Preliminary study of CD34 stem cells in rheumatoid arthritis patients

To study CD34+ stem cells count in the peripheral blood [PB] of patients with rheumatoid arthritis [RA] and to correlate it with the activity and severity of the disease as a preliminary study for their role in the disease pathogenesis. This study was conducted on 20 RA patients in addition to 10 healthy subjects as a control group. All patients were subjected to full history taking and thorough clinical examination. Assessment was done using modified DAS far disease activity, Speed severity index [SSI] for disease severity, and Larsen score for radiological assessment of the plain x-ray findings of both hands. Assessment of CD34+ stem cells count in the PB was done by using fluorescence-activated cell sorting [FACS]. In this study there was a significantly higher count of CD34+ stem cells in the PB of RA patients compared to the controls. Stem cells absolute count and percentage were significantly negatively correlated with modified DAS, SSI and Larsen score. Bone marrow stem cells [CD34 cells] could play a crucial role in RA. Their level is elevated in the PB of RA patients in comparison with controls. It is suggested that the reduced number of CD34[+] cells in the PB of patients with more severely destructed joints is due to their recruitment to sites of inflammation. Studies are required to further investigate the role of the bone marrow and stem cells in the disease pathogenesis of RA. It could be a future target of treatment in these patients

Quantitative assessment of rehabilitation results in peripheral arterial disease

Peripheral arterial disease [PAD] patients are commonly classified on the basis of subjective evaluations of pain and fatigue. It could he important to have, at least, an objective measurement ofJƒtigue for better evaluation of muscle performance and exercise tolerance in such patients as well as for serial quantitative assessment of different vascular rehabilitation programs designed for claudications. Median frequency [MDF] analysis has been recently used to monitor electromyo graphic [EMG] power spectrum shift toward lower frequencies due to muscle fati gue. Twenty-five PAD patients and ten control subjects matched for age and sex were studied. Surface EMO was recorded over the medial gastrocnemius muscle along 40 seconds at maximal voluntaty contraction. The median frequency of the electromyoraphic power spectrum was calculated in the first 10 seconds [TO] and the last 10 seconds [T1]. Change from TO to T1 was statistically calculated and considered as the fatigue index [FI]. EMG reassessment was done for the patients' group after completing a physical training program. Significantly lower initial Ti values, compared with initial TO, were found in both the PAD and the control groups. A highly significant difference was documented regarding all the initial MDF parameters between the patient and control groups. Moreover, a highly significant difference was recorded between the initial and the post-rehabilitation FI in the patients' group. EMG frequency analysis can be considered an easy, painless, practical and reproducible method which has a high degree of precision and accuracy in providing objective information on the muscle performance and fatigue in PAD patients

Value of endothelin-1 in rheumatoid vasculitis and synovitis

Rheumatoid vasculitis is a potentially serious complication of RA, usually occuring in long standing erosive nodular disease. It has several clinical presentations, which can be sometimes difficult to diagnose. Endothelial cells produce a variety of vasoactive substances including the potent vasoconstrictor peptide Endothelin-1 [ET-1], which has a wide range of action on mammalian tissues. ET-1 produces sustained vasoconstriction; such action may have an important pathophysiological role in initiation and development of vascular injury and hence vasculitis. Was to study plasma and synovial fluid ET-1 levels in RA and its role in pathogenesis of rheumatoid vasculitis and its correlation to disease activity in an attempt to throw light on possible new strategies in the management of this disease. We conducted our study on 30 RA patients, in addition to 10 normal healthy subjects who served as a control group. Patients and control plasma and synovial fluid samples were subjected to EIA test to measure endothelin-1 level. There was a highly significant high level of plasma ET-1 in the patient's group as compared to the control group and it was positively correlated with the presence of vasculitis in these patients and there was no correlation with the disease activity. Synovial ET-1 in the patient"s group [n = 10] was lower than their plasma level. ET-1 may play a role in pathogenesis of rheumatoid vasculitis rather than arthritis. Under this point of view, ET-1 receptor antagonist will be a novel strategy for the treatment of vasculitis associating rheumatoid arthritis

Serum thrombomodulin as a marker in assessment of systemic lupus erythematosus

Systemic lupus erythematosus is the prototype of autoimmune disease. Since organ involvement in SLE is due to a vascular inflammatory process, many researchers try to find a marker of endothelial cell damage, which may indicate active vasculitis in SLE. Serum thrombomodulin [TM] is considered a marker of endothelial cell dysfunction. It is one of the soluble forms of tissue TM. A common mechanism for the increase of soluble TM may be an accelerated release of TM from injured endothelial cells. Measurement of the level of serum TM in systemic lupus erythematosus patients and to correlate it with the different clinical manifestations and laboratory parameters. This work was performed on 30 Egyptian SLE female patients and 10 .controls. Those patients were subjected to thorough clinical examination, laboratory tests including complete blood picture, ESR serum creatinine level, SCOT, SGPT, blood glucose level, serum C3, C4 level, ANA, anti-DNA, in addition to complete; urine analysis and estimation of the level of TM with ELISA. The level of serum TM differentiated lupus patients from controls. In addition it correlated strongly with disease activity score [as assessed with SLEDAI], with activity parameters and parameters of renal damage as serum creatinine level and proteinuria.[s]TM was higher among patients with pleurisy, pericarditis and thromboembolic manifestations and vasculitis, and this implies its valuable role in the immune pathogenesis of vasculitis in SLE. Results recommend measurement of serum TM in the assessment of SLE patients regarding activity and endothelial cell injury

pathophysiology of esophageal affection in rheumatic diseases

This study comprised 42 Egyptian female patients, 15 RA, 15 SLE and 12 SSc patients, compared to 12 healthy subjects matched with age and sex. Esophageal manometry and upper gastrointestinal endoscopic biopsy were performed for all subjects. The results of this study revealed manometric abnormalities in the three diseases. Hypoperistalsis and diminished resting lower esophageal sphincter pressure were evident in RA and SSc patients but more severe in SSc. Hypotonic lower esophageal sphincter was the prominent feature in SLE patients. Retrograde and non-transmitted contractions were detected in a variable percentage in the three diseases. No correlation was found between manometric abnormalities and disease activity, while; there was a significant correlation between these abnormalities and disease severity in SSc patients. Reflux esophagitis was detected in 26.7% of RA and 75% of SSc patients. Histopathological study revealed esophageal mucosal damage due to chronic inflammatory process and vasculitic changes in RA and SSc. The esophagus was histopathologically normal in SLE patients

