Abir Naguib

Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity

Abstract Objectives. To evaluate the effectiveness of infliximab (IFX) injection into sacroiliac joints (SIJs) of non-radiographic axial spondyloarthritis (nr-axial SpA) and its impact on clinical and MRI parameters of disease activity. Methods. Thirty-seven patients fulfilling the Association of Spondyloarthritis International Society (ASAS) criteria for axial SpA were initially studied, with disease duration not exceeding 1 year and failed to respond to non-steroidal anti-inflammatory drugs (NSAIDs). Only SpA having active sacroiliitis on MRI without spondylitis (number = 7) were selected to receive bilateral SIJ injection of 20 mg IFX. Follow-up MRI was done at 24 weeks post-injection. Patients were clinically evaluated before, and 12 and 24 weeks after SIJ injection. Evaluation included back pain and stiffness scores, and Bath Ankylosing Spondylitis (BAS) Disease indices and C-reactive protein (CRP) levels. ASAS response criteria were also assessed. Results. Twelve and twenty-four weeks after injection, there was significant decrease in back pain, stiffness, and BAS Disease Activity and Global indices. BAS Functional index, CRP, and mean bone marrow edema score of SIJs were decreased without reaching statistical significance. All patients achieved ASAS20 and five (71.4%) achieved ASAS40. Conclusion. SIJ injection of IFX could be a therapeutic option in early nr-axial SpA who failed to respond to NSAIDs.

Evaluation of early changes of cartilage biomarkers following arthroscopic meniscectomy in young Egyptian adults

Abstract Background The metabolic imbalance in the articular cartilage following meniscectomy includes an increase in cartilage degradation with an insufficient reparative or anabolic response resulting in structural, biochemical and mechanical changes that can progress from pre-clinical, to pre-radiographic, to radiographic damage of the joint. Purpose To evaluate combinations of imaging and biochemical biomarkers for cartilage breakdown, synthesis and quantity in the early period of post-arthroscopic meniscectomy. Subjects and methods Twenty young adults (three of them were females) who underwent unilateral arthroscopic partial meniscectomy were evaluated. The patients had a mean age of 32.5 years (range, 24–39), mean BMI of 28.5 kg/m2 (range, 24–34). Preoperative and six months postoperative US and MRI-based markers (cartilage thickness and volume, respectively) were quantified for medial and lateral tibio-femoral compartments for both knees. Preoperative, three and six months postoperative biochemical markers serum assays were measured; COMP and Col II (cartilage matrix breakdown) and PIICP (cartilage synthesis). These three markers were measured in an age, sex and BMI matched twenty healthy subjects for comparison. Results The meniscectomized knees had significantly lower total knee cartilage volume, P < 0.05 but non-significant mean thickness than the intact contralateral knees. Among the individual biochemical markers, PIICP had the highest significant diagnostic accuracy quantified as the area under the receiver-operator characteristics curve (AUC) of 0.75 (95% confidence interval: 0.509–0.912) higher than all others, P < 0.05 to distinguish subjects with progressive cartilage loss from non-progressors. Diagnostically, ratio of COMP and Col II to PIICP scored AUC of 0.90 (0.69–0.98, higher than PIICP: P = 0.0001). For prediction of cartilage loss, none of the individual markers could be used. Conclusion Cartilage volume loss by MRI combined with changes in cartilage matrix turnover detected by molecular biomarkers may reflect the initial changes associated with cartilage degeneration that account for early OA.

The relation between serum visfatin levels and cardiovascular involvement in rheumatoid arthritis

Abstract Objectives To investigate the effect of visfatin on the cardiovascular system in rheumatoid arthritis (RA) patients. Methods Twenty patients diagnosed with RA were recruited, as well as 15 age and sex-matched healthy controls. The RA patients underwent thorough clinical examination including body mass index (BMI) and waist/hip ratio measurement. The disease activity score (DAS 28) was calculated. Echocardiography and coronary artery calcium scoring (CACS) were performed, as well as measurement of serum visfatin levels, total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), and serum triglycerides. The healthy control group had serum visfatin levels measured. Another group for risk stratification (RS) included 30 non-RA female patients who were referred for calcium scoring to exclude coronary artery disease and for lipid profile assessment. Results RA patients’ ages ranged from 27 to 61 years (mean: 43.9 ± 11.6). They all had normal echocardiographic findings. Serum visfatin levels were significantly higher in the RA group (58.8 ± 6.6 ng/ml) versus the controls (13.8 ± 8.11 ng/ml). Eleven RA patients (55%) had evidence of coronary atherosclerotic changes with a mean CACS of 86.4 ± 360. There was a significant correlation between serum triglycerides and CACS (P = 0.014); however, there was no significant correlation of the CACS with the visfatin level, disease duration and DAS. Serum visfatin levels did not correlate with BMI or waist/hip ratio. Compared to the RS group, the RA group was significantly younger (43.9 ± 11.6 versus 56.8 ± 11.6 years, P < 0.0001). However, there was no statistically significant difference in the frequency of coronary artery calcification between the RA group (55%) and the RS group (32%) (P = 0.65) and no significant difference between the two groups in the CACS. Conclusion Coronary atherosclerosis occurs at least 10 years earlier in female patients with RA. Serum visfatin levels are elevated in RA patients; however, it does not explain early subclinical atherosclerosis.

