BackgroundThe diagnosis of osteoarthritis is currently based on radiographic criteria (eg, joint space width) and clinical symptoms (eg, pain and loss of function).The evaluation of new disease-modifying osteoarthritis drugs (DMOADs) is performed on the same basis, since the regulatory bodies currently require evidence for an impact on radiographic joint space narrowing (JSN) and an impact on symptoms However, the limitations of radiography have led to research into alternative parameters for monitoring osteoarthritis that could serve as biomarkers in drug development.ObjectivesDetection the serum level of MMP-13 and IL-1 β In OA of the knee during remission and exacerbation and if these Biomarkers can be validated as gold biomarkers in assessing OA progression and drug development in OA treatment.MethodsThis study was performed on 60 patients with knee osteoarthritis, 18 males (30%) and 42 females (70%), all diagnosed as osteoarthritis of one or both knees. Their ages ranged from (40 -65) years. The duration of their disease ranged from one to 15years. The control groups were 8 males (32%) and 17 females (68%). their ages ranged from (40–65) years. The patients were allowed to continue on the medications that they have pro inflammatory cytokines (IL-1β) and degradative enzymes (MMP-13) are measured.Clinical assessing for pain using visual analogue scale (0–10)Assessing for pain, stiffness and physical functions by:(A) the WOMAC osteoarthritis index(B) Lequesne's algo functional indexAsssesing the flare-ups using Knee Osteoarthritis Flare Ups Score (KOFUS). ResultsPatients who had 3 flare-ups (during one year follow up) showed the statistically significantly highest mean IL-1β & MMP13 level.There was no statistically significant difference between patients with no flare-up, 1 flare-up and 2 flare-ups; all showed statistically significantly lower mean levels.There was a statistically significant positive (direct) correlation between IL-1β, disease duration, KL, VAS, stiffness score, pain score, functional score, WOMAC and KOFUS. An increase in all these variables is associated with an increase in IL-1β & MMP13.Conclusions There is a potential role for IL1 beta and MMP 13 biomarkers in assessing the development in osteoarthritis.IL 1 β and MMP 13 were founded to be correlated positively in patients with knee OA this correlation sounded right as the expression of MMP 13 depends on the level of IL1 β.Although all medications groups failed to lower the level of IL 1 β and MMP 13,yet there was a numerical difference in favor of Diacerine and NSAID.patients on both Diacerine and NSAID had the lowerest rate of flare upsIt is recommended that the early measurement of biomarkers may detect cases to progress and thus stronger treatment may be given for these groups. Disclosure of InterestNone declared
BackgroundSLE is a complex autoimmune disorder, characterized by multisystem involvement including the nervous system, juvenile onset SLE has more aggressive clinical course in comparison with adult-onset SLE.ObjectivesTo study the neuropsychiatric manifestations of SLE in Egyptian children.MethodsWe reviewed the charts of all children and adolescents who were diagnosed with SLE and evidence of neuropsychiatric manifestations was defined by full neuropsychiatric history and examination.ResultsOut of 54 children with SLE, 30 (55.6%) had neuropsychiatric (NP) manifestations, the mean age at onset of the disease was 13.6 years. The mean period between onset of SLE and NP manifestations 15.5 months. NP manifestations was the presenting feature in 3 patients. Headache was the initial symptom of central nervous system (CNS) involvement in 35% of patients seizures was the most frequent CNS finding seen in 7(23.3%) patients, 6 (20%) patients had congnifive impairment, 6(20%) patient had cognitive impairment, 6(20%) patients had CVA, 2(6.7%) had chorea, 2(6.7%) had psychosis, 2(6.7%) had depression, 1(3.3) had cerebritis, 1(3.3%) had peripheral neuropathy. Lupus anticoagulant was high in patients with chorea, seizures or cerebrovascular accidents (CVA). Electroencephalogram (EEG) was abnormal in 30% of patients presented by seizures and rarely helpful in patients with diffuse NP symptoms. Magnetic resonance imaging (MRI) was abnormal in 13 cases, long term outcome was good, 3 patients had significant persistent CNS deficits, the majority of patients (90%) had excellent recovery from neuropsychiatric SLE.ConclusionNPSLE is one of the most common serious complications of pediatric SLE, so early recognition and management are of paramount importance. CNS involvement was observed in 55% of our pediatric patients with SLE, 76% of whom developed symptoms during the first year of onset of the disease Headache and seizures were the most common neurological manifestations of pediatric SLE, followed by CVA and intellectual disability. Psychosis, depression and chorea were less frequent in our study group, while peripheral neuropathy and cerebritis were rare.References[1] Smith PP and Gordon C (2010): Systemic lupus erythematosus: clinical presentations. Autoimmunity Reviews, 10(1): 43–45.[2] Khajezadeh M (2016): The prevalance of neurologic manifestation of children diagnosed by systemic lupus erythematous refer to the children medical center since during 10 years. in MD (speciality of Pediatrics) disertation, Tehran University of Medical Sciences, In Persian.[3] Fernandes M, Trevisani V, Castro AA, Ferreira Neves Neto J, Atallah AAN (2013): Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database Syst Rev., (2):CD002265.[4] Zambrano YC, Ramos JD, Vargas NE, Ramirez DC, Rodriguez SM, Niño AC, Bello áH (2014): Risk factors for neuropsychiatric manifestations in children with systemic lupus erythematosus: case-control study. Pediatric Neurology, 51(3):403-9...
