inflammatory autoimmune disease with a frequency of 0.5–1.0% between the adult population of developed countries. It is marked by chronic inflammation of synovial tissue and accompianed by damage of the articular cartilage and adjecent bone, leading to substantial disability. Objectives: The aim of this study is to determine serum and synovial fluid levels of calprotectin in rheumatoid arthritis patients and to determine its relation with disease activity and severity. Methodology: This study was carried out on 40 rheumatoid arthritis patients who were admitted to Rheumatology, Rehabilitation and Physical Medicine Outpatient’ clinic and Inpatient Department of Benha University Hospital .Also Thirty age and sex matched( 28 females and 2 males ) apparently healthy volunteers were included in the study as a control group . All patients were assessed by full medical history, clinical examination, functional assessment, laboratory investigations including CBC, ESR ,CRP, liver functions, RF, Anticcp antibody, and Xrays were done to both hands. Serum and synovial levels of calprotectien were measured using the ELISA technique. Results: Serum levels of calprotectien were significantly higher in RA patients than healthy subjects [p<0.001], also there was a highly statistically significant increase in the mean synovial fluid calprotectin levels than mean serum calprotectien levels [p<0.001]. Local and systemic levels of calprotectin correlate with clinical, immunological and instrumental assessments of disease activity and the inflammatory degree of the joint. Conclusion: Calprotectin could be used as a new biomarker for monitoring the disease activity and severity of RA. Larger sets are needed to confirm the diagnostic and prognostic accuracy of calprotectin in RA
BackgroundPatients in clinical remission may continue to have synovitis detected by the musculo skeletal ultrasonography (MSUS).Recently,B-lymphocyte chemoattractant chemokine (CXCL13) has reported to be upregulated and risen to be a possible new marker of disease inflammation in RAObjectivesto detect early synovitis by grey scale and power Doppler MSUS, measure serum levels of CXCL13 and to correlate these levels with both clinical and ultrasonographic disease activity in early RA patientsMethodsRA was assessed by the modified disease activity score (DAS28).Hands and feet plain radiography were evaluated by Laresn score. A semi-quantitative score (0–3) was used to score synovial effusion (SE), synovial proliferation (SP) and power Doppler (PD) signals by MSUS in 6 synovial sites in 3 joints bilaterally: wrist (dorsal radiocarpal recess). 2nd MCPJ (dorsal and palmar side) and knee (suprapatellar recess) according to the European Leauge Against Rheumatism guidelines. A total MSUS score is the sum of scores for SE, SP and PD signals of the six joints in each patient (0–54).Quantitative detection of serum (CXCL13) levels of all subjects was done by ELISA.ResultsThe mean serum CXCL13 values were highly significantly higher in fifty RA patients than in 30 age and sex matched control subjects with a mean of (388.86±283.63 pg/ml) and (62.96±32.5 pg/ml) respectively (p<0.001) and were significantly positively correlated with morning stiffness durations (p<0.001), Tender Joint Counts (p<0.001), Swollen Joint Counts (p<0.001), VASs (p<0.001), ESR 1st h values (p<0.001) and the platelets count (p<0.05), negatively correlated with disease durations (p<0.05) and HB concentrations (p<0.05) and showed no differences according to presence of extra-articular manifestations or CRP, RF or ACCP seropositivity.(p>0.05). In our RA patients' group, MSUS detected either synovial effusion and /or synovial hypertrophy with or without PD signal in 132 (65%) joints out of 203 clinically silent joints and and detected erosions in 93/300 joints (31%) compared to 27/300 joints (9%) detected by x ray.the serum CXCL13 levels were highly significantly positively correlated with the total MSUS score for each patient (p<0.001),SP and SE gradings (p<0.001) and (p<0.05) and were significantly higher in RA patients with MSUS detected erosions but were not correlated with either PD gradings (p=0.11) or Larsen scores (p>0.05).ConclusionsMSUS is more sensitive than clinical assessment and conventional radiology in detecting synovitis and erosions in RA. Serum CXCL13 levels correlated with MSUS and DAS 28 scores and can be used as a marker for activity and severity of RA.Screening early RA patients by MSUS for more precise evaluation of synovitis activity, severity and better management of the disease and follow up patients to detect if elevated CXCL13 affect RA disease progression or patient disability are recommended.References Naredo E, Valor L, De la Torre I, Martinez-Barrio J, Hinojosa M, Aramburu F, et al., (2013): Ultrasound joint inflammation in rh...
Complications that might arise from diabetes include kidney illness; neuropathy; retinopathy; and musculoskeletal (MSK) symptoms. MSK symptoms in people with DM might have a negative influence on their quality of life. Adhesive capsulitis, shoulder hand syndrome (SHS), diabetic hand syndrome (DHS), DISH, Dupuytren's contracture (DC), and neuroarthropathy are a few of the symptoms that might appear. Musculoskeletal imaging is becoming more and more common with the use of ultrasound, a very effective imaging modality. Patients with diabetes mellitus (DM) were studied utilising musculoskeletal ultrasound (MSUS) imaging in order to examine alterations in certain tendons, in both the upper and lower limbs, as well as their clinical condition, illness duration, glycemic management, and other laboratory data. Methods: Forty diabetic individuals who met the American Diabetes Association's definition of diabetes mellitus (DM) were studied in this research (Group I). Attendants of the Endocrinology unit of Benha University Hospitals' Internal Medicine department were invited to participate in the study. Group II: twenty-five seemingly healthy participants were chosen from hospital staff and relatives of other patients to serve as a control group. Conclusions: In this investigation, tendons were found to be prominent on one side in both the control and non-complaining groups. Tenderness in the biceps tendon was found in three healthy controls and 18 cases, whereas discomfort in the supraspinatus tendons was found in three healthy controls and six diabetes patients who underwent palpation testing. DM patients' Subscapularis tendons were found to be 10% painful, whereas Achilles tendons were found to be 25% tender. Twelve biceps tendons, eight supraspinatus tendons, and eight subscapularis tendons in DM patients had statistically negligible differences from healthy controls in terms of tendon degradation. Tendon thickness differences between DM patients and healthy controls were found to be statistically significant. There was evidence of effusion in four out of the eight biceps tendons evaluated, despite the fact that none of the healthy controls exhibited any signs of bicipital tendinitis. Diabetes patients had higher tendon calcifications in their biceps, supraspinatus, and subscapularis than healthy controls, although the differences were not statistically significant. Over 5 percent of the supraspinatus tendons had partial tendon tears, but no partial tendon tears were found in any of the Subscapularis tendons, and no full thickness tears were found in any of the tendons we investigated. Tenderness in the Achilles tendon was seen more often in people with diabetes than in healthy controls, although the difference was statistically insignificant. According to MSUS, the investigated patients had greater Achilles tendon degeneration, calcium deposits, and a retrocalcaneal bursa than the healthy controls did, although the differences were statistically insignificant. Even though there was a statistically significant differen...
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