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

Effects of intensive rehabilitation on locomotor capacity after total knee replacement

To evaluate the effectiveness of a pre- and post-operative exercise protocols and intensive functional rehabilitation [IFR] program on locomotory capacity in the first three months after primary total knee arthroplasty [TKA] for severe osteoarthritis. The study was conducted on 20 patients-with severe osteoarthritis knees who underwent TKA. They were divided randomly into 2 equal groups. The first group received an intensive rehabilitation program while the second received ordinary rehabilitation program. Before program start all patients were subjected to clinical examination. Postural assessment was done to all patients twice pre-operatively and 12 weeks post-operatively using Computerized Dynamic Posturography including motor control, adaptation and sensory organization tests, The ordinary rehabilitation group showed a statistically significant increase in post-operative weight symmetry p<0.05 compared with normal. There were statistically significant high values in both groups in pre- and post-operative strength symmetry p<0.05 compared with normal. Adaptation test toes down showed a statistically significant difference from normal in both groups of rehabilitation in all trials post-operatively, and in intensive rehabilitation group in trial 1, and trial 3, while in ordinary rehabilitation program in trial 2 pre-operatively p<0.05. Amplitude scaling f with affected side of the lower limb, showed a statistically significant decrease in ordinary rehabilitation group in small / and medium f. p<0.05. Intensive rehabilitation group showed no significant change in comparison to normal. There was more balance affection in toes up position in ordinary rehabilitation group. There was better balance in intensive rehabilitation group on affected side

Effects of intesive rehabilitation on functional ability after total knee arthroplasty

To evaluate the effectiveness of a pre- and post-operative intensive functional rehabilitation [IFR] program in the first three months after primary total knee arthroplasty [TKA] for severe osteoarthritis on functional ability and muscle isokinetics. Twenty severe osteoarthritis knee patients underwent primary total knee arthroplasty. They were divided randomly into 2 groups of 10 each. The first group received intensive program of rehabilitation, the second received ordinary rehabilitation program. All patients were subjected to clinical examination, functional assessment using WOMAC score, knee range of motion, 6 Minute Walk test, Timed Up and Go test, and Isokinetic Assessment, at start, 6 and 12 weeks afterwards. Total WOMAC score, pain, stiffness, and difficulty WOMAC scores showed a significant decrease after 6 and 12 weeks in both groups. The first group showed more decrease than ordinary program. Timed Up and Go test showed a significant decrease after 12 weeks in both groups p=0.003, shorter time in the first group than the second. Isokinetic parameters as peak torque and peak torque per body weight showed significant increase after 6 weeks in first group p=0.01, but not in second p>0.05. After 12 weeks there was a statistical significant increase in both groups p<0.001, higher in first group p<0.05]. Total work, average power, and maximum repetition total work showed better improvement in first group. IRP applied in the first 3 months after TKA is effective in promoting better functional ability, less pain and stiffness and results in better ROM and longer distance walked

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

Macrophage inflammatory protein 1 - alpha [MIP -I]: its pathogenetic role in some connective tissue diseases

This study aimed to measure serum level of macrophage inflammatory protein 1- alpha [MIP-la] in some connective tissue diseases as rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc] in order to clarify its possible role in their immunopathogenesis. Fifteen RA patients [group I], 15 SLE patients [group II], 10 SSc patients [group III] and 10 healthy controls [group IV] were participated in this study. A full history taking, thorough clinical examination and routine rheumatological profile investigations were done. Serum MIP-1-alpha was measured in all patients and control groups using ELISA technique. In conclusion, the higher level of serum MIP-1-alpha in RA, SLE and SSc patients could reflect its immunopathogenetic role as an important stimulator of T cells, monocyte macrophage as well as its variable pro-inflammatory activates

Serum adrenomedullin level in rheumatoid arthritis compared with systemic lupus erythematosus

