Non traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

Cardiovascular events are markedly increased in rheumatoid arthritis, and they remain poorly understood. To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients. Thirty RA patients were included in this study. All of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 +/- 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by health assessment questionnaire [HAQ] score. Carotid Duplex was done to measure the intima-media thickness [IMT] and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation [FMD] to confirm presence of endothelial dysfunction in those patients. Ten out of 30 RA patients [33.3%] had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers [CRP, ESR and IL-6] and VCAM-1 [a marker of endothelial dysfunction], lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose. The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors

Receptor activator of nuclear factor-kappa B ligand [RANKL] and osteoprotegrin [OPG] in rheumatoid arthritis

To evaluate serum and synovial fluid levels of receptor activator of nuclear factor Kappa B ligand [RANKL] and osteoprotegrin [OPG] in patients with rheumatoid arthritis [RA] and to determine the level of osteoclastic bone resorption by the ratio of RANKL to OPG as well as their correlation with the clinical activity, radiological grades and bone mineral density. 45 RA female patients and 15 age-matched healthy females with post traumatic knee effusion [as controls] were subjected to full history taking, complete clinical examination, assessment of disease activity using DAS score, radiological progression assessment using Larsen score, laboratory investigations including ESR, CRP and RF. Also, serum and synovial fluid levels of RANKL and OPG and bone mineral density [BMD] were done. RA patients had significantly higher levels of serum and synovial fluid RANKL, OPG and RANKL/OPG ratio than controls. Levels of RANKL, OPG and RANKL/OPG ratio were significantly higher in SF than in serum and in the active than in non active RA patients. The serum RANKL significantly correlated with disease duration, RF, ESR, DAS score and T- score, with no correlation with CRP or Larsen score. Synovial RANKL did not correlate with any of the previous parameters. As regards to serum OPG, it correlated with disease duration, RF, T-score and Larsen score, while synovial OPG showed correlation only with CRP. The serum RANKL/OPG ratio had significant positive correlation with CRP, DAS score and Larsen score. RANKL has a crucial role in the pathogenesis of bone loss in rheumatoid arthritis and can be used as a marker of bone erosion and disease activity. OPG plays a protective role against bone erosion and joint destruction in RA. RANKL/OPG ratio is more informative about bone resorption than each of RANKL or OPG alone

Can dermatoglyphics be used as an anatomical marker in Egyptian rheumatoid patients?

To find out a possible correlation of some quantitative and qualitative dermatoglyphic variables with rheumatoid arthritis [RA] and it's radiological grading. This study was conducted on 60 RA patients and an equal number of controls. Different qualitative dermatoglyphic patterns [ulnar and radial loops, whorls and arches] and quantitative dermatoglyphic measures [total finger ridge count, pattern intensity and a-b ridge count] in addition to palmer creases were studied in both groups. Correlation between significant dermatoglyphic changes in RA patients and radiological changes were studied. Loops were the most common type of the qualitative dermatoglyphic patterns of the fingers, followed by whorls then arches. In both male and female patients, there was significant marked decrease in ulnar loops and increase in arches. Total ridge count and pattern intensity of patients were decreased in both hands of both sexes; however, this decrease was significant in the left hand of males and right hand of females. Moreover, the a-b ridge count was significantly decreased in both hands of female and left hand of male patients. Regarding the unusual palmer flexion creases, there was significant increase only in the Sydney line in female right hands. Significant inverse correlation was noted between total ridge count of the fingers and the radiological erosion in both males and females. Dermatoglyphics can represent an anatomical, non - invasive, inexpensive tool for screening high-risk population, and facilitate early detection and management of RA. Dermatoglyphic variable might also play a significant role not only for screening but also for studying the behavior of the disease

Study of resistin and YKL-40 in rheumatoid arthritis

To investigate the association between serum and synovial fluid levels of both resistin and YKL-40 with markers of inflammation, disease activity and radiographic grading and to determine if they have a role in the pathogenesis of RA. This study was conducted on 30 patients with RA and 15 healthy controls with acute post traumatic knee effusion. Serum and synovial fluid levels of both resistin and YKL-40 were measured in patients and controls using ELISA technique. Plain x-ray of hands, wrists and feet were done for all patients and assessed according to Larsen score. Serum levels of resistin and YKL-40 were significantly higher in RA patients than controls and in active RA than in non active patients. Also, their levels significantly correlated with CRP, ESR, RF, disease activity parameters and Larsen score. Furthermore, synovial levels of resistin and YKL-40 were significantly higher than that of the serum, and synovial YKL-40 levels showed significant correlation with CRP, ESR, RF, disease activity parameters and Larsen score. On the other hand, resistin synovial levels significantly correlated with CRP, ESR, RF and synovial leucocytic count. Resistin and YKL-40 were increased in the serum and synovial fluid of rheumatoid arthritis patients. Their serum levels correlated with markers of inflammation, parameters of disease activity and radiographic progression of joint damage. These results suggested the key roles of resistin and YKL-40 in the pathogenesis of RA and they may be important new therapeutic targets

