Role of dexamethasone iontophoresis in treatment of epicondylitis as evaluated with quantitative high resolution ultrasonography

To evaluate the effect of dexamethasone iontophoresis in treatment of epicondylitis based on high resolution ultrasonography. This study included 25 patients with epicondylitis and 14 healthy controls. Pain intensity was assessed by visual analogue score [VAS] and by patient global assessment [PGA]. Measuring the maximum grip force of the sound side, maximum grip force [MGF] and pain-free grip force [PFGF] of the affected side, using the hand grip dynamometer, were also assessed. Ultrasonographic assessment was performed for the site of complaint either the common extensor origin [CEO] or the common flexor origin [CFO]. Patients received 6 sessions of 4 mg/ml dexamethasone [DXM] iontophoresis on alternating days over a period of two weeks. After the treatment program, the patients were re-assessed both clinically and by ultrasonography. After treatment with dexamethasone iontophoresis, the decrease in the VAS, PGA as well as the changes in MGF and PFGF of the affected side was statistically significant. Regarding diagnostic US, abnormal findings were detected in 11 patients [44%] at the beginning of the study with no abnormal findings in the control group. High resolution ultrasonography proved to be of 48.5% sensitivity. and 65.7% specificity in diagnosing epicondylitis. The improvement of epicondylitis after iontophoresis treatment, though well evident and proved on clinical reassessment, couldn't be detected except in 3 patients out of the 6 patients reassessed by ultrasonography. Dexamethasone iontophoresis could be considered a simple, easy, safe, effective and non-invasive therapeutic option for epicondylitis. High resolution ultrasonography has a role in diagnosing epicondylitis but has no role in follow up

Anticyclic citrullinated peptide antibodies in systemic sclerosis

To measure the serum levels of anti CCP antibodies in patients with systemic sclerosis and to correlate these levels with joint involvement extent of skin sclerosis and pulmonary involvement. 22 SSc patients were grouped into [group II] included 10 patients had limited cutaneous SSc and [group III] included 12 patients had diffuse SSc in addition to 10 healthy subjects as a control group [group I]. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, chest and hand-x-ray, pulmonary function tests, capillary microscope. Measurement of anti-CCP antibodies using ELISA technique. Anti-CCP antibodies serum level was significantly higher in SSc patients than the control [p<0.05]. Also anti-CCP antibodies serum level was significantly higher in patients with arthritis and pulmonary affection than those without arthritis or pulmonary affection. There was a significant association between anti-CCP antibodies positivity and capillaroscopic abnormalities. Our results suggest that anti-CCP antibodies might be linked to disease severity

Value of anti-cyclic citrullinated peptide antibodies and magnetic resonance imaging in early rheumatoid arthritis

To assess the value of the presence of anti-cyclic citrullinated peptide antibody [anti-CCPAb] as well as magnetic resonance imaging [MRI] in early rheumatoid arthritis [RA]. The study was performed on twenty early RA patients [with disease duration <1 year] diagnosed according to the 1987 ACR classification criteria. They underwent full history taking and thorough clinical examination. Anti-CCPAb was assessed with ELISA technique. MRI study was done for both wrist joints and hands of all patients and evaluated according to the OMERACT 2002 RAMRIS scoring system. Disease activity was assessed with CRP and 28 joint disease activity score [DAS28]. Rheumatoid factor [RF] IgM was analyzed with latex agglutination. We divided the patients according to the presence or absence of anti-CCP antibodies into two groups: Eleven [55%] patients were positive for anti-CCP and 9 [45%] patients were anti-CCP negative. Comparison between the two groups revealed that there was a highly statistical significant difference as regards the CRP level and DAS28 score [p<0.001]. There was a statistically significant difference in the initial presentation between the two groups; in anti-CCP positive patients symptoms started more often in the upper limbs while the anti-CCP negative group they often presented in both upper and lower limbs. Bone marrow edema was more frequent in patients with positive than those with negative anti-CCP-Ab with a highly statistical significant difference [p<0.001]. The highest global scores for bone edema were seen in triquetral and lunate bones. The prevalence and severity of synovitis as well as the MRI scoring of bone erosions did not differ significantly between the two groups [p>0.05]. The highest global score of erosions was located in the same sites in the wrist and MCP joints. Tenosynovitis was observed nearly equally in both groups of patients. Global scores of tenosynovitis in both groups were high in the extensor tendons of the wrist and in the flexor tendons of the MCP joints. The study showed the importance of the presence of positive anti-CCPAb at baseline and its high association with greater disease activity [DAS28], higher levels of CRP, and bone marrow edema as an indicator of future bone erosion in early RA. MRI can be added as a useful tool for evaluation of early RA. This aspect is important because an early diagnosis of RA may modify the therapeutic strategy substantially, suggesting the use of more aggressive pharmacological agents that can delay progression of joint damage and thus substantially change the natural history of the disease