Staphylococci in rheumatoid arthritis

To determine the prevalence of oral staphylococcal carriage in rheumatoid arthritis [RA] patients compared with healthy controls. The study was performed on 27 RA patients and 25 healthy volunteers. Clinical and laboratory data of RA activity were studied. Tongue and anterior nasal swabs were obtained for culture on blood agar. Isolates of Staphylococci were identified and collected from the oral cavity of 96.3% of RA patients, 53.8% of whom carried staphylococcus aureus. The carriage rate of staphylococcus aureus was significantly higher in RA patients than in healthy controls [p<0.05]. The oral carriage of staphylococcus aureus was common in RA patients, which might be the source of septic arthritis in such patients

Anti-cyclic citrullinated peptide [anti-CCP] antibodies in juvenile rheumatoid arthritis children

To determine if anti-cyclic citrullinated peptide antibodies [Anti-CCP] can be detected in sera of with juvenile rheumatoid arthritis [JRA] patients and to study its clinical significance. Serum anti-CCP antibodies were measured with ELISA technique in 20 JRA patients. Thirty adult RA patients and 20 apparently healthy children were also included in the study. Correlations between anti-CCP, disease characteristics, medication and radiological damage were also determined in JRA patients. Anti-CCP was positive in 10% [2/20] of JRA patients and in about 67% [20/30] of adult RA patients while it was not detected in healthy children. The two JRA patients were girls with seropositive [IgM-RF] polyarticular subtype. There was a statistically significant difference in radiological damage and rheumatoid factor seropositivity between anti-CCP positive and negative JRA patients. On the other hand, disease duration, antinuclear antibody positivity and medication did not differ statistically between the previous two groups. Anti-CCP antibodies can be detected in the sera of JRA patients but less frequently present than adults with RA. Anti-CCP antibodies are exclusively present in the subset of seropositive polyarticular JRA

Effect of progressive resistance training on glycemic control in elderly type II diabetic patients

To investigate the effect of progressive resistance training [PRT] on glycemic control in elderly type II diabetic patients. The study was conducted on 40 elderly individuals with type II diabetes. They were divided into 2 equal groups. The progressive resistance training [PRT] group received 16 weeks of PRT program plus the usual diabetic care, while the control group received a controlled exercise program plus the usual diabetic care. Glycemic control, lipid profile, resting blood pressure, muscle strength and anthropometry were evaluated for the 2 groups at baseline and at end of the study. For the PRT group we found a highly significant reduction in glycosylated hemoglobin level [HbA1c] [t=13.64, p<0.001], highly significant increase in muscle strength [t=10.19, p<0.001], trend for reduction in blood pressure and trend for reduction in triglyceride level. PRT when included with usual diabetic care for elderly people with type II diabetes is of benefit in glycemic control and at the same time is safe and well tolerated

Bone mineral density in premenopausal women with rheumatoid arthritis and systemic lupus erythematosus

Little is known about bone mineral density [BMD], as measured by dual energy x-ray absorptiometry [DEXA], in patients with rheumatoid arthritis [RA] versus matched systemic lupus erythematosus [SLE] and healthy controls at the same time. However, most of these data have been confined to Caucasian population with conflicting results. Also factors controlling bone homeostasis may be different between ethnic groups with lacking data in Orientals. Is to study BMD in premenopausal women with RA and to compare the data of RA patients with matched SLE patients and healthy controls. Moreover, is to evaluate the possible relationship between BMD and disease variables. This study included 60 premenopausal women divided into three equal groups, 20 subjects each, RA patients group, SLE patients group, and healthy controls group. BMD at the lumbar spine [L1-L4] was measured by DEXA. Also, disease variables and biochemical parameters were assessed. Patients with RA and SLE had significantly lower BMD values at lumbar spine compared to healthy controls [p=0.0001]. Similar BMD values were detected in RA and SLE patients. Osteopenia was detected in 40% of RA and SLE patients groups, while osteoporosis [OP] was detected in 40% and 30% of those patients, respectively. There was no correlation between BMD and age of patients, body mass index [BMI], disease activity, as well as disease duration. In contrast, there was an inverse correlation between BMD and dose as well as duration of corticosteroid [CS] therapy [p<0.05]. A high incidence of low BMD at the lumbar spine was found in our premenopausal women with RA and SLE on chronic CS and calcium supplementation compared with healthy controls. In those patients, BMD was related to the dose and duration of CS therapy, but not with disease duration or disease activity

