Interstitial lung disease, a common manifestation of early onset polymyositis and dermatomyositis

This study included 30 patients [17 with polymyositis and 13 with dermatomyositis], they were 12 males and 18 females with a mean age 47 +/- 2.9 years and the aim of this work is to study the polymyositis- dermatomyositis associated interstitial lung disease [ILD] in the newly diagnosed cases .All patients were subjected to: Thorough medical history taking, complete clinical examination, Electromyograhpy, muscle biopsy, Spiro metric pulmonary function tests, arterial blood gas analysis [ABG], plain x-ray chest, high resolution computerized tomogram [HRCT] on chest, lung biopsy either fine needle aspiration under computed tomography [C.T.] guidance for 12 patients or trans- bronchial lung biopsy for 7 patients [Total number 19 patients who showed clinical and radiological picture compatible with ILD] and biochemical and auto antibody analysis for: Serum creatine kinase [CK], alanine and aspartate amino transferrase [ALT,AST], lactate dehydrogenase [LDH], Rheumatoid factor [RF], antinuclear antibodies [ANA] and antihistidyl-tRNA synthetase [anti- Jo-1]. Pulmonary manifestations alone presented by 20% of patients as initial manifestations, 19 out of the thirty patients proved to have interstitial lung disease. The majority were having non specific interstitial pneumonia NSIP [15 patients, 78.95%]. Our results showed that only 12 out of 30 patients had positive muscle biopsies findings and EMG changes of myositis. The anti Jo-1 antibody was more significant in patients with ILD than those without ILD [p>0.05]. Regarding the radiological abnormalities HRCT was more sensitive than x-ray in detecting such abnormalities and the most common abnormality was irregular linear opacities. The pulmonary function tests and chest radiological abnormalities were significantly correlated with both duration of disease and anti Jo-1 antibody [p> 0.05 and > 0.001 respectively]. ILD was frequently seen in patients with early onset polymyositis [PM] and dermatomyositis [DM]. PM/DM may be initially manifested with pulmonary manifestations. The anti Jo-1 antibody is significantly correlated with pulmonary function tests as well as abnormal radiological abnormalities for patients with ILD

Adrenocortical function relation to inflammatory markers in early untreated rheumatoid arthritis

To study adrenocortical function alterations in patients with early rheumatoid arthritis [RA]. 25 untreated patients with new onset RA were studied and compared with 25 age and sex-matched healthy subjects [controls]. All subjects were studied for plasma ACTH, cortisol, dehyroepiandrosterone sulfate [DHEAS], free and total testosterone, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor. No significant differences in the basal levels of ACTH, Cortisol, DHEAS, and total testosterone when comparing RA patients with controls were found, while there were statistically significant elevations in the inflammatory indices [ESR and CRP] and lower basal morning levels of free testosterone [Lower in males age >/= 45 years] in RA patients when compared with controls. From this study we concluded that adrenocortical function seem to be unaltered in early untreated RA patients

Relationship of disease severity to some biochemical markers of generalized osteoarthritis

To find out whether serum level of MMP-3, plasma level of TIMP-1 and urinary pyridinoline are specifically increased in generalized osteoarthritis [OA] or not. Also whether there is a relationship between those markers and the disease severity as detected clinically and radiologically. Thirty females suffering of generalized OA and 15 apparently healthy matched females as controls were studied. Serum MMP-3, plasma TIMP-1 and urinary pyridinoline were measured. The knee and hand joints were graded clinically [Steinbrocker] and radiologically [Kellgren and Lawrence]. Serum level of MMP-3, plasma level of TIM-1 and urinary pyridinoline were significantly higher in generalized OA patients than normal controls. The joint space width decreased with increasing Kellgren - Lawrence grade. All biochemical markers had negative correlations with the joint space width, but only urinary pyridinoline had a significant correlation. All biochemical markers had positive correlations with Steinbrocker grading. Some biochemical markers of OA may be of diagnostic value and a predictor for the severity of the disease in progressive generalized OA. The inhibition of their production and activity may decrease or delay the joint damage

Effect of epidural steroids on epidural infusion pressure and clinical outcome of degnerative lumbar spine disease

Assessment of epidural infusion pressure and clinical outcome in low back pain patients due to degenerative lumbar spinal disease before and after epidural steroid injection. This study was conducted on 30 patients, 20 males and 10 females with a mean age of 49 +/- 6.0. They used to complain of radicular low back pain with radiological evidence of degenerative lumbar disc herniation or spinal stenosis coming to the Pain Clinic of Zagazig University Hospitals for an epidural steroid injection. At the start of therapeutic intervention and after 4 weeks of treatment, low back pain intensity, tenderness severity on palpation, tension sign [straight leg raising test], functional disability, lumbar mobility and infusion epidural pressure were assessed. A significant decrease in epidural infusion pressure from baseline level was observed after epidural steroid injections. Significant improvements in pain, tenderness, disability, lumbar mobility and tension sign [straight leg raising test] were observed when comparing baseline values with that at the end of treatment. Epidural steroid agents have a clinical benefit because they provide pain relief, decrease outflow obstruction of epidural space, decreased drug dependence, and may decrease the need for surgery