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Background: Patients with rheumatoid arthritis (RA) are more susceptible for having psychological comorbidities than the normal population. This is due to many factors like pain, disability, and social impacts of the arthritis besides other metabolic co-factors like vitamin D deficiency. Purpose: To study the link between vitamin D level as a co-factor in mood changes outcome in RA patients and the extent of mood change variables affection as well as the relation to disease activity. Patients and Methods: This study included 100 adult RA patients divided into two groups; Group1(G1): RA patients with low vitamin D level and Group 2(G2):RA patients with normal vitamin level, both groups were subjected to assessment of mood change and disease activity. Results: This study found that total Beck scale for depression and mood change variables were significantly different between the two groups (p < 0.001). Significant correlation was also found between vitamin D level and total Beck scale and mood changes (P,0.001). Disease activity index was in reverse correlation with vitamin D level in total patients' sample (r = -0.143), but no significant difference was found between both groups (p = 0.139). Conclusion: Patients with rheumatoid arthritis who have vitamin D deficiencies are more prone to exhibit psychological and mood disorders regardless the status of disease activity

Background: Myofascial pain syndrome (MPS) is a musculoskeletal disorder, that results from trigger points, which are small, taut skeletal muscle and fascia. Objective: To compare the efficacy of Extracorporeal Shock Wave Therapy (ESWT) versus corticosteroid injection in the treatment of patients with MPS of the upper trapezius muscle. Patients and Methods: This prospective randomized study included fifty patients with MPS who were randomly divided equally into two groups. The active myofascial trigger points (MTrPs) in the upper trapezius were identified. Group 1 patients received ESWT 3 times at one-week intervals and group 2 patients received one injection of corticosteroids. The visual analog scale (VAS), Neck Disability Index (NDI), and pain pressure threshold (PPT) assessed the outcomes. Results: VAS scores were 7.24±1.01, 3.72 ±1.43 and 2.44±1.36 at baseline, week-4 and -8 respectively in group1; while were 7.16±1.03, 5.76 ±1.16 and 5.24±1.48 at baseline, week-4 and -8 respectively in group2. NDI scores were 11±2.63, 7.92±2.63 and 6.52±2.66 at baseline, week-4, and -8 respectively in group1, whereas were 11.16±2.36, 8.72±2.37 and 7.64±2.66 at baseline, week-4 and -8 respectively in group2. PPT scores were 2.81±0.70 at baseline, and 4.64 ±1.03 and 5.54±1.1 at week-4 and week-8 in group1, while, in group2 the scores were 2.89±0.71, 3.92 ±0.81 and 4.08±0.92 at baseline and week-4 and -8 respectively. VAS, NDI, and PPT pre-and post-treatment results showed statistically significant improvements in both groups, P <0.001. Conclusion:ESWT and corticosteroid injection considerably reduced pain intensity, physical impairment, and MTrP sensitivity to pressure in patients with MPS. ESWT was more effective in the reduction of pain and MTrPs sensitivity to pressure.

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