Non-traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients. Thirty RA patients were included in this study all of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 +/- 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by Health assessment questionnaire [HAQ] score. Carotid Duplex was done to measure the intima- media thickness [IMT] and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation [FMD] to confirm presence of endothelial dysfunction in those patients. Ten out of 30 RA patients [33,3%] had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers [CRP, ESR and IL-6] and VCAM-1 [a marker of endothelial dysfunction], lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose. The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors

Some therapeutic options in treating chronic sciatic pain

Chronic back pain has become one of the most expensive causes of disability among people under the age of 45 years. A wide variety of non operative treatment options are advocated in the management of chronic sciatic pain [CSP] due to lumbar disc prolapse [LDP]. The most prevalent therapy for this pain is physical therapy. Recently electro-acupuncture [EA] is an established adjuvant analgesic modality in the management of chronic pain. In our study we tried to evaluate the efficacy of exercise therapy, low power laser therapy [LPL] and electro-acupuncture [EA] in the treatment of chronic sciatic pain due to lumbar disc prolapse. 45 patients with chronic sciatic pain due to [LDP] were included in this study. Their age ranged from 20 to 45 years. They were divided into 3 groups: Group I [Exercise only], Group II [LPL+ Exercise] and Group III [EA + Exercise]. The treatment program continued 3 months. All patients were evaluated by taking full history, full clinical examination and investigated by plain X-ray and MRI. They were assessed by VAS, Roland Disability Questionnaire [RDQ], Schober's test, Finger Floor Test, Straight Leg Raising [SLR] test and Japanese Orthopedic Association [JOA] score. Our results demonstrated significant improvement in all parameters in the 3 studied groups with best improvement was in group III. Electro-acupuncture is an effective modality in controlling chronic sciatic pain and complications and may thus be used as a good alternative in indicated cases

Laser acupuncture in treatment of idiopathic carpal tunnel syndrome

Objectives: To evaluate the effect of low level laser therapy applied to acupuncture points [laser acupuncture] in the treatment of idiopathic carpal tunnel syndrome

Patients and methods: This study was carried out on 40 hands of patients with minimal, mild and moderate idiopathic CTS. All patients received sessions of laser therapy for 1.5 months, 3 times a week. The red beam laser was applied to shallow acupuncture points on the affected fingers and hand and to deep acupuncture points located on the elbow, shoulder, upper back and cervical paraspinal areas on the affected side. Clinical and electrophysiological evaluations were done before, after 1.5 months of treatment and 2 months later as follow up. Forty healthy volunteers [80 hands] matched in age and sex were considered as a control group for the electrophysiological studies

Results: The results of this study revealed significant improvement of all clinical parameters including pain, parasthesias, awakening at night and both Tinel's and Phalen's signs. There was also significant improvement of distal motor latency and sensory conduction velocity of median nerve. These improvements were maintained through the follow up period

Conclusion: Laser acupuncture is a new conservative modality recommended for the treatment of mild and moderate cases of idiopathic CTS

Correlation of functional outcome in early rheumatoid arthritis with clinical laboratory, radiological findings

Objective: To analyze the correlation between functional disability score and clinical status, laboratory findings and radiographic scores in early rheumatoid arthritis patients

Methods: Forty rheumatoid arthritis patients of less than one year duration and diagnosed according to the ACR [1987] revised criteria were subjected to: [a] Functional assessment by Arthritis Impact Measurement Scale 2 questionnaire [AIMSZ], [b] Pain assessment by visual analogue scale [VAS], [c] Tenderness and swelling assessment according to 28-j0int count measuring tender and swollen joints, [d] Disease Activity by Modified Disease Activity score [DAS], [e] Laboratory assessment i.e. ESR, CRP and RF and [f] Radiological assessment in which hand and feet radiographs were scored for erosions using the method developed by Rau et al. [1998]

Results: There was a significant correlation between functional disability score and CRP, VAS, and radiographic score

Conclusion: In this study we have observed that a clinically important association exists between functional disability, disease activity, and radiographic damage, suggesting that intervention that suppresses disease activity and slow down radiographic progression may improve the patient’s health status