Hepatocyte growth factor [HGF], HGF activator [HGFA] and c-met expression in rheumatoid synovial tissues in relation to disease activity

We examined the localization and mRNA expression of HGF, HGFA and c-Met in synovial tissues [ST] in rheumatoid arthritis [RA] in relation to disease activity to characterize its biologic function in that disease. Immunohistochemical staining and RT-PCRfor HGF, HGFA and c-Met were performed on ST specimens from 34 RA-patients and 20 osteoarthritis [OA] controls. Synovial fluid [SF] samples were taken from all RA and OA for measuring HGF with ELISA technique. Immunohistochemical staining of RAST revealed that HGFA and c-Met were strongly expressed infibroblasts, macrophages, endothelial cells and less so on synovial lining cells. But HGF was expressed faintly in macrophages andfibroblasts. While, in OAST, HGFA and c-Met were detected in the same cells as RAST but in a different distribution. HGF was localized in vascular endothelial cells. RT-PCR showed HGF, HGFA and c-Met mRNA in all RAST and all OAST. HGF levels in SF samples were higher in RA patients [range 5.6-39.2 ng/ml and mean 26.3 +/- 1.2 ng/ml] than OA controls [range 4.2-37.5 ng/ml and mean 11.2+2.4 ng/ml]. The differences were statistically significant [p<0.001]. A non-significant correlation was found between HGF-SF levels and disease activity score [DAS] [p>0.5]. HGFA, HGF and c-Met mRNA are expressed in ST in RA and OA. Lack of correlation between HGF-SF levels and DAS indicated that HGF played a regulatory role in the immunopathogenesis of RA

Role of high sensitivity C-reactive protein and bone scintigraphy in the assessment of erosive osteoarthritis of the hand

To investigate the role of serum C reactive protein [CRP] as a marker of erosive osteoarthritis [EOA] of the hand. sixty patients, 40 with EOA and 20 with non-EOA of the hand, were included in the study and analyzed for radiographic score [RS], number of erosions, and joint count [JC] at clinical observation and at bone scintigraphy. CRP was assayed in a serum sample by a highly sensitive immunonephelometric method. The median [interquartile range] CRP level was 4.7 [2.4-6.9] mg/l in the EOA and 2.1 [0.5-4.9] mg/l in the non-EOA group [p = 0.001]. In all patients, CRP correlated with RS [p<0.001], and mainly with JC at clinical observation [p<0.001] and at bone scintigraphy [p<0.001]. The correlation of CRP with RS and JC was confirmed at clinical observation and at bone scintigraphy in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup. CRP levels are higher in EOA than in non-EOA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and at bone scintigraphy

Role of anti-keratin antibodies in differentiation between early rheumatoid arthritis and polyarthritis associated with hepatitis C infection

Objective: To distinguish between rheumatoid arthritis [RA] and polyarthritis associated with hepatitis C virus infection [HCV] using a marker more specific to RA than the rheumatoid factor [RF] such as antikeratin antibody [AKA]

Methodology: Fifty rheumatoid factor [RF] positive patients were selected from those fulfilling the American College of Rheumatology [ACR] revised criteria. They were classified into two groups. Group I: 25 patients who were anti HCV antibodies seropositive. Group II: 25 patients who were anti HCV antibodies seronegative. In addition, 15 healthy individuals acted as controls. Investigations were done for all groups such as: Complete blood count [C.B.C], erythrocyte sedimentation rate [ESRO, C reactive protein [CRP], Antinuclear antibody [ANA] and [AKA]. Plain X- rays of both hands were done for all patients to exclude the patients with bone erosions

Results: Seropositive AKA was found in a high percentage in group [II] 60% whereas it was found in lower percentage in group [I] 12% and not found at all in control group. The specificity and sensitivity of AKA in group I was 91.1%, 60% respectively. Also, we found that the presence of AKA is associated with raised both ESR and CRP

Conclusion: Anti-Keratin Antibodies are a relatively simple means, which may help in discrimination of patients with HCV related arthritis from those with true RA

Detection of vertebral fractures versus bone mineral density in early ankylosing spondylitis

To determine bone mineral density [BMD] in patients with mild ankylosing spondylitis [AS], to establish the prevalence of vertebral fractures and fracture risk in these patients, and to determine the relationship between BMD and vertebral fractures. Twenty patients were compared with five healthy subjects were included in the study as a control group. Bone mineral density [BMD] was evaluated at the lumbar spine, forearm and femoral neck by dual X-ray absorptiometry [DXA] and A clinical index of disease activity [BASDAI; Bath Ankylosing Spondylitis Activity Index] was also evaluated and plain radiographs of the thoracic and lumbar spine were obtained in all subjects. In patients with AS, BMD was reduced in both the lumbar spine T score -1.0700 +/- 1.9572] and femoral neck [T score -1.3850 +/- 1.2999] and forearm [T score-.9150 +/- 7969] There was no correlation between BMD of the lumbar spine, forearm or femoral neck and duration of disease in patients with AS. four of 20 [20%] patients with AS had a vertebral fracture. Patients with AS with fractures were not significantly older [mean age 34.0 +/- 2.120P=0.301], but had significantly longer disease duration [7.4500 +/- 1.1459, P<0.05] than patients without fractures. No significant correlation between indices of disease activity [ESR and BASDAI] and vertebral fractures in patients with AS. No significant correlation was observed between BMD of the lumbar spine, forearm or femoral neck and vertebral fractures in patients with AS. In addition, there was no significant difference in the lumbar spine, forearm or femoral neck BMD in AS patients with fractures compared with those without. Osteopenia of spine, forearm and femur and vertebral fractures are a feature of mild AS. However, there was no correlation between BMD and vertebral fractures in these patients. AS patients with mild disease had a higher risk of fractures compared with the normal population and this increased with the duration of disease