Egyptian Rheumatologist最新文献

Methotrexate intolerance in rheumatoid arthritis: Prevalence, risk factors and impact on treatment adherence 类风湿关节炎患者甲氨蝶呤不耐受：患病率、危险因素和对治疗依从性的影响

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-29 DOI: 10.1016/j.ejr.2026.01.006

Aya K. El-Hindawy, Hala A. Raafat, Marwa Magdy, Dina Ossama Abdulazim

Aim of the work

To assess methotrexate (MTX) intolerance in rheumatoid arthritis (RA) patients and to identify its predictors using validated Arabic version of the MTX Intolerance Severity Score (MISS).

Patients and methods

The study included 355 RA patients on MTX for at least three months. Detailed disease and drug history were recorded. MTX intolerance was assessed using a validated Arabic version of the MTX Intolerance Severity Score (MISS) and compliance assessed using the Arabic version of the 5-Item Compliance Questionnaire for Rheumatology (CQR5).

Results

50.7% of the patients were MTX intolerant while 66.2% were compliant on MTX. The mean age of the patients was 38.4 ± 12.1 years and 92.7% were females. Predictors of MTX intolerance using MISS were younger age at disease onset (p = 0.006), longer disease duration (p = 0.001), parenteral MTX administration (IM/oral p < 0.001, OR 3.95, SC/oral p < 0.001, OR 7.73), fixed morning dosing compared to divided or inconsistent schedule divided/morning p < 0.001, Inconsistent time/morning p = 0.014), receiving MTX before meals versus after meals (p = 0.007, OR 5.61), concomitant leflunomide use (p = 0.01, OR 1.88) and higher tender joint count (p = 0.03). While leflunomide intake (p = 0.002, OR 2.65) and parenteral MTX administration (IM/oral 0.002, OR 6.06, SC/oral < 0.001, OR 14.3) were the only predictors in multivariate logistic regression. MTX intolerant patients were receiving significantly lower number of cigarette pack/year (p = 0.007). However caffeine intake, folate adherence and dosage, disease activity, presence of extra-articular manifestations were not associated with MTX intolerance.

Conclusion

MTX intolerance is frequent in RA patients especially females. A significant association was found with parenteral route of administration and concomitant leflunomide intake.

研究目的：评估类风湿性关节炎（RA）患者的甲氨蝶呤（MTX）不耐受，并使用经过验证的阿拉伯版本MTX不耐受严重程度评分（MISS）来确定其预测因素。患者和方法该研究包括355名接受MTX治疗至少3个月的RA患者。详细记录疾病和用药史。使用经过验证的阿拉伯版MTX不耐受严重程度评分（MISS）评估MTX不耐受，使用阿拉伯版5项风湿病依从性问卷（CQR5）评估MTX依从性。结果50.7%的患者MTX不耐受，66.2%的患者MTX依从。患者平均年龄为38.4±12.1岁，女性占92.7%。使用MISS进行MTX不耐受的预测因子为发病年龄较小（p = 0.006）、病程较长（p = 0.001）、肠外给药（IM/口服p <； 0.001, OR 3.95， SC/口服p <； 0.001, OR 7.73）、固定的早晨给药与不一致的时间表（p < 0.001，不一致的时间/早晨p = 0.014）、餐前给药与餐后给药（p = 0.007, OR 5.61）、同时使用来氟米特(p = 0.01，OR 1.88)和更高的压痛关节计数（p = 0.03）。而来氟米特摄入量（p = 0.002, OR 2.65）和肠外给药MTX （IM/口服0.002,OR 6.06， SC/口服0.001,OR 14.3）是多因素logistic回归的唯一预测因素。甲氨蝶呤不耐受患者每年接受的卷烟包数明显减少（p = 0.007）。然而，咖啡因摄入量、叶酸依从性和剂量、疾病活动性、关节外表现的存在与MTX不耐受无关。结论甲氨蝶呤不耐受在RA患者中较为常见，尤其是女性患者。发现肠外给药途径和同时服用来氟米特有显著关联。

