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   2017| January-March  | Volume 44 | Issue 1  
    Online since February 23, 2017

 
 
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ORIGINAL ARTICLES
Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline. A comparative study
Mahmoud El Tayeb Nasser, Ahmed Z El Yasaki, Reem M Ezz El Mallah, Amal S.M. Abdelazeem
January-March 2017, 44(1):1-10
DOI:10.4103/1110-161X.200838  
Background Lateral epicondylitis (LE) is the most common overuse syndrome and related to excessive wrist extension, known as tendonitis of the extensor muscles of the forearm, and refers to pain and tenderness over the lateral epicondyle of the humerus. Local corticosteroid injection has short-term benefits in pain reduction, global improvement, and grip strength compared with placebo (saline or lidocaine) and other conservative treatments. Autologous platelet-rich plasma (PRP) injection has gained popularity within the sports medicine literature because of its presumed safety and ease of use as a potential treatment for any musculoskeletal problems by inducing cell proliferation and promoting the healing process. This thesis was carried out to assess the effectiveness of different types of injections (PRP, glucocorticoid, and saline) in improving pain and function in patients with LE. Patients and methods This study included 45 patients with LE (more than 3 months) between 31 and 58 years of age. All patients were subjected to assessment of history, clinical examination by the visual analogue scale (VAS), functional assessment by patient-rated tennis elbow evaluation (PRTEE), laboratory investigations, and ultrasonography assessment of the elbow. All the patients were divided randomly into three groups: group I received a saline injection, group II received a PRP injection, and group III received a corticosteroid injection. Patients were reassessed clinically and by ultrasound after 3 months. Results The present study showed that VAS and PRTEE scores were highly significantly reduced after injection in group II than group I and group III. Moreover, the reductions in VAS and PRTEE were highly significantly different in group III in comparison with group I. In terms of ultrasonographic changes and reduction in tenderness, there was a highly significant improvement in group II than group I and group III. Moreover, the reduction was highly significantly different in group III than group I. Conclusion PRP injection may offer several therapeutic advantages over corticosteroid injection.
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CASE REPORT
Poncet disease, tuberculosis-arthritis: a case report in upper Egypt and a review of the literature
Amal Fehr, Fatma El-Nouby, Abeer A Eltony, Yasser Abdelkareem, Shazly Bogdady
January-March 2017, 44(1):39-42
DOI:10.4103/1110-161X.200834  
Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis characterized by polyarticular impairment observed in patients with active TB, with no evidence of direct bacillary invasion of the joints. The literature related to this syndrome is scarce and restricted to case reports, which contributes to its underdiagnosis. This study aimed at reporting a case of Poncet’s arthritis diagnosed at our hospital, and at reviewing the diagnostic and therapeutic aspects involved; hence, we describe a case of Poncet’s disease in a 13-year-old girl whose reactive arthritis overshadowed other clinical symptoms of TB, resulting in delayed diagnosis and treatment. Anti-TB treatment was initiated. Clinical remission occurred after 2 weeks and the diagnosis of Poncet’s arthritis was established, concluding that taking a thorough medical history and performing relevant examinations and investigations for possible TB, especially in endemic areas, will help expedite the diagnostic process even in the absence of TB symptoms.
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ORIGINAL ARTICLES
Assessment of 25-hydroxyvitamin D level in patients with Behçet’s Disease and its correlation with disease activity and severity
Manal M Sedky Abdou, Marwa M Sheta, Dina A Effat, Amany Elsayed Haikal
January-March 2017, 44(1):30-38
DOI:10.4103/1110-161X.198429  
Objective The aim of this study was to assess the level of vitamin D in Behçet’s disease (BD) patients and in healthy controls, and to correlate its level with clinical and laboratory data as well as disease activity and severity. Patients and methods Forty patients with BD and 40 age-matched and sex-matched healthy controls participated in this study. Serum 25-hydroxyvitamin D [25(OH)D] was estimated using enzyme-linked immunosorbent assay in both patients and controls. Behçet’s Disease Current Activity Form 2006 was used to assess disease activity. Disease severity was evaluated in BD patients. Results The mean 25(OH)D level in BD patients was lower than that in the control group, but with no statistical significance (P>0.05). The frequency of vitamin D deficiency was (27.5%) in BD patients whereas in controls, it was (7.5%), and the frequency of normal vitamin D level in BD was (2.5%) whereas in controls, it was (15%); the difference between the patients and controls was statistically significant (P=0.006). We found a significant negative correlation between the serum vitamin D level in BD patients and disease duration (r=−3.38; P=0.015). No significant correlation was found between the 25(OH)D level and disease activity of BD patients (P>0.05). According to the level of vitamin D, we classified our patients into three groups: normal (>30 ng/ml), insufficient (10–30 ng/ml), and deficient (<10 ng/ml) vitamin D level. A statistically significant difference was found between the three groups of BD patients with regard to the serum calcium level (P=0.03) and disease severity (P=0.028). Conclusion Vitamin D was lower in BD patients than in the healthy control group; hence, assessment of its level should be carried out in all patients with BD. Furthermore, vitamin D could be used as a new marker for disease severity in BD.
  1,218 111 -
Differences in body mass index, waist circumference, and waist-to-hip ratio in patients with rheumatoid arthritis: association with serum adiponectin and disease parameters
