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