A study of serum levels of B cell-attracting chemokine-13 (CXCL 13) and rheumatologic manifestations of chronic hepatitis C virus infection in a cohort of Egyptian patients

AbstractMany rheumatologic manifestations have been associated with Hepatitis C virus (HCV) infection including; arthralgia, myalgia, fatigue, fibromyalgia, vasculitis, and sicca syndrome. The relationship between emergence and persistence of intrahepatic or circulating B cell clonotypes and HCV infection is still unknown. However accumulating evidences indicate that certain chemokines play a critical role in providing the appropriate environment for activation and expansion of naïve lymphocytes, one of these chemokines is B cell-attracting chemokine-13 (CXCL13).CXCL13 is a major regulator of B-cell trafficking. This study evaluates circulating levels of CXCL13 protein in chronically HCV-infected Egyptian patients compared with healthy controls and its association with articular synovial hypertrophy. Rheumatic manifestations were present in 85% of patients; included fatigue (20%), arthralgia (the commonest manifestation) (65%), fibromyalgia (22%), myalgia (37%), Rayunad’s phenomenon (10%), peripheral neuropathy and arthritis (2.5%), and tendenitis (7.5). Cryoglobulins recorded in this study were of type II & III mixed cryoglobulins (MC) positive in 25% all of which showed positive rheumatoid factor (RF). Significant low levels of C3 and C4 were reported in the patient group. CXCL13 serum levels were significantly high in the patient group especially in the MC positive group compared to controls. The highest levels of CXCL13 were significantly associated with rheumatologic manifestations with or without mixed cryoglobulinemia and significantly associated with articular synovial hypertrophy

Bone Mineral Density Changes in Patients with Recent-Onset Rheumatoid Arthritis

Background Osteoporosis and related fragility fractures are one of the most common complications seen in patients with rheumatoid arthritis (RA) and dramatically affect quality of life. Objective To evaluate changes in bone mineral density in patients with recent onset rheumatoid arthritis (< 1 year) and its correlation if any with a modified DAS-28 score and simple erosion narrowing score (SENS). Methods This study included 30 patients with recent-onset rheumatoid arthritis fulfilling the new American College of Rheumatology/European League Against Rheumatism diagnostic criteria for rheumatoid arthritis and 20 healthy volunteers as controls. All were subjected to a complete blood count, erythrocyte sedimentation rate, C-reactive protein, liver function tests, renal function tests, rheumatoid factor, and plain x-rays of the hands and feet. Dual-energy x-ray absorptiometry DEXA was used to measure bone mineral density (BMD) of the left proximal femur, lumbar spine (L1–L4), and lower distal radius at the time of recruitment. Results In the RA patients, 13.3% had osteoporosis, 50% had osteopenia, and 36.7% had normal BMD. The most common site of osteoporosis was the lumbar spine (four patients, 13.3%) followed by the femur (two patients, 6.6%), and forearm (only one patient, 3.3%). There was a significantly higher percentage of osteoporosis among RA males than females and the difference was statistically significant ( P = 0.009). Osteoporosis was more common in patients treated with corticosteroids and disease modifying antirheumatic drugs (DMARDs) than in patients treated with only nonsteroidal anti-inflammatory drugs ( P = 0.004). Higher disease activity (DAS-28) was found in RA patients with osteoporosis compared to RA patients with normal BMD or osteopenia, but the difference was not statistically significant. Osteoporotic RA patients were found to have a higher SENS score for radiological damage than nonosteoporotic ones. Conclusion BMD changes do occur in patients with early RA, and are not necessarily correlated with disease activity (DAS-28). However, a significant negative correlation was found between BMD and the score of radiological damage (SENS). Dual energy x-ray absorptiometry is an important investigation to assess BMD in early RA patients