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引用次数: 0

Inflammatory bowel disease among radiographic axial spondyloarthritis’ patients: Frequency and diagnostic value of fecal calprotectin 轴型脊柱关节炎患者的炎症性肠病：粪便钙保护蛋白的频率和诊断价值

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-28 DOI: 10.1016/j.ejr.2026.01.005

Ghada A. Ahmed , Fatma M. Aboud , Mohammad M.A. Alsawe , Alshymaa M.F. Motaher

Background

Inflammatory bowel disease (IBD) affects 5–10% of patients with axial spondyloarthritis (axSpA). Patients with axSpA and concurrent IBD may experience more severe disease and exhibit a lower prevalence of human leukocytic antigen-B27 (HLA-B27).

Aim of the work

To determine the frequency of IBD in patients with radiographic axSpA (r-axSpA) and to analyze the clinical characteristics associated with its presence.

Patients and methods

This study included 97 r-axSpA patients. Colonoscopy was performed in patients presenting with gastrointestinal symptoms suggestive of IBD. The ankylosing spondylitis disease activity score (ASDAS) and Bath ankylosing spondylitis disease activity index (BASDAI) were assessed.

Results

The mean age of patients was 36.9 ± 4.8 years, 59 females and 38 males (F:M 1.6:1). HLA-B27 was positive in 74 (76.3%). The mean ASDAS was 2.4 ± 0.94 and BASDAI 3.53 ± 1.5. Fifty (51.5%) patients had concurrent IBD and a significantly higher C-reactive protein (CRP)(57.5 ± 20.03 mg/dl) and erythrocyte sedimentation rate (ESR)(29.8 ± 13.5 mm/1^sthr) levels than those without IBD (1.66 ± 2.70 mg/dl and 7.55 ± 4.99 mm/1^sthr; p < 0.001for both). r-axSpA patients with IBD had significantly higher mean fecal calprotectin levels (522 ± 178.52 µg/g) compared to those without (232.57 ± 70.13 µg/g)(p < 0.001). No significant differences were detected between those with and without IBD regarding HLA-B27 positivity (p = 0.87), ASDAS (p = 0.18) and BASDAI (p = 0.32). Fecal calprotectin showed excellent diagnostic performance discriminating those with IBD at cut-off 353 µg/g.

Conclusion

There is clinical heterogeneity within the spectrum of r-axSpA and the significance of recognizing concurrent IBD is underscored, particularly in patients who present with gastrointestinal symptoms, elevated inflammatory markers, or increased fecal calprotectin levels.

背景炎性肠病（IBD）影响5-10%的轴性脊柱炎（axSpA）患者。axSpA合并IBD的患者可能会经历更严重的疾病，并表现出较低的人类白细胞抗原b27 （HLA-B27）患病率。研究目的：确定影像学axSpA （r-axSpA）患者IBD的发生频率，并分析其临床特征。患者和方法本研究纳入97例r-axSpA患者。对出现提示IBD的胃肠道症状的患者进行结肠镜检查。评估强直性脊柱炎疾病活动性评分（ASDAS）和巴斯强直性脊柱炎疾病活动性指数（BASDAI）。结果患者平均年龄36.9±4.8岁，女性59例，男性38例（男女比1.6:1）。HLA-B27阳性74例（76.3%）。平均ASDAS为2.4±0.94，BASDAI为3.53±1.5。50例（51.5%）患者同时患有IBD，其c反应蛋白（CRP）（57.5±20.03 mg/dl）和红细胞沉降率（ESR）（29.8±13.5 mm/ 1thr）水平明显高于非IBD患者（1.66±2.70 mg/dl和7.55±4.99 mm/ 1thr; p < 0.001）。r-axSpA合并IBD的患者粪钙保护蛋白水平（522±178.52µg/g）显著高于未合并IBD的患者（232.57±70.13µg/g）（p < 0.001）。IBD患者与非IBD患者HLA-B27阳性（p = 0.87）、ASDAS阳性（p = 0.18）、BASDAI阳性（p = 0.32）差异无统计学意义。粪钙保护蛋白在353µg/g的临界值上对IBD有很好的诊断效果。结论r-axSpA谱存在临床异质性，强调了识别并发IBD的重要性，特别是在出现胃肠道症状、炎症标志物升高或粪便钙保护蛋白水平升高的患者中。

