Thyroid dysfunction in systemic lupus erythematosus and rheumatoid arthritis: Its impact as a cardiovascular risk factor

AbstractIntroductionThyroid dysfunction and autoantibodies have been frequently associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Aim of the workTo assess thyroid function and anti-thyroid antibodies in both diseases and elucidate the effects of the thyroid dysfunction on the clinical parameters, disease activity and cardiovascular risk.Patients and methodsForty SLE and forty RA female patients in addition to twenty controls were included. Free thyroxine (FT3), free triiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase antibodies (TPOabs), anti-thyroglobulin antibodies (TGabs), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and intima-media thickness (IMT) were measured. Disease activities were assessed in both diseases. In RA patients, the anti-cyclic citrullinated peptide (anti-CCP) was evaluated.ResultsA significantly higher TSH level was found in SLE patients compared to RA patients and controls. No significant difference was present between the RA patients and controls. Anti-TPOabs and anti-TGabs were more frequently detected in SLE (85% and 55%) compared to RA (50% and 37.5%). Abnormal thyroid function tests were detected in SLE, RA patients and controls in 52.5%, 17.5% and 10%, respectively. Subclinical hypothyroidism was the most common abnormality present followed by clinical hypothyroidism then euthyroid sick syndrome in both SLE and RA patients. A positive anti-CCP and high disease activity score (DAS28) in RA were among the strongest independent determinants of cardiovascular disease.ConclusionThyroid dysfunction is frequent in SLE and RA patients. Those with thyroid dysfunction had increased cardiovascular risk

Dynamic contrast enhanced MRI of wrist as a useful diagnostic tool in early rheumatoid arthritis

Magnetic resonance imaging is the only tool, that provides the possibility of studying bone marrow edema. Aim of the work: To investigate whether DCE-MRI has a role in assessing disease activity in RA. Furthermore, if these imaging parameters could provide reliable information about destructive joint changes during follow up period. Patients and methods: 48 Patients with early RA were followed up with plain X-ray of both hands and feet with DCE-MRI of the clinically more affected wrist. Synovial inflammation was assessed by measuring E-rate. Synovial membrane hypertrophy, bone edema and erosions were scored by OMERACT at baseline and 18 months. Response to treatment was evaluated based on whether or not ⩾50% improvement was achieved. Results: Erosion score progressed while clinical and laboratory measures improved significantly from baseline to 18 months. Baseline bone edema, synovitis, pain scores, E-rate and ESR were correlated with static MRI erosion score at 18 months. Conclusion: DCE-MRI produces sensitive information regarding diagnosing and scoring synovitis (1–3) in early RA. Furthermore, it provides studying bone marrow edema which is the strongest predictor of bone erosion in early RA. Hence we conclude that DCE-MRI has a diagnostic and prognostic value in predicting bone erosion development later on

Diagnostic value of diffusion weighted magnetic resonance image in early ankylosing spondylitis

Background: Diffusion-weighted MRI (DW-MRI) shows the early changes in microscopical movement of water molecules, hence diagnosis of early sacroiliitis which is one of the diagnostic criteria of seronegative spondyloarthropathies. Objective: To determine the value of DW-MRI in detection of signal characteristics of the sacroiliac joints in patients with early ankylosing spondylitis (AS). Patients and methods: Fifteen patients with clinically suspected AS, 20 patients with mechanical low back pain and 20 healthy controls underwent conventional MRI and DWI. Apparent diffusion coefficient (ADC) was measured. In addition ten clinically confirmed AS patients underwent whole body-DWI. Results: Mean ADC values of both sacroiliac joints in AS patients were (0.523 ± 0.15) × 10−3 mm2/s in the ilium and (0.502 ± 0.15) × 10−3 mm2/s in the sacrum. There was no significant difference between mechanical LBP and healthy controls. But there was a significant difference between AS and LBP patients. Mean ADC value of focal lesions of clinically confirmed AS was 0.965 ± 0.25 × 10−3 mm2/s in the sacrum and 0.932 ± 0.31 × 10−3 mm2/s in the ilium. Conclusion: Subchondral bone marrow ADC values of sacroiliac joints allow differentiation between inflammatory and mechanical LBP. Furthermore, it may be helpful in evaluating the efficacy of the treatment and determine disease prognosis

