Pulsed electromagnetic field [PEMF]: effective adjuvant therapy in venous and vasculitic leg ulcers

Chronic leg ulcers occur in 1% of the adult population with considerable associated morbidity and tend to follow a chronic course of recurrent healing and breakdown. Venous insufficiency is the commonest cause of chronic leg ulcers in the community, but vasculitic ulcers are known to be more resistant to treatment and also more painful than ulcers of other aetiologies. A proportion of leg ulcers will heal on conservative treatment, those which do not respond cause considerable distress. Many modalities have been used for conservative treatment of leg ulcers and pulsed electromagnetic field [PEMF] was used for wound healing as it has a number of well-documented physiological effects on cells and tissues. A total of 48 patients with 53 resistant venous and vasculitic leg ulcers unresponsive to medical treatment were enrolled in this study. The patients were randomly divided into control group who received standard wound care and active group who received standard wound care plus active [PEMF] therapy 3 days per week for 12 weeks for a total of 36 sessions. Ulcer size, appearance of the ulcer and surrounding skin, and pain intensity were assessed at the entry of the study, at 6 weeks and at the end of the treatment. At week 12 the active group showed a 56.4% reduction in the ulcer surface area for venous ulcers, and 48.6% for vasculitic ulcers compared to only 17.2% in controls [P=0.01, 0.007, respectively]. A significant decrease in pain intensity was seen in the active group [P= 0.007, 0.006 respectively]. No adverse events were reported. PEMF therapy improve the rate and degree of healing and reduces pain in resistant venous and vasculitic leg ulcers, this suggests that it could be a useful addition as an effective adjuvant treatment to non surgical therapy of leg ulcers. There is need for further studies in a larger population to determine the optimal treatment dose, timing and duration of electromagnetic therapy and applicability of using it in resistant ulcers of other aetiologies

Anti-chromatin and anti-histone antibodies in Egyptian patients with systemic lupus erythematosus

There has been a renewed interest in anti-chromatin and anti-histone antibodies in the last few years. A number of research papers have demonstrated the clinical utility of these antibodies to help diagnosis of systemic lupus erythematosus [SLE]. To assess the prevalence of anti-chromatin and anti-histone antibodies in patients with SLE and to correlate serum levels of these antibodies with clinical features of the disease. The presence of anti-chromatin and antihistone antibodies in 38 patients with SLE was investigated by an enzyme- linked immunosorbent assay [ELISA] To determine the specificity of these antibodies, 15 patients with rheumatoid arthritis, 15 patient with systemic sclerosis and 15 normal controls were also tested. Increased levels of anti-chromatin antibodies were detected in 89.5% of SLE patients. In contrast they were found in only 33.3% of those with rheumatoid arthritis [RA], 26.7% with systemic sclerosis [SSc] and in non of the healthy controls. Increased levels of anti-histone antibodies were detected in 92.1% of SLE patients. In contrast they were found in only 20% of RA patients, 33.3% of SS patients and in non of the healthy controls. Sensitivity of anti-chromatin antibodies in SLE patients was 89.5% and specificity was 80.0%, while sensitivity of anti-histone antibodies was 92.1% and specificity was 82.2%. Significant associations were found between the levels of anti-chromatin antibodies and arthritis, malar rash, oral ulcer, and pulmonary affection [P<0.05] and also, lupus nephritis [P<0.01], and disease activity score as measured by SLE disease activity index [SLEDAI] [P<0.001]. Significant association was found between anti-histone antibodies and fatigue [P<0.05]. The incidence of positive anti-chromatin and anti-histone antibodies was significantly higher than that of anti-dsDNA antibodies in early stage of the disease. Anti-chromatin and anti-histone antibodies are both sensitive and specific for SLE and could be a useful addition to the laboratory tests that can help in the diagnosis of SLE. Anti-chromatin antibodies seem to be a promising marker useful in early diagnosis and assessment of disease activity in SLE patients especially in patients who are negative for anti-dsDNA antibodies