Shereen R Kamel, Hanaa A Sadek, Fatma A Mohamed, Lamia H Ali, Haidy M Osman
January-March 2017, 44(1):24-29
DOI:10.4103/1110-161X.200837  
Objective The aim of this study was to investigate differences in BMI, waist circumference (WC), and waist-to-hip ratio (WHR) in rheumatoid arthritis (RA) patients and their association with serum adiponectin and disease parameters. Patients and methods Fifty RA patients and 25 matched healthy controls were included. Anthropometric measurements, disease status, and serum adiponectin level were assessed. Results Out of 50 RA patients, 48% had normal BMI (18.5–24.9 kg/m2), 20% had BMI in the range of 25.0–29.9 kg/m2, which is considered to be overweight, and 32% were obese, with BMI greater than 30 kg/m2. Almost similar findings were observed by the measurements of WC − that is, 34% of patients were obese ‘abdominal obesity’. However, the percentage of obese patients increased to 42% when classified as per WHR ‘truncal obesity’. Serum adiponectin was significantly increased in RA patients compared with controls (P=0.002). Significant negative correlations of BMI and WC with serum adiponectin level were found (r=−0.9, P≤0.001; r=−0.7, P≤0.001, respectively). There were positive correlations of WHR with Disease Activity Score 28 (r=0.3, P=0.047), Multidimensional Health Assessment Questionnaire (r=0.3, P=0.04), and ultrasound Disease Activity Score (r=0.4, P=0.04), whereas there was a significant negative correlation with ultrasound erosion rate (r=−0.3, P=0.02). Conclusion BMI, WC, and WHR measurements should be used and encouraged in the RA population. Our findings suggested that WHR was better associated with disease activity, disability, and severity than with other measures.
  1,044 114 -
Ultrasonographic findings of the shoulders in Egyptian patients with rheumatoid arthritis
Ali Ibrahim Fuda, Nashwa Ismail Hashaad, Osama Galal, Afaf Mahmoud Azzam
January-March 2017, 44(1):17-23
DOI:10.4103/1110-161X.200836  
Objective This study aimed to highlight the diagnostic value of musculoskeletal ultrasonography (US) in the evaluation of inflammatory changes in the shoulders of rheumatoid arthritis (RA) patients and to correlate those findings with the clinical, laboratory, and radiological parameters of the disease activity. Patients and methods This study included 40 RA patients diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. In addition, 20 age-matched and sex-matched healthy individuals were included. US assessment was performed bilaterally in RA patient's shoulder and unilaterally in controls. All US examinations were carried out using LOGIQ P6 PRO machine equipped with 6–8 MHz broadband multifrequency linear transducer. Result US on shoulders detected that 21 (52.5%) RA patients studied had erosions, 18 (45%) RA patients had synovitis, 21 (52.5%) RA patients had tenosynovitis, seven (17.5%) RA patients had bursitis, and 18 (45%) RA patients had rotator cuff tendinopathy. There was a significant relation between US-detected erosion in RA patients and disease duration (P = 0.037) and rheumatoid factor (RF) level (P = 0.02), whereas there was no significant relation between US-detected erosion in RA patients and shoulder pain (P = 0.185), Disease activity score 28 (DAS28) (P = 0.163), erythrocyte sedimentation rate (P = 0.519), and C-reactive protein levels (P = 0.561). There was a significant relation between US-detected tenosynovitis in RA patients and shoulder pain (P = 0.025). There was no significant relation between US-detected bursitis in RA patients and disease duration (P = 0.970), shoulder pain (P = 0.907), DAS28 (P = 0.471), erythrocyte sedimentation rate (P = 0.220), and RF levels (P = 0.755), whereas there was a significant relation between US-detected bursitis in RA patients and C-reactive protein (P = 0.036). Conclusion US became a problem-solving approach and the tool of choice for cases with shoulder problem, and can provide an accurate answer to many clinical questions and give an accurate diagnosis of different pathological abnormalities encountered.
  879 115 -
Study of early atherosclerosis in juvenile-onset systemic lupus erythematosus patients
Emtethal A Said Ahmed, Sahar S Ganeb, Ahmed Y El-shambaky, Osama T Galal, Mai Y Tohamy
January-March 2017, 44(1):11-16
DOI:10.4103/1110-161X.200835  
Objective The aim of this study was to investigate early atherosclerotic changes in juvenile-onset systemic lupus erythematosus (jSLE) patients and its relation with disease activity. Patients and methods Thirty patients suffering from jSLE diagnosed according to the 2012 SLICC SLE criteria were included in the study. Clinical and laboratory parameters, disease activity, and traditional risk factors for atherosclerosis were assessed. B-mode ultrasound was performed to measure carotid intima–media thickness (CIMT) and the number and size of plaque deposits in both the left and the right common carotid arteries. A total of 20 healthy volunteers were taken as a control group. Results The mean±SD age of the patients was 18.93±2.81. The mean±SD disease duration was 4.33±2.25. The mean±SD CIMT differed significantly between the patient and control (n=20) groups (0.74±0.21 vs. 0.38±0.05; P<0.001). The presence of lymphopenia, serum creatinine, total cholesterol, triglycerides, and low-density lipoprotein was positively associated with the progression of CIMT (P=0.049, P=0.02, P≤0.001, P≤0.001, and P=0.006, respectively). Conclusion In patients with jSLE, some traditional and nontraditional risk factors such as increased low-density lipoprotein, triglycerides, total cholesterol, BMI, fasting blood sugar, and proteinuria for the development of subclinical atherosclerosis were identified. It is likely that good disease control is the optimum way to prevent premature atherosclerosis in jSLE.
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ERRATUM
Erratum: Measurement of serum trace elements levels in patients with juvenile idiopathic arthritis

January-March 2017, 44(1):43-43
DOI:10.4103/1110-161X.200839  
  520 64 -
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