Hand osteoarthritis: Clinical and imaging study

Abstract Aim To examine the validity of US in assessing hand osteoarthritis (OA) and to study the relationship between ultrasonographic findings and OA symptoms. Methods This study was carried out on thirty patients with primary hand OA, and fifteen healthy subjects serving as a control group. Patients were classified according to ultrasonographic findings of joint involvement into two subgroups: 15 patients with interphalangeal (IP) OA and 15 patients with IP and first carpometacarpal (CMC) joint OA. All hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement (nodes), and deformity. Functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by Visual Analogue Scale (VAS) were carried out. Plain X-rays of both hands were taken and classified according to the Kellgren–Lawrence (K–L) grading scale. High resolution US of the hand joints was performed which focused on examining cartilage thinning, joint space narrowing (JSN), and osteophytes (OST). Results There was a positive correlation between the K–L grading and US findings regarding JSN and OST. There was a positive correlation of AUSCAN score with cartilage thinning, OST and JSN. There was a negative correlation of grip strength with cartilage thinning and OST. There was a negative correlation between pinch strength and US findings (cartilage thinning, OST and JSN). There was a positive correlation between pain and US findings. Heberdens nodes were associated with underlying distal IP cartilage thinning, OST and JSN. On comparing the two subgroups of patients; patients with both IP and first CMC joint involvement experienced significantly higher levels of pain and disability and had weaker pinch strength. Conclusions Ultrasonographic findings correlated with clinical findings as nodes, functional parameters as grip and pinch strength, and pain. The increased detection of OA structural pathology by US may make this a useful tool for hand OA assessment.

Poster 48: Evaluation of a New Technique to Measure Femoral Articular Cartilage Thickness Using Infrapatellar Ultrasonographic Imaging

Objective: To look for the better condition to treat partial tear of Achilles tendon in immobilization or free mobilization immediate after injury. Design: The pure strains mice divided into 2 groups followed a sevenday adaptation, given a tenotomy and appropriate treatment based on its group. In the next seven days, the mice were given LLLT therapy for 4,28J/cm in three minutes alternately. Group 1 we apply casting and group 2 free mobilization Afterwards, the mice were taken to the laboratory for microscopic assessment. Setting: Animal laboratory, Veterinary medicine faculty, Hasanuddin University, Indonesia. Participants: The 14 pure strains mice. Interventions: All mice given a tenotomy and appropriate treatment based on its group. In the next seven days, the mice were given LLLT therapy for 4,28J/cm in three minutes alternately. Group 1 we apply casting and group 2 free mobilization. Main Outcome Measures: Histopathology by analyzing its collagen fiber formation. Results: The result showed that the mice with free mobilization gained better collagen fibers formation than the immobilization ones. Conclusions: Histopathology study shows that free mobilization condition promotes healing faster combine with LLLT therapy in partial tear of Achilles tendon. Level of Evidence: Level III

Poster 104 Neuromyelitis Optica Precipitated by Chikungunya Viral Infection: A Case Report

the hospital after she began to have fever and pain at the site of her Perm-A-Cath. The Perm-A-Cath was removed, and she was deemed a candidate for AV fistula placement for hemodialysis access. Within 24 hours of fistula placement, she developed pain and the inability to flex or extend her left wrist and fingers. She was diagnosed with ischemic steal syndrome. An urgent distal revascularization interval ligation was performed. Setting: Academic medical center. Results or Clinical Course: Although the fistula was salvageable, she continued to have extremely limited use of the left upper extremity despite occupational therapy. Nerve conduction studies were performed on her left upper extremity four weeks later and revealed absent left median, ulnar, and radial sensory and motor responses. Needle EMG on the left arm revealed no motor units firing for the distal median, ulnar, and radial nerves. Discussion: A serious complication of hemodialysis vascular access is ischemic steal syndrome. Steal syndrome, which is generally distal hypoperfusion, can be caused by three main etiologies. They are arterial occlusive disease, excess blood flow through the AV fistula, or failure of collateral flow development. These conditions “steal” blood flow meant for distal profusion and can potentially cause irreversible impairment if not detected early in the fistula’s development. Patients with diabetes are at greater risk for development of steal syndrome. If surgical intervention is required, the procedure of choice is distal revascularization with interval ligation. Conclusion: Steal syndrome is an uncommon but serious complication of hemodialysis shunts. Irreversible functional impairment may occur if steal syndrome is not detected early on.

