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- Title
EVALUAREA MIOPATIEI DIN POLIARTRITA REUMATOIDĂ - STATUSUL VITAMINEI D ŞI CORELAŢII CLINICO-BIOLOGICE ŞI ELECTROMIOGRAFICE.
- Authors
Negru, Maria-Magdalena; Berghea, F.; Iancu, C.; Bălănescu, A.; Bojincă, V.; Săulescu, I.; Groşeanu, L.; Opriş, D.; Abobului, M.; Vlad, V.; Borangiu, A.; Predeţeanu, D.; Ionescu, R.
- Abstract
Muscle damage is one of the least studied and also one of the least known entities of extra-skeletal manifestations of RA. Objective. Evaluation of vitamin D status in a group of patients with RA and clinical myopathy and establish some correlations with clinical and electromyographic muscle activity indices. Material. We prospectively evaluated a total group of 45 subjects, including 25 patients with rheumatoid arthritis and myopathy and 20 healthy subjects, admitted in Internal Medicine and Rheumatology Department of St. Maria" Hospital during September 2013 - August 2014; to all patients in the active group and to 10 subjects in the control group were performed electromyography exams. I used concentric needle method for recording MUP and quantitative analysis of multi-MUP. Vitamin D was assessed by dosing serum level of 25 (OH) vitamin D. I watched EMG correlation with serum levels of vitamin D and validated clinical parameters of muscle testing (muscle pain VAS score, muscle force testing, 6-minutes walking test, chair rising test, TUG-Timed up and go test, TGT- tandem test), with titre of specific muscle enzymes made (CK, LDH) or acute phase reactants (ESR, CRP), the degree of activity/disability disease (DAS28 /HAQ). Results. Overall study group (45 subjects) had a mean age of 55.40 (14.57) years. It's remarkable predominant female sex, ratio F/M was 23:2 (92% women and 8% men) in the active group and 3:1 (75% women and 25% men) in the control group, the latter according with known gender distribution of literature data (F/M 2:1-4:1). Mean serum levels of vitamin D in the active group was 26.12 (13.18) ng /ml, 28% fits into the category of insufficiency and 40% in the category of deficiency. In the group of healthy subjects, the mean serum level of vitamin D was increased, 29.71 (23.26), predominantly (55%) patients with deficiency of vitamin D. The mean duration of disease in the active group was 10.16 (7.9) years and mean value of the disease activity score (DAS28) was 4.1 (1.4), 66.7% of patients with RA with moderate or high active disease (DAS28 > 3.2). EMG changes were better expressed in the active group with rheumatoid myopathy compared to the control group and especially for the studied parameters of the upper limb (average amplitude, polyphazicity of MUP). Also, the two groups are significantly different (p = 0.028) regarding to interference pattern (IP) on voluntary contraction. From the RA group, 56% of patients had a complete, full interference pattern (myogenic) at a lower force than in normal muscle. Regarding serum levels of vitamin D and various EMG parameters, the latter were differently distributed according to subjects belonging to one of the subgroups of vitamin D (< 20 ng/mL, 20-30ng/mL, > 30 ng/mL). Conclusions. In the muscle damage in PR, one of the least known entities of extra-skeletal manifestations in which vitamin D deficiency is strongly correlated with the degree of disease activity, electromyography appears to be a useful tool in myopathy evaluation.
- Publication
Romanian Journal of Rheumatology / Revista Romana de Reumatologie, 2014, Vol 23, Issue 3, p149
- ISSN
1843-0791
- Publication type
Article