الفهرس 
الملخص العربىOnly 14 pages are availabe for public view
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Abstract
Some of the connective tissue diseases, such as rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis may cause various disorders of the nervous system. Neurological affection in such diseases may be subclinical but once they occur, they are irreversible and add extra burden and suffering to the patients’ lives.
Early detection of these subclinical neurological affection helps a lot in the early intervention prevent to avoid the irreversible damage to the nervous system.
The aim of this study was to characterize the neurological manifestations in three systemic rheumatic diseases: Rheumatoid Arthritis, systemic lupus Erythematosus and systemic sclerosis and to obtain the electrophysiological documentation of possible neurological abnormalities even in the absence of neurological symptoms.
Twenty four patients with RA, 11 patients with SLE and 9 patients with SSC were included in this study. Thirty control persons were also involved.
The patients and control were submitted to the following investigations:
1. Full clinical and neurological examination.
2. Laboratory investigations including:
a) Complete blood count.
b) Liver function tests.
c) Kidney function tests.
d) Erythrocyte sedimentation rate.
e) C-reactive protein.
f) Rheumatoid factor and titer.
g) Anti-nuclear antibody.
h) Anti-double strand DNA antibody.
i) Anti-SCL 70 antibody.
j) Anti-cardiolipin antibody.
3. Neurophysiological studies: including:
a-Motor nerve conduction studies and F-wave to the median, ulnar and common peroneal nerves.
b-H-reflex.
c-Visual evoked potential for examination of the optic nerve
d-Brain stem auditory evoked potential for examination of the auditory nerve.
e-Somatosensory evoked potential of upper limbs for examination of the spinothalamic tract from the sensory receptor to the sensory cortex.
f-Motor evoked potential of thenar muscles for examination of the pyramidal tract from the motor cortex to the thenar muscle.
4. Radiological examination:
Hand and cervical X-ray were done to patients with RA.
from our results we conclude that, overt neurological signs were found in 50% of patients with SLE which is much more than that found in RA (29.2%) and SSC (22.2%). Clinical peripheral nervous system (PNS) affection was recorded only in the RA group, while clinical CNS affection was recorded in the 3 groups but more in the SLE group where it represented 50% of patients.
This was agreed with most of the studies done on SLE which states that clinical central nervous system (CNS) involvement occurs in approximately 50% of SLE patients.
Abnormal VEP in this study ranged from 58.3% to 88.9% in the 3 studied groups, with more affection in SSC group (88.9%). These findings may constitute evidence for the presence of subtle optic neuropathy in the studied diseases. Abnormal BAEP in our series was more in SLE where it represented (60%) compared to 55.6% in SSC group and 29.2% in RA group. The ratio of peripheral to central affection was 6/1 in RA group and 4/1 in SSC group while it is 1/5 in SLE group where CNS involvement predominates more. Abnormal MCS were found in 66.7% in SSC group compared to 60% in SLE group and 58.3% in RA group. Abnormal production of collagen tissue and the presence of microvascular disease are considered to be two possible causes.
Abnormal SSEP and MEP values were more found in SSC group as compared with both the RA and SLE group.
In this study, the prolongation of central conduction time (CCT) of SSEP and MEP in RA, SLE and SSC groups suggested that CNS is more vulnerable to be affected in the previous diseases than peripheral nervous system in the studied group (Table 44 ).