Hand osteoarthritis and bone mineral density in postmenopausal women; clinical relevance to hand function, pain and disability.

OBJECTIVE: The aim of the present study was to assess phalangeal bone mineral density (BMD) in postmenopausal females with hand osteoarthritis (OA) and to correlate the measured levels with the radiographic OA grade, pain, function and disability of the hand. METHODS: The study group constituted 40 postmenopausal women with hand OA (range; 45-83 years). Socio-demographic data were collected. They underwent a comprehensive clinical examination of joint status and health outcome measure including Australian Canadian (AUSCAN) OA hand index. Hand radiographs were quantified and graded according to Kellgren and Lawrence (K-L) scoring system. Bone mineral content (BMC) and BMD of the third finger were measured using the accuDEXA (Schick, New York, NY). Twenty females matched for age and years of menopause were studied as a control group. RESULTS: Phalangeal BMC and BMD were significantly reduced in women with hand OA compared to controls and related to radiological erosive OA. The AUSCAN pain and function subscales were worse in proportion to the severity of hand OA. OA X-ray score was significantly associated with reduced right grip strength, pain, and function scales while, decreased BMD was related to Ritchie index and pain scale. CONCLUSION: Postmenopausal women with clinical and radiological hand erosive OA are at risk of development of hand osteoporosis (OP). Phalangeal bone densitometry is an objective reproducible investigation. Poor physical function due to increased pain associated with increasing severity of radiographic hand OA leads to worse BMD results.

The role of heat shock protein 60, vascular endothelial growth factor and antiphospholipid antibodies in Behçet disease.

BACKGROUND: Behçet disease is a systemic inflammatory disease of unknown aetiology. T cells in this disease proliferate vigorously in response to a specific peptide of heat shock protein (HSP) 60 in an antigen-specific fashion. Vascular endothelial cell growth factor (VEGF) is a cytokine participating in the inflammatory process. One of the prominent features of Behçet disease is vasculitis as a result of endothelial dysfunction. Antiphospholipid antibodies (APA) may play a role in the development of thrombosis by inhibiting production of prostacyclin by endothelial cells. OBJECTIVES: To investigate the role of HSP60, VEGF and APA in Behçet disease and their relation to clinical manifestations and disease activity. METHODS: Thirty patients with Behçet disease were included; 17 were in the active stage and 13 were in the inactive. Fifteen age- and sex-matched healthy subjects served as controls. Complete clinical examination and Doppler examination were done. Serum levels of HSP60, VEGF and APA were performed. RESULTS: Serum levels of HSP60, VEGF and APA were significantly higher in patients than in controls; however, their level did not correlate with disease activity. The serum level of VEGF correlated significantly with the presence of vascular manifestations and ocular involvement. The serum level of APA was greater in patients with thrombosis. HSP60 has an important role in aetiopathogenesis of Behçet disease, which sheds new light on its autoimmune nature. CONCLUSIONS: An elevated serum level of VEGF may be a risk factor for the development of ocular disease contributing to poor visual outcome.