Background:Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of osteoporosis because of their age, limited physical activity, smoking, malnutrition and use of corticosteroid. Inhaled corticosteroid (IC) is used in COPD as these agents decrease the frequency of exacerbations. Objectives: To assess bone mineral density (BMD), serum osteocalcin and marker of bone turnover in patients with COPD treated with IC (Beclomethasone). Subjects & Methods: Sixty Patients with moderately severe COPD, according to the criteria of GOLD committee, under IC therapy for at least one year, were assessed clinically and by evaluation of BMD. In addition, biomarkers of bone turn over, urinary hydroxyproline, total pyridinoline, and biomarker of bone formation, serum osteocalcin, were assessed. The results were compared to 20 age and sex matched healthy individuals serving as a control group. Results: There were 28 (46.7%) male and 32 (53.3%) female patients. T-score was highly significantly lower in COPD patients in comparison to control. Osteocalcin level was significantly lower in patients than in control group (P<0.05). Urinary pyridinoline level was highly significant higher in COPD group compared with control (P≤0.001). Urinary hydroxyproline level was non significantly lower in patients than control (P=0.06). T-score was significantly inversely correlated with serum osteocalcin, and urine pyridinoline levels, while it was not significantly correlated with neither patient's age nor hydroxypyroline level. Conclusion: Regular evaluation of osteocalcin and BMD would be helpful for detecting any detrimental changes of bone in COPD patients under long term IC therapy. [Egypt J Rheumatology & Clinical Immunology, 2015; 3(1): 47-53]
Background: Observational studies in humans suggest an association between vitamin D deficiency and many rheumatologic disorders. Pathophysiological investigations confirm that severe hypovitaminosis D, in genetically predisposed subjects, can impair self tolerance and immune responses by compromising the regulation of dendrite cells, regulatory Tlymphocytes, Th1 cells and B cell function. Objectives: The aim of our work was to assess Vit D level in patients with RA, SLE and Behcet's disease and to evaluate its relation to various parameters of the disease and its activity. Results: Ninety patients (20 RA, 54 SLE and 16 Behcet's disease) were included in this work. They were 42 (46.7%) males and 48 (53.3%) females, their age ranged from 20-50 years in males, and 20-45 years in females with mean (44.4±2.4) years. Twenty apparently healthy person, age and sex matched to the patients were included as a control group. Comparison between the groups of SLE patients, RA patients and controls as regards titer of auto antibodies (LA, RO, SM, anti-DNA, ANA) showed statistically significant differences between SLE patients and both RA patients and controls (p<0.001). Vitamin D level was found to be lower than normal in all patients groups. It was lower in RA patients 7.62±1.58 than in SLE 12.81±1.92 and in Behcet's disease 13.68±1.99, comparing vitamin D level in patients and controls showed that it was significantly lower in patients group than controls (p<0.001).Vitamin D level showed a significant negative correlation with various markers of disease activities of the studied groups, where p value was <0.001 with DAS28 in RA patients and with SLEDIA in SLE patients while it was 0.009 with BDCAF in Behcet's disease. Conclusion: The current study stressed the high prevalence of vitamin D deficiency in patients with autoimmune and inflammatory diseases including RA, SLE and Behcet's disease. Correlation between this defiecincy and indices of disease activity suggest the major role of vitamin D in modulation of immunological etiopathogenesis of these diseases. [Egypt J Rheumatology & Clinical Immunology, 2015; 3(2): 111-120]
Background: Fibromyalgia syndrome (FMS), is one of the most common causes of widespread pain and diffuse tenderness. It is characterized by reduced pain threshold (hyperallgesia) & pain with normally innocuous stimuli (allodynia).This diffuse pain is often disease associated with wide range of other symptoms including fatigue, sleep disturbance, stiffness & more. FMS often occur concomitantly with other rheumatologic diseases such as rheumatoid arthritis (RA), systemic lupus erthymatosus (SLE) and many other systemic connective tissue diseases. The pineal hormone melatonin (MT) exerts a variety of effects on the immune system. MT activates immune cells and enhances inflammatory cytokine and nitric oxide production. Cytokines that are strongly involved in the synovial immune and inflammatory response in rheumatoid arthritis, reach the peak concentration in the early morning, when MT serum level is at its highest concentration. Objective: The aim of this study was to assess serum melatonin level & investigate it ' s correlation-if any to clinical features of fibromyalgia syndrome (FMS). Methods: This is a cross sectional case control study in which we've studied 50 FMS patients defined according to the American Colleague of Rheumatology (ACR 2010) classification criteria (Wolfe et al., 2010) [24]. They were classified into two groups: Group I: They included 25 primary FMS patients. Group II: They included 25 secondary FMS patients, they were fulfilling the classification criteria of other rheumatologic disease such as RA, SLE. Additionally, twenty age and sex matched healthy individuals were included in the study as a control group. Results: Mean Melatonin titers were significantly reduced (p<0.0001) in primary FMs patients compared to the controls (21.32 vs. 30.9 pg/ml), but they were significantly elevated (p<0.0001) in secondary FMS compared to controls (140.8 vs.30.9 pg/ml). Our data imposed that, in 1ry FMS there were negative correlations of MT titers with tender points (r=-0,967**,p<0.0001), sleep disturbance (r=-0.963**, p<0.0001**), Fatigue (r=-0.972**, p<0.001**), WPI (r=-0,933**, p<0.0001) and SS (r=-0.934**, p<0.0001). There were positive correlations of MT titers with cognitive symptoms (r=0.36, p<0.061). Conclusions: In primary FMS patients melatonin level is lower than melatonin level in controls, meanwhile MT level is higher in secondary FMS patients than that of controls. There was a significant negative correlation between MT titers with tender points, sleep disturbance, fatigue, symptoms severity (SS) & widespread pain index (WPI) in primary fibromyalgia syndrome. However, there was a positive correlation between MT level & cognitive symptoms.
Background: Cardiovascular disease is a leading cause of morbidity and mortality in rheumatoid arthritis (RA) patients through progressive atherosclerosis. Inflammation plays a crucial role in atherogenesis. Paraoxonase-1 (PON1) has important role in decreasing susceptibility of LDL to lipid peroxidation and prevent or at least limits the oxidation of HDL which play a role in decreasing the susceptibility to atherosclerosis. Aim of the study: To estimate serum paraoxonase-1 (PNO1), in rheumatoid arthritis patients and its correlation -if any to disease activity and lipid profile. Methods: Sixty rheumatoid arthritis patients, attending the rheumatology department at Benha teaching hospital and thirty healthy volunteers were included in this study. Both groups were subjected to full history taking, clinical examination, laboratory assessment of serum paraoxinase-1 level, lipids profile, CBC, ESR and CRP. Results: The mean serum PNO1 level in RA patients was (41.53±31.79 U/ml) and this was highly significantly lower than its level in control group (177 ± 40.77 U/ml) (p<0.001). Correlations between this level and different laboratory and clinical parameters showed significant negative correlations with ESR, CRP, DAS-28 score, cholesterol and LDL. While serum PON-1 shows significant positive correlation with HDL. ROC curve was obtained to assess for the validity of paraoxinase-1 in prediction of cardiovascular risk in severly active RA patients, it showed that paraoxinase -1 at a cut off value ≤ 26 can significantly predict cardiovascular risk in severly active RA patients, with sensitivity 76.5% and specificity 72.1%. Conclusion: low serum paraoxinase-1 activity is a real risk factor for cardiovascular disease in RA patients, as it is significantly negatively correlated with RA disease activity.
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