Assessment of fatigue in ankylosing spondylitis patients: clinical and self-reported measures

Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis [AS]. However, fatigue has been reported as the major complaint of AS patients. To evaluate fatigue as a potential independent domain in comparison to the conventional ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug [NSAID] therapy. Twenty patients were selected as having painful AS [modified New York criteria 1984]. The following variables were recorded at baseline and after six weeks of NSAID therapy: pain [VAS], function [Bath Ankylosing Spondylitis Functional Index], patient's global assessment [VAS], inflammation [night pain], morning stiffness, metrology [Schober test, finger-to-floor] and fatigue using 0-100 VAS scale. Analysis consisted of the prevalence of fatigue [VAS value of at least 50mm] and the sensitivity to change, by calculating the standardized response mean [mean change / S.D. change] [SRM] between before and after NSAID therapy. Fatigue was considered important in 14 patients [out of 20: 70%]. The information provided by pain, function and global assessment explained only 44% of the variability of the variable "fatigue" [similar analyses considering "pain" on the one hand and "function" on the other hand as the dependent variables showed an R value of 34 and 60%, respectively]. The NSAID treatment effect [SRM] was higher for the variables "pain" and "function" [0.76 and 0.71 respectively] than for "fatigue" [0.34]. This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on fatigue than on pain or functional impairment

Role of ultrasonography in the diagnosis and management of plantar fasciitis

To evaluate the sonographic features of plantar fasciitis and to investigate the efficacy of ultrasound-guided local steroid injection in its management. Forty patients, aged 25-55 years who had a clinical diagnosis of plantar fasciitis, 1-3 years previously and twenty age-matched healthy volunteers [control group], were evaluated with conventional x-rays then with ultrasound using a 7.0 MHZ linear-array transducer. All patients had calcaneal spurs in their X-rays. Heel pain was unilateral in 24 patients and bilateral in 16. Sagittal sonograms were obtained, and the thickness of plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other findings including hypoechoic fascia, fiber rupture, perifascial fluid collections and calcifications were searched for. Evaluations were performed before, at 2 weeks and 3 months after a single dose of ultrasound-guided local steroid [7 mg Betamethasone and 0.5ml of 1% lidocaine] injection into the inflamed plantar fascia. Pain intensity was quantified with a tenderness threshold [TT] and visual analog scale [VAS]. Plantar fascia thickness was significantly increased in heels of patients with plantar fasciitis [mean 3.91 +/- 0.53] as compared to control [mean 2.13 +/- 0.18] [p<0.0005]. The mean thickness of the plantar fascia had decreased significantly on evaluation after 2 weeks [mean 3.73 +/- 0.53] [p<0.05]. While after 3 months there was a highly significant decrease [mean 2.39 +/- 0.43] [p<0.0005]. The mean VAS score and TT showed a highly significant improvement on evaluation after 2 weeks and 3 months [mean 4.57 +/- 0.98, 1.55 +/- 0.84 and 7.12 +/- 0.75, 9.47 +/- 1.66 respectively, p<0.0005]. The comparison between the second and third evaluations of all our parameters showed a highly significant improvement [p<0.0005]. The proximal plantar fascia was diffusely hypoechoic as compared to controls. No fascial rupture, perifascial fluid collection or calcifications were identified. Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. Sonography provides sufficient information for the physician to confirm an initial diagnosis of plantar fasciitis and assess individual treatment regimens

Level of serum transforming growth factor-beta1 in different rheumatological disorders

