Cartilage oligomeric matrix protein [COMP] in arthritis: is it a valuable serum marker of inflammation and bone mineral density changes?

Cartilage Oligomeric Matrix Protein [COMP] is a non-collagenous glycoprotein, which occurs mainly in an articular cartilage. This protein increases under the influence of cytokines and growth factors as a result of various diseases that cause damage to cartilage, fragments of it are released into synovial fluid and then into blood [serum COMP]. To assess the value of serum COMP [sCOMP] as an inflammatory marker in Rheumatoid Arthritis [RA], Systemic Lupus Erythematosus [SLE], Osteoarthritis [OA] patients, and to find its correlation with disease activity and bone mineral density changes [BMD]. This study was conducted on 100 subjects including ten healthy volunteers as group I, 30 RA patients [group II], 25 SLE patients [group III], and 35 patients with knee OA [group IV]. In addition to the physical examinations, activity was assessed in RA and SLE patients. WO MAC index was also performed for OA patients. Assessment of sCOMP level was determined, in addition to assessment of bone mineral density changes by DEXA, The mean values of sCOMP in RA, SLE and OA patients were 10.6 +/- 3.8 U/l 1L9 +/- 3.1U/1, and 10.9 +/- 2.9U/l respectively. In the control group it was 5.9 +/- L1U/L Serum COMP level in RA patients was significantly higher in patients with DAS >3.7 [p<0.05], and in patients with [ESR] value > 40 mm/h compared with patients with ESR value < 40mm/h [p<0.05]. A high significant elevation of sCOMP level was obtained in SLE patients with hemoglobin [Hb] <11.0 g/l, as well as those with ESR > 40 mm/h [p<0.01]. In addition, SLE patients with SLEDAI > 6 showed high significantly elevated sCOMP level than those with SLEDAI < 6 [p<0.01]. In OA patients, the level of sCOMP was significantly elevated in those with BMD < -2.5 than those with BMD >/= 2.5, High significant elevation was detected on comparing sCOMP level in either of group II, group III or group IV with group I [p<0, 01 for all]. In RA patients a significant positive correlation was detected between the sCOMP level and disease activity score [DAS], Hb, ESR [r = 0, 42, 0.39, 0.37 respectively] [p<0.05 for all]. In SLE patients a high significant negative correlation was found between the sCOMP level and Hb [r= -0.50, p<0.01], and significant positive correlation was found between the sCOMP level and ESR [r = 0.40, p<0.05]. In OA patients a significant positive correlation was found between the sCOMP level and WOMAC index [r =0.39], and high significant negative correlation between the sCOMP level and T-score [r=-0.60, p>0.01]. Measurement of sCOMP is valuable for monitoring inflammation in both inflammatory e.g. [SLE, RA] and degenerative joint diseases e.g. [OA] we observed its correlations with activity parameters in RA and SLE. More over OA patients had significant and high significant positive correlation of sCOMP with WOMAC index and the changes of bone mineral density [T-score] values respectively

Efficacy of different modalities on spasticity management of spinal cord injury: clinical and electrophysiological study

To evaluate the effectiveness of TENS [versus oral anti- spasticity drugs and physical therapy alone] on management of spinal cord injury [SCI] spasticity. Also, to study the role of the clinical and electrophysiological methods of assessment of spasticity. This study was performed on 40 patients with traumatic spinal cord injury suffering from spasticity. They were 24 males [60%] and 16 females [40%], their ages ranged from 35 to 45 years with a mean + SD of 38.9 +2.9 years. The patients were randomized into 3 treatment groups: Group[I]: included 15 patients who were taking oral anti-spasticity drugs in the form of baclofen and tizanidine and performed physical therapy program [1 session daily] for 6 weeks. Group [II]: included 15 patients who were subjected to TENS therapy applied to spastic lower limbs, lasting for 15 minutes daily and performed the same previous physical therapy program for 6 weeks. Group [III]: included 10 patients who were subjected to the same previous physical therapy program only daily for 6 weeks. Spasticity of these patients was evaluated clinically by: Lower Limb Ashworth score [LLAS], ankle clonus scale, Modified Barthel Index [MBI], and Walking Index for Spinal Cord Injury [WISCI] and electrophysiologically by: H reflex including H amplitude, H[max]/M [max] ratio and H latency. These evaluations were performed at the initial presentation and after 6 weeks of the treatment program. There was a highly significant difference [p<0.001] between the pre and post treatment assessments in group [II] in all clinical parameters and H amplitude and H [max] / M [max] ratio, the same results were obtained in group [I] except for ankle clonus scale which showed significant difference [p<0.05], while in group [III] this significant difference was shown as regards MBI, H amplitude and H [max] / M [max] ratio. There was significant difference in all clinical and electrophysiological parameters when comparing groups [II] and [III], but when comparing groups [I] and [III], this result was seen as the previous except in ankle clonus scale and MBI. But when comparing groups [I] and [II], there was non significant difference in all parameters. Also, group [I] showed significant correlation between H amplitude and all clinical parameters except WISCI [showed non significant correlation], while H max / M max ratio showed highly significant correlation between it and LLAS and significant correlation between it and ankle clonus scale and WISCI. In group [II] there were non significant correlation between both H amplitude and H max/ M max ratio and LL AS and ankle clonus scale and significant correlation between them and MBI and WISCI. But, group [III] showed significant correlation between the electrophysiological [H amplitude and H [max] / M [max] ratio] and the clinical parameters except between H max/ M max ratio and MBI, there was no significant correlation detected. TENS is an effective, economic, non- invasive and readily applicable method that has few side effects. It can be used as a supplement to other treatment methods [oral medication, TENS and physical therapy] in its management