Electrophysiological study and glutamic acid decarboxylase 65 in detection of subclinical neuropathy in type 1 diabetes mellitus

To evaluate the role of electrophysiological studies and serum glutamic acid decarboxylase [GAD65Ab] in the detection of subclinical neuropathy, in Type 1 diabetes mellitus [TIDM]. This study was conducted on 30 patients of Type 1 diabetes mellitus within the first year of diagnosis and 20 controls. All subjects were evaluated for subjective neuropathy symptoms, neurological examination, electrophysiological findings, GAD65Ab, glycosylated hemoglobin [HbA1], cholesterol and triglyceride in serum. At least two abnormal independent neurophysiological nerve parameters were accepted as the criteria of peripheral nervous system involvement. Electrophysiological study showed peripheral nervous system involvement in 93.3% of patients. The percentages of affection were 90% in sural nerve, 82.4% in peroneal motor nerve, 68.5% in posterior tibial motor nerve, 62.2% in median motor nerve, 59.9% in ulnar motor nerve, 65.2% in median sensory nerve, and 60.5% in ulnar sensory nerve. Antibodies to GAD65 were detected in 18 of 30 patients [60%]. Patients with positive GAD65Ab had slower motor nerve conduction velocities in the median, ulnar, and peroneal nerves and prolonged sural nerve latency. There is a positive correlation between HbA1 levels and peripheral nerve dysfunction in the lower extremity. Highly significant correlation between HhA1 and GAD65 in patients group was noticed. Subclinical diabetic peripheral neuropathy can be detected by electrophysiological tests, especially for nerves of lower extremity. The poor glycemic control and GAD65Ab have an impact on peripheral nerve function

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

Serum YKL-40 as marker of articular manifestations in inflammatory bowel disease

Articular disease is a well-recognized manifestation of inflammatory bowel disease [IBD].A variety of joint disease patterns were described from oligo to polyarthritis or spondyloarthropathy. The aim of this study was to evaluate serum YKL-40 as a possible marker for articular disease in patients with IBD and to compare it with levels of CRP in these patients. This study included 38 patients suffering from IBD, including UC and CD. Patients with IBD were classified into two groups: Group A included 20 patients without articular manifestations. While Group B included 18 patients with articular manifestations and were subdivided into 3 subgroups according to their articular pattern. Fifteen age and sex matched healthy controls were enrolled as Group C. All patients and controls were subjected to complete history taking with stress on presence of articular disease, full clinical examination, laboratory investigations including: ESR, CRP [Avitex- Latex test] and Serum YKL-40 [MetraT YKL-40 EIA Kit]and radiological assessment. The distribution of articular disease in group B, type III [axial disease] was the commonest [61.1%], followed by type I [oligoarthritis] [22.2%] and lastly type II [polyarthritis] [16.7%]. Serum YKL-40 was the highest in group B, with significant difference when compared with group A and highly significant difference between both groups when compared with controls. While ESR and CRP showed non significant difference between groups A and B but significant difference was recognized when comparing both groups with control group. Also serum YKL-40 was the highest in type II subgroup of group B without any significant difference between the 3 subgroups. The latter observation was also found as regards results of CRP values in these subgroups, but type I was the highest. The mean number of affected joints [NAJs] in the 3 subgroups was the highest in type II without any significant difference between them. While a positive correlation was observed between [NAJs] and serum YKL-40 but no correlation was found between [NAJs] and CRP. SerumYKL-40 may be a useful laboratory marker in IBD which is able to predict the presence and perhaps the degree of joint disease regardless the influence of bowel inflammation. While CRP, although is a sensitive inflammatory marker lacks specificity to joint disease among these patients