Expression of osteopontin in synovial tissue of rheumatoid arthritis: its relation to disease activity and severity

To demonstrate the expression of osteopontin in synovial tissue of patients with rheumatoid arthritis and to correlate it with disease activity and severity in order to find out its possible role in the pathogenesis of the disease. This study was conducted on 30 RA patients and 10 control subjects with post traumatic knee injury. All patients were subjected to full medical history taking, thorough clinical examination with special attention to articular manifestations [Modified disease activity score] [DAS], and spread severity index [SSI]. Laboratory investigations included: CBC, ESR, CRP and RF. Radiological investigations included: plain x-ray of the affected knee joint using Larsen's score for assessment of joint damage and expression of osteopontin [OPN] in synovial tissues of both patients and controls was determined by immunohistochemical staining of formalin fixed, paraffin embedded synovial tissues. We demonstrated by immunohistochemistry that OPN was detected as brown cytoplasmic staining expressed predominantly in the lining layer of rheumatoid synovium rather than the sublining layer and it was absent in the lymphoid aggregates. In contrast, synovial tissue of the control group showed weak scattered staining for OPN. We found a highly statistical significant difference between RA patients and controls regarding the synovial expression of OPN which was highly associated with the activity. Also, percentage of OPN positive cells was highly associated with the severity of RA assessed clinically by SSI and radiological [p<0.01]. Osteopontin is critically involved in the pathogenesis of both inflammatory and joint-destructive processes in rheumatoid arthritis. OPN may reflect disease activity and can be used as a marker of disease severity

Electromyographic assessment of spinal stabilizing muscles activity in degenerative spondylolisthesis before and after a specific spinal stabilization rehabilitation program

To assess the electrical activity of local spinal stabilizing muscles in chronic low back pain [CLBP] diagnosed radiologically as degenerative spondylolisthesis, before and after a specific spinal stabilization program. Twenty patients complaining of CLBP longer than 3 months with or without radiation to the lower limbs diagnosed radiologically as degenerative spondylolisthesis were studied and compared to matched 10 controls. Patients underwent medical history, and thorough clinical and neurological examinations. Pain was assessed with McGill pain questionnaire, functional disabilities with Oswestry functional disability questionnaire. Flexion/extension plain x-rays were taken for spinal instability. Electrical activity [mean number of turns per second [T/s] and mean amplitude per turn [A/T]] of both lumbar multifidi [LM] and internal oblique [IO] was examined using surface electrodes. Group [I] of 10 patients received a specific spinal stabilization program and [II] received ordinary one. Reassessment was done after 10 weeks. Group [1] showed a significant improvement [p<0.05] in local spinal tenderness, lumbar paraspinal muscles spasm, painful back movements and overall electrical activity after than before rehabilitation program. The difference was highly statistically significant [p<0.001] for overall pain intensity, pain descriptor scores and functional disability scores. Group [2] showed a significant improvement [p<0.05] in spasm of lumbar paraspinal muscles, pain descriptor scores and functional disability scores. The difference was highly significant [p<0.001] for overall pain intensity, but not significant [p>0.05] for electrical activity of both LM and IO. After rehabilitation, group [1] had a significant improvement [p<0.05] in local tenderness and painful back movements as compared to group [II]. Group [1] had a highly significant improvement [p<0.001] in overall pain intensity, pain descriptor scores and functional disability scores. Group [1] had a significant improvement of overall electrical activity of the LM and IO [p<0.05] compared to group [II]. Group [1] had a highly significant improvement in [A/T] of IO [p<0.001]. Specific spinal stabilizing exercises are essential in any therapeutic exercise program advocated for treatment of CLBP patients

Undifferentiated polyarthritis: is it a hiddrn form of RA? The value of anticyclic citrullinated peptide antibodies as a diagnostic and prognostic marker for rheumatoid arthritis

