study of intrinsic and extrinsic risk factors in falls among the elderly

The aim of this study is to identify the intrinsic and extrinsic risk factors involved in falls in elderly focusing on the kinematic, temporal and phasic characteristics of gait using the 2-dimentional motion analysis system. One hundred elderly fallers, 100 elderly non fallers matched for age and sex and 50 apparently healthy young individuals were subjected to the following to achieve the purpose of the study: a questionnaire which was developed to identify intrinsic and extrinsic factors associated with falls, clinical evaluation of neuromuscular system, functional performance tests, visual examinations, routine laboratory investigations, radiological investigations and two dimensional gait analysis. There was a significant difference as regard the time of fall in favor of daytime [P<0.001]. Higher frequency of falls in elderly with neurological insult, impaired cognitive functions, multiorgan affection and those receiving higher number of medications [P<0.001]. All members of both elderly groups complaining from osteoarthritis [OA] knees, there was a significantly higher number of fallers in higher grades of radiological severity [P<0.001]. Also, higher incidence of knee and ankle joint synovitis in fallers [P<0.001] As regard the antigravity muscle power, there was a highly significant [P<0.001] weakness in four groups tested in fallers. There were highly significant differences [P<0.001] as regard heel rise, toe rise and timed up and go tests of functional performance, denoting the possibility of using these tests as screening for predilection of falls. As regard the visual parameters, there was a significantly higher incidence [P<0.001] of poor vision, cataractus lenses and constricted field of vision in fallers group. Examination of averaged hip, knee and ankle joints kinematics showed significant differences [P<0.001], [P<0.05] between groups, except for knee joint extension at terminal stance [P>0.05]. There was insignificant difference [P>0.05] between non fallers and fallers elderly groups except for hip joint extension at terminal stance, knee joint flexion at initial swing and ankle joint planter flexion at preswing [P<0.05]. As regard the results of general phasic and temporal gait parameters among the three groups, showed highly significant difference of all parameters [P<0.001]. From these results we can concluded that, most of the falls occur at the daytime while the elderly is moving and for those receiving higher numbers of medications. Elderly complaining from neurological, visual, musculoskeletal and multiorgan disorders are more prone to fall. Timed up and go [TUG], heel rise and toe rise tests are advisable as screening tools to predict falls in elderly. Limited hip extension at terminal stance, limited knee flexion at initial swing, limited ankle planter flexion at preswing, increased temporal parameters and decreased stride length, step length, cadence and velocity have a significant role in fall in elderly

Markers of type II collagen synthesis and degradation as a predictor of radiographic progression in knee osteoarthritis

The aim of this study was to evaluate serum PIIANP and urinary CTXII as a parameters of type II collagen synthesis and degradation, respectively, in patients with OA knees and to investigate whether the use of these two molecular markers could predict the progression of joint damage evaluated by radiography during a period of 3 years. Sixty patients had symptomatic primary knee OA of Kellgren-Lawrence [K-L] grade I-III and met ACR criteria. These patients were evaluated prospectively for 3 years. Serum PIIANP and urinary CTX-II levels were measured by ELISA at baseline and at study end and their levels compared according to the changes in joint space width [JSW], K-L grade and WOMAC index, over 3 years. Also, we assessed the diagnostic value of those molecular markers and their performance for prediction of radiological progression. Serum and urinary levels also compared with 40 matched healthy subjects as a control group. There were significant decrease in the baseline serum PIIANP [P<0.001] and increase in the baseline urinary excretion of CTX-II [P<0.001] in knee OA patients in comparison with the control, in bilateral than unilateral cases [P<0.05], [P<0.05] and also with increasing the K-L radiological severity of the disease [P<0.05], [P<0.001], respectively. There were significant decrease in the mean baseline serum PIIANP and highly significant increase in the mean baseline urinary excretion of CTXII in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of the signal or both knees [P<0.05], [P<0.001], respectively. There were significant decrease in the mean study end serum PIIANP and highly significant increase in the mean study end urinary excretion of CTX-II in progressors [JSW narrowing > 0.5 mm] and in patients showed increase in K-L grading either of signal or both knees [P<0.05], [P<0.001], respectively. There were insignificant correlation between serum PIIANP and urinary CTX-II either at the baseline or study end and also insignificant correlation between those molecular markers with disease duration, BMI and WOMAC index [P>0.05]. Urinary CTX-II showed a higher diagnostic sensitivity and specificity [75% - 92%] than serum PIIANP [60% - 90%], respectively. The diagnostic specificity was greatest when both tests were found in combination [96%]. Also, combination of tests showed higher diagnostic sensitivity [92.3%] and specificity [55.3%] for predicting the radiological progression over 3 years than either one alone. In conclusion: using specific molecular markers serum PIIANP and urinary CTX-II, we found that patients with knee OA are characterized by depressed type II collagen synthesis and increased type II collagen degradation. Combining these two molecular markers allows the identification of patients with a high risk of subsequent progression of joint damage

Assessment of fatigue in rheumatoid arthritis

This study was carried out to assess the level of fatigue in patients with rheumatoid arthritis [RA] and to determine its Correlation to demographics, psychosocial and disease-related variables. Forty RA patients and 20 matched healthy controls were subjected to thorough clinical assessment, routine laboratory investigations and measurement of serum cortisol level Questionnaires included the Multidimensional Assessment of Fatigue Scale, Sleep Survey, Health Assessment Questionnaire, Social Support List-Interactions, Social Index, State Trait Anxiety Inventory, and Beck Depression Inventory. Our results showed that fatigue scores were significantly higher [P>0.001] in patients with RA than in controls. Fatigue most affected exercise and work. No significant correlations [p<0.05] were found between fatigue and demographic variables but highly significant correlations [p>0.001] were found between fatigue and both psychosocial and disease-related variables. With multiple regression analyses, the best predictors of increased fatigue were higher levels of cortisol, prolongation of morning stiffness, more depressive symptoms, and higher functional disability. Form this study, we concluded that, fatigue was a prevalent and persistent symptom in our RA patients. Effective management is needed to control clinical manifestations that were found to be strongly associated with fatigue such as disease activity, functional disability, depression, and poor sleep

Assessment of joint damage from analysis of released bone sialoprotein into synovial fluid of rheumatoid arthritis patients

Bone sialoprotein [BSP] was quantified in synovial fluids and sera from rheumatoid arthritis [RA] patients to elucidate whether its release from bone relates to the degree of joint tissue destruction. BSP levels were determined by immunoassays of knee synovial fluids and of sera from 60 RA patients who were classified into 4 groups on the basis of radiographic knee joint tissue damage. Serum levels were compared with 15 matched healthy subjects as a control group. Synovial fluid concentrations of BSP increased with increasing degree of knee joint damage [F=13.5 and P<0.001]. Serum concentrations of BSP were increased above normal [t=5.9 and P<0.001]. but did not relate to the degree of joint damage [F=0.02 and P>0.05]. From these results we concluded that quantification of BSP in the synovial fluid can be useful as a mean for assessing the degree of tissue damage at the molecular level in patients with RA