Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

AbstractPurposeTo determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.Patients and methodsA total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.ResultsElectrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11mm2 was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.ConclusionMedian nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome

CXC ligand 13 in rheumatoid arthritis and its relation to secondary Sjögren’s syndrome

AbstractAim of the workThe aim of the present study was to measure the level of the chemokine CXC ligand 13 protein (CXCL13) in the plasma and unstimulated saliva of rheumatoid arthritis (RA) patients in order to find out its role in the disease activity and its relation to secondary Sjögren’s syndrome (sSS).Patients and methodsThe study was conducted on thirty rheumatoid arthritis patients attending the Outpatient Clinic of Rheumatology and Rehabilitation department of Ain shams University Hospitals. The patients’ group had been classified into group (1) which included fifteen RA patients associated with sSS diagnosed according to the American–European Consensus Group Classification Criteria and group (2) which included fifteen RA patients not associated with sSS. Ten healthy subjects were included as a control group. Patients were subjected to full history taking, clinical examination, and laboratory detection of CXCL13 level in the plasma and saliva of patients as well as the control groups using ELISA technique. Assessment of disease activity in RA patients was done using the disease activity score (DAS28).ResultsPlasma levels of CXCL13 were significantly higher in RA patients than control group (p<0.001). Plasma levels of CXCL13 were significantly correlated with the RA disease activity (r=0.677, p<0.001) and disease duration (r=0.406, p<0.05), while the salivary levels were higher in those with sSS and correlated with sSS disease duration (r=0.536, p<0.05). A highly significant correlation was found between salivary CXCL13 and severity of sSS (r=0.816, p<0.001). Salivary levels of CXCL13 above 110pg/ml may diagnose sSS with sensitivity 80% and specificity 84%.ConclusionThe results of this preliminary study point out the importance of CXCL13 as a marker for RA disease activity, its role in diagnosing sSS, and estimation of sSS severity

Platelet indices as markers of inflammation in systemic sclerosis patients: Relation to vascular endothelial growth factor and flow mediated dilatation

Aim of the work: To evaluate platelet indices in systemic sclerosis (SSc) patients and identify their clinical significance as novel inflammatory biomarkers in correlation to markers of endothelial dysfunction: vascular endothelial growth factor (VEGF) and flow mediated dilatation (FMD). Patients and methods: Thirty-five SSc patients were enrolled in addition to 35 age and sex matched healthy volunteers as controls. All patients and controls underwent full medical history taking, thorough clinical examination, assessment of severity extent of skin sclerosis using the modified Rodnan skin score (mRss), erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), complete blood count with special consideration to mean platelet volume (MPV), platelet distribution width and platelets count, assay for serum VEGF concentration, and brachial FMD assessment by color duplex sonography. Results: There was a highly significant decrease in the mean MPV in SSc patients compared to the controls (8.65 ± 0.6 fl vs. 9.55 ± 0.52 fl). There was a significant increase in the mean platelet count in SSc patients compared to controls (331.63 ± 64.66 × 103/ml vs. 297.80 ± 44.48 × 103/ml). In SSc patients, a significant negative correlation was found between the mean MPV and each of ESR, CRP and VEGF (r = −0.42, r = −0.37 and r = −0.55 respectively, p < .05); and a significant positive correlation was found between the mean MPV and mean FMD (r = 0.38, p < .05). Linear regression test, showed an association between mean MPV and each of ESR and CRP (t = −3.31, −2.92 respectively, p < .05). Conclusion: MPV levels could be an easily measurable parameter to reflect the inflammatory condition in systemic sclerosis patients. Keywords: Systemic sclerosis (SSc), Platelet indices, Vascular endothelial growth factor (VEGF), Flow mediated dilatation (FMD

Liver fatty acid binding protein: A potential urinary and tissue biomarker for lupus nephritis

Aim of the work: To assess urinary liver fatty acid binding protein (uL-FABP) levels and tissue expression (tL-FABP) in renal biopsies of active and inactive lupus nephritis (LN) patients and examine their relationship with disease characteristics. Patients and methods: uL-FABP levels and tL-FABP expression were assessed in 75 systemic lupus erythematosus (SLE) patients; 25 active LN, 25 inactive LN and 25 SLE without LN as well as 10 matched healthy control. Results: Mean age was 33.9 ± 6.7 years, disease duration 4.6 ± 2.4 years and were 66 females and 9 males. Patients with active LN had higher uL-FABP higher than patients with inactive LN and without LN. uL-FABP in patients with active and inactive LN significantly correlated with renal SLEDAI (r = 0.96, r = 0.92 respectively and p < 0.0001) and 24-h urinary protein (r = 0.97, r = 0.68 respectively and p < 0.0001) but negatively correlated with the estimated Glomerular Filtration Rate (r = −0.97, r = −0.84 respectively and p < 0.0001). uL-FABP significantly correlated with grade of renal biopsy in active and inactive LN (F = 155.6 and 40.7 respectively, p < 0.0001). L-FABP was highly expressed in renal tissue of LN patients; the tubules seemed to be the main location for tL-FABP staining. The uL-FABP levels significantly correlated with the chronicity index score of renal pathology (F = 17.6, p < 0.0001) and the expression of tL-FABP in active and inactive LN (F = 21.4 and 42.2 respectively, p < 0.0001). Conclusion: Urinary and tissue L-FABP levels were associated with active renal disease. Urinary levels of L-FABP might be a potential non invasive marker for the presence of renal involvement in patients with SLE alternative to renal biopsy

Anti-carbamylated protein antibodies in psoriatic arthritis patients: Relation to disease activity, severity and ultrasonographic scores

Background: Anticarbamylated proteins (anti-CarP) are a novel family of antibodies recently identified in patients with inflammatory arthritis. Aim of the work: To investigate the anti-CarP serum levels in psoriatic arthritis (PsA) patients. The relation of anti-CarP to disease activity and severity as well as to the ultrasonographic findings and scores were well thought-out. Patients and methods: Forty-five PsA patients diagnosed according to the classification of psoriatic arthritis (CASPAR) criteria. 45 matched controls were included. The erythrocyte sedimentation rate (ESR), C-reactive protein and serum anti-CarP antibody were measured. PsA disease activity was recorded according to the modified disease activity score (DAS28). The severity and extent of psoriasis was assessed by the psoriasis area severity index (PASI). Musculoskeletal ultrasound (US) of the small hand joints was performed using grey scale (GS) and power Doppler (PD) to derive composite scores based on abnormal counts and severity. Results: The mean age of the patients was 44.58 ± 6.76 years, 40 females and 5 males (F:M 8:1), disease duration 4.93 ± 3.17 years. Serum levels of anti-CarP antibody were increased in PsA patients (33.48 ± 14.05) compared to controls (12.21 ± 4.71 ng/ml) (p < 0.001). The mean DAS28 was 4.61 ± 1.59 There was a significant correlation between anti-CarP antibody and each of DAS28, ESR, CRP, PASI, the GS and PD joint counts (r = 0.97, r = 0.97, r = 0.97, r = 0.97, r = 0.96, r = 0.9 respectively) as well as with the US joint scores; GSJS and PDJS (r = 0.98, r = 0.97 respectively) denoting severity. Conclusions: Anti-CarP antibody might represent a promising marker to predict joint damage and disease activity in PsA patients