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

Magnetic resonance imaging of the brain in systemic lupus erythematosus

To evaluate the brain magnetic resonance imaging [MRI] findings in patients with systemic lupus erythematosus [SLE]. Thirty female SLE patients were included in this study. Their age ranged from 19 to 60 years. All patients were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI], assessment of SLE-related disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] damage index and MRI study. Out of the 30 SLE patients, thirteen [43.33%] had neuropsychiatric [NP] manifestations, and twelve [40%] had Abnormal MRI findings. Eight of the 13 patients with NP [61.54%] manifestations had abnormal MRI findings. The SLE patients with NP manifestations had statistically significant [p<0.05] higher frequency of the abnormal MRI findings than the SLE patients without NP manifestations. The patients with abnormal MRI findings had statistically significant [p<0.05] higher SLICC damage score than the patients with normal MRI. There were statistically nonsignificant [p>0.05] differences between the patients with abnormal MRI findings and the patients with normal MRI regarding the age, disease duration, SLEDAI, C3, C4, anti-ds-DNA antibodies, use of glucocorticoids ever or current use and the prednisolone dose at the study. Our results suggest that MRI has an important role in the management of SLE patients

Plasma adrenomedullin level in systemic lupus erythematosus patients and its relation to disease activity and lupus nephritis

To study the plasma adrenomedullin [AM] level in systemic lupus erythematosus [SLE] patients and investigate its relation to disease activity and lap us nephritis. Taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and plasma AM assay. Renal histopathology was done for the patients with overt renal involvement. Patients were divided into two subgroups: subgroup [1a] included patients with a history of renal involvement, and subgroup [1b] included patients without renal involvement. Ten age and sex-matched healthy subjects were included as a control group. SLE patients had highly significant higher plasma AM concentration than controls. In SLE patients, there was significant positive correlation between plasma AM concentration and each of SLEDAI and prednisolone dose. On the other hand, plasma AM concentration didn't show significant correlation with age, SLE disease duration, creatinine, proteinuria, C3 and C4. Subgroup [1a] had statistically significant higher plasma AM concentration and higher SLEDAI with increased proteinuria and creatinine than subgroup [1b]. SLE patients had higher plasma AM concentration than controls. SLE patients with a history of renal involvement had significant higher plasma AM concentration than those without renal involvement. These results suggest that AM has a role in the pathogenesis of SLE and lupus nephritis

Diagnostic role of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis and its relation to disease activity

To determine diagnostic value of anti-cyclic citrullinated peptide antibodies [anti-CCP] in rheumatoid arthritis [RA] patients, and its association with disease activity. Thirty RA female patients were included in this study. All patients were subjected to full history taking, thorough clinical examination, laboratory investigations, assessment of disease activity using Disease Activity Score 28 [DAS28] and anti-CCP assay. Ten age and sex-matched healthy subjects were included as a control group. Twenty one out of the 30 RA patients were anti-CCP positive while 9 were anti-CCP negative. All the 10 controls were anti-CCP negative. The sensitivity of the anti-CCP test for RA was 70% and the specificity was 100%. Twenty three RA patients were rheumatoid factor [RF] positive while 7 were RF negative. One out of the 10 healthy controls was RF positive. The sensitivity of the RF was 76.67% and the specificity was 90%. Nineteen out of the 21 anti-CCP positive patients' were RE positive while 4 out of the 9 anti-CCP negative patients were RE positive. The presence of either anti-CCP or RF increased testing sensitivity to 83.33%. There were statistically nonsignificant differences between the anti-CCP positive and negative patients regarding age, disease duration and DAS28. On the other baud, there were statistically significant differences between them regarding the frequency of RF, CRP and ESR. The anti-CCP antibodies had comparable sensitivity and higher specificity than the RF. The presence of either anti-CCP or RF increased testing sensitivity. It is suggested that anti-CCP antibodies assay has a useful role in the diagnosis of RA and might have an association with the disease activity

Serum interleukin-16 level in systemic lupus erythematosus

To detect serum interleukin-16 level in patients with systemic lupus erythematosus and to find out its correlation with disease activity. The study included 30 female patients with systemic lupus erythematosus. 20 apparently healthy females with matched age represent the control group. All patients subjected to full history taking, thorough clinical assessment of disease activity using SLE Disease Activity Index [SLEDAI] serum level of IL-16 mere examined using an enzyme-linked immunosorbent assay [ELISA]. Serum level of interleukin-16 [IL-16] was significantly increased in patients with systemic lupus erythematosus compared to controls and there was a significant positive correlation between IL-16 levels and disease activity assessed by the SLEDAI score. Circulating IL-16 levels are high in SLE patients and are correlated with the disease activity so serum level of IL-16 can be used as a useful indicator of SLE disease activity

Possible role of serum levels of vascular endothelial growth factor and endostatin in rheumatoid arthritis angiogenesis imbalance

