Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power doppler ultrasonography: correlation with disease activity

Assessment of synovitis in rheumatoid arthritis [RA] is a major issue for proper treatment; it has been proven that high resolution ultrasound [US] examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. We evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 [DAS 28]. Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. Serum CXCL13 level was significantly increased in early RA patients vs. controls [p < 0.001]. High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 [r = 0.42, p = 0.02], synovial thickness [r = 0.39, p = 0.03] and power Doppler US score [r = 0.43, p = 0.02]. Serum CXCL13 level correlated with synovial thickness [r = 0.63, p = 0.001] and power Doppler US score [r = 0.69, p = 0.001] Recent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28

HLA-DRB1 in Egyptian rheumatoid arthritis patients and its association with anti-CCP antibody and disease activity

Rheumatoid arthritis [RA] is a multifactorial disease involving environmental and genetic components. A complex group of human leucocyte antigen [HLA] class II alleles are associated with an increased risk of developing RA, but their exact role in its pathogenesis remains unclear. Many studies examined the hypothesis that shared epitope [SE]-containing HLADRBl alleles can account for these associations. The presence of anti-cyclic citrullinated peptide antibody [anti-CCP] has been associated with RA development. We aimed to assess presence of HLADRBl in RA patients and its association with anti CCP and disease activity. Forty rheumatoid arthritis patients were assessed clinically with disease activity score [DAS]. Serum rheumatoid factor [RF] and anti CCP antibodies level were assessed. HLA-DRBl typing was done with sequence specific oligonucleotide probe [SSOP] technique and was compared with normal Egyptian population. HLA-DRBl 04 were the most frequent allele followed by HLADRBl 10 in RA patients [30.2%, 7.9% respectively]. HLA-DRBl 03 and HLA-DR Bl 02 were found to be protective alleles as they are less frequent in the patients than the controls. HLA-DRBl 04 showed a significant positive association with both positive anti-CCP antibodies and RF level. Concerning the disease activity, HLA-DRBJ 04, HLA-DRBl 08 and HLA-DRBl 01 showed a significant association with higher disease activity. HLA-DRBl 04 gene may be not only an indicator for the development of rheumatoid arthritis but also associated with positive anti-CCP antibody production and higher disease activity

Assessment of osteoporosis in psoriasis with and without arthritis: correlation with disease severity

To assess osteoporosis in psoriatic and psoriatic arthritis [PsA] patients, by dual energy x ray absorptiometry [DEXA], and measuring serum osteoprotegrin [OPG] level, and to correlate findings with the extent of both skin and joint manifestations. Fifty psoriatic patients [16 of them had arthritis] were assessed by psoriasis area and severity index [PASI]. Total joint score was used to assess joint manifestations in PsA patients. DEXA were done for all patients and 20 healthy controls. Laboratory assessment of erythrocyte sedimentation rate, serum calcium, rheumatoid factor, and OPG was done. Fifty OPG level was significantly increased in both psoriatic and PsA patients in comparison to controls. However, PsA patients had more significant osteoporosis in neck of femur and wrist as detected by DEXA. In PsA patients, total joint score was positively correlated with disease duration and extent of skin involvement [area score of PASI] and negatively correlated with Z score of femur. Psoriatic patients with or without arthritis could suffer from osteoporosis as evidenced by significantly increased OPG. Prolonged and extensive cutaneous disease is an important risk factor for the development and severity of PsA

Nerve conduction study of sensory distal nerves in mild diabetic foot neuropathy

Nerve conduction studies of distal sensory nerves are used in diagnosis of polyneuropathy. However at present, there is little data about electrophysiological assessment of these nerves according to severity of polyneuropathy. In this study, we aimed to evaluate sural, dorsal sural and medial plantar nerve conduction studies in different grades of mild diabetic sensory polyneuropathy. Twenty diabetic patients with mild degree of sensory polyneuropathy according to neuropathy disability score, and 20 healthy subjects served as control group were included in this study. In all subjects, motor nerve conduction of posterior tibial nerve, F wave, and sensory nerve conduction of sural, dorsal sural and medial plantar nerves were performed bilaterally. There was a significant statistical reduction in the sural, dorsal sural and medial plantar nerves amplitude with a reduction in the conduction velocities and delay in peak latencies of these nerves between diabetic patients and controls. The sensitivity of medial plantar nerve amplitude was 90%. However, dorsal sural nerve amplitude showed a significant reduction with different grades of diabetic polyneuropathy [p<0.05]. Medial plantar nerve has the highest diagnostic sensitivity. Dorsal sural nerve may be used in following up progression in mild diabetic sensory polyneuropathy

Assessment of sleep breathing disorders in ankylosing spondylitis patients

To investigate the occurrence of obstructive sleep apnea [OSA] as one of common sleep breathing disorders in patients with Ankylosing Spondylitis [AS] and its relation to disease duration, activity and pulmonary function tests. This study included 15 male patients with AS fulfilled the Modified New York criteria for diagnosis of AS. All the patients were subjected to full medical history, thorough general and local examination of the chest, ear, nose and throat [ENT], pulmonary function tests [FVC- FEV 1 and FEV 1/FVC] and one night polysomnography [PSG] at the sleep laboratory. Polysomnographic data revealed OSA in 5 cases [33.3%] and normal sleep pattern in 10 cases [66.7%]. There was statistically non significant difference between patients with and without OSA as regards disease activity and the results of pulmonary function tests [p>0.05] while patients with OSA showed higher body mass index [BMI] and longer disease duration than patients with no evidence of OSA [p<0.05]. OSA is commonly associated with patients with AS. Early detection of this sleep breathing disorder in patients with AS will help to improve the fatigue symptoms in these patients, decrease their suffering as well as decrease the morbidity and mortality of OSA