Pregabalin versus amitriptyline in the treatment of fibromyalgia patients [a double blind comparative study]

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, fatigue, sleep and mood disturbances. Its etiology and treatment remain challenging. Oxidative stress may play a role in its pathogenesis. The efficacy of pregabalin to that of amitriptyline on FM and the effect of treatment on oxidative status were examined. 123 patients fulfilling the Wolfe 2010 criteria for fibromyalgia diagnosis and assessment were randomized to receive amitriptyline [25 mg] or pregabalin [75 mg] once daily for 12 weeks. The revised fibromyalgia impact questionnaire criteria were also used. Malondialdehide and glutathaion levels were checked at the beginning and at the end of the study. Improvement in the pain was better with pregabalin than with amitriptyline [P=0.0001] at 4 weeks of treatment, but achieved comparable improvement at 8 and 12 weeks. The reduction in the somatic symptoms scale was significant for both drugs in favour of pregabalin. Sleep was improved significantly but pregabalin over amitriptyline [P=0.0001]. Oxidative status was significantly improved. Both drugs improved the symptoms. Pregabalin was better than amitriptyline concerning SSS and sleep, but with a comparable effect on pain. Oxidative status was improved. Amitriptyline was better than pregabalin concerning patient compliance and tolerability

Correlation of lung function with disease activity rheumatoid arthritis

To find a correlation between Lung function with the disease activity in Rheumatoid arthritis [RA]. The study was carried out on 40 [35 female and 5 male] patients with active RA who fulfilled the ARA 1987 reversed criteria for the classification of RA. Patients with signs and symptoms of respiratory disease or chest injury were excluded from this study. The patients were all examined clinically by weighted and selective index for active synovitis and assessed for functional status of the following; ESR, Hb% level, pulmonary function tests including FEV1, VC, FEV, /FCV and DL [co]. Another group of 30 [27 female and 3 male] patients with active RA served as a control group. The results showed that Hb level ranged between [7-13.3 gm/dl], ESR ranged between 11-131 mm/hr and restrictive ventilatory defect was observed in 15 [37.5%] patients. Obstructive ventilator defect was presented in 10 [25%] patients. A decreased in DLCO was detected in 23 [51.5%] patients. There was a positive correlation between PETS with Hb%, ESR, Disease duration and activity of synovitis [P<0.005]. Lung function can be used to stratify abnormalities in a clinically useful manner and can be used as an indicator of disease activity in RA

echocardiographic abnormalities in 52 Iraqi patients with rheumatoid arithritis

To study the prevalence of echocardiographic findings in unselected population of patients with rheumatoid arthritis [RA] Fifty two RA patients and fifty two normal healthy people assessed clinically, Echo Cardiografically, ECG, pulmonary function tests and laboratory investigations. Two-dimensional echocardiography demonstrated significant cardiac disease in [59%] of patients in form of right ventricular dilatation [25%], left ventricular dilatation [11.5%], left atrial dilatation [3.8%], mitral valve abnormalities [11.5%] [M.V. regurgitation, M.V. thickening, M.V. prolapsed, M.V. stenosis], septal hypertrophy [5.8%], diastolic pressure dysfunction[5.8%], thick aortic calcified cusps [3.8%], aortic regurgitation[5.8%], mild pericardial effusion[13.5%], tricuspid Regurgitation [11.5%] and raised pulmonary artery pressure above 30 mmHg [3.8%].The normal healthy people had only two people one had M.V. regurgitation and the other had mild M.V. prolapse and there were no other abnormalities in [ECG] of [PFT]. Wide and frequent varieties of echocardiographic cardiac abnormalities were found in an unselected population of patients with RA, using Doppler echocardiography giving different grades of severity of cardiac manifestation