To measure serum levels of the main angiogenic inducer marker [VEGF] and the main angiogenic inhibitor marker [endostatin] in rheumatoid arthritis patients. Also, to study their correlation to clinical and laboratory variables of the disease in an attempt to provide more insight regarding their possible role in the angiogenesis imbalance and pathogenesis of RA. Twenty RA patients and fifteen age and sex matched healthy persons served as a control group underwent full history taking, thorough clinical examination, and routine rheumatological profile. Measurement of serum VEGF and endostatin levels were done using enzyme linked immunosorbent assay [ELISA] in rheumatoid arthritis patients and compared with controls. Comparison between patients with or without systemic involvement regarding serum level of VEGF was done. Correlations between serum levels of VEGF and signs of disease activity were also done. A highly significant increase in the mean values of serum VEGF was found in RA patients compared to control subjects [t=11.83, p<0.00l], while there was no statistically significant difference between both RA and control groups regarding mean values of endostatin [t=0.06, p>0.05]. In addition a highly significant increase in the mean values of serum VEGF was found in RA Patients with extra-articular manifestation [EAM] compared to Patients without EAM [t=2.98, p<0.0l]. Serum VEGF was positively correlated with ESR, DAS, and CRP [r =8.48, p<0.01; r = 0.542, p< 0.5; and r = 0.49, p< 0.5] respectively. We found an imbalance between the production of angiogenic growth factors and angiogenic inhibitors in RA. This may play an important role in the angiogenesis imbalance and pathogenesis of RA. In addition we conclude that VEGF level is related to disease activity and extra-articular manifestation of RA, so it can be considered a good indicator for evaluation of disease activity, systemic organ involvement and planning treatment strategies

Orthostatic hypotension in stroke patients

To assess the incidence of orthostatic hypotension [OH] in stroke patients undergoing rehabilitation and to determine clinical variables associated with it. Thirty patients with a first clinical stroke who underwent rehabilitation within one month of stroke onset were included in this study. They were 17 males and 13 females. Their age ranged from 49 to 68 years [mean +/- SD= 58.1 +/- 6.3]. Patients were subjected to full history taking, thorough clinical examination and investigations. Patients' blood pressure was measured in the supine position and on tilting at 90[0]. OH was defined as a drop in systolic blood pressure [SBP] of 20 mmHg or more. OH was present in 14 [46.7%] patients. Age was highly significantly associated [p<0.001] with OH and admission modified Barthel Index [MBI] score was significantly associated [p<0.05] with OH. There was a non-significant correlation with the site of stroke or the use of anti-hypertensives. OH was common in stroke patients undergoing inpatient rehabilitation especially in older patients who have a lower functional status

Musculoskeletal pain in obese Egyptians

Obesity is associated with musculoskeletal pain and osteoarthritis. This study compares the prevalence of work-restricting musculoskeletal pain in obese and general population and investigates changes in the incidence of and recovery from musculoskeletal pain after surgical or conventional obesity treatment. A random sample of 50 subjects from the general population was compared with 50 obese subjects. For the obese subjects, information about musculoskeletal pain was also collected 6 and 12 months after obesity surgery or the start of non-surgical treatment. In both sexes, work-restricting pain in the neck and back regions and in the hip, knee and ankle joints was more common in the obese subjects than in the control population. Operated obese women had a lower incidence of work-restricting pain in the knee and ankle joints as compared with the conventionally treated control group over 6 and 12 months. Among subjects reporting symptoms at baseline, the recovery rate for pain in the knee and ankle joints in obese men and pain in the neck and back and in the hip, knee and ankle joints in obese women improved in the surgical group as compared with the control group after 12 months. Obese subjects have more problems with work-restricting musculoskeletal pain than the general population. Surgical obesity treatment reduces the long-term risk of developing work-restricting musculoskeletal pain and increases the likelihood of recovering from such pain

Effects of physical exercise on HCV chronic active hepatitis patients

Infection with HCV shows a high prevalence in our country and often becomes chronic and proceeds to a state of chronic active hepatitis, a condition which is not easy to treat and almost always end up in liver cirrhosis as well as a high risk of hepatocellular carcinoma. The aim of the this work was to study the effect of regular physical exercise over a period of 6 weeks on some parameters usually used to evaluate the liver condition and the activity of the disease. Patients were randomized into 3 groups; Group I: 20 patients with chronic active hepatitis due to infection with HCV and showed a significant reduction in ALT and AST levels over the period of the exercise program. Group II: 20 patients with decompensated liver condition due to HCV infection with at least one of the manifestations of liver cell failure and exhibited a bad exercise tolerance with non-significant changes in their laboratory data. Group III: 20 patients with compensated HCV liver disease were not included in the exercise program and were considered as a control group. It was concluded that physical exercise was well tolerated by HCV chronic active hepatitis patients and may be of benefit while in decompensated patients physical exercise should be restricted as much as possible

Role of extended field of view ultrasonography in musculoskeletal disorders

Real time ultrasound [U/S] scanning is useful to detect abnormalities of musculo-skeletal system [MSK] and shows the effect of movement. However, documentation is best with the extended field of view [Fov] ultrasonography. This new imaging technique identifies identical structures on two successive images for position registration to display a large area in real time without position sensors. To evaluate the usefulness of extended Fov U/S in displaying and documenting on a single, static image a more panoramic depiction of MSK abnormality and its relationship to adjacent structures. Abnormalities of tendons, muscles, and soft tissue infection and masses are examples of lesions documented by high frequency extended Fov U/S. The study was monitored for 24 months period and included 18 patients [7 males and 11 females] of variable age groups. Six patients with tendon pathology, three with muscle pathology, eight with soft tissue masses, and one with a bony lesion. Large resolution preserved composite images of up to 30 cm were obtained. The display of the relationship of abnormalities to surrounding structures is very important and allows for better interpretation of findings and appreciation of the diagnosis on a static image. In addition, easily useful applicable comparative measurements on follow up scanning were done. Extended Fov U/S allowed: [a] better appreciation of MSK disorders [b] sizing of large masses on a single global image [c] relating the lesion to surrounding structures [d] greater measurement reproducibility at follow up scanning in circumstances under which conventional real time scans could not provide this information