Factors affecting radiographic progression of knee osteoarthritis.

AIM: To determine factors affecting radiographic progression of knee OA. METHODS: A cross sectional study comprise of patients with OA of knee joints. Kellgren and Lawrence (K-L) grading scale was used to evaluate the radiographic progression of knee OA. All of the patient were noted the demographic data including age, gender, duration of illness, body mass index and bone mass density. Lunar DEXA was used to measure total body-BMD (T-BMD), total bone mineral content (T-BMC) and legs-BMD (L-BMD). RESULTS: About 91 patients was enrolled in this study There were significant differences of body mass index (BMI) (p=0.01) between subgroup of knee OA grading. OR between grade 2 and grade 4 for BMI score highest tertile and BMI score lowest tertile were 5.26 (95% CI 0.59-47.20). There were no significant differences for age, sex, and duration of illness, T-BMD, L-BMD and T-BMC between subgroup of knee OA grading. There were a tendency of correlation on increased of age (OR 2.17, 95% CI 0.56-8.41), log-duration of illness, percentage of T-BMD (4% between grade 2 and 4) with increased of knee OA grading. There was a tendency decrease of percentage of L-BMD (of 7%) between grade 3 and 4. CONCLUSION: In this cross sectional model, BMI was significantly associated with increased of knee OA grading or it could be said that BMI was risk factors for radiographic progression of OA. Subjects who already have knee OA and also have high BMI must be careful about the progression of their knee OA.