5%) in the control group (P = 0.002). In the RA group, US abnormalities were recorded in 62 SC joints (51%) compared with 3 (2.5%) in the healthy control group (P = 0.0001), comprising synovitis in 28 (23.3%) versus 3 (2.5%);(P <0.001), erosions in 27 (22.5%) versus none (P <0.001), and intraarticular PD in 7 (5.8%) versus none (P = 0.031). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. Figure (1) showing erosions of clavicular head of sternoclavicular joint. Conclusion:US is extra sensitive than medical examination for detecting SC joint involvement in RA. The correlation amongst US synovitis, intraarticular PD, and the DAS28 show that SC joints actively participate within the systemic inflammatory manner of RA. The precise position of US within the assessment of the SC joint in sufferers with RA is but to be mounted firmly in the rheumatologic examination.
Background:Fibromyalgia is characterized by chronic widespread musculoskeletal pain that often co-exists with sleep disturbances, fatigue, cognitive dysfunction, stiffness and tenderness to palpation at specific tender points.Selective serotonin reuptake inhibitors represent a class of commonly used antidepressants. They act by preventing the reuptake of 5-hydroxytryptamine (5-HT) (Serotonin) through the inhibition of the 5-HT transporter (5-HTT) which is located on the presynaptic neuron, thereby increasing levels of 5-HT within the synaptic cleft and modulating neurochemical signaling.Usage of SSRIs was significantly associated with lumbar spine BMD reduction, particularly for old people.DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BM.Objectives:This work aim to determine the correlation between selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) usage and bone mineral density (BMD) and trabecular bone score (TBS) changes in primary Fibromyalgia patientMethods:The present cross sectional study was conducted on a Hundred (100) Egyptian patients diagnosed as primary fibromyalgia divided according to drug medication into two 2 groups, 50 patients on SSRIs and 50patients on SNRIs, recruited from Rheumatology, Physical Medicine and Rehabilitation departments at AlHussein and Sayed Galal, Al-Azhar University Hospitals. In addition to another 50 age matched the control group subdivided into 25 primary fibromyalgia patients not on those drugs and 25 healthy individuals selected by nurses and medical staff, after an informed consent from all subjects from June 2018 to December 2018..An approval was obtained from the medical ethics committee of Al-Azhar University before starting this study. All the patients were informed about the study procedures and a written consent was obtained from all of them. The subjects were categorized into three groups. Group A: 50 1ry fibromyalgia patients on SSRI. Group B: 50 1ry fibromyalgia patients on SNRI. Group C: 50 individuals as a the control group subdivided into: group C-1: 25, 1ry fibromyalgia patients non SRIs-users and group C-2: 25) healthy individuals.Results:DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BMDConclusion:The present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BMD. Keywords: SSRI, SNRI, FMS, fibromyalgia, osteoporosis, TBS, BMD, bone mineral density, trabecular bone score.Disclosure of Interests:None declared
Article information Background: Cases of rheumatoid arthritis [RA] are characterized by a decreased life expectancy, as well as a 50% are at greater risk of developing cardiovascular diseases [CVD] compared to other subjects. Precocious myocardial dysfunction can be detected more accurately and faster with speckle -tracking Echocardiography. The aim of the work: This study attempts to evaluate the function of myocardial Left ventricular [LV] systole via Speckle Tracking Echocardiography [STE] strain imaging in RA cases with the absence of [CVD] and to correlate the results with the disease features. Patients and Methods: A case control study, which recruited 60 RA cases [with a median age of 46.22 ± 8.14 years] without known CVD, as well as 60 healthy controls. Results: Assessment of speckle-tracking for [LV] systolic function revealed diminished Global Longitudinal Strain [GLS] in patient group [-16.80% vs. -22.35%, PP<0.001]. A negative association has been detected between RA as well as GLS duration [r = -0.301]. Receiver operating characteristics [ROC] curve was utilizedto determine the optimal cut-off value GLS value that was -20, with 76.7% sensitivity, 80% specificity, 92% positive predictive value, 63% negative predictive value, as well as with 83.9% diagnostic accuracy. Conclusion: GLS measurement using STE is valuable in detecting impairment of left ventricle systolic function in RA patients, even in the presence of normal ejection fraction. Not only that but also, the degree of systolic function impairment is correlated to RA disease activity. This raises the concern that inappropriate management of RA activity could lead to development of CVD.
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