Ultrasound-guided local injection: autologous blood versus dexamethasone for treatment of recurrent plantar fasciitis

To compare the efficacy of Ultrasound-guided local autologous blood injection to Ultrasound-guided local dexamethasone injection for treatment of recurrent Plantar fasciitis. Nineteen consecutive patients with recurrent refractory plantar fasciitis were recruited into the study following informed consent. Patient were assessed by numerical visual analogue scale [VAS], heel tenderness index [HTI], laboratory investigations, and heel ultrasound scanning. Eight patents had ultrasound guided local autologous blood injection as a treatment modality [Group I], while the other eleven patients had ultrasound guided local dexamethasone injection [Group II]. After care was given and patients were monitored at one week, four weeks, three months, and six months by the previous evaluation parameters. Demographic and some clinical characteristics of groups showed non significant differences at base line. Follow up and monitoring showed improvement of symptoms in both groups. Follow up of VAS, HTI, the planter fascia thickness, echogenicty and percentage of mean change [m c%] at 6 months compared to base line measurements reveled highly significant difference in for Group I and Group II. The mean change percentage decrement for Group II was less than that for Group I. Comparison between Group I and Group II as regards the evaluation parameters at the end of six months showed significant difference and better symptom improvement for Group I except for lat band thickness. Autologous blood injection appears to be a viable alternative to steroid injection therapy for treatment of recurrent plantar fasciitis. It appears to be safe and no reports of reflex sympathetic dystrophy, infection or other major complications

Correlation of serum VEGF levels with clinical, laboratory and MRI findings in patients with ankylosing spondylitis

To investigate serum VEGF levels as an objective activity parameter and its relationship with clinical and laboratory parameters as well as MRI findings in ankylosing spondylitis [AS]. Twenty four patients with AS and 8 healthy matched individuals were recruited in this study consecutively. Cross-sectional study was planned and demographic, clinical, functional, MRI findings, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were also assessed respectively, with Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Short-Form 36 [SF-36]. Mander Enthesis Index [MEI] was used for evaluation of enthesis involvement. We examined serum concentrations of serum VEGF levels pg/ml in patients with AS and controls. The mean value of serum VEGF levels in patients and controls were 316.4 pg/ml and 117.3 pg/ml, respectively. This difference was meaningful [p=0.04]. There was a significant correlation between VEGF level and C reactive protein level, albumin, C3, and IgA levels. MRI sacroiliitis grading showed significant correlation between VEGF levels and grades 1, 2, 3 and 4. A significant correlation between VEGF levels and distance of hand-floor, modified lumbar Schober's test, distance of chin to chest and extra-articular manifestations was found. However, there was no significant correlation between VEGF levels with MEI, BASFI, BASDAI, and SF-36 [p >/= 0.05]. Serum VEGF levels were significantly higher in AS patients than controls. Serum VEGF levels may be a potential biomarker of axial inflammation and disease activity in AS

Association between rheumatoid arthritis activity and atherosclerosis

We assessed atherosclerosis as a risk factor in rheumatoid arthritis [RA] patients who experience excess atherosclerosis and cardiovascular risk. They were compared with osteoarthritis [OA] patients as a control group. The severity of atherosclerosis remains to be determined through carotid intima-media thickness [IMT] as a reflector for systemic atherosclerosis. The study was performed on 30 RA patients without history of cardiovascular accidents. The severity of carotid atherosclerosis was evaluated with the mean max IMT, i.e., mean of the maximal wall thickness at carotid segments. Serum level of IL-18 was measured in both RA and OA groups. Erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] were used to measure systemic inflammation. The relationship of the carotid artery IMT with inflammatory markers was examined in RA versus OA as a control. IL-18 concentration was higher in RA versus OA and it positively correlated with IMT, p<0.05. Lipid profile was also higher in RA than OA and positively correlated with CRP, ESR and IL -18 serum level hyperlipidemia and body mass index [BMI], p<0, 05, We demonstrated an association between higher serum IL-18 level and atherosclerotic risk factors. Increased liability of atherosclerosis has the link between IL-18 and atherosclerosis. So, inflammation and cardiovascular risk factors interact to enhanced atherosclerosis in RA patients. Our findings need more evaluation in large study groups with cardiovascular risk profiles