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引用次数: 0

Role of urinary biomarkers in the diagnosis of lupus cystitis in systemic lupus erythematosus patients: Relation to disease activity and lower urinary tract manifestations 尿生物标志物在系统性红斑狼疮患者狼疮性膀胱炎诊断中的作用：与疾病活动性和下尿路表现的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-22 DOI: 10.1016/j.ejr.2026.01.004

Safaa A. Hussein , Dahlia Abdel Mohsen , Maryam A. Abdulrahman , Maha A. Elserwy , Khaled S. Soliman , Tasneem E. Mohammed , Amr M. Hawwash

Aim of the work: To assess the role of urinary biomarkers, macrophage inflammatory protein (MIP)-1β and chemokine (C-X-C motif) ligand 10 (CXCL10), in the diagnosis of lupus cystitis (LC) in systemic lupus erythematosus (SLE) patients, and to determine its relation to SLE disease activity and lower urinary tract symptoms (LUTS). Patients and methods: 72 SLE patients were studied. Modified British Isles Lupus Assessment Group (BILAG) index, BILAG-2004 index, was assessed. Lower urinary tract symptoms score (LUTSS) questionnaire was conducted. Urinary MIP-1β and CXCL10 levels were measured. Pelvic ultrasound was performed to assess urinary bladder wall thickness (BWT). Results: The 72 patients mean age was 30.54 ± 9.22 years; were 62 females, 10 males. Positive LUTSS was detected in 37 patients, with mean score 14.01 ± 6.7. The mean urinary BWT was 4.39 ± 1.29 mm, and 57 patients had thickened urinary bladder wall. MIP-1β was significantly high in patients with severe renal disease activity, albuminuria and pyuria. Both MIP-1β and CXCL10 were significantly high in patients with microscopic hematuria. MIP-1β significantly correlated with protein/creatinine ratio, and CXCL10 had positive correlation with erythrocyte sedimentation rate (ESR). MIP-1β was positively correlated with serum creatinine in patients with thickened urinary bladder wall. Conclusion: Lupus cystitis and LUTS are frequent in SLE patients. Lupus cystitis might be asymptomatic. Urinary bladder ultrasound plays an important role in the early recognition of LC. Lupus cystitis is possibly associated with SLE disease activity. Urinary MIP-1β and CXCL10 may have a potential role in the evaluation of SLE disease activity, particularly lupus nephritis.

研究目的：评估尿液生物标志物巨噬细胞炎症蛋白(MIP)-1β和趋化因子（C-X-C基序）配体10 （CXCL10）在系统性红斑狼疮（SLE）患者狼疮膀胱炎（LC）诊断中的作用，并确定其与SLE疾病活动性和下尿路症状（LUTS）的关系。患者与方法：对72例SLE患者进行研究。采用修正英伦三岛狼疮评估组（BILAG）指数，即BILAG-2004指数进行评估。采用下尿路症状评分（LUTSS）问卷。检测尿MIP-1β和CXCL10水平。盆腔超声评估膀胱壁厚度（BWT）。结果：72例患者平均年龄30.54±9.22岁；女性62人，男性10人。LUTSS阳性37例，平均评分14.01±6.7分。尿BWT平均值为4.39±1.29 mm， 57例患者膀胱壁增厚。MIP-1β在严重肾脏疾病活动性、蛋白尿和脓尿患者中显著升高。显微镜下血尿患者MIP-1β和CXCL10均显著升高。MIP-1β与蛋白/肌酐比值显著相关，CXCL10与红细胞沉降率（ESR）呈正相关。MIP-1β与膀胱壁增厚患者血清肌酐呈正相关。结论：狼疮性膀胱炎和LUTS是SLE患者的常见病。狼疮性膀胱炎可能无症状。膀胱超声对LC的早期识别具有重要作用。狼疮性膀胱炎可能与SLE疾病活动性有关。尿MIP-1β和CXCL10可能在SLE疾病活动性评估中具有潜在作用，特别是狼疮性肾炎。