Assessment of skeletal maturation of igna children during the years of sanctions

To study the skeletal maturation and appearance of ossification centers in Iraqi children after six years of embargo. Eight hundred fifty five children [441 boys and 414 girls] of ages of 1 month to 13 years, from kindergartens and schools, during the periods June 1995- June 1996, were submitted to radiography of the hand and wrist. A comparison of the films was made with a previous study done in Iraq in 1990, and with other studies conducted in USA. East Africa, and other countries. A great delay was found in skeletal maturation reaching up to two years behind that found in an Iraqi study before the sanctions. A delay of about one year behind US children, and almost equal to that of a East Africa. We believe the cause of the delay is multi factorial, and may be at least partially related to the poor nutritional status of children brought on by the embargo

Clinical presentation of reitet's syndrome among Iraqi patients

To shed some light on the clinical features of patients'with Reiter's syndrome. Reiter's syndrome in 50 patients [38 males and 12 females] was reported in a prospective study. All patients were subjected to detailed history, full clinical assessment and a slit lamp eye examination by an Ophthalmologist. A. Dermatologist opinion was sought when needed and thorough laboratory and radiological investigations were made for all patients. Reiter's syndrome was post-dysnteric in 44 [88%] of patients and post-venereal in 6 [12%] patients. Its clinical features are similar to other series. Arthritis was noted in all patients, diarrhea in 44 [88%], eye lesions in 40 [80%] and mucocutaneous lesions in 37 [74%] patients but significant differences were noted between our study and others with respect to sex ratio, lower back pain, urethritis, oral ulcer, circulate balanitis. Tissue typing for HLA-B27 was positive in 72% of our patients. Reiter's syndrome is not rare in Iraq as previously thought Physicians need to be more aware of its existence in young adult men who develop arthritis following dysentery

Some immunological profile of rheumatoid arthritis

Seventy- four cases of clinically diagnosed Rheumatoid Arthritis [RA], fifty cases of systemic lupus erythematosus [SLE], and thirty healthy normal controls "were investigated for detection of rheumatoid factor [RF], total serum immunoglobulins [Igs], antinuclear antibody [ANA], and ANA subtype anti-double stranded DNA [anti-ds DNA], Patients with RA showed 58.1% positive for RF comparable with 14% positivity in SLE patients and 6.6% in normal individuals. Serum Igs [IgA,IgG] were found to be elevated in RA and SLE patients [62.2%, 36.5%] [54%, 38%] respectively. This study revealed that ANA is found in 88% of SLE patients sera and 78% of these ANA is ds DNA in comparison with only 6.8% of RA sera were found positive for ANA

Rheumatiod factor isotype in rheumatiod arthritis patients

Rheumatiod factor in patients with Rheumatoid arthritis [RA] could be oflgM, IgG, or IgG isotypes. To study the occurance of each or all these isotypes in RA patients. Enzyme linked Immune Sorbent Assay [ELISA] and Latex agglutination test were used to asses RF in 74 patients with RA. Using ELISA, 58 [78.4%] patients had positive RF [IgM 48.6%, IgG in 47.3% and IgA in 54.1%], while only 43 [58.1] patients were positive by AG. All RF isotypes should be assessed in patients with RA

Effect of IL-6 on immunoglobulin production in patients with rheumatoid arthritis

Objective: to assess serum level of 1L -6 in RA Compared to SLE and healthy controls and to estimate serum lg Levels [IgG,IgM,IgA] in the three groups and evaluate their level in comparison to 1L6

Methods: a cross sectional study of 35 patients with RA and 25 Patients with SLE and 20 healthy [volunteers ] as control groups was conducted using immunological tests to evaluate them

Result: in this study, we found that IL-6 was detected in 19 patients [54.3%] with RA compared to patients [60%] with SLE and non of the healthy control. Serum IgG, IgA Levels were elevated in RA patients compared to the serum Level for healthy controls, although not significant statistically. There was a moderately strong linear correlation between serum IgG and IL-6 and there was a moderately strong positive linear correlation between serum IgA and IL-6

Conclusion: IL-6 was significantly higher in sera of patients with Rheumatoid arthritis, while different levels of immunoglobulin [high IgG, IgA and normal IgM] were detected

