Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients.

BACKGROUND: Suprascapular nerve block (SSNB) is used in the management of frozen shoulder. There are no evidences from the literature that can determine how many blocks and the interval between them. OBJECTIVE: To compare between single and multiple (nine) SSNB in the treatment of diabetic frozen shoulder. METHODS: Ninety six patients with Type 2 diabetic and a frozen shoulder divided into 2 equal groups. Patients in group1 were subjected to single SSNB. Patients in group 2 were subjected to multiple (nine) SSNB. Participants were assessed clinically and by ultrasound at baseline and after 3 weeks and 4 months. RESULTS: After 3 weeks, there was a significant improvement of all clinical & ultrasound parameters in both groups. But the improvement in group 2 was significantly better than the improvement in group 1. Also after 4 months, all parameters in both groups showed a further improvement in comparison with the base line parameters but still there was a highly significant improvement in group 2 versus group1. CONCLUSION: A course of multiple (nine) injections for suprascapular nerve block gave a better outcome than a single injection for suprascapular nerve block.

APRIL Level as a Marker of Disease Activity in Treated Rheumatoid Arthritis Patients: Association with Disease Activity and Anti-CCP Antibody.

Rheumatoid arthritis (RA) is a chronic autoimmune disease with joint inflammation and autoantibody production. Cytokines play an important role in the pathogenesis of RA. Among the cytokines that regulate B cell homeostasis is the "A Proliferation-Inducing Ligand" (APRIL). To determine the differences in APRIL in response to treatment in anti- cyclic citrllinated peptides (anti-CCP) positive versus anti-CCP negative patients with established RA. Concentrations of APRIL in sera of 10 anti-CCP positive RA patients, 18 anti-CCP negative RA patients, and 12 healthy controls were measured by enzyme-linked immunosorbent assay (ELISA) at treatment initiation and after 6 months of treatment with methotrexate and hydroxychloroquine. Correlations between serum anti-CCP, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), 28-joint Disease Activity Score (DAS28), and serum level of APRIL were analyzed. Serum APRIL levels were increased in rheumatoid arthritis patients in comparison with healthy volunteers. APRIL correlated positively with disease activity; swollen joint count, visual analog score and simplified disease activity index (all P < 0.05). In addition, APRIL was significantly higher in patients with positive anti-CCP. After treatment, APRIL levels significantly decreased in the anti-CCP positive RA patients than in anti-CCP negative RA patients. In conclusions, serum APRIL may be a good predictor marker for joint injury and therapeutic response in patients with RA.