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引用次数: 0

Assessment of kinesiophobia in patients with rheumatoid arthritis and systemic lupus erythematosus and its association with disease activity, functional status, pain severity and depression 类风湿关节炎和系统性红斑狼疮患者运动恐惧症的评估及其与疾病活动性、功能状态、疼痛严重程度和抑郁的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-18 DOI: 10.1016/j.ejr.2026.01.002

Aya H. Eldesouky , Yara M. Amin , Hanaa M. Rady

Aim of the work

To evaluate and compare the frequency of kinesiophobia in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), as well as its association with disease parameters.

Patients and methods

The study included 63 RA patients, 63 SLE patients, and 63 matched controls. The Tampa Kinesiophobia Scale (TKS) was assessed. The disease activity score (DAS28) in RA and SLE disease activity index 2000 (SLEDAI-2K) were evaluated. The health assessment questionnaire (HAQ) was used to assess functional status, the visual analogue scale (VAS) was used to assess pain severity, and depression was assessed using a validated Arabic version of the patient health questionnaire-9 (PHQ-9).

Results

The mean age of RA patients was 49.1 ± 10.2 years, 58 females and 5 males (F:M 11.6:1); SLE patients’ age was 34.5 ± 9.3 years, F:M 11.6:1. Kinesiophobia was significantly more frequent in RA compared to SLE (n = 46, 73 % vs. n = 42, 66.7 %; p = 0.44). The PHQ9 and VAS-pain were significantly higher in SLE patients (19 ± 8.07 and 5.2 ± 3.1) compared to RA (15.6 ± 9.1 and 4 ± 3.02 respectively, p = 0.03 and p = 0.027). TKS significantly correlated with DAS28 in RA (r = 0.422, p = 0.001) but not with SLEDAI-2K in SLE (r = 0.117, p = 0.36). TKS significantly correlated with HAQ, PHQ9, and VAS in RA (r = 0.49, p < 0.001; r = 0.33, p = 0.009 and r = 0.35, p = 0.004 respectively) and in SLE (r = 0.46, p < 0.001; r = 0.31, p = 0.013 and r = 0.35, p = 0.004 respectively) patients.

Conclusions

Both RA and SLE patients have a high frequency of kinesiophobia. It appears to be higher in RA patients and is associated with disease activity. It is critical to identify and treat kinesiophobia to lessen long-term effects.

目的评价和比较系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者运动恐惧的频率及其与疾病参数的关系。患者和方法该研究包括63例RA患者，63例SLE患者和63例匹配的对照组。采用坦帕运动恐惧症量表（TKS）进行评估。评估RA患者疾病活动性评分DAS28和SLE患者疾病活动性指数2000 （SLEDAI-2K）。采用健康评估问卷（HAQ）评估功能状态，采用视觉模拟量表（VAS）评估疼痛严重程度，采用经验证的阿拉伯文版患者健康问卷-9 （PHQ-9）评估抑郁程度。结果RA患者平均年龄49.1±10.2岁，女性58例，男性5例（男∶女11.6:1）；SLE患者年龄34.5±9.3岁，F:M: 11.6:1。与SLE相比，RA患者的运动恐惧症明显更常见（n = 46, 73% vs. n = 42, 66.7%; p = 0.44）。SLE患者PHQ9评分（19±8.07）和VAS-pain评分（5.2±3.1）明显高于RA（15.6±9.1和4±3.02,p = 0.03和p = 0.027）。TKS与RA患者DAS28有显著相关性（r = 0.422, p = 0.001），与SLE患者SLEDAI-2K无显著相关性（r = 0.117, p = 0.36）。在RA （r = 0.49, p < 0.001; r = 0.33, p = 0.009, r = 0.35, p = 0.004）和SLE （r = 0.46, p < 0.001; r = 0.31, p = 0.013, r = 0.35, p = 0.004）患者中，TKS与HAQ、PHQ9、VAS显著相关。结论RA和SLE患者均有较高的运动恐惧发生率。在类风湿性关节炎患者中，它似乎更高，并且与疾病活动有关。识别和治疗运动恐惧症对于减少长期影响至关重要。