Hyperuricaemia study in Iraqi men

A survey of 200 men of working age, revealed asymptomatic hyperuricaemia in 20 men [10%]. Those with hyperuricaemia showed more body weight, no association with family history of arthritis but more association with alcohol ingestion and elevated blood pressure. Hyperuri-caemia showed no association with blood urea level and serum creatinine but more with the 24 hour urinary uric acid excretion

Neuropsychiatric manifestations in systemic lupus erythematosus

An unselected group of 52 patients with SLE [48 females-4 males] were studied for neuropsychiatric manifestations. Clinical, standard laboratory and serological tests were performed. There were 18 patients [34.6%] with 24 neuropsychiatric episodes. Seven patients [13.4%] showed pure neurological episodes, 7 patients [13.4%] showed pure psychiatric and 4 patients [7.6%] showed both. The commonest neurological manifestations were convulsions seen in 6 patients [11.5%], with abnormal EEG findings in more than 2/3 of them. The most common psychiatric manifestations were paranoid reactions and Depression were reported in 5 patients [9.6%] for each. Our study revealed higher prevalence of these complications in Iraqi SLE patients than most of the previous reports

Lateral epicondylitis [tennis elbow]: the use of ultrasound in treatment [a double blind study]

Of 88 Patients with 92 lateral epicondylitis [4 patients have bilateral condition.], 44 patients [46 conditions] were randomly allocated to receive ultrasound treatment and 44 patients [46 conditions] placebo. 8 patients with 8 conditions treated with ultrasound and 19 patients [21 conditions] treated with placebo were missed on follow-up. All the remaining were given 6 iteaunents each over 2 week. The condition of 28 patients [78%] treated with ultrasound and 7 patients [28%] given placebo improved, the difference being significant the 1% level. Improvement in particular clinical variables [pain score, weight lifting grip strength] also showed an advantage for the patients given ultrasound treatment. Ultrasound enhances recovery in most patients with lateral epicondylitis

Radiological changes of bones and joints in brucellosis

Twenty-six patients with radiographic changes of brucella spondylitis and arthritis were studied. The diagnosis was based on clinical and serological tests. Of those 26 patients [12 males,14 females], the following spinal involvement was observed: lumbar [15] patients, dorsal [1] patient, dorsolumbar patient [1] patient, cervical [6] patients. Periphral joint involvement included: Knees [3 patients], hips [2 patients], shoulder [1 patient], unilateral sacroilitis [5 patients], multiple abnormalities [10 patients The main changes were destructive lesions in the vertebral bodies [usually marginal] with characteristic sclerotic reactions around them and proliferative marginal new bone formation; the disc space was usually narrow

Shoulder arthrography

Shoulder arthroqraphy had been performed for 33 patients [22 females, 11 males] with a mean age of 55 years presented with shoulder pain and restriction of movement, of the 34 cases, there were 10 cases [2 males, 8 females] of rotator cuff tear, 6 cases of frozen shoulder [all females], 3 cases [2 males, 1 female] of subluxation of the shoulder joint, and two cases [males] of repeated anterior shoulder dislocation with Bankart lesion. 12 cases [5 males. 7 females] presenting with shoulder pain and limitation of movement had been referred with diagnosis of frozen shoulder and rotator cuff tear were found to be normal on arthrography [negative arthrography]. The result compares with result of similar study in the west

Cyclosporin A in Behcet's uveitis

Six patients [4 males, 2 females] with confirmed diagnosis of Behcet's disease and uveitis were put on Cyclosporin A [CyA], a potent cell mediated immune suppressant. A total of Eleven eyes were studied, with significant improvement [P< 0.01]. There was also improvement in the extraocular manifestations of the disease. Though the drug seems to be a good substitute to steroids, chlorumbucil and colchicine, a double-blind controlled trial to compare [CyA] with these drugs needs to be done in the future