Vitamin d status in adolescent idiopathic scoliosis in girls

To investigate the correlation between vitamin D status in Adolescent Idiopathic Scoliosis [AIS] in girls. Assessment of 25-hydroxycholecalciferol [25[OH] D], parathyroid [PTH], Osteocalcin, serum deoxypyridinoline [DPD], serum calcium, phosphorus, albumin, alkaline phosphatase, and cobb angles in 20 female patients with AIS and in 20 healthy females aged between 12-14 years was performed. Our results asserted that vitamin D levels in the AIS group had a mean of 32.300 +/- 5.2, which is in the level of vitamin D insufficiency [levels <40 nrnol/L]. The control group showed a mean vitamin D level of 87.18 +/- 4.6, which is on the lower margin of normal vitamin D level. All of our AIS patients had angles less than 40 degrees [mean 24.67+7-3.05] that is categorized as moderate. Most patients with vitamin D levels below or equal to 30 nmol/L had an angle above 20 degrees, whereas most of those with vitamin D levels above 30 nmol/L had angles below 20 degrees. Vitamin D insufficiency is a major contributor to AIS in areas where vitamin D insufficiency is endemic. It seems that the muscle weakness resulting from vitamin D insufficiency is the triggering factor for scoliosis whereas the direction is determined by the postural habits of the individual, probably due to the asymmetrical mechanical forces around the vertebral bodies. Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting. Measurement of serum 25-OH Cholecalciferol is sensitive and specific for detection of vitamin D deficiency, and hence for presumed AIS in patients with chronic low back pain

Changes in lipid profile during infliximab treatment for rheumatoid arthritis

To evaluate the changes in lipid profile in early diagnosed active Rheumatoid Arthritis [RA] patients as well as the effect of immuno-intervention with the anti tumor necrosis factor alpha [anti-TNF-alpha] infliximab on the atherogenic index. Eighteen patients with early RA [disease durations of less than one year] were included. Infusions with infliximab were given at weeks 0, 2, 6, then 8 weeks. Infliximab was administered intravenously at a starting dose of 3 mg/Kg. Blood samples [fasting] were collected at 0 then at 8 weeks. Total serum cholesterol and triglycerides were measured using Roche clinical chemistry analysis. HDL-cholesterol was determined with polyethylene glycol-modified enzymes. The atherogenic index was calculated using the following formula: atherogenic index= total / HDL-cholesterol. Treatment with infliximab leads to a significantly better DAS 28 score at 8 weeks as compared with base line: 5.4 versus 4.45. Following 8 weeks of treatment, mean total cholesterol [TC] levels increased from 4.55 to 4.86 nmol/L that were statistically significant. However, high density lipoprotein cholesterol [HDL-cholesterol] levels were more or less steady, resulting in slight decrease in the atherogenic index that was statistically not significant when compared with base line. Triglycerides [TG] and low density lipoprotein [LDL-cholesterol] mean levels were significantly decreased. Anti-TNF treatment might affect lipid profile in RA patients. In view of the clear relationship between disease activity and cardiovascular disease in RA a tight disease control is mandatory. This might have favorable effects on the lipid profile and hence it might also decrease CVD risk

clinical significance of anti-Ro antibodies in patients with systemic lupus erythematosis

Systemic lupus erythematosus [SLE] is characterized by serum autoantibodies against protein components of small cytoplasmic ribo-nucleoproteins [scRNPs]. The origin and regulation of these anti-Ro/SS-A and anti-La/SS-B antibodies are not well understood. We attempted to define the association between the presence and absence of anti-Ro [SS-A] antibodies [Abs], and the criteria of SLE classification and non criteria manifestation of SLE, for better understanding of the disease course and prognosis. Ninety three SLE patients were included in the study. Retrospective analysis of their medical records was performed. 25% of SLE patients showed anti-Ro positive AB of which 91.3% were females. Anti Ro was significantly associated with lupus nephritis. While it showed a border line association with discoid rash and vasculitis. The presence of anti Ro antibodies with anti La antibodies increased the tendency of subcutaneous lupus to occur. Another interesting finding was the absence of antiphospholipid [APS] syndrome presentation [n=zero] in patients with anti Ro antibodies alone or in association with anti La positive antibodies versus seven patients detected with that syndrome in anti Ro and anti La negative group of patients [p=0.04]. Anti Ro is significantly associated with lupus nephritis. This may assist to predict renal involvement and to improve patient outcomes while simultaneously reducing disease costs. A paradox in disease severity may be suggested by a possible protective role against APL syndrome in these patients. The latter finding certainly warrants further investigations by studying larger population of patients