{"title":"Assessment of kinesiophobia in patients with rheumatoid arthritis and systemic lupus erythematosus and its association with disease activity, functional status, pain severity and depression","authors":"Aya H. Eldesouky , Yara M. Amin , Hanaa M. Rady","doi":"10.1016/j.ejr.2026.01.002","DOIUrl":"10.1016/j.ejr.2026.01.002","url":null,"abstract":"<div><h3>Aim of the work</h3><div>To evaluate and compare the frequency of kinesiophobia in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), as well as its association with disease parameters.</div></div><div><h3>Patients and methods</h3><div>The study included 63 RA patients, 63 SLE patients, and 63 matched controls. The Tampa Kinesiophobia Scale (TKS) was assessed. The disease activity score (DAS28) in RA and SLE disease activity index 2000 (SLEDAI-2K) were evaluated. The health assessment questionnaire (HAQ) was used to assess functional status, the visual analogue scale (VAS) was used to assess pain severity, and depression was assessed using a validated Arabic version of the patient health questionnaire-9 (PHQ-9).</div></div><div><h3>Results</h3><div>The mean age of RA patients was 49.1 ± 10.2 years, 58 females and 5 males (F:M 11.6:1); SLE patients’ age was 34.5 ± 9.3 years, F:M 11.6:1. Kinesiophobia was significantly more frequent in RA compared to SLE (n = 46, 73 % vs. n = 42, 66.7 %; p = 0.44). The PHQ9 and VAS-pain were significantly higher in SLE patients (19 ± 8.07 and 5.2 ± 3.1) compared to RA (15.6 ± 9.1 and 4 ± 3.02 respectively, p = 0.03 and p = 0.027). TKS significantly correlated with DAS28 in RA (r = 0.422, p = 0.001) but not with SLEDAI-2K in SLE (r = 0.117, p = 0.36). TKS significantly correlated with HAQ, PHQ9, and VAS in RA (r = 0.49, p < 0.001; r = 0.33, p = 0.009 and r = 0.35, p = 0.004 respectively) and in SLE (r = 0.46, p < 0.001; r = 0.31, p = 0.013 and r = 0.35, p = 0.004 respectively) patients.</div></div><div><h3>Conclusions</h3><div>Both RA and SLE patients have a high frequency of kinesiophobia. It appears to be higher in RA patients and is associated with disease activity. It is critical to identify and treat kinesiophobia to lessen long-term effects.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"48 2","pages":"Pages 106-109"},"PeriodicalIF":1.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical relevance of plasma soluble urokinase plasminogen activator receptor (suPAR) in Behçet’s disease 血浆可溶性尿激酶纤溶酶原激活剂受体（suPAR）与behaperet病的临床相关性

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-13 DOI: 10.1016/j.ejr.2026.01.003

Nada M. Gamal , Eman R. Badawy , Dalia Tohamy , Esraa A. Talaat

Background

Behçet’s disease (BD) is a chronic systemic vasculitis disease affecting many systems and presented with heterogeneous manifestations. No standard marker for BD diagnosis and monitoring its activity. The soluble urokinase plasminogen activator receptor (suPAR) is a membrane-bound glycoptotein that is primarily expressed on the surface of immunologically active cells; mirroring local inflammation and immune activation.

Aim

of the work.

To assess plasma suPAR in BD patients compared with healthy controls. In addition to analyze its association with BD clinical features, disease activity and damage index.

