CT Scan of the Foot in Patients with Chronic Non-Healing Diabetic Foot Ulcer

Background: Diabetes mellitus is a chronic disease where there is an increased blood sugar level in the body which is either caused due to inability of the pancreas to secrete insulin or the body’s inability to utilize it. The prevalence of diabetes mellitus is growing rapidly worldwide. Statistics show that in the year 2014, there were a total of 422 million cases of DM. Diabetes mellitus is a major cause of heart attacks, kidney failure, blindness and leg amputations. Diabetic foot ulcers are quite common and are estimated to affect nearly 15% of all diabetic patients during their lifetime. In long standing diabetic patients with chronic non-healing ulcers, bony changes or deformities are not uncommon. These bony changes can be identified using CT scans. Materials and Methods: An observational study was conducted on a total of 40 patients with chronic non-healing ulcer attending the surgery outpatient department of Saveetha Medical College, Chennai, Tamilnadu. The CT-scans of their foot were observed for deformities or bony changes. Results: Out of 40 patients, 67.5% were males and 32.5% were females. A maximum number of subjects fell under the age group of 51 - 60 years. The most common site of the ulcer was found to be in the plantar surface of big toe (53%). Among the 40 patients, 33 of them were found to have bony abnormalities on the CT scan of foot and no apparent changes were seen in the rest. Bone erosions (35%), osteopenic changes (22.5%), Charcot’s joint (2.5%), osteophyte formation (12.5) and reduced joint space (10%) were the predominant changes observed on the CT scans of the study population.

Elevated serum Dickkopf-1 is a biomarker for bone erosion in patients with psoriatic arthritis

Background:Psoriatic arthritis(PsA)is an inflammatory arthropathy characterized by psoriasis and bone erosion on radiology.Dickkopf-1(Dkk-1)is considered to be the main inhibitor of the Wnt signaling pathway and results in reduced osteoblast proliferation.The aim of this study was to investigate the serum level of Dkk-1 and its association with bone erosion in PsA patients.Methods:Serum Dkk-1 levels were measured by enzyme-linked immunosorbent assay(ELISA)in 69 patients with PsA and 60 controls,including 39 rheumatoid arthritis(RA)patients,and 21 healthy controls(HCs).Rheumatoid factor and anti-cyclic citrullinated peptide levels were also determined by ELISA.The association of Dkk-1 level with clinical and laboratory features of PsA was analyzed.Logistic regression analysis was used to analyze the risk factors for bone erosion in PsA.Results:Dkk-1 was elevated in 68.1%(47/69)of the patients with PsA,46.2%(18/39)of RA patients,and 9.5%(2/21)of HCs.Serum Dkk-1 concentration was significantly higher in PsA patients compared with that in HCs.The level of serum Dkk-1 was correlated with a swollen joint count,and levels of complement components 3 and 4.Elevated Dkk-1 level(odds ratio=4.440,95%confidence interval:1.246-15.817,P=0.021)was identified as the risk factor for bone erosion in PsA.Conclusions:The serum level of Dkk-1 is abnormally elevated in PsA patients.The elevation of Dkk-1 might be involved in the mechanism of bone erosion in patients with PsA.

Anti-inflammatory effects of aucubin in cellular and animal models of rheumatoid arthritis

Rheumatoid arthritis(RA)is a chronic inflammatory autoimmune disease.It is known that aucubin(AU)exerts anti-inflammatory activity,but its effects and mechanisms in RA are unclear.This study investigated the anti-inflammatory effects and mechanisms of AU in vivo and in vitro.Human fibroblast-like synoviocyte cells from patients with RA(HFLS-RA),RAW264.7 cells,and MC3T3-E1 cells were used to evaluate the effects of AU on migration,invasion,apoptosis,osteoclast differentiation and production.Immunofluorescence was used to observe nuclear translocation of nuclear factor(NF)-/cB,the double luciferase reporter gene method was used to observe NF-/cB-p65 activity in AU-treated MC3T3-E1 cells.RT-qPCR was used to measure expression of bone metabolism and inflammation-related genes,and western blot was used to measure bone metabolism and NF-a:B protein expression levels.Collagen-induced arthritis(CIA)rat model was used for pharmacodynamics study.Arthritis indexes were measured in the ankle and knee,histological staining and Micro-computed tomography were performed on the ankle joints.Also,inflammatory factor gene expression and the levels of NF-/cB-related proteins were detected as in vitro.AU effectively inhibited HFLS-RA cell migration and invasion,promoted apoptosis,and inhibited RAW264.7 cell differentiation into osteoclasts,as well as inhibited NF-/cB-p65 activity in MC3T3-E1 cells.Notably,AU significantly reduced the gene expression levels of three cell-related inflammatory factors and bone metabolism factors,effectively inhibited the expression of p-lKKafi,p-lA:Ba,and p-p65 proteins.In vivo,AU relieved joint inflammation,reduced related inflammatory factors,and inhibited NF-/cB signaling.It could be used to treat RA-related synovial inflammation and bone destruction through the NF-/cB pathway.