The Arabic LupusPRO: A Cross-Cultural Validation of a Disease-Specific Patient-Reported Outcome Tool for Quality of Life in Lupus Patients.

OBJECTIVE: To translate and cross-culturally adapt the Arabic version of LupusPRO v.1.8 and to test its reliability and validity. METHODS: LupusPRO was translated into the Arabic language following a standard procedure with forward-backward translation and was tested in patients with systemic lupus erythematosus (SLE) before use. The Arabic version was administered to 107 Egyptian SLE patients, along with a validated Arabic version of RAND 36-Item Health Survey 1.0 (SF-36). The internal consistency and test-retest reliability were determined. Validity was assessed by correlating LupusPRO scores with SF-36, Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The conceptual framework of the Arabic LupusPRO was evaluated using confirmatory factor analysis (CFA). RESULTS: Among the 107 SLE patients, 95% were women with a median (range) age of 32 (18-55) years, median (range) SELENA-SLEDAI of 6 (0-23) and median (range) SDI of 0 (0-6). The Cronbach's alpha for the Arabic LupusPRO ranged from 0.71 to 0.98, except for the social support domain (0.65). Test-retest reliability ranged from 0.95 to 0.99. Convergent validity with corresponding domains of SF 36 was satisfactory. For criterion validity, there was a weak but significant correlation between several LupusPRO domains with SELENA-SLEDAI. CFA showed a good model fit. CONCLUSION: The Arabic version of LupusPRO v1.8 is a reliable and valid tool for measuring quality of life among Arabic speaking SLE patients.

Ultrasound-guided caudal epidural steroid injection in chronic radicular low back pain: short-term electrophysiologic benefits.

OBJECTIVE: To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain. METHODS: Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group (n = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml-1 Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group (n = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion. RESULTS: Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment (p > 0.05). CONCLUSION: Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard. ADVANCES IN KNOWLEDGE: This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.

MTHFR functional genetic variation and methotrexate treatment response in rheumatoid arthritis: a meta-analysis.

AIM: To date, functional MTHFR SNPs have been tested for their impact on low-dose methotrexate (MTX) response in small rheumatoid arthritis (RA) cohorts. We sought to test their effect in the single largest cohort studied to date, and undertook a meta-analysis utilizing stringent study inclusion criteria. MATERIALS & METHODS: RA patients treated with MTX monotherapy from the Yorkshire Early Arthritis Register (YEAR) were genotyped using RFLP assays, and tested for association with treatment efficacy. Studies for meta-analysis were screened by a set of stringent inclusion criteria. RESULTS & CONCLUSION: rs1801131 and rs1801133 were not associated with response to MTX in the YEAR cohort, nor did they affect the probability of achieving a low disease activity state. A meta-analysis of comparable studies found no association with these SNPs. MTHFR SNPs rs1801131 and rs1801133 are unlikely to have a clinically meaningful effect on the first 6 months of MTX treatment in early RA.

Evaluation of pulsed electromagnetic field therapy in the management of patients with discogenic lumbar radiculopathy.

AIM: This randomized clinical trial was designed to evaluate the effect of pulsed electromagnetic field therapy (PEMF) in the management of patients with discogenic lumbar radiculopathy. METHODS: Forty patients suffering from lumbar radiculopathy due to lumbar disc prolapse were randomly assigned to one of two groups: a study group that included 20 patients who received PEMF therapy and a control group that included 20 patients who received placebo treatment. Both groups were evaluated at bases line and after 3 weeks by using a visual analogue scale (VAS) (0-10), somatosensory evoked potentials (SSEPs) for selected dermatomes and Modified Oswestry Low Back Pain Disability Questionnaire (OSW), and findings were compared before and after treatment. RESULTS: Significant differences were observed between both groups before and after application of PEMF therapy relative to VAS (P=0.024), total OSW (P<0.001), and other domains of OSW score (pain intensity [P=0.009], personal care [P=0.01], lifting [P<0.001], walking [P<0.001], sitting [P<0.001], standing [P<0.001], sleeping [P<0.001], social life [P<0.001] and employment [P=0.003]). Other significant differences were observed between both groups relative to SSEP latency and amplitude of the evaluated dermatomes on the right side (P=0.022 and P=0.001, respectively), and left side latency and amplitude (P=0.016 and P=0.002, respectively). CONCLUSION: PEMF therapy is an effective method for the conservative treatment of lumbar radiculopathy caused by lumbar disc prolapse. In addition to improvement of clinically observed radicular symptoms, PEMF also seems effective in reducing nerve root compression as evidenced by improvement of SSEP parameters after treatment.

Diminished CD4+CD25+ T-lymphocytes in peripheral blood of patients with systemic lupus erythematosus.

The exact aetio-pathogenesis of systemic lupus erythematosus (SLE) is still speculative, where dysregulation or depletion of CD4+CD25+ T lymphocytes is among the supposed mechanisms. In this study, we thought to investigate patients with SLE for percentages of CD4+CD25+ T cells in their peripheral blood and to correlate this with their disease activity scores. Twenty-five patients with SLE who fulfilled, at least, four of the revised Criteria of the American College of Rheumatology (ACR) and twenty healthy volunteers participated in this study. Activity of SLE was assessed by SLE disease activity index (SLEDAI) score. Percentages of CD4+CD25+ T-cells were determined by a flowcytometric technique, while recently activated T-cells were analysed by assaying the expression of the T-cell activation marker, CD69. A statistically significant (p = 0.003) reduction of percentage of CD4+CD25+ T cells was observed among patients (mean 7.16+/-4.53 %) when compared with control subjects (mean 11.36+/-4.50 %), while a non-significant (p = 0.475) low expression of CD69 on CD4+ T cells was observed between patients (mean 0.32+/-0.28 %) and control subjects (mean 0.32+/-0.38 %). In addition, no correlation could be detected between percentages of CD4+CD25+ T cells and SLEDAI scores among SLE patients (p=0.079). In conclusion, this study adds some evidence for the role of CD4+CD25+ T cells in the pathogenesis of SLE that may have some future therapeutic applications.