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  Citation statistics : Table of Contents
   2014| April  | Volume 41 | Issue 2  
    Online since May 14, 2014

 
 
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ORIGINAL ARTICLES
Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity
Enas A. Elattar, Takwa B. Younes, Sameh A. Mobasher
April 2014, 41(2):58-65
DOI:10.4103/1110-161X.132458  
Background and objective The relationship between thyroid disease and rheumatic disorders has been the subject of considerable debate. Thyroid abnormal function and/or autoimmune thyroid disease were observed in patients with rheumatoid arthritis (RA), which could be attributed to the natural feature of autoimmune diseases and their tendency to overlap. Consideration of the fact that autoimmunity plays a role in the pathogenesis of both RA and hypothyroidism has raised the need to study the frequency of hypothyroidism and thyroid antibodies in RA patients and their relation to disease activity. Patients and methods One hundred and fifty RA patients and 50 control participants were included in this study. RA patients were subjected to a full assessment of medical and rheumatological history, and examination as well as routine lab tests. Patients and controls underwent thyroid function testing including thyroid antibodies. Patients' disease activity was determined using the Modified Disease Activity Score and their functional status was assessed using the Modified Health Assessment Questionnaire. Results The most common thyroid dysfunction was hypothyroidism, which was found in 36 (24%) RA patients, followed by subclinical hypothyroidism in six (4%) patients, whereas subclinical hyperthyroidism was present in two (1.3%) patients. Autoimmune thyroid disease was present in 10 (6.6%) patients and absent in the controls. There was a significant positive correlation between thyroid stimulating hormone levels and RA disease activity parameters. Conclusion Hypothyroidism was the most common thyroid disorder associated with RA, present in 24%, with a significant association with RA disease activity parameters.
  3 17,110 754
Value of musculoskeletal ultrasonography in the diagnosis of peripheral enthesopathy in early spondyloarthropathy
Amal A. Hassan, Ayman F. Darwish, Fatma A. Mohamed, Mohamed A. Ibrahim, Ahmed H Abd El-Karima
April 2014, 41(2):51-57
DOI:10.4103/1110-161X.132457  
Objective The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis. Patients and methods A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups - axial subgroup (19 patients) and peripheral subgroup (11 patients) - and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography. Results A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score. Conclusion Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients
  2 2,026 229
Assessment of serum vitamin D level in patients with systemic lupus erythematosus
Fahmi E. Emam, Taghreed M Abd El-Wahab, Maha S. Mohammed, Amal S. Elsalhy, Sabah I Abdel Rahem
April 2014, 41(2):71-78
DOI:10.4103/1110-161X.132460  
Objective To evaluate the serum level of vitamin D in patients with systemic lupus erythematosus (SLE) and its relationship with disease activity. Patients and methods Forty patients suffering from SLE were enrolled in this study (group I). They were further divided into two subgroups according to the SLE disease activity index (SLEDAI) score: group Ia with respect to disease activity and group Ib with respect to disease remission. Another 20 age-matched and sex-matched healthy individuals were chosen as control group II. All patients underwent complete medical history taking and thorough clinical examination; the disease activity was assessed by the use of SLEDAI score. Serum vitamin D level in all patients and controls was measured. Results Vitamin D level was significantly higher in controls than in patients. The vitamin D deficiency was highly prevalent among patients with disease activity than in the remission group. There was highly significant inverse correlation between vitamin D level and SLEDAI score in the patient group. Vitamin D level correlated inversely with C reactive protein (CRP) and anti-dsDNA in the disease activity group, whereas it correlated positively with C3. Conclusion Vitamin D deficiency is prevalent in SLE patients more than in healthy controls; vitamin D deficiency is highly prevalent among patients with disease activity than in the remission group, and vitamin D level correlated inversely with disease activity, which suggest that inadequate vitamin D level, among other factors, probably contributed to the development of active disease in patients with SLE.