Patients and methods

The study included 50 BD patients and 40 controls, disease activity was assessed using an Arabic version of the Behçet’s Disease Current Activity Form (Ar-BDCAF). The damage events in BD patients were determined by Behçet’s disease damage index (BDI). Plasma suPAR level was measured by Enzyme linked immunosorbent assay (ELISA).

Results

The study included 50 BD patients; 41 males and 9 females, with a mean age of 34.9 ± 8.1 years and disease duration 6.8 ± 0.6 years. The mean Ar-BDCAF was 3.24 ± 0.42 (0–13) and BDI was 5.04 ± 0.48 (0–12). Plasma suPAR level in BD patients (0.97 ± 0.11; 0.55–4.86) ng/ml was significantly higher than in controls (0.53 ± 0.1; 0.32–0.69), p < 0.001. The optimum cut-off value for suPAR to predict BD was > 0.67 with accuracy 88 %, sensitivity 82 %, specificity 94 %, p < 0.001. There was a significant correlation between plasma suPAR level in BD patients and Ar-BDCAF (r = 0.81, p < 0.001).

Conclusion

Plasma suPAR level may serve as a promising marker that can be helpful in diagnosis and monitoring disease activity of BD patients.

背景behet病（BD）是一种累及多系统的慢性全身性血管炎，表现多样。没有标准的双相障碍诊断和监测其活性的标志物。可溶性尿激酶纤溶酶原激活物受体（suPAR）是一种主要表达于免疫活性细胞表面的膜结合糖蛋白；反映局部炎症和免疫激活。工作的目的。评估BD患者血浆suPAR与健康对照组的比较。并分析其与BD临床特征、疾病活动性及损伤指标的关系。患者和方法该研究包括50名BD患者和40名对照者，使用阿拉伯版本的behet疾病当前活动表（Ar-BDCAF）评估疾病活动性。采用behet疾病损害指数（BDI）测定BD患者的损伤事件。采用酶联免疫吸附试验（ELISA）检测血浆suPAR水平。结果纳入50例BD患者；男性41例，女性9例，平均年龄34.9±8.1岁，病程6.8±0.6年。平均Ar-BDCAF为3.24±0.42 (0-13)，BDI为5.04±0.48（0-12）。BD患者血浆suPAR水平（0.97±0.11;0.55-4.86）ng/ml显著高于对照组（0.53±0.1;0.32-0.69），p < 0.001。suPAR预测BD的最佳临界值为0.67，准确性88%，敏感性82%，特异性94%，p < 0.001。BD患者血浆suPAR水平与Ar-BDCAF有显著相关性（r = 0.81, p < 0.001）。结论血浆suPAR水平可作为BD患者诊断和监测疾病活动度的重要指标。

{"title":"Clinical relevance of plasma soluble urokinase plasminogen activator receptor (suPAR) in Behçet’s disease","authors":"Nada M. Gamal , Eman R. Badawy , Dalia Tohamy , Esraa A. Talaat","doi":"10.1016/j.ejr.2026.01.003","DOIUrl":"10.1016/j.ejr.2026.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Behçet’s disease (BD) is a chronic systemic vasculitis disease affecting many systems and presented with heterogeneous manifestations. No standard marker for BD diagnosis and monitoring its activity. The soluble urokinase plasminogen activator receptor (suPAR) is a membrane-bound glycoptotein that is primarily expressed on the surface of immunologically active cells; mirroring local inflammation and immune activation.</div></div><div><h3>Aim</h3><div>of the work.</div><div>To assess plasma suPAR in BD patients compared with healthy controls. In addition to analyze its association with BD clinical features, disease activity and damage index.</div></div><div><h3>Patients and methods</h3><div>The study included 50 BD patients and 40 controls, disease activity was assessed using an Arabic version of the Behçet’s Disease Current Activity Form (Ar-BDCAF). The damage events in BD patients were determined by Behçet’s disease damage index (BDI). Plasma suPAR level was measured by Enzyme linked immunosorbent assay (ELISA).</div></div><div><h3>Results</h3><div>The study included 50 BD patients; 41 males and 9 females, with a mean age of 34.9 ± 8.1 years and disease duration 6.8 ± 0.6 years. The mean Ar-BDCAF was 3.24 ± 0.42 (0–13) and BDI was 5.04 ± 0.48 (0–12). Plasma suPAR level in BD patients (0.97 ± 0.11; 0.55–4.86) ng/ml was significantly higher than in controls (0.53 ± 0.1; 0.32–0.69), p < 0.001. The optimum cut-off value for suPAR to predict BD was > 0.67 with accuracy 88 %, sensitivity 82 %, specificity 94 %, p < 0.001. There was a significant correlation between plasma suPAR level in BD patients and Ar-BDCAF (r = 0.81, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Plasma suPAR level may serve as a promising marker that can be helpful in diagnosis and monitoring disease activity of BD patients.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"48 2","pages":"Pages 101-105"},"PeriodicalIF":1.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Liver fibrosis assessment in rheumatoid arthritis patients on long-term methotrexate therapy using hepatic fibroScan (transient elastography) 肝纤维扫描（瞬时弹性成像）评估长期甲氨蝶呤治疗的类风湿关节炎患者肝纤维化