This study was conducted to measure the level of serum adrenomedullin [AM] in rheumatoid arthritis [RA] and systemic lupus erythematosus [SLE] to find out its role in their pathogenesis and its correlation with clinical and laboratory parameters of disease activity. Twenty-five RA patients [group I], 15 SLE patients [group II] and 10 healthy controls were included in this study. They were subjected to full history taking, thorough clinical examination and CBC, ESR, RF, ANA, Ant ds DNA investigations and measurement of serum adrenomedullin level with ELISA. An assessment of disease activity was done using Duke score for RA patients and SLE-DAI score for SLE. From the results obtained, it was concluded that serum level of AM was elevated in both RA and SLE [more in RA than SLE] patients and it was correlated with the disease activity parameter RA [only with ESR in SLE]. These findings emphasized that AM is involved in the pathogenesis of RA and SLE

Macrophage inflammatory protein 1-alpha [MIP-1alpha]: its pathogenic role in some connective tissue diseases

To measure serum level of macrophage inflammatory protein 1alpha [MIP-1alpha] in some connective tissue diseases as rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc] in order to clarify its possible role in their immunopathogenesis Fifteen RA patients [Group I], fifteen SLE patients [Group II], ten SSc patients [Group III] and 10 healthy controls [Group IV] were participated in this study. A full history taking, thorough clinical examination and routine rheumatological profile investigations were done. Serum MIP-1alpha was measured in all patients and control groups using ELISA technique. The three patients groups [RA, SLE and SSc] had a significantly higher level [p<0.001] of serum MIP-1alpha [118.9 +/- 31.4 pg/mL, 106.2 +/- 13.3 pg/mL and 94.2 +/- 4.6 pg/mL] respectively when compared to controls [70.3 +/- 5.4 pgm/mL]. The highest level was among RA patients. Furthermore, there was a significant positive [p<0.05] correlation between serum MIP-1alpha level and disease activity parameters [Duke score, ESR in RA patients; SLEDAI and ESR in SLE patients and only ESR in SSc patients]. The higher level of serum MIP-1alpha in RA, SLE and SSc patients could reflect its immunopathogentic role as an important stimulator of T cells, monocyte macrophage as well as its variable proinflammatory activites. Future theraputic researches should target MIP-1alpha which play an important immunopathogenetic role in chronic inflammatory diseases

Endothelin-1 and ocular involvement in behcet's disease

To detect plasma Endothelin-1 [ET-1] in Behcet's disease [BD] and to assess if ET-1 is associated with ocular BD. 20 BD patients [12 with ocular and 8 without ocular disease] and 10 healthy control subjects were included in the study. The plasma level of Endothelin-1 was measured with Enzyme Immunometric Assay [EIA]. Plasma ET-1 levels were significantly higher in patients with BD than in the control subjects. Among patients with ocular BD, the mean plasma ET-1 levels were significantly increased when compared with non ocular disease and control subjects. Elevated plasma Endothelin-1 may play a role in ocular involvement of BD

Seroprevalence of helicobacter pylori infection in sjogren's syndrome

To identify the prevalence of Helicobacter pylori [H. pylori] infection in patients with Sjogren's syndrome [SS] and its correlation with clinical and laboratory parameters of the disease as an implication for handling these patients from the diagnostic point of view. Four groups of patients were studied. Group I, 22 patients with primary SS; Group II, 21 patients with secondary SS; Group III, 30 patients with various connective tissue diseases not suffering from sicca symptoms, and Group IV, 30 healthy controls. Clinical assessment was done and a score for disease manifestation was given for every SS patient. Serum IgG and IgM antibodies to H. pylori were assessed by ELISA. The prevalence of H. pylori infection [Ig G anti H-pylori positive] in patients with SS was in group I [81.8%] and in group II [80.9%], both were significantly higher than in group III [60.6%] and group IV [56.7%] [p<0.01]. The mean titer for both Ig G and Ig M anti H-pylori were significantly higher in group I [3.86 +/- 0.079, 3.67 +/- 0.46] and group II [3.27 +/- 0.9, 2.8 +/- 0.57] than in group III [1.96 +/- 0.83, 0.83 +/- 0.64] and group IV [1.21 +/- 0.54, 0.51 +/- 0.7] [p<0.001]. There was a significant correlation between H. pylori infection and age, disease duration, global score for disease status and C reactive protein [CRP] in SS patients. On the other hand there was a non significant correlation with ESR. Patients with Sjogren's Syndrome are more prone to have H. pylori infection in comparison to other connective tissue diseases. Serum antibody titer to H. pylori correlated with index for clinical disease manifestations, CRP and disease duration. Assessment of H. pylori infection in patients who are suffering from primary SS for relatively longer duration [more than 3 years] is recommended