Diagnostic potential of high resolution ultrasound and nerve conduction study in patients with idiopathic carpal tunnel syndrome

Aim of the work: To evaluate the diagnostic utility of high resolution ultrasound in comparison to nerve conduction study (NCS) in patients with idiopathic carpal tunnel syndrome (CTS). Patients and methods: 40 patients with CTS (56 hands) and 30 matched controls (30 hands) were included. Patients and controls were assessed by clinical examination, ultrasonographic parameters including cross sectional area (CSA), flattening ratio 1 (FR1) at pisiform and FR2 at hamate and NCS including distal motor latency (DML), motor (MCV) and sensory (SCV) conduction velocity, sensory latency and amplitude. Results: The mean age of the patients was 36.02 ± 8.4 years; 39 females and 1 males. This study included 37 right (92.5%) and 3 left-handed (7.5%) patients. Right-hand affection was detected in 17 (42.5%) patients, left-hand in 3 (7.5%) while bilateral hands affection was detected in 20 (50%). CSA and FR2 were significantly associated with CTS severity. CSA significantly correlated with all electrophysiological parameters including DML, sensory amplitude, sensory latency and SCV. FR1 significantly correlated with sensory latency and FR2 with SCV. Regarding sensitivity of ultrasonographic parameters, FR2 was the highest (91.3%) while CSA and FR1 were 80.3% and 50% respectively. Specificity of all ultrasonographic parameters was 100% and the highest sensitivity was for SCV (94.6%). Conclusions: There was an insignificant difference between nerve conduction study and high resolution ultrasound in diagnosis of idiopathic CTS. However, high resolution ultrasound had a superior diagnostic utility in CTS, and is valuable for exclusion of secondary CTS and anatomical variants of the median nerve. Keywords: Median nerve, Carpal tunnel syndrome, Nerve conduction study, High resolution ultrasoun

Association of circulating endothelial cells with flow mediated vasodilation and disease activity in patients with systemic lupus erythematosus

The aim of this study was to determine the correlation between CEC count and endothelial function, disease activity, and organ involvement in patients with SLE. Background: Premature atherosclerosis in patients with systemic lupus erythematosus (SLE) is not explained by traditional risk factors. Circulating endothelial cells (CEC) have been identified as a surrogate marker of endothelial dysfunction Methods: The present study included 30 premenopausal women with SLE and 20 age and sex matched healthy controls (HC). Endothelial function was studied by flow mediated vasodilation (FMD%) in the brachial artery. Serum levels of VCAM-1, ICAM-1 were measured. Results: FMD% was lower in patients with SLE than HC (3.5 ± 0.4 vs 9.7 ± 3.2, p < 0.001). CEC count was significantly elevated in patients with SLE compared to HC (38 ± 18 vs 7 ± 3, p < 0.001). CEC count correlated positively with systemic lupus activity score (r = 0.97), and negatively with FMD% (r = −0.94). Serum levels of VCAM-1 and ICAM-1 were significantly elevated in patients with SLE compared to HC (p < 0.001). There was a significant correlation between CEC count and vasculitic skin lesions (p < 0.01), renal involvement (p < 0.01), and VCAM-1 levels (p < 0.001). Conclusion: CEC is associated with endothelial dysfunction, disease activity and increased VCAM-1 levels in patients with SLE. These findings suggest a potential role of CEC in the pathophysiology of cardiovascular disease in these patients

Fibroscan versus liver biopsy in the evaluation of response among the Egyptian HCV infected patients to treatment