Poster 7 Hand Function in Systemic Sclerosis using Clinical and Ultrasonographic Evaluation: A Feasibility Study

due to low prevalence, severe cognitive and functional deficits, and poor prognosis at time of diagnosis. Conclusions: Those suffering PML are often left with severe disabilities and may benefit from an intense multidisciplinary rehabilitation program to improve function and enhance quality of life. Inpatient rehabilitation also allows for daily monitoring of response to HAART and potential dangerous complications such as immune reconstitution inflammatory syndrome.

Poster 88 Hand Osteoarthritis: Clinical and Imaging Study

Disclosures: D. Sanghi, none. Objective: There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA). The present study sought to identify influence of dietary nutrients in prevalence of OA of the knee. Design: A cross-sectional study. Participants: 150 subjects were recruited from an outpatient clinic with the diagnosis of knee osteoarthritis (KOA) according to the criteria of American College of Rheumatology (ACR). Controls were age and gender matched healthy subjects who were free from disease under study. OA was radiologically graded according to Kellgren-Lawrence grades. Body mass index (BMI) was recorded by standard procedure. Dietary nutrient intakes were analyzed by self-administered questionnaire, including 3-day dietary recall and food frequency table (FFQ). Results: An average weight and BMI was significantly higher in subjects with OA knee in comparison with subjects without KOA. Among all dietary factors under study, riboflavin, -carotene, vitamin C, and vitamin D was significantly lower in subjects who have OA knee in comparison with subjects without OA knee. In unadjusted logistic regression, lower intake quartile of riboflavin, -carotene, vitamin C and vitamin D having higher risk of OA knee in comparison with higher intake quartiles. However, in adjusted analysis, the risk of OA knee for riboflavin was diminished and -carotene lose some strength, but vitamins C and D have similar strength of risk of OA knee in quartile having a lower intake. As the severity of disease was only defined by vitamin D intake. Conclusions: The present cross-sectional study revealed that a lower intake of -carotene, vitamin C and vitamin D intake is risk factor for knee OA. These nutrients might be an explanatory nutrient for the course of OA knee and might lead disease-modifying effect.

Poster 85 The Relationship Between Osteoarthritis of the Hands, Bone Mineral Density, and Bone Turnover Markers

Aim: To investigate the relationship between hand osteoarthritis (HOA), bone mineral density (BMD), and bone turnover markers. Methods: Twenty post-menopausal women aged 50-73 years (mean: 62.4 ± 6.5) diagnosed with HOA were recruited along with 10 age-matched post-menopausal women with no signs of HOA as the control group. Both groups had postero-anterior hand radiographs taken and evaluated according to the Kellgren-Lawrence scale to assess OA severity. They underwent thorough clinical examination including measurement of body mass index (BMI). They completed the AUSCAN

The relationship between osteoarthritis of the hands, bone mineral density, and bone turnover markers

Abstract Aim To investigate the relationship between hand osteoarthritis (HOA), bone mineral density (BMD), and bone turnover markers. Methods Twenty post-menopausal women aged 50–73 years (mean: 62.4 ± 6.5) diagnosed with HOA were recruited along with 10 age-matched post-menopausal women with no signs of HOA as the control group. Both groups had postero-anterior hand radiographs taken and evaluated according to the Kellgren–Lawrence scale to assess OA severity. They underwent thorough clinical examination including measurement of body mass index (BMI). They completed the AUSCAN questionnaire. Grip strength was measured using a hand held dynamometer and lateral pinch strength was measured using a pinchmeter. They underwent BMD measurement at the hip and wrist using Dual energy X-ray absorptiometry. Furthermore, they had serum osteocalcin and urinary deoxypyridinoline (DPD) measured. Results There was no statistically significant difference in T-scores of the hip (P = 0.168) and wrist (P = 0.45) between the patients and the controls. However, six patients (30%) had osteoporosis. A total of 12 patients had diminished BMD at the hip. There was no significant increase in serum osteocalcin levels in patients compared to controls (P = 0.382). However, urinary DPD was significantly elevated in the patient group compared to the controls, (P < 0.0001). There was a positive correlation between T-scores at the hip and BMI (P = 0.017). There was a negative correlation of T-scores at the hip and wrist with postmenopausal duration and parity. There was no correlation between the T-scores and bone turnover markers. There was a positive correlation between OA severity and both T and Z-scores at the wrist. Conclusions Although there was no significant association between HOA and BMD, HOA is associated with increased bone turnover as demonstrated by the significant elevation in urinary DPD. These patients should be followed up to assess the need for medical treatment to prevent future fractures.