Melanoma inhibitory activity [MIA] and transforming growth factor- beta [TGF-beta] levels in the sera of juvenile arthritis

We measured serum levels of MIA and TGF-beta by means of ELISA and investigated whether they provide clinically relevant parameters in juvenile arthritis patients. We also evaluated their correlations with clinical and laboratory parameters. Serum was obtained from 10 poly-articular juvenile arthritis [pa-JRA [patients, 10 childhood systemic lupus erythematosus [ch-SLE] patients, 10 childhood systemic sclerosis]ch-SSC] patients and 10 apparently healthy children as a control group. Both MIA and TGF-beta serum concentrations were found to increase in both destructive [JRA] and non-destructive [ch-SLE and ch-SSc] juvenile arthritis. We found no correlation with disease activity, clinical or laboratory parameters except RF. MIA and TGF-beta are not serum markers of a specific disease. In addition, the presence of elevated MIA in the sera of juvenile arthritic patients very likely reflects passive release from necrotic or apoptotic chondrocytes and is partly due to chondrocyte activation. This is supported by the fact that MIA level was only associated with RF positivity and not with markers of inflammation

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

role of interleukin-1 receptor antagonist in the pathogenesis of arthritis

The objectives from this study was to compare serum levels of interleukin-1 receptor antagonist [IL-1Ra] with synovial fluid levels in patients with rheumatoid arthritis [RA] and osteoarthritis [OA], and to correlate the level of the naturally occurring IL-1 inhibitor with indices of disease activity and severity in RA patients. A correlation was also done between IL-1Ra and tumor necrosis factor alpha [TNF-alpha] with knee radiographs in OA patients as a parameter of disease severity. IL-1Ra and TNF-alpha were assessed by Enzyme Linked Immunosorbent Assay [ELISA] in serum and synovial fluids in 20 female patients with RA, 20 female patients with OA and in the serum of 15 controls. We found that IL-1Ra and TNF-alpha concentrations were increased in both RA and OA sera compared with the control group. Although there was no significant difference between the concentration of serum IL-1Ra in RA patients when compared to those with OA, we observed that its mean level were higher in patients with RA. Moreover, IL-1Ra levels were correlated significantly with the levels of ESR, CRP as well as all the clinical parameters of disease activity measured in RA patients. We also found significant correlation between the synovial levels of both IL-1Ra and TNF-alpha in RA when compared to OA patients. The mean level of synovial IL-1Ra in RA patients is about twice that was found in OA patients. Our data reveal a consistent association between IL-1Ra production and disease activity and severity in RA patients. It also reveals a high serum and synovial IL-1Ra and TNF-alpha in OA patients that make us suggest that OA should be considered a disease with a systemic and local inflammatory response. Further studies are needed to determine the association of cytokines and its inhibitors in OA

Observational study on patients suffering of Raynaud's phenomenon

We examined Raynaud's phenomenon in systemic sclerosis [SSc], systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA] to determine its relation to the clinical and laboratory data of different rheumatic diseases. Thirty-six patients were included in our study 18 of them with and 18 without Raynaud's phenomenon. There was a significant difference between both groups as regards clinical data of cerebritis, nephritis and systolic blood pressure where such were higher in the Raynaud's positive group than Raynaud's negative group. These findings can be explained on the patho-physiological basis of the disease itself. We can get either affection of the kidney [nephritis] or vasculitis presenting by cerebritis or due to the circulating endothelin substance

Ultrasonographic assessment of the quadriceps muscle in elderly women

Anthropometrical and qualitative ultrasonographic assessment of the quadriceps muscle [vastus lateralis] in thirty elderly women was done before and after a physical training program to develop muscle strength for eighteen weeks. Statistical comparison in different assessment parameters showed that there was no statistical significant difference [p > 0.05] in body weight, thigh girth and cross sectional area of the quadriceps before and after the physical training program. But there was a statistical significant difference [p < 0.05] as regards thigh subcutaneous fat and muscle thickness