The study was undertaken to assess the value of anti-cyclic citrullinated peptide antibodies [anti-CCP] in comparison to anti-perinuclear factor [APF] and IgM rheumatoid factor [IgM RF] in the early diagnosis of rheumatoid arthritis [RA] in patients with undifferentiated polyarthritis [UPA]. Serum samples of sixty patients with UPA [not fulfilling any of the ACR criteria for the diagnosis of any of the connective tissue diseases] and of other twenty age and sex matched healthy volunteers act as a control group was tested for IgM RF, APF and anti-CCP antibodies at first visit. Follow-up and reassessment of all patients was done monthly till the end of the study after one year. Measurement of APF was done by indirect immunofluorescence [IIF] and anti-CCP was done by enzyme linked immunosorbent assay [ELISA]. Forty two [70%] out of 60 UPA patients met the revised criteria of diagnosis of RA after one year of follow-up. A positive anti-CCP test was highly specific for RA [specificity 88.8%] being found in 30 [71.5%] out of 42 RA patients and its sensitivity was [71.4%]. IgM RF had the highest sensitivity [76%] and it was less specific for RA [66.6%] while the specificity and the sensitivity of APF were 77.7% and 52.38%, respectively. There was a highly significant association between anti-CCP antibodies positive RA patients and high disease activity score as well as disease severity score [p<0.001] while there was significant association between IgM RF and APF positive RA patients separately and high disease activity score [p<0.02 and 0.01, respectively] as well as disease severity score [p<0.05 and 0.01, respectively]. These results suggest that anti-CCP antibody is a highly specific serologic marker for RA and its determination is of value in the diagnosis of early cases of RA. Furthermore, anti-CCP may have prognostic significance because of their association with more severe and active form of RA

Immunological effects of estrogen on CD40 ligand expression on T cells of systemic lupus erythematosus female patients

Systemic lupus erythematosus [SLE] predominantly affects women during their reproductive years. Its pathogenesis has been postulated to involve T cells hyperactivity that can be induced by over-expression of signaling molecules such as CD40 ligand [CD40L] on T cells. This is supposed to lead to B cells proliferation, differentiation and autoantibodies production. To investigate the immunological effects of estrogen on CD40L expression on T cells in vivo as well as its relation to disease activity in SLE female patients. Thirty SLE female patients were included in this study. They are subdivided into two groups: Group Ia: 15 SLE patients during their reproductive years and Group IIa: 15 post menopausal SLE patients. The clinical activity of the disease was assessed with SLE disease activity index [SLEDAI]. The results were compared to two control groups: Group Ib: 10 normal females during their reproductive years and Group IIb: 10 normal postmenopausal women. Routine investigations were performed. Serum estradiol was assessed with electrochemiluminescence immuno-assay. Whole blood was used to determine CD40L expression on T lymphocytes with direct immunofluorescence technique. Renal biopsy was performed for SLE patients only. CD40L expression on T cells was significantly higher in group Ia than in group IIa [p<0.01]. Also it was significantly higher in group Ia than that in group Ib [p<0.01]. There was no significant difference between both groups regarding estrogen level [p>0.05]. In spite of that, SLEDAI score was significantly higher in group Ia than that in group IIa [p<0.01]. Also 24 hrs urinary protein was significantly elevated in group Ia than that in group IIa [p<0.01] while creatinine clearance and serum C3 level were significantly reduced in group Ia than that in group IIa. Of group Ia 66.7% had WHO class IV and V glomerulonephritis [GN] as compared to only 6.7% of group IIa [p<0.01]. There was a non-significant difference between groups IIa and IIb regarding CD40L expression on T cells [p>0.05]. Also, there was a significant correlation between CD40L expression on T cells, estrogen level and SLEDAI score in groups Ia and IIa patients [p<0.01]. On the other hand, there was a non-significant correlation between CD40L expression on T cells and estrogen level in groups Ib and IIb [p>0.05]. Estrogen plays an important role in the pathogenesis of SLE through increasing the expression of CD40L on T cells in SLE female patients, but not in normal females. This action is dose-dependent as we found that CD40L expression on T cells was significantly higher in SLE female patients during their reproductive years than during their postmenopausal years. Again, its level correlated well with markers of disease activity i.e. SLEDAI