BackgroundUsing intra-articular injections of autologous platelet-rich plasma (PRP) has showen promising results in treatment of knee osteoarthritis (KOA). Its regenerative properties depends on the amount of growth factors (GF) released after platelets activation. Using large-volume of blood for obtaining allogenic PRP can provide higher concentrations of platelet and GF. However once prepared, PRP is stable for only 8-hours. Freeze drying (lyophilization) can be used to stabilize the biological materials for prolonged storage without causing their damage (1).ObjectivesInvestigating the effectiveness of intra-articular allogenic lyophilized growth factors (L-GF) injection in patients with symptomatic KOA using clinical and knee ultrasonography assessment.Methods30-patients with symtomatic primary KOA, diagnosed according to revised criteria of the aCR (2), were enrolled. Local ethical approval was obtained. All patients had given a written informed consent. The study group was equally randomized into intervention and control groups. Both was subjected to baseline functional assessment using WOMAC score; evaluating pain, stiffness, and physical function (3), and ultrasonography (US) assessment of knee effusion. The patients in control group were kept on their medications without intervention. The intervention group was recieved two doses of L-GF; at baseline and after 2-months. L-GF was prepared from platelets derived from individual whole blood donations. Each unit of platelets was tested in and found to be non-reactive for HBsAg, HIV I & II antibodies, HIV p-24 antigen, HCV antibodies and antibodies to Treponema Palidum, by licensed assay methods. Seronegative plasma were further examined by Nuclear acid Testing. Further viral inactivation by UV-radiation and Riboflavin by the Mirasol system was done. The platelets in the buffy coat layer were activated using CaCl2 to release their GF. Excess water, cellular elements and fibrinogen were removed and the remaining GF were “ultraconcentrated.” Lyophilization of the obtained GF was then processed. The L-GF was supplied as powder in tightly sealed container and was stored at 2° to 8° C. Prior to use, reconstitution of the product was done using 1-ml saline and 1-ml lignocaine then the mixture was kept at ambient temperature for 5-min. To ensure complete protein re-hydration. After 6-months the WOMAC score and knee US were repeated for all particepients. Then percent of improvement of WOMAC and US detected effusion were calculated for all patients.ResultsThe patients in the intervention group was significantly older (56±9 years) and had heigher BMI (38±5.3 kg/m2) in comparison to control (44±11 years, 33±5.6 kg/m2). Both groups showed statistically insignificant difference regarding the baseline total WOMAC score and radiographic assessment. Post injection pain was reported by all patients in intervention group, it lasted only for 2.4±0.83 hours and was graded as mild. The mean of total WOMAC score and its 3-compenents in addition to knee effusion were decreased signi...

Rheumatologic manifestations not only are encountered in leprosy but also can be the first and even the sole presenting manifestation. The hallmark of leprosy is skin and peripheral nerve affection; however, it can affect a wide range of other organs, with the joints being the commonest. We have searched PubMed with the key words leprosy, arthritis, vasculitis, rheumatic diseases, and autoantibodies in a proper combination. Relevant studies were retrieved from scanning of their abstracts. The relevant references provided in these articles were also selected and reviewed. We summarize the clinical and laboratory manifestations that make leprosy masquerade as a systemic rheumatic disease. Moreover, we report 4 Egyptian patients who presented with rheumatologic manifestations, namely, arthritis and vasculitis that turned out to be leprosy related.

All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.

The first cases of systemic lupus erythematosus (SLE) with effects on the nervous system were reported more than 100 years ago. Cerebellar involvement and obstructive hydrocephalus are rarely encountered in patients with SLE. We report two patients with SLE who developed cerebellar ataxia. The first patient presented with significant headache at time of SLE diagnosis and negative brain imaging studies on initial evaluation. The headache recurred with findings of cerebellar ataxia and obstructive hydrocephalus. The patient's symptoms markedly improved with shunt insertion and immunosuppressive therapies. The second patient, known to have SLE, presented with crossed hemiplegia and cerebellar symptoms. Imaging studies showed cerebellar atrophy as well as thalamic and brainstem lesions. The patient had partial improvement with immunosuppression. To understand the impact of SLE on the cerebellum and in hydrocephalus formation, we reviewed the literature and case reports over the last 50 years. Clinical presentations, laboratory results, imaging results, treatment and outcomes, for reported cases found in the literature, were summarized and discussed along with our conclusions. We emphasize the importance of history, examination and close monitoring of patients with SLE presenting with headache or any new neurological symptoms.