  2 2,063 252
Relationship between serum 25-hydroxy vitamin D levels, knee pain, radiological osteoarthritis, and the Western Ontario and McMaster Universities Osteoarthritis Index in patients with primary osteoarthritis
Ahmed A Lotfi, Rasha A. Abdel-Magied, Rawhya R. El-Shereef, Ahmed A. Saedii, Ehab A. AbdelGawad
April 2014, 41(2):66-70
DOI:10.4103/1110-161X.132459  
Objective This study aims to detect the relationship between serum 25-hydroxy vitamin D (25-OHD) levels in patients with primary osteoarthritis (OA) of the knees and with other disease parameters of OA, mainly radiological findings, functional assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pain [numerical rating scale (NRS)]. Patients and methods We studied 140 consecutive patients with primary knee OA, 110 female patients and 30 male patients. They were clinically, radiologically, and also functionally evaluated regarding OA; pain was also assessed using NRS, and serum 25-OHD, serum parathormone, serum calcium, phosphorus, and alkaline phosphatase were measured. Results In our patient sample, we found that 90 (64.3%) patients had lower 25-OHD levels. The mean serum 25-OHD was 35.77 ± 14.6 (range 10.62-71.82) ng/ml; 25-OHD was negatively significantly correlated with patients' age (P = 0.013, r = −0.236), radiological degree of OA (P = 0.036, r = −0.20), WOMAC (P < 0.0001, r = −0.337), and NRS for pain (P < 0.0001, r = −0.580). When comparing between patients with hypovitaminosis, 25-OHD less than 40 ng/ml, and patients with desirable 25-OHD levels, we found that radiographic grading of OA was significantly higher in the hypovitaminosis group (t = 2.024, P = 0.045); WOMAC was also significantly higher in the hypovitaminosis group (t = 3.226, P = 0.002) and NRS was also higher in the hypovitaminosis group (t = 4.468, P < 0.0001). Conclusion 25-OHD deficiency is prevalent in our patients suffering from OA; in addition, 25-OHD may play a role in patients suffering from OA.
  1 2,428 296
Anti-Saccharomyces cerevisiae antibodies and its relationship with radiological damage in ankylosing spondylitis
Eman El-Dessoky El-Shahawy, Dalia S. Fahmy, Ghada S. Nageeb, Hanan Samir, Alaa A Al Moaty Omran, Inas M. El-Fiki
April 2014, 41(2):45-50
DOI:10.4103/1110-161X.132456  
Aim The presence of anti-Saccharomyces cerevisiae antibodies (ASCA) is controversial in ankylosing spondylitis (AS). In this study, we aimed to investigate the prevalence of ASCA in AS and its relationship with disease activity and radiological damage in patients attending Sharkia governorate hospitals. Patients and methods Thirty AS patients and 30 apparently healthy volunteers were included in the present study. All patients were questioned for Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis metrology Index and Bath Ankylosing Functional Index (BASFI). Total Bath Ankylosing Spondylitis Radiology Index (BASRI-T) and ASCA levels were measured. Results ASCA IgA level was significantly higher in AS patients than in healthy controls (P < 0.001). The ASCA-positive group, although not significant, tended to have higher BASFI scores. ASCA IgA-positive patients had higher BASRI-T levels (P = 0.037). In AS patients, significant positive correlation was found between ASCA IgA level and BASRI-T and BASFI (r = 0.19 and 0.31, respectively, P < 0.05). Bath Ankylosing Spondylitis Disease Activity Index scores, BASFI and ASCA IgA positivity were significantly associated with increased BASRI-T (P= 0.01, 0.03 and 0.04, respectively). The most significant risk factor for increased BASRI-T is ASCA IgA positivity (P < 0.001). Conclusion ASCA IgA was detected more frequently in AS patients than in healthy controls. ASCA IgA could be considered a marker of severe radiological damage. Further studies are recommended to investigate ASCA level versus radiological damage and intestinal involvement in AS patients.
  - 1,802 142
Risk factors of persistent synovitis development in early undifferentiated arthritis patients
Ghada S. Nageeb, Enass A. Elewa, Taghreed M. Azmy, Hazem Tantawy
April 2014, 41(2):79-84
DOI:10.4103/1110-161X.132461  
Background Persistent synovitis (PS) may lead to erosive joint damage and result in functional disability. Objectives The aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt. Patients and methods A total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments. Results Among 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score. Conclusion Baseline PD total score is the most significant risk factor for development of PS in EUA patients. Recommendation PD examination of all patients presenting with EUA should be performed.
  - 2,360 168
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