Background/aim: Hepatitis C virus (HCV) infection usually progress to chronic infection with subsequent cirrhosis and cancer. Therapies aim to eradicate the virus and prevent further progression. Interferon is claimed to have anti-fibrotic effect. Histopathology is the gold standard in diagnosis and grading of hepatic fibrosis, but transient elastogram (Fibroscan) can be used as alternative noninvasive modality. This prospective study aimed to evaluate the accuracy of fibroscan in diagnosis of liver fibrosis, and assess the effect of antiviral therapy on fibrosis stages in HCV patients. Patients and methods: The study was conducted from September 2012 to December 2014 as a project funded by Science and Technology Development Fund, Egypt, Grant No. 3448. It included 498 patients; 150 HCV cirrhotic patients as control, and 348 HCV naive patients grouped according to their liver biopsy into; mild (group I) and moderate (group II) fibrosis. They were examined using fibroscan (Echosens, Paris, France, device 502, M probe) before, 12, 24, and 48 weeks of therapy, with 300 patients (150 patients in each group) completed follow-up regardless of their response. The results of fibroscan were compared to each other and to liver biopsy. Results: Fibroscan can diagnose F1 at 6 kPa with 26% sensitivity, 8% specificity, AUC = 0.037; F2 at level of 7 kPa with 84.6% sensitivity, 71.3% specificity, AUC = 0.692 and F3 at 9.5 kPa with 96% sensitivity, 97% specificity, AUC = 0.997. The fibrosis results had regressed significantly after 48 weeks of starting therapy of both patients’ groups (p < 0.05). When categorized by response to therapy, responders showed significant decline in their fibroscan scores compared to non-responders of same fibrosis degree. Conclusion: Fibroscan correlated with histopathology in moderate (F2–F3), but not mild (F1) fibrosis. The degree of fibrosis regresses significantly in HCV responders on anti-viral INF based therapy. Besides its accuracy as noninvasive device in detecting degree of fibrosis, fibroscan can be very useful in assessment of degree of fibrosis during and after therapy

Serum calprotectin as a potential biomarker for subclinical enthesitis in psoriatic patients

Aim of the work: To assess serum calprotectin level in psoriatic patients and investigate its potential relation to clinical and ultrasonographic enthesitis. Patients and methods: The study included 45 psoriatic patients and 20 matched healthy controls. Enthesitis was assessed clinically, by musculoskeletal ultrasound (MSUS) and power Doppler, by Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis Enthesitis (MASES), Spondyloarthritis Research Consortium of Canada (SPARCC) and Madrid Sonography Enthesitis Index (MASEI) scores. The Psoriasis Area, Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were evaluated. Serum calprotectin was measured using enzyme-linked immunosorbent assay. Results: The study included 45 psoriatic patients with a mean age of 49.9 ± 7.8 years and they were 23 males and 22 females with disease duration of 5.2 ± 3 years, (0.5–11 years). Patients were categorized into those with enthesitis (n = 25; 20 clinically and 5 subclinically diagnosed by MSUS) and those without (n = 20). Serum calprotectin was significantly higher among patients with enthesitis (clinical 593.7 ± 192.5 ng/ml and subclinical 692 ± 265.9 ng/ml) compared to those without (381.2 ± 198.5 ng/ml) and to the control (111.1 ± 15 ng/ml) (p = 0.001). The DLQI was significantly severer in patients with clinical enthesitis compared to those subclinically detected or without (p < 0.001). The acute phase reactants (erythrocyte sedimentation rate and C-reactive protein) were comparable between patients and control. Serum calprotectin significantly correlated with MASES, LEI, SPARCC and MASEI score in psoriatic patients (p < 0.001). At cutoff 141 ng/ml, calprotectin yielded specificity 69% and sensitivity 75% to detect enthesitis (p = 0.008). Conclusion: Calprotectin may be considered as a potential biomarker for detection of enthesitis in psoriatic patients

The Role of Hepatic Expression of STAT1, SOCS3 and PIAS1 in the Response of Chronic Hepatitis C Patients to Therapy

BACKGROUND: The underlying mechanisms of hepatitis C virus (HCV) resistance to treatment are unknown. Signal transducers and activators of transcription (STAT) proteins play a critical role in antiviral defense

Can Musculoskeletal Ultrasound Help Decision Making on Post-traumatic Treatment of a Proximal Phalanx Fracture?

Proximal phalanx fractures are common. Impingements of flexor tendons on the fractured segment after intervention may occur and can be diagnosed by high-resolution ultrasound. The present report highlights the usefulness of musculoskeletal ultrasound in evaluation of persistent finger pain after a proximal phalanx fracture and the importance of dynamic examination in identifying the painful mechanism, which may alter the decision regarding the postoperative treatment course