CXCR3 and CXCR4 receptors expression on peripheral blood T-lymphocytes from patients with rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory condition that affects multiple joints. Chemokines and their receptors are involved together in the development and perpetuation of inflammation Chemokine receptors CXCR3 and CXCR4 are among the main regulators of T cell recruitment in autoimmune diseases. The present study aimed at detection of the frequency of CXCR3 and CXCR4 chemokine receptors expression on peripheral blood T-lymphocytes in patients with rheumatoid arthritis in an attempt to identify suitable targets for therapeutic intervention. Twenty eight patients with rheumatoid arthritis, selected from those attending the Rheumatology and Rehabilitation outpatient clinic, Ain Shams University Hospitals, were studied. Ten age and sex matched healthy subjects were served as controls. All patients were subjected to full medical history, thorough clinical examination, evaluation of the disease activity using disease activity score 28 [DAS28] and radiological assessment by plain X rays of both hands and feet [posterior - antero views] for the erosive changes. Peripheral blood lymphocytes analysis was performed by flow cytometry using anti-CD3, anti-CXCR3 and anti-CXCR4 monoclonal antibodies. High statistically significant difference was determined between patients and controls as regard relative count of T- lymphocytes expressing CXCR4 receptors [35.068 +/- 5.098, 23.59 +/- 4.601, respectively and P< 0.001]. Also, there was a significant positive correlation between relative count of T- lymphocytes expressing CXCR4 receptors and disease activity using disease activity sore 28 [DAS28] disease duration and the hemoglobin level. On the other hand, no significant correlation was determined between relative count of T- lymphocytes expressing CXCR3 receptors and any of the clinical and laboratory parameters of patients. Increased expression of CXCR4 on peripheral T cells of Patients [RA Patients] and its positive correlation with the disease activity indicate that this chemokine receptor plays a central role in the process of chronic inflammation in RA and suggests that targeting CXCR4 could provide a new treatment for this disease. Although our data did not prove that CXCR3 expression is higher in patients with RA, however, it can be expected that it is involved in the inflammatory process based on reported functional studies

Pulmonary manifestations in ankylosing spondylitis: value of high resolution computed tomography

Hypothesis: Pulmonary involvement in ankylosing spondylitis [AS] is often asymptomatic and chest radiographs may be insensitive to early changes

Objective: To study the distribution of pulmonary lesions in AS patients with high resolution computed tomography [HRCT] and to correlate findings with disease duration and pulmonary function tests [PFTs]

Methodology: The study was conducted on 18 AS patients. PFTs and HRCT of thorax were performed on same day chest x-ray was taken

Results: 9 patients had interstitial lung abnormalities on HRCT. Only 3 out of 18 patients had abnormal findings on plain chest x-ray. PFTs showed a restrictive process in 4 patients and obstructive pattern in 2 patients

Conclusion: No correlation was found between HRCT abnormalities and either PFTs or disease duration. As HRCT findings did not correlate with PFTs impairments, so this impairment could be a sequel of stiffness of thoracic cage in AS patients

Serum high sensitivity c-reactive protein as an approach to assess disease activity in hand osteoarthritis

Objective: To measure serum level of high sensitivity C-reactive protein [hs CRP] in patients with hand osteoarthritis [OA] and to correlate this level with the activity of the disease as detected by bone scintigraphy of both hands

Methodology: The study included 59 patients with hand OA, J6 non erosive OA [non EOA] and 23 erosive OA [EOA]. All patients were subjected to full medical history taking, thorough general clinical examination and clinical examination of hand joints, plain x-ray and bone scintigraphy of both hands. Serum level of hs CRP was measured by particle enhanced immunoturbidimetric method

Results: Serum level of hs CRP was significantly higher in patients with EOA [6. 74 +/- 0.52 mg/L] than in non EOA patients [5.38 +/- 0.58 mg/L]. There was a statistically highly significant difference between both groups as regards the number of scintigraphically positive joints. There was also a significant correlation between hs CRP and the number of clinically affected joints within each group. The correlation between hs CRP and scintigraphically affected joint count was highly significant in EOA patients only. The radiological joint count did not correlate with hs CRP in either group

Conclusion: Higher serum level of hs CRP in EOA may indicate the presence of an inflammatory element in this type of OA. The positive correlation between the level of hs CRP and the count of scintigraphically affected hand joints in EOA demonstrates that it can be used as a feasible test to assess disease activity

Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty

Background: Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. The primary focus of early rehabilitation is ambulation of patients and regaining range of motion in the knee. Although many studies suggested that continuous passive motion should be implemented in the first rehabilitation phase following surgery, others concluded that the use of continuous passive motion was of no added benefit

Objective: The aim of our study was to compare the effectiveness of rehabilitation programs with and without continuous passive motion for range of motion in knee flexion and knee extension, functional ability and length of stay after primary total knee arthroplasty

Methodology: Forty patients suffered from osteoarthritis who underwent unilateral total knee arthroplasty were selected. Immediately after total knee arthroplasty, they were subdivided into two groups. Group 1 of 20 patients who received conventional physical therapy only and group 2 of another 20 patients who received conventional physical therapy with two hours of continuous passive motion applications daily. All subjects were evaluated once before total knee arthroplasty and at discharge. The primary outcome measures was active range of motion in knee flexion at discharge. Active range of motion at knee extension, timed "Up and Go" test results, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire scores, and length of stay were the secondary outcome measures

Results: The characteristics of and outcome measurement for the subjects in the two groups were similar at baseline. No significant difference between the two groups was demonstrated in primary or secondary outcomes at discharge

Conclusion: The results of this study do not support the addition of continuous passive motion application to conventional physical therapy in rehabilitation program after primary unilateral total knee arthroplasty. It did not further reduce knee motion impairments or disability or reduce the length of the hospital stay

Impaired antioxidant status in systemic lupus erythematosus patients

Objective: to measure the level of serum malondialdehyde [MDA] as a marker of oxidative stress of the activity of blood glutathione peroxidase [GSH Px] and the blood glutathione [GSH] as markers of antioxidant capacity in systemic lupus erythematosus [SLE] patients compared with normal control individuals. Also to detect if there is correlation between these biochemical changes and disease activity and some clinical and laboratory data of SLE patients

Methodology: twenty five SLE patients and ten healthy controls were subjected to clinical examination, history taking and estimation of [a] serum MDA [nmol/ml], [b] blood GSH level [mg/dL] and blood GSH Px activity [u/L]

Results: highly significant increase in serum MDA [p<0.0001] in SLE patients and statistically significant lower level of blood GSH and GSH Px activity compared to the control group [p<0.0001]. Disease activity index was positively correlated to MDA serum level and negatively correlated to both blood GSH level and blood GSH Px

Conclusion: excess production of free radicals as a result of lipid peroxidation and reduction in the antioxidant protection capacity were proved in SLE patients and observed to be more in the presence of some clinical manifestations of SLE. In addition, MDA serum level, blood GSH content and blood GSH Px activity may be used as useful markers for disease activity in SLE