Subclinical carotid atherosclerosis in juvenile onset systemic lupus erythematosus and its correlation with osteoprotegerin

To assess subclinical atherosclerosis in patients with juvenile onset systemic lupus erythematosus [jSLE] with the carotid intima media thickness [cIMT] and investigate their relation to osteoprotegerin and traditional risk factors. The study included 25 jSLE patients and 10 age and sex- matched controls. All patients underwent full medical history, thorough clinical examination, disease activity evaluation with SLEDAI and routine laboratory investigations. Serum osteoprotegerin was measured in both patients and controls using ELISA technique. The cIMT was measured using ultrasonography. jSLE patients had higher cIMT in relation to controls yet the difference did not reach a statistical significance [0.56 +/- 0.35 mm versus 0.45 +/- 0.18 mm, p >/= 0.05]. There was an increased incidence of dyslipidemia in our patients. Patients had significantly higher serum OPG than controls 21[11] versus 11[9] pg/ml, p<0.05]. Correlations between cIMT, traditional risk factors, SLEDAI and osteoprotegerin were statistically insignificant [p>0.05 for all]. We found an increased atherosclerotic risk in jSLE patients as evidenced by increased cIMT and dyslipidemia, which necessitates ardent screening and prompt intervention to prevent life threatening complications in later years. Also, it seems likely that elevated circulating OPG levels in patients with jSLE represent an increased production of this molecule in response to inflammation yet its role as a marker of subclinical atherosclerosis in these patients is doubtful

Tumor necrosis factor-alpha and tumor necrosis factor receptor-1 in postmenopausal osteoporosis: relation to serum estradiol

To measure serum levels of TNF-alpha and TNFR-1 in women with postmenopausal osteoporosis and correlate them with serum level of estradiol. This study was conducted on 26 postmenopausal females. They were divided according to their BMD into two groups. Group [I] consisted of 16 patients with osteoporosis [T score < -2.5] and group [II] consisted of 10 patients with osteopenia [T score -1 to -2.5]. Ten healthy postmenopausal women with normal range of BMD [T score >-1] served as control group. The serum levels of TNF-alpha TNFR-1 were measured with ELISA and serum estradiol was determined with electrochemiluminescence immunoassay [ECLIA]. Bone mineral density was measured with dual-energy x-ray absorptiometry. Serum estradiol level was significantly lower in both osteoporotic [7.88 +/- 3.14pg/ml] and osteopenic patients [8.54 +/- 3.99 pg/ml] as compared to controls [13.62 +/- 4.57 pg/ml]. Serum level of TNF-alpha and TNFR-1 were insignificantly highest among osteoporotic patients as compared to osteopenic patients and controls. There was no significant correlation between estradiol and TNF-alpha or TNFR-1 [r=0.12, p>0.05 and r=0.07, p>0.05] respectively. A significant negative correlation was found between femoral BMD of patients and serum TNF-alpha [r=-0.43, p<0.05] and TNFR-1 [r=-0.47, p<0.05]. TNF-alpha also showed significant positive correlation with weight [r= 0.41, p<0.05] as well as the BMI [r=0.44, p<0.05]. TNF-alpha has a role in the pathogenesis of postmenopausal osteoporosis, which seems to be independent of estradiol and may thus be a novel target for therapy in resistant cases of postmenopausal osteoporosis

OX40/OX4OL in systemic lupus erythematosus: association with disease activity and lupus nephritis

To evaluate the role of OX40/OX40L as markers of disease activity and nephritis in SLE patients. The study included forty SLE patients [38 females and 2 males]. They underwent full history taking, clinical examination, and routine laboratory investigations. Their disease activity was assessed according to the SLEDAI. Twenty age and sex matched subjects were included as controls. Patients were divided into two groups; first group included 20 patients with biopsy proven lupus nephritis [LN] and the second group included 20 patients without evidence of renal involvement. We assessed the percentage of OX40+CD4+lyrnphocytes by flowcytometry and serum soluble OX40L by ELISA in patients and controls. The percentage of OX40+CD4+ lymphocytes in SLE patients was significantly higher than controls. There was a highly significant increase in the percentage of OX40+CD4+lymphocytes among the patients with nephritis as compared to the patients without nephritis. It correlated significantly with s.creatinine and SLEDAI. Soluble serum OX40L was significantly higher in SLE patients as compared to controls and the level in patients with LN was statistically higher when compared to patients without LN. It showed positive significant correlation with s.creatinine but did not correlate with the SLEDAI. Our results suggest that the interaction between OX40 and its ligand play an important role in the pathogenesis of SLE. The expression of OX40 on CD4+T cells and the level of OX40L may act as markers of LN. Furthermore, measurements of the percentage OX40+CD4+T cells may serve as an indicator of disease activity in SLE patients

Sympathetic skin response in carpal tunnel syndrome

Sympathetic skin response [SSR] is most frequently used in diagnosing functional impairment of non-myelinated postganglionic sympathetic fibers. Early diagnosis of autonomic dysfunction is important in patients with carpal tunnel syndrome [CTS] as the earlier the diagnosis the more effective the treatment. Aim of this work was to measure the SSR in patients with CTS to detect its relation with possible autonomic dysfunction. This study included 18 patients [23 hands] with CTS, graded according to Bland [2000]. SSR measurement was done, and the latency and amplitude were measured. Clinical manifestations of autonomic dysfunction were present in 6 hands [26%]. There was statistically high significant longer disease duration among patients with autonomic dysfunction in comparison to those without. Among our patients, 3 hands [13%] had no elicited SSR. This was associated with very severe carpal tunnel syndrome, female sex, and long disease duration. There was a statistically high significant difference between patients and controls as regards the latency of SSR with no significant difference as regards the amplitude. There was a statistically high significant positive correlation between the SSR latency and the grading of CTS, and statistically high significant negative correlation between the amplitude of SSR and the grading of CTS. SSR can be used in the electrodiagnostic workup for patients with carpal tunnel syndrome where it can be used as a method for detection of autonomic dysfunction in these patients

Value of dexamethasoneiontophopresis vs. local injection of dexamethasone in the treatment of plantar fasciitis

To evaluate the effect of dexamethasone [DXM] iontophoresis in treating plantar fasciitis compared to the effect of local DXM injection. The study was performed on 21 patients [26 feet] complaining of plantar fasciitis of at least 2 months duration. Patients were selected on the basis of their clinical presentation and confirmed by plain Xray and diagnostic ultrasonography. Patients were classified into 2 groups: Group I [11 patients] received 10 sessions of iontophoresis using solution of 0.4% DXM on alternating days, while Group Ii [10 patients] received one local steroid injection of DXM into the area of maximum tenderness. Reassessment of the patients of both groups was done 3 weeks after starting their treatment program by assessment of pain intensity using numerical visual analogue scale [VAS], assessment of tenderness using Heel Tenderness Index [HTI] and ultrasonography examination. There was high statistical significant improvement of in all patients of group I, and in 7 patients of group II. Two feet had steroid flare in group II. No difference of statistical significance between the 2 groups was detected regarding change in HTJ, or change in ultrasound findings. However, there was a statistical significance difference regarding decrease in pain intensity with higher improvement in group I. Dexamethasone is an effective anti-inflammatory drug in treating plantar fasciitis whether applied by iontophoresis or by local injection. However, lontophoresis has the advantages of painless application with no risk of infection or fascial rupture