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2026-01-01 DOI: 10.1016/j.ejr.2026.01.001

Nermeen Samy , Dalia Fayez , Emad Kelada , Dalia Mostafa Mohamed Sdik , Nouran M. Elshahat , Maha Ahmed El-Serwi

Aim of the work

To assess liver stiffness (LS) and fibrosis in rheumatoid arthritis (RA) patients receiving long-term methotrexate (MTX) therapy using FibroScan (transient elastography).

Patients and methods

Sixty RA patients treated with uninterrupted weekly MTX for a minimum of five years were enrolled. Clinical evaluation, liver function tests, aspartate aminotransferase (AST)-to-platelet ratio index (APRI), abdominal ultrasonography, and FibroScan were performed. The disease activity score (DAS28) was assessed. Patients with obesity, diabetes, hyperlipidemia, alcohol consumption and those with liver diseases or nonalcoholic fatty liver disease (NAFLD) were excluded.

Results

Patients were predominantly females (85 %), had mean age of 39.5 ± 9.9 years, disease duration 8.2 ± 4.5 years and mean body mass index of 24.4 ± 1.97.The mean DAS28 was 3.64 ± 1.34. The weekly MTX dose ranged from 12.5–25 mg, with a mean duration of 7.8 ± 4 years and mean cumulative dose of 6728 ± 3948.4 mg. All patients exhibited normal AST, alanine trasnferase (ALT), AST/ALT, APRI and abdominal ultrasound findings. Regarding fibroscan, the mean controlled attenuation parameter (CAP) score was 170.4 ± 38.79 dB/m, corresponding to steatosis grade 0 (S0). Fifty-six (93.3 %) patients demonstrated fibrosis grade 0 (F0), while four (6.7 %) had mild, non-significant fibrosis (F1). No significant differences were noted among F0 and F1 groups in demographic, clinical, or laboratory parameters, or in MTX duration or cumulative dose.

Conclusion

Long-term MTX therapy, in the absence of metabolic risk factors, did not significantly contribute to hepatic fibrosis in RA patients, supporting its favorable hepatic safety profile. Transient elastography may be most beneficial for monitoring high-risk patients with metabolic comorbidities.

目的：利用纤维扫描（瞬时弹性成像）评估长期接受甲氨蝶呤（MTX）治疗的类风湿性关节炎（RA）患者的肝脏僵硬（LS）和纤维化。患者和方法60例RA患者接受每周不间断MTX治疗至少5年。临床评价、肝功能检查、天冬氨酸转氨酶（AST）与血小板比值指数（APRI）、腹部超声检查、纤维扫描。评估疾病活动度评分（DAS28）。排除了肥胖、糖尿病、高脂血症、饮酒、肝脏疾病或非酒精性脂肪性肝病（