Antiperinuclear and hidden rheumatoid factors in monitoring disease activity of juvenile rheumatoid arthritis

The serological diagnosis of juvenile rheumatoid arthritis [JRA] is difficult, as classical 19S IgM rheumatoid factors [RF] as detected by the latex fixation test [LFT] are usually found in the sera of only 5-10% of JRA children, as compared with 80% of rheumatoid arthritis adults [RA]. Hidden 19S IgM rheumatoid factors [hidden RF], i.e., 19S IgM RF that can be detected in the IgM containing fraction after acid gel filtration of the serum, are found in 59-68% of seronegative JRA patients. This test correlates strongly with the disease activity in JRA patients, but it requires serum separation and is not available in most laboratories. Antiperinuclear factor [APF] has been described in both seropositive and seronegative adult rheumatoid arthritis [RA] patients, but has not been thoroughly evaluated in JRA children The study was conducted on 76 patients, 58 JRA with mean age 12.7 +/- 3.0 years and 18 SLE cases with mean age 10.3 +/- 3.7 years. The group of JRA was subdivided into 2 subgroups, JRA children [mean age 11.5 +/- 2.7 years] and group of adolescents JRA onset [mean age 18.3 +/- 1.1 years]. Thirteen healthy children served as a control group who were matched for age and sex. We tried to evaluate the diagnostic sensitivity and specificity of both antiperinuclear factor and hidden rheumatoid factor in JRA, and their correlation with the disease activity. The levels of erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] assessed the disease activity. Sera from JRA children, systemic lupus erythematosus [SLE] and control children were tested for the presence of antiperinuclear factor with indirect immunofluorescence technique [IIF] and hidden rheumatoid factor was determined with Rose-Waaler test [RWT] in the IgM-containing fraction of serum after separation by ion exchange chromatography. Thirty-eight of 58 patients [65.5%] showed the presence of hidden 19S IgM RF in their serum, only 3/18 [16.6%] in SLE patients and none was found in the control group. APF was found in 22/58 [38%] JRA, in 2/18 [11%] SLE and was not detected in the control group. The disease activity correlated positively only with hidden RF titers in the evaluated group of JRA, while no positive correlation was found between APF and the disease activity parameters [erythrocyte sedimentation rate and C reactive protein]. As expected both hidden RF and APF tests showed high specificity of 90.3% and 93.5% respectively. Although APF detection technique is indeed easier than hidden RF technique, the detection of APF alone will not be of a good diagnostic value in seronegative cases suspected to have JRA

Implications of cytokines and growth factors in osteoporosis

Assessment of IGF-1, IL-6 levels in post-menopausal osteoporosis [OP] to find out their relation to the clinical and radiological presentation of the patients. Twenty primary osteoporotic post-menopausal women were subjected to: 1] Clinical examination. 2] Laboratory investigations in the form of serum Ca, P, alkaline phosphatase, estradiol, osteocalcin, IL-6, IGF-1. 3] Radiological assessment in the form of plain X-rays and Dual Energy X-ray Absorptiometry [DEXA]. Serum osteocalcin and IL-6 were significantly elevated while IGF-1 was significantly decreased than controls [4 +/- 1.2ng/ml, 39.3 +/- 21.4 pg/ml and 61.9 +/- 31 ng/ml respectively]. Bone mass density significantly correlated with osteocalcin, estradiol and IGF-1 but not with IL6. This study suggested that the impaired bone formation and elevated bone resorption in post-menopausal women may be due to in part to the reduced IGF-1 and an over production of IL-6 in the bone of those women

Human parvovirus B19 infection: its role in acute arthropathies

Viral infections have a number of important effects on the immune system. Infection with human parvovirus B19 [B19] has a diverse range of clinical manifestations including erythema infectiosum, polyarthropathy, transient aplastic crisis, hydrops fetalis and fetal death as well as chronic infection and anemia in immunocompromised hosts. Since its discovery in 1975, it has been noted that HPV B19 frequently causes a self-limiting polyarthritis in adults. It has also been debated whether, in some patients, B19 may act as a trigger for RA. The aim was to determine the incidence and significance of antibodies to the parvovirus B19, we detected the presence of B19 IgM and IgG antibodies in 40 rheumatoid arthritis [RA] patients, 10 SLE patients, 10 osteoarthritis patients and 30 normal adults. B19 IgM was positive in 60% of RA patients. This rate was significantly higher than the control group. They were mostly females [70%], duration of illness was 3 months to one year [68.7%] with polyarthritis, large and small joints were more affected [72.7%] with manifestations of acute inflammation. Rheumatoid factor [RF] was negative in 70% of them. Regarding osteoarthritis patients, B19 IgM antibodies were detected in 40% of them. They were females [60%] with polyarthritis, large and small joints were more affected [75%]. On the other hand B19 IgM antibodies were not detected in SLE patients or in the control group. Parvovirus B19 is important viral agent causing joint manifestations and should be considered in the differential diagnosis of acute arthropathy in adults, as early treatment of these cases results in fewer complications

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