Antikeratin antibodies and antiperinuclear factor as diagnostic criteria for rheumatoid arthritis

Various auto-antibodies have been described in the serum of rheumatoid arthritis [RA] patients, such as rheumatoid factor [RF], Antiperinuclear factor [APF] and antikeratin antibodies [AKA]. The aim of this study was to evaluate the association of AKA with the activity and severity of RA. Also, to assess their diagnostic value in relation to RF and APF, as well as to determine whether measurements of these antibodies are useful to distinguish early RA from other inflammatory connective tissue disorders. One hundred and ten serum samples from connective tissue [CT] disorders patients who were diagnosed according to the American College of Rheumatology [ACR] criteria were enrolled in this study. They included 68 RA and 42 different rheumatic disorders. They were tested along with 30 serum samples from apparently healthy subjects. AKA and APF were detected with the indirect immunofluorescence [IIF] technique. RF was estimated with latex fixation test [LFT] and then titrated with Rose Waaler test [RW]. Detection of erythrocyte sedimentation rate [ESR] and C reactive protein [CRP] were used as disease activity parameters. Hands and wrists x-ray films were obtained from all RA patients for joint damage evaluation. A positive AKA test was found in 48.5% of RA patients and turned to be highly specific for RA cases [disease specificity 95.8%]. RF and APA were more sensitive than AKA in detection of RA [78% and 58.8% respectively] but less specific [83.3% and 90.2% respectively]. RF positivity [>1:128] was restricted to RA but occurred only in 39.6% of sero-positive RA cases. AKA fluorescence intensity grade 2 and 3 occurred only in RA patients and in 57.5% of AKA -positive RA cases. APF titer >1:20 was restricted to RA and occurred in 42.5% of APF-positive RA cases. No significant differences were found between RA positive and negative cases of AKA, APF or RF as regards the age or the disease duration. While significant differences were found when positive and negative cases of AKA and RF were compared as regards the ESR, CRP and radiographic changes. A significant positive correlation was found between the degree of positivity of AKA and RF titers. Moreover, a significant positive correlation was found between the degree of positivity of AKA levels and ESR and CRP levels, and also with the radiographic changes

Prevalence of staphylococci in rheumatoid arthritis patients

Recent studies suggested that staphylococcal exotoxin may be involved in the pathogenesis of rheumatoid arthritis. The objective of this study was to determine the prevalence of oral staphylococcal carriage in patients with RA compared with healthy controls. This study was performed on 27 patients with RA and 25 healthy volunteers. Clinical and laboratory data of RA activity were studied. Tongue and anterior nasal swabs were obtained for culture on blood agar. Isolates of staphylococci were identified and collected from oral cavity of 96.3% of RA patients, 53.8% of whom carried staphy. aureus. On the other hand 88% of the healthy volunteers showed staphylococci, 36.4% of whom carried staph aureus. The carriage rate of staph aureus was significantly higher in RA patients than in healthy controls [P<0.05]. So we conclude that the oral carriage of staph. aureus was common in patients with RA. This may be the source of septic arthritis in such patients

Anti-neutrophil cytoplasmic antibodies in juvenile chronic arthritis and rheumatoid arthritis

To assess the incidence and clinical significance of ANCA in RA and JCA patients, and to study the relation between ANCA and granulocyte specific ANA. Serum antineutrophil cytoplasmic antibodies were determined with indirect immunofluoresescent [IIF] technique in 20 RA and 12 JCA patients. ANCA was detected in sera from 10 RA patients [50%] and their titer ranged from 110-350 and JCA patients [25%], their titer ranged from 70-230. ANCA titer was not correlated with RF, disease duration and the presence of ANA. p-ANCA were found in 25% RA patients and 8% of JCA patients, c- ANCA were seen in 25% of RA patients and 17% of JCA patients. The laboratory and histologically proven nephropathy were seen in 25% of RA patients 8% of JCA patients, they were associated with p- ANCA. We concluded that early diagnosis of ANCA associated vasculitides is a key to prevent renal failure, and to measure the serum ANCA titer not only for the diagnosis the clinical course, but also to early treatment of renal affection

Possible role of serum thrombomodulin as a mediator of endothelial cell damage in systemic sclerosis

The aim of this study was to find out the role of thrombomodulin as a mediator of damage to endothelial cells in systemic sclerosis patients. This study was carried out on 20 systemic sclerosis patients who used to attend the Outpatient Clinic of the Rheumatology and Rehabilitation Department of Ain Shams University Hospitals. All patients fulfilled the American College of Rheumatology criteria for diagnosis of systemic sclerosis. Ten age and sex matched healthy controls were also included. Determination of serum thrombomodulin [TM] level was done for both patients and controls using sCD141 thrombomodulin kit, which is a solid phase sandwich enzyme linked immunosorbant assay [ELISA]. Serum TM was higher in the patients group than in the control group with a highly significant difference [t=6.75, p<0.001]. There was also, a significant difference between the level of serum TM in patients with Raynaud's phenomenon, digital ulcers and interstitial pulmonary fibrosis as compared to those without these clinical manifestations [t=0.034, 0.013, 0.25 respectively, p<0.05]. There was a significant positive correlation between serum TM level and the duration of illness, Raynaud's phenomenon, digital ulcers and interstitial pulmonary fibrosis [r=0.69, 0.48, 0.58, 0.49 respectively, p<0.05]. Also, there was a significant positive correlation between serum TM level and ESR and serum urea [r=0.72, 0.61 respectively, p<0.05]. We can conclude that the serum level of TM was higher in our patients and this may reflect its pathogenetic role [through endothelial cell damage] in systemic sclerosis

Treatment of chronic rotator-cuff impingement with arthroscopic subacromial decompression

We made a prospective study on 29 patients who had arthroscopic subacromial decompression for chronic rotator-cuff impingement. All patients were diagnosed as having chronic rotator-cuff impingement on the basis of clinical and sonographic examination. All patients were assessed pre-operatively and at 3, 6 and 12 months post-operatively using the shoulder-rating scale of the University of California at Los Angeles [UCLA]. The dominant arm was affected in 24 patients. There were 26 males and only three females. Before operation, the UCLA shoulder score was poor or fair in all patients. After three months of the operation 48% of patients had satisfactory relief of symptoms but at one year 93% of patients examined had a good or excellent result We concluded that arthroscopic subacromial decompression is an effective form of treatment, but full recovery of function and relief of symptoms could take long time

Back pain among Egyptian Doctors

Chronic back pain in one of the most important areas in the entire spectrum of disability. Occupational or job-related back pain due to mechanical stress factors is important. Two hundred doctors were included in this study. They were asked to fulfill a questionnaire format. Results showed that doctors are exposed to back pain where their job necessitates long hour of standing without real exercise. Changes of life style and daily exercises were recommended

Observational study on patients suffering of Raynaud's phenomenon

We examined Raynaud's phenomenon in systemic sclerosis [SSc], systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA] to determine its relation to the clinical and laboratory data of different rheumatic diseases. Thirty-six patients were included in our study 18 of them with and 18 without Raynaud's phenomenon. There was a significant difference between both groups as regards clinical data of cerebritis, nephritis and systolic blood pressure where such were higher in the Raynaud's positive group than Raynaud's negative group. These findings can be explained on the patho-physiological basis of the disease itself. We can get either affection of the kidney [nephritis] or vasculitis presenting by cerebritis or due to the circulating endothelin substance

Ultrasonographic assessment of the quadriceps muscle in elderly women

Anthropometrical and qualitative ultrasonographic assessment of the quadriceps muscle [vastus lateralis] in thirty elderly women was done before and after a physical training program to develop muscle strength for eighteen weeks. Statistical comparison in different assessment parameters showed that there was no statistical significant difference [p > 0.05] in body weight, thigh girth and cross sectional area of the quadriceps before and after the physical training program. But there was a statistical significant difference [p < 0.05] as regards thigh subcutaneous fat and muscle thickness