Bone turnover markers in relation to menopause in rhematoid arthritis patients

Biochemical markers of bone turnover are extremely useful for the management of generalized osteoporosis associated with rheumatoid arthritis [RA]. They provide information that is different and complementary to bone mass measurements. We assessed the effect of menopause and disease activity on bone turnover markers in RA patients by measuring two bone formation markers ;Bone Alkaline Phosphatase [BAP] and Osteocalcin [OC] as well as two bone resorption markers by measuring urinary pyridinoline [PYD] and deoxypyridinoline [D-PYD]. The present work was done on 80 females aged between 35-65 years. They were divided into two groups: Group I normal controls [NC] constituted 20 females; 10 premenopausal [Pre NC] and 10 postmenopausal [Post NC]. Group II RA patients: 30 premenopausal RA [Pre RA] and 30 postmenopausal RA [Post RA]. Among bone formation markers, both BAP and OC were significantly lowered in RA than in NC [p<0. 05 each] particularly in postmenopausal period. On the other hand bone resorption markers urinary PYD and D -PYD were increased in RA in comparison to NC during both premenopause and postmenopause [p<0. 05 each] and menopause exaggerated this condition. Meanwhile, RA activity altered bone formation markers with increased OC in premenopausal [p<0. 05] and decreased BAP in postmenopausal period [p<0. 05]. On the other hand, RA activity exaggerated the increased bone resorption markers PYD and D-PYD especially in the postmenopausal period [p<0. 05 each]. Both RA and menopause accelerated osteporosis by inducing a disequilibrium between bone formation markers [BAP and OC] and bone resorption markers [PYD and D-PYD]. While bone formation markers were reduced, bone resorption markers were exaggerated. RA activity further altered bone formation markers and exaggerated bone resorption markers which should be considered during management of osteoporosis. Furthermore, biochemical markers of bone turnover are simple, cost effective, non-invasive methods that offer an alternative to bone imaging techniques

Early detection of cervical myelopathy in some rheumatic diseases using somatosensory and motor evoked potentials

Neurological affection in rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc] may be subclinical but once they occur, they are irreversible and add an extra burden and suffering to the patient's lives. Early detection of such disease subclinical neurological affection helps a lot in the early intervention to prevent and avoid the irreversible damage to the nervous system. To characterize the neurological manifestations in RA, SLE and SSc and to obtain the electro-physiological documentation of possible cervical myelopathy. Twenty four RA patients, 11 SLE patients, and 9 SSC patients were included in this study. Thirty control age and sex matched persons were also enrolled. All subjects were submitted to the following: clinical and systemic examination, rheumatological and neurological examinations for signs of myelopathy or neuropathy. Laboratory studies included complete blood count, liver function tests, kidney function tests, erythrocyte sedimentation rate [ESR], C- reactive protein [CRP], and quantitative Rheumatoid factor tests. Specific tests were anti-nuclear antibody [ANA], anti-double stranded DNA [ds-DNA], anti SCL70, and Anti cardiolipin antibodies. Somatosensory and motor evoked potentials [SSEP, MEP] of upper limbs were recorded. Overt neurological signs were found in 50% of SLE patients, which are much more than that found in RA [29%] and SSC [22.2%]. Clinical cervical myelopathy was recorded in 40% in SLE, 22.2% in SSC and 16.7% in RA. Cervical myelopathy was detected with SSEP and MEP in 50% of SLE, 66.6% in SSC, and 20.8 in RA. There was a significant correlation between central conduction time with rheumatoid factor [p=0.017], anticardiolipin antibody [p = 0.001], and anti ds DNA antibody [p= 0.00!] in RA. The results support that SSEP and MEP are the most reliable data evaluating the risk of cervical myelopathy in some rheumatic diseases

Evaluation of some angiogenic stimulators in rheumatoid and osteoarthritis patients

Angiogenesis, the development of new blood vessels, is important in rheumatological disorders. Vascular endothelial growth factors [VEGF], itnerleukin-8 [IL-8] and nitric oxide [NO] are important angiogenic stimulators that play a crucial role in angiogenesis. Serum levels of VEGP, IL-8 and NO were determined in 20 rheumatoid arthritis [RA] patients; 32 osteoarthritis [OA] patients and 10 completely healthy individuals comparable to patients in age and serving as a control group. The serum levels of these bioindices were correlated to criteria of activity of RA and OA. The study revealed significantly increased levels of angiogenic factors in RA and OA as compared to controls. However, the levels of VEGP and IL-8 were insignificantly higher in RA as compared to OA. But NO levels were significantly higher in RA as compared to OA. The levels of these indices were related to activity criteria of RA, being higher in patients with greater number of joints affected, advanced function loss or x-ray grade, and correlated significantly with ESR and articular index as well. In OA, VEGP, IL-8 and NO reflected the activity of the disease, being higher in advanced grades of disease and correlated with ESR. The sources of these agiogenic stimulators are multiple. They can be derived from a variety of activated cells [including chondrocytes, synovial cells and macrophages]. The effect of some currently used antirheumatic agents could be attributed to their effects on those angiogenic stimulators. New pharmacologic interventions using new antiangiogenic drugs could be helpful in rheumatology