اسم المؤلف:
مصطفى سالم خلف
اسم المشرف:
عدنان فاضل النجار | عباس طعمة جودة الخزاعي
المستخلص:
الفصا العظمي العقدي هو واحد من انواع التهاب المفاصل الموضعي. هو مرض المفصل التنكسي او الانحلالي, ويشمل الغضروف المفصلي والعظم تحت الغضروف, وهو يعتبر نوع من انواع امراض المناعة الذاتية. السبب الرئيسي للفصال العظمي العقدي غير معروف لكن هناك اسباب متنوعة مثل | Nodal osteoarthritis (NOA) is one type of the localised osteoarthritis that mostly occurs with postmenopausal women. It is degenerative joint disease, including articular cartilage and subchondral bone, it consider type of autoimmune diseases. The main cause of NOA is unknown but there are variety of causes like hereditary and metabolic, may initiate processes leading to loss of cartilage. The cartilage loss process usually lead to induce the immune system to release many of immune factors like cytokines , these factors lead to generation of immune response and inflammation in the joint. The NOA mostly occurs with postmenopausal women. It affects the smaller joint. Over several years, firm knobbly swellings form on the finger joints. These are caused by osteophytes so lead to bony enlargement and are known as Heberden's nodes when they are at the end joints of fingers (distal interphalangeal joints) or Bouchard's nodes when they are at the mid - finger joints (proximal interphalangeal joints). Once the nodes are fully formed, and not necessarily painful, they do limit the movement of the fingers significantly. NOA leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain, but in advance cases, many of Symptoms may include like joint pain, stiffness and sometimes an effusion. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.Many studies have been done about inflammatory and biochemical markers in NOA and they found conflicting results. Objective1 - To evaluate serum adiponectin , interleukin - 6 (IL - 6) , anti cyclic citrullinated peptide (ACCP) and bone mineral density (BMD) in NOA.2 - To asses the CRP , RF and ESR in NOA.3 - To asses effect of age , gender , effect of BMI , smoking habit and duration of disease in NOA.Material and Method This study performed during the period from November 2013 to February 2014. These subjects were selected from patients attending the Rheumatology & Rehabilitation Consultation Unit at Al - Yarmouk Teaching Hospital. Patients and controls with hypertension, diabetes mellitus, malignancy, chronic disease of kidney, liver and any patients taken drugs that might effect the results have been excluded from the study.The laboratory tests were done in Al - Yarmouk teaching hospital laboratories and the laboratory research unit in collage of medicine / department of medical biochemistry. Subjects80 subjects (60 patients & 20 healthy controls) were enrolled in this study : A. First group : Patients with Nodal Osteoarthritis (NOA), No. = 60 (female =49 & male =11), rang of age (40 - 88) years.B. Second group : Healthy control group who had no history or clinical evidence of NOA or any other chronic disease like hypertension, DM and other chronic disease that might effect on the study data, No. 20 (female = 15 & male =5 ), rang of age (48 - 82) years.The patients were diagnosed as NOA according to the 2013 American College of Rheumatology (ACR) criteria, also the patients were diagnosed as normal, osteopenia and osteoporosis according to the 2013 American College of Rheumatology (ACR) criteria by measured of BMD (T - score) Normal : T - score (more than or equal - 1), Osteopenia : T - score ( - 1.1 - - 2.5) and Osteoporosis : T - score (less than - 2.5). The patients BMI were measured and determined as Normal (18 - 24.9 kg/m2), Over weight (24.9 - 29.9 Kg/m2), Obese grade - I (29.9 - 34.9 kg/m2) and Obese grade - II (more than 34.9 kg/m2) according to WHO 2012.MethodsELISA technique was used for the determination of serum adiponectin, IL - 6 and ACCP. Measurement of serum uric acid was done by spectrophotometric instrument. qualitative serological tests were used for determination of the CRP and RF also ESR determination were done in hospital laboratory. The BMI was determined by WHO equation's (2012) (weight/ (length) 2), also the BMD was determined by DXA scan according to ACR limits.Results obtained were subjected to statistical analysis by using SPSS and Excel program.ResultsLevels of serum adiponectin, IL - 6, CRP, ESR and BMI were significantly increased in NOA patients most than healthy controls, also the BMD (T - score) significantly decreased in NOA patients than healthy controls. But the age, gender, serum ACCP and uric acid were not significantly changed in NOA patients compared with healthy controls. Study of age, gende , BMI and duration of disease, found that they did not effect any parameters studied in NOA patients, only serum ACCP level was found to be significantly increased in females than males. Serum adiponectin level and CRP were significantly increased more in osteoporosis than osteopenia and normal. CRP was significantly increased in smoker than non smoker NOA patients.This study showed negative correlation between serum adiponectin and BMD, positive correlation between serum adiponectin and ESR, serum adiponctin and IL - 6 and IL - 6 and ESR in NOA patients. This study illustrated change in the status of the inflammatory markers like adiponectin, IL - 6 and other parameters in NOA disease. It illustrated effect of some of the factors like age, gender, BMI, BMD, smoking habit and duration of disease on development of NOA disease and on the status of the parameters studied. Also this study illustrated some correlation between the parameters in NOA patients.
