Pulomanry involvement in asymptomatic Systemic Lupus Erythematosus patients with antiphospholipid syndrome multislice CT angiography and pulomnary involvement in asymptomatic SLE patients with APS

To detect the pulmonary involvement in asymptomatic secondary APS patients by pulmonary function tests [PFTs] and chest multislice HRCT angiography. Comparing the pulmonary findings to those of asymptomatic SLE patients without APS was considered. Thirty-four SLE patients with APS and another 34 SLE patients without APS and with a negative ACL test were included as control. All patients were asymptomatic for any pulmonary manifestations. Plain chest X-ray, HRCT angiography and PFTs were performed for all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] while assessment of organ damage was made using the Systemic Lupus International Collaborating Clinics/ACR [SLICC/ACR] index. There were abnormal pulmonary CT findings in 11 [32.35%] of the asymptomatic secondary APS patients with an obvious association to lupus anticoagulants. However, plain X-ray showed basal atelectasis and/or elevation of the copulae in four patients. Pulmonary abnormalities included a high frequency of pulmonary artery aneurysms [20.59%] thrombosis, basal atelectasis, embolism, bronchiectasis, pleural effusion and thickening. The SLEDAI and SLICC were significantly higher in APS patients. More SLE patients without APS were receiving hydroxychloroquine which suggests a protective role on the thromboembolic events occurring in APS. Multislice HRCT pulmonary angiography, with its multiplanar capability, vascular reconstruction and high quality, is useful in demonstrating the entire thoracic spectrum in asymptomatic APS patients. Particular concern about the medications used in APS could prevent the risk of developing noticeable thromboembolic events

Impaired bone formation and osteoporosis in postmenopausal elderly onset rheumatoid arthritis patients

Bone metabolism may be uncoupled in postmenopausal rheumatoid arthritis [RA]. Osteoporotic fracture in RA is highest for the hip especially in elderly women. To detect the bone mineral density [BMD] and markers of bone turnover in postmenopausal RA patients and study the influence of age at disease onset. Correlation with clinical and laboratory manifestations and disease activity were considered. Sixty postmenopausal RA patients were recruited into two groups, group I: 30 elderly onset [EORA] and group II: 30 young onset [YORA] patients. Thirty age and sex matched healthy subjects served as control. Full history taking, clinical examination, relevant investigations including calcium, phosphorus, total alkaline phosphatase [ALP], bone specific alkaline phosphatase [BALP], osteocalcin [OC], and N-terminal cross-linked telopeptides of type I collagen [NTX] were measured and BMD assessed by DEXA in all patients and control. Disease activity score in 28 joints [DAS-28] was calculated. The NTX was remarkably increased and the BMD decreased in RA patients. Osteocalcin in RA was 3.87 +/- 1.15 ng/ml being obviously lower in EORA patients compared to YORA and control. In EORA, a significant correlation was present between the ALP and OC [r 0.41, p 0.025] and the NTX and BALP [r 0.46, p 0.011] and a negative correlation between the hip BMD and DAS-28 [r -0.43, p 0.019]. Impaired bone formation and uncoupling of bone turnover are more evident in postmenopausal EORA patients which form a risk predictor of fracture hip in this subgroup of patients

Differentiation of osteoporotic and neoplastic vertebral fractures by [in-phase and out-of- chemical shift MR imaging

Objective: The objective of this study was to establish the cutoff value of the signal intensity drop on chemical shift magnetic resonance imaging [MRI] with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine

Patients and Methods: All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensities after [in-phase and out-of-phase] images were obtained. A DEXA was performed

Results: A total of 40 patients were included, 20 with osteoporotic wedging [group. 1] and 20 neoplastic [group.2]. They were 21 males and 19 females. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups [p <0.05]. At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%

Conclusion: A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process