Serum and synovial fluid insulin like growth factor-1 and its binding protein-3 in rheumatoid arthritis

Insulin-like growth factor-1 [IGF-1] and its binding protein-3 [IGFBP-3] in human synovial fluid play an important role in maintaining articular cartilage metabolism. In this study, we measured serum and synovial fluid [SF] concentrations of IGF-1 and IGFBP-3 in 20 rheumatoid arthritis patients [RA] and 10 matched controls [with traumatic knee effusion] using radioimmunoassay. Also, we tried to correlate serum and synovial levels with each other and with disease activity and severity measures. Our results showed a significant increase in synovial fluid level of both IGF-1 and IGFBP-3 in RA patients as compared to controls. Serum IGF-1 correlated with synovial fluid level but serum IGFBP-3 did not correlate with synovial fluid level. Disease activity markers correlated significantly with synovial fluid IGF-12 and IGFBP-3 levels, but did not show significant correlation with their serum level. In conclusion the pattern of IGF-1 and IGFBP-3 in SF differs in inflammatory versus non-inflammatory joints

Diagnostic value of antikeratin antibodies and serum ICAM-1 in some rheumatic disorders

The aim of this study was to find out whether antikeratin antibodies [AKA] has an additional diagnostic and/or prognostic value when performed with rheumatoid factor [RF] in inflammatory and degenerative arthritis. We also assessed the level of circulating intercellular adhesion molecule-1 [ICAM-1] and correlated serum levels with clinical parameters of disease activity and severity. Moreover, we examined whether AKA have an association with circulating serum ICAM-1. Forty RA patients, 15 SLE patients, 15 OA patients and 15 healthy controls were enrolled in this study. The occurrence of AKA reached 55% in RA while it did not exceed 13.5% in other groups. RA patients who were AKA positive suffered from significantly higher disease activity indices and degree of X-ray severity than RA patients who were AKA negative. Again, serum ICAM-1 was significantly higher in the AKA positive as compared to the AKA negative RA patients. Serum ICAM-1 levels were significantly higher in RA and SLE patients than in OA and controls [p<0.01]. Serum ICAM-1 levels correlated with disease activity in RA and SLE. None of the clinical parameters correlated with ICAM-1 serum levels in OA patients. Therefore, AKA was found to have a diagnostic and prognostic value in RA patients. Moreover, circulating serum ICAM-1 levels may act as a disease activity marker in RA and SLE patients

Insight on the relationship between osteoporosis and osteoarthritis

In this study, we tried to investigate some of the factors that may have a role in the pathogenesis of osteoarthritis OA and osteoporosis OP, such as BMI, levels of estrogen, IGF-1 and bone mass density. We correlated all these parameters to find the relation between those two pathologic conditions. Forty postmenopausal females were studied, 20 with OP and 20 with OA. Our results showed a significant elevation of estrogen and IGF levels and BMD in OA group in relation to OP group. The mean BMI showed a significant increase in OA than OP. This inverse relation could be explained by the difference in growth factors and estrogen that stimulate bone formation. There is an inverse relationship between OA and OP. Thus OA might have a protective or retarding effect on the development of OP and could be a negative risk factor for OP. This could be an important element in determining patients who at risk developing OP and should take preventive therapy for OP at the time of menopause

Acupuncture as an alternative adjunctive modality for treatment of post traumatic stiffness

A 35 years old housewife, married and has three children, presented to the Out-patient Clinic of the Rheumatology and Rehabilitation Department of Ain Shams University Hospitals with facial pain and inability to open her mouth. Her past history revealed that she was hit on the left part of her face by a sliding door of a microbus 2 months prior to presentation. This resulted in fracture of her left mandible. On examination the patient's height was 165 cm and weighed 55 Kg/ms [she lost about 7 Kg/month since the accident, as she was unable to chew]. The left part of the face was swollen. Infection of both mouth corners were observed. Palpation revealed, severe tenderness over the temporomandibular joint and two other points shown on Fig [1]. Bad odor came from her mouth, many dyspeptic ulcers were seen, the exact number couldn't be detected as she was unable to open her mouth properly. The distance between the upper incisor and the lower incisor was 0.5 cm. The x-ray revealed a fracture of the left mandible fixed with a plate and screw