Clinical Research Directory

Kinesiophobia in Rheumatoid Arthritis: Associations With Functional Disability, Disease Activity, and Related Clinical Factors

Objectives: Impairment of physical function is a core feature of RA, particularly in patients with high disease activity where pain and inflammation directly limit movement. but, Reduced mobility in RA is not exclusively driven by inflammatory pathology. There are non-inflammatory factors, including kinesiophobia, fatigue, depression, and anxiety, may significantly contribute to functional limitation and may initiate a self-perpetuating cycle in which movement avoidance leads to physical deconditioning, muscle weakness, and progressive functional decline. The aim of this study is to examine the relationship between kinesiophobia and functional outcomes in patients with rheumatoid arthritis, and to investigate its associations with disease activity, pain, fatigue, depressive symptoms, anxiety, and sarcopenia, with a focus on factors relevant to functional assessment and rehabilitation. Patients and Methods A case - control study will be conducted on Two hundred adult patients previously diagnosed with RA according to ACR/EULAR 2010 criteria for RA and 200 apparently healthy volunteers with age and sex matching will be involved in the study. The study will be conducted in Rheumatology department, Minia university Hospital, Egypt. All patients will be subjected to history taking, clinical examination, and assessment of the following parameters: 1. Kinesiophobia: using the Arabic version of TSK-17 2. Disease activity: using DAS 28 3. pain severity using the Visual Analogue Scale (VAS) 4. Fatigue: using the Arabic version of the Fatigue Severity Scale (FSS) 5. Depression: using the Arabic version of the BDI-2 6. Anxiety: using the Arabic version of the BAI 7. sarcopenia using the Arabic version of the SARC-F questionnaire 8. Functional disability: using the Arabic version of the HAQ-DI 9. Physical activity:using IPAQ-SF

Persona SoluTion PPS Femur PMCF

The goal of this study is to generate clinical evidence and evaluate the safety and performance of the Persona® SoluTion® PPS Femurs in the US market, with data supporting global regulatory submissions, including CE marking under EU MDR. The target population consists of adults undergoing knee arthroplasty with the Persona SoluTion femoral component paired with a Medial Congruent (MC) or Posterior Stabilized (PS) articulating surface in line with its current cleared Instructions for Use (IFU). The primary endpoint is the assessment of clinical performance and benefits by evaluating the average change in the KOOS JR score between pre-operative and 2-year post-operative follow-up.

Evaluation of CCR6 Gene Expression and Circulating CCL20 Levels as Potential Biomarkers in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is characterized as a systemic auto immune disorder linked to a persistent inflammatory process that can harm both joints and extra articular organs. The upregulation of the CCR6/CCL20 axis in the synovial tissues and salivary glands (in cases of secondary Sjögren's syndrome) is considered to contribute to the recruitment of Th17 cells, which in turn enhances IL 17A production and promotes the inflammatory cycle.

Pharmacogenetics of Leflunomide in the Management of Rheumatoid Arthritis

1. Patients taking leflunomide as the only disease-modifying anti-rheumatic drug (DMARD) will be recruited after consent. 2. Blood sample for DNA extraction will be taken The patient will be followed up till two visits 3 months apart, and efficacy and toxicity will be checked using DAS28, ultrasonography, and blood tests for ESR, CRP, anti-CCP, liver function tests, etc. The data form for toxicity will be filled. 3. DNA will be extracted in the laboratory, and SNP will be identified. 4. The efficacy and toxicity data will be studied against the SNPs found 5. An algorithm will be constructed for Pakistani RA patients taking leflunomide.

Rehabilitation Approaches Used in Total Knee Replacement

In this study, we will investigate the rehabilitation approaches commonly used by physiotherapists in Pakistan following total knee replacement. Total knee replacement is a frequently performed surgical procedure, and effective postoperative rehabilitation is essential for improving pain, mobility, and functional outcomes. A web-based cross-sectional survey will be conducted among practicing physiotherapists from different provinces of Pakistan. Data will be collected using a structured questionnaire to explore demographic characteristics, rehabilitation techniques employed at various stages of recovery, and challenges faced in post-TKR rehabilitation. The collected data will be analyzed using appropriate descriptive and inferential statistical methods. The findings will help identify prevailing rehabilitation practices and variations among physiotherapists. This study will contribute to understanding current clinical trends, identifying gaps in practice, and promoting the use of evidence-based and standardized rehabilitation protocols. Ultimately, the results will support improved patient recovery, guide professional training, and assist in developing consistent post-TKR rehabilitation strategies in Pakistan.

Very Low Dose Prednisolone on Newly Diagnosed Rheumatoid Arthritis

Objective To investigate the efficacy of prednisolone 4mg/day added to standard of care in newly diagnosed rheumatoid arthritis (RA) patients with active disease. Hypothesis Add-on prednisolone 4mg/day is efficacious compared to placebo in newly diagnosed RA patients with active disease. Design and subjects This is a 12-week, randomized, placebo-controlled, double-blind study. We plan to enroll 112 adult patients with newly diagnosed active RA (Disease Activity Score 28-C-Reactive Protein \[DAS28-CRP\] \> 3.2). They will be randomized 1:1 to receive prednisolone 4mg once daily for 5 weeks then tapering at 1mg/week each week till off or placebo. Conventional synthetic disease-modifying-anti-rheumatic-drugs (DMARDs) will be started and adjusted according to a standard protocol aiming to achieve low disease activity. Patients with contra-indications to prednisolone, or requiring biologic or targeted synthetic DMARDs will be excluded. Study instruments Clinical response will be monitored using DAS28-CRP every 4 weeks. Adverse events (AE), severe AE (SAE) and AE of special interest (AESI) will be recorded at every visit. Main outcome measures and analysis The primary outcome is the change of DAS28-CRP comparing the two groups at week-4 by student T test. Secondary outcomes include the changes of DAS28-CRP at week-8 and week-12 as well as proportion of patients with AE comparing the two groups. Independent factors predicting disease control will be analyzed by multivariate logistic regression.

LA Function and Dimensions As Predictors of Disease Activity in RA

the aim of this study is to * describe subclinical echocardiographic changes of the LA (dimensions and function) in patients with rheumatoid arthritis. * evaluate the correlation between Rheumatoid arthritis activity and subclinical structural changes of LA. * determine the association of LA volume index and atrial fibrillation or HFpf in RA patients. * apply Musculoskeletal Ultrasound detected synovitis to be correlated with cardiac function.