To detect the serum level of transforming growth factor- beta[1] [TGF- beta[1]] in Beh‡et disease, systemic lupus erythromatosis [SLE] and rheumatoid arthritis [RA]. Also, to compare them with healthy controls, to determine the relationship between TGF- beta[1], and other parameters of disease activity. The study was performed on 50 subjects. Ten patients had Beh‡et disease, 14 had SLE, 16 had RA besides 10 healthy controls. At the time of the study, all patients had clinically active disease and were subjected to detailed clinical assessment and laboratory investigations. None of them were using immunosuppressive drugs. Steroids were discontinued 30 days before blood samples were collected. Estimation of serum TGF- beta[1] was done using TGF- beta[1] Elisa kit. There was a statistically significant decrease in the mean level of TGF- beta[1] in our SLE group, while there was a statistically significant increase in our RA group. On the other hand, there wasn't any statistically significant difference in our Beh‡et group as compared with the control group [mean 72.5 +/- 9.6, 139.3 +/- 23.8, 105.0 +/- 4.7, 102.0 +/- 8.5, p<0.05, p>0.05 respectively]. Neither sex nor the presence of oral or genital ulcers, eye affection, or superficial or deep phlebitis showed any significant difference in Beh‡et patients with or without those manifestations [p>0.05]. The mean serum level of TGF- beta[1] showed a negative significant correlation with disease duration in the Beh‡et group [r: -0.65, p<0.05]. In the SLE group, a significant difference in the mean level of TGF- beta[1] was detected only in patients having CNS manifestations, Raynauds phenomenon or oral ulcers [p<0.05]. Also, there was a negative correlation between the ESR and TGF- beta[1] [r: -0.93, p<0.05]. In the RA group, patients having positive rheumatoid nodules showed a significant difference in level of TGF- beta[1] [p<0.05]. Both the disease activity index and the ESR showed a positive significant correlation with level of TGF- beta[1], while both the disease duration and total leucocytic count showed a negative one [r: 0.59, r: 0.72, - 0.55, -0.85 respectively, p<0.05]. Our results suggest that the serum level of TGF- beta[1] could play a role in the immunologic defect of different rheumatological disorders

Serum and synovial oncostatin M and leukemia inhibitory factor in rheumatoid and osteoarthritis

To measure levels of oncostatin M [OSM] and leukemia inhibitory factors [LIF] in the serum and synovial fluid of rheumatoid arthritis [RA] and osteoarthritis [OA] patients. Also, to correlate their levels with the parameters of disease activity in RA and severity in both RA and OA. This study was conducted on 20 RA patients, 10 OA patients and 10 healthy controls. Serum and synovial fluid levels of both OSM and LIF were measured using quantitative sandwich enzyme immunoassay technique. The mean levels of serum and synovial OSM as well as LIF were significantly higher in RA patients than controls [30.3 +/- 14.5, 252 +/- 117, 23.5 +/- 5.2, 41.8 +/- 7.2 pg/ml respectively, p<0.001]. Similar findings were also detected only in synovial OSM and LIF of OA patients [39.5 +/- 4.8, 22.4 +/- 4.5 pg/ml respectively, p <0.001]. On comparing RA and OA patients, there was a highly significant increase in the serum and synovial OSM as well as LIF in RA patients [p <0.001]. Also, there was a highly significant correlation between the serum and synovial OSM in RA and OA patients. Similar findings were found between synovial OSM and LIF as regards the activity score, total number of WBCs and ESR. Stepwise multiregression analysis revealed that serum LIF and ESR were the best parameters to discriminate patients with more active RA. On the other hand, serum OSM, peripheral WBC count and synovial LIF were the best parameters to detect the severity of the disease. Our results confirm the role of both OSM and LIF as important factors that mediate the pathophysiologic events in RA, besides their role in detection of activity of RA and severity of both RA and OA

association between rheumatoid arthritis and hepatitis C virus infection

To study the association between rheumatoid arthritis and HCV infection. The study included 40 RA patients diagnosed according to the ACR criteria [group I]. It also included 20 inflammatory arthritis patients with RF positive but not fulfilling the criteria for diagnosis of RA [group II]. Ten age and sex matched subjects were taken as controls. Anti HCV antibodies were detected in the sera of these patients. 0.5% of the patients of group I had anti HCV antibodies while 20% of patients of group II had anti HCV antibodies. As regards the control group, none was anti HCV antibody positive. There is a strong association between the presence of anti HCV antibodies and rheumatoid factor that is stronger than the association between anti HCV antibodies and rheumatoid arthritis. Patients with anti HCV antibodies may have rheumatoid factor positive in their serum, but the picture may not fulfill the criteria of RA. Thus in any case of inflammatory arthritis, hepatitis C virus must be put in consideration