RESUMO
Background: Lupus nephritis is the major cause of morbidity and mortality in systemic lupus erythematosus [SLE] patients, and renal biopsy is the most accurate method for the evaluation of the degree of renal affection. Recent studies suggest that antichromatin antibodies [anti-CHR] could help in early detection of lupus nephritis in SLE patients
Objective: To assess the prevalence of serum anti-CHR antibodies in SLE patients, to evaluate their clinical significance and their value as a marker of lupus nephritis and to correlate them with histopathological findings of lupus nephritis
Methodology: Serum anti-CHR antibodies were determined by an enzyme linked immonsorbent assay [ELISA] in 30 SLE patients, and 30 control subjects [10 cases of rheumatoid arthritis [RA], 10 cases of osteoarthritis [OA] and 10 healthy persons]. Patients and controls were also subjected to history taking, clinical examination and routine laboratory investigations including CBC, ESR, serum complement, serum creatinine, creatinine clearance; in addition to complete urine analysis, urinary protein measurement and serum albumin. Renal biopsy was performed on 20 patients of SLE with clinical and laboratory evidence of nephritis and examined by both light microscopy [LM] and electron microscopy [EM]
Results: Anti-CHR antibodies in SLE patients were positive in 20/30 [66.7%], while they were negative in all controls including cases of RA and OA, with a 66.7% diagnostic sensitivity and 100% specificity. Anti-dsDNA antibodies were detected in 13/30 [43.3%] cases of SLE only, with a 43.3% diagnostic sensitivity and 100% specificity. Positive results of anti-CHR antibodies were found in 17/20 [85%] cases of lupus nephritis [85% diagnostic sensitivity and 70% specificity]; whereas anti-dsDNA antibodies were detected in 11/20 cases [55%] only [55% diagnostic sensitivity and 80% specificity]. Significant positive correlations were found between anti-CHR antibodies and disease duration, disease activity, serum creatinine, creatinine clearance, proteinuria, ESR, ANA level and nephritic lesions seen in renal biopsy. Meanwhile, negative correlations were found with blood platelets, serum albumin, serum complement C3 level [p<0.05]. A highly significant correlation was also found between anti-CHR antibodies and disease activity score measured by ECLAM [p<0.001]. Renal biopsy findings showed that WHO class of lupus nephritis had a significant impact on anti-CHR antibody level [p<0.05], with the association of higher antibody levels with proliferative glomerular lesions and frequent electron dense deposits mainly in the subendothelial location, while no significant difference was found in case of anti-dsDNA antibodies
Conclusion: Antichromatin antibodies are more sensitive and specific than anti-dsDNA antibodies for the diagnosis of SLE and more sensitive as regards lupus nephritis. Moreover, serum level of anti-CHR antibodies can be a helpful test to expect the extent of renal affection and hence -choose patients candidate for renal biopsy
RESUMO
Background: Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. The primary focus of early rehabilitation is ambulation of patients and regaining range of motion in the knee. Although many studies suggested that continuous passive motion should be implemented in the first rehabilitation phase following surgery, others concluded that the use of continuous passive motion was of no added benefit
Objective: The aim of our study was to compare the effectiveness of rehabilitation programs with and without continuous passive motion for range of motion in knee flexion and knee extension, functional ability and length of stay after primary total knee arthroplasty
Methodology: Forty patients suffered from osteoarthritis who underwent unilateral total knee arthroplasty were selected. Immediately after total knee arthroplasty, they were subdivided into two groups. Group 1 of 20 patients who received conventional physical therapy only and group 2 of another 20 patients who received conventional physical therapy with two hours of continuous passive motion applications daily. All subjects were evaluated once before total knee arthroplasty and at discharge. The primary outcome measures was active range of motion in knee flexion at discharge. Active range of motion at knee extension, timed "Up and Go" test results, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire scores, and length of stay were the secondary outcome measures
Results: The characteristics of and outcome measurement for the subjects in the two groups were similar at baseline. No significant difference between the two groups was demonstrated in primary or secondary outcomes at discharge
Conclusion: The results of this study do not support the addition of continuous passive motion application to conventional physical therapy in rehabilitation program after primary unilateral total knee arthroplasty. It did not further reduce knee motion impairments or disability or reduce the length of the hospital stay
RESUMO
Objectives: To detect the diagnostic value of serum level of anti beta-2 glycoprotein I [anti GP beta-2] among suspected patients of antiphospholipid syndrome [APS] either in its primary form [patients with thrombotic tendency without an underlying autoimmune disorder] or in its secondary form [patients with an underlying autoimmune disorder such as systemic lupus erythematosus, SLE]. Also, to define the usefulness of this test in predicting thrombotic events in comparison to other markers of APS such as anticardiolipin [aCL] and lupus anticoagulant: [LA]
Methodology: Fifty eight children with suspected antiphospholipid syndrome were included in this study. They were divided into patients with suspected primary APS [group I, n=19] and patients with secondary APS [group II, n=29]. According to the results of LA patients of group I were subclassified into subgroup LA [proved primary APS, n=10, +ve LA] and subgroup IB [undefined thrombosis, n=9,-ve M]. Similarly, patients of group II were subclassified into subgroup IIA [APS secondary to SLE, n=9, +ve LA] and subgroup IIB [SLE without APS, n=20,-ve LA]. The results of these patients were compared to those of 30 healthy children. Laboratory investigations were performed to all subjects including: antinuclear antibodies [ANA], anti-dsDNA, LA [using two tests], anti beta-2 GPI, aCL IgG antibody in addition to routine investigation including serum creatinine, CBC, PT, PTT, ESR, and routine urine analysis
Results: Highly significant differences were found regarding the results of anti beta-2 GPI and LA in both groups I and II as compared to controls. Moreover, a significant difference between groups I and II was observed for anti beta-2 GPI results only being higher in group I [suspected 2ry APS]. APS subgroups [IA and HA] also had significantly higher results of anti beta-2 GPI as compared to SLE patients without APS [IIB] [p<0.01, respectively]. While, no significant differences were observed for anti beta-2 GPI results in subgroups IA and [IA when compared to patients of subgroup IB [p> 0.05, respectively]. Frequencies of seropositive results [anti beta-2 GPI>20 standard GPI units and ratio of LA>1.36] in different groups were compared using Chi-square test. For anti beta-2 GPI, it revealed highly significant differences in both groups I and II as compared to controls [p<0.01, respectively] and a significant difference was found between groups I and II [p<0.05]. On the other hand, LA results showed similar highly significant differences for both patients' groups compared to controls but there was no significant difference between groups I and II [p>0.05]. The seropositivity of aCL in group IA was 80% while it was 90% for anti beta-2 GPI in the same group. The efficiency in diagnosis was higher for anti beta-2 GPI in both groups 1 and 2 [90% and 81% respectively] while it was much lower for LA [73% and 66% respectively]. In group I AUC were 0.75 and 0.7 for anti beta-2 GPI and LA respectively with a non-significant difference between both parameters [p>0.05]. While, in group II the performance of anti beta-2 GPI was better as AUC were 0.87 and 0.65 for anti beta-2 GPI and LA respectively with a significant difference between the AU C of both markers [p<0.05]
Conclusion: About one half of the thrombotic events that appear to be unexplained are due to APS. Anti beta-2 GPI proved itself as a sensitive and efficient test for the detection of 2ry as well as 2ry APS. Its diagnostic value resides in being reliable for the diagnosis of APS especially when there is a strong clinical suspicion in the absence of positive aCL or LA. In SLE patients, the presence of anti beta-2 GPI would be of value in the discernment of 2ry APS from other overlap symptoms of disease activity
RESUMO
Objective: To determine the presence of antimyloperoxidase [anti-MPO] in rheumatoid arthritis patients in order to assess its relation to disease pattern
Methodology: Serum antimyeloperoxidase antibodies were assessed with Enzyme Linked Immunosorbent Assay [ELISA] in 25 rheumatoid arthritis patients and 10 controls
Results: Anti-MPO was found in 60% of patients and 10% of controls with a high statistical difference between the patients and control groups [p > 0. 001]. Also there was a highly significant difference between the patients and controls regarding ESR [p < 0.001] and serum creatinine [p< 0.05]. There was no correlation between the mean anti-MPO and activity sore, duration of morning stuffiness and number of affected joints [p> 0.05]. There was a positive correlation between serum creatinine duration of RA, ESR and disease severity with mean of Anti-MPO among cases [p<0.01]
Conclusion: The use of Anti-MPO helps in the assessment of RA disease activity and help in the assessment of disease severity and prediction of renal affection. It cannot be used to predict the onset of RA but can be used as an indicator of long standing RA disease