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Abstract
Osteoarthritis is the most common chronic articular disease worldwide and one of the most common cause of long-term disability over the age of 65 years. Nearly half the adult population (46%) will develop over their lifetime painful knee OA in at least one knee. There is growing evidence have demonstrated that primary knee OA is not exclusively a disorder of articular cartilage but the subchondral bone is metabolically active in primary knee OA and play a prominent role in its pathophysiology.
Vitamin D influences the mineralization of bone matrix, and has a direct effect on bone cells and bone growth that would stabilize the knee joint and stop progression of the primary knee OA. It has been found that low levels of vitamin D may interfere with chondrocyte metabolism and increase cartilage degeneration.
Vitamin D influences both musculoskeletal health and neuromuscular function and correlates directly with an improvement in disability measures in primary knee OA. However its effect is relatively small, this is not going to make someone with a lot of knee pain feel all better usually but it is an effective disease-modifying intervention for primary knee OA.
The present study was carried out to conduct clinical and laboratory assessment of serum 25-Hydroxycholecalciferol in patients with primary knee osteoarthrosis, in order to correlate its level with disease severity,
The study included 20 female patients with primary knee OA, they were subjected to full history taking with clinical assessment for knee pain and knee function, thorough clinical examination, radiological assessment by plain x-rays anteroposterior and lateral views of affected knee joints for grading of OA severity and laboratory investigations included routine tests e.g. CBC and special tests to exclude other rheumatic diseases e.g. ANA, to exclude causes of secondary knee OA e.g. Fasting and postprandial blood sugar and to exclude causes of vitamin D deficiency e.g. Kidney and Liver functions. Serum level of 25-Hydroxycholecalciferol were measured by 25-Hydroxycholecalciferol EIA kit using direct ELISA technique.
Serum level of 25-hydroxycholicalciferol is sufficient in 10 patients (50%), insufficient 5 patients (25%) and deficient in 5 patients (25%).
By comparing the clinical, radiological and laboratory findings in the three groups of patients, there were highly significant differences:
As regards disease duration, we found that insufficient and deficient groups had longer disease duration than sufficient group with highly statistical difference
As regards pain assessment by VAS, our comparison studies showed higher VAS in both insufficient and deficient groups compared to VAS in sufficient group with highly statistical difference. As regards knee function assessment by WOMAC score, our comparison studies showed higher WOMAC score in sufficient group compared to WOMAC score in both insufficient and deficient groups with highly statistical difference.
As regards x-ray grading, comparison studies showed that patients with higher grades of X-ray (III, IV) had lower serum level of 25-hydroxycholicalciferol and lower grades of X-ray (I, II) had higher serum level of 25-hydroxycholicalciferol with highly statistical difference.
The results of the present study provide that serum level of 25-Hydroxycholecalciferol has highly significant negative correlations with disease duration, VAS and knee plan x-ray and highly significant positive correlations with WOMAC score.
Our comparison studies showed also that patients with higher serum level of 25-hydroxycholicalciferol, had not muscle weakness or ligament laxation, while patients with lower serum level of 25-hydroxycholicalciferol had muscle weakness or ligament laxation with highly statistical difference. On the other hand, presence or absence of knee joint inflammation and effusion had non statistical difference as regards serum level of 25-hydroxycholicalciferol. Patients were on analgesic regularly and patients were not on analgesic regularly revealed non statistical difference also as regarding 25-hydroxycholicalciferol level.
In conclusion, patients with low serum level of 25-hydroxycholicalciferol had longer disease duration, experienced significantly more pain and disability and more severe X-ray grading than those with higher serum level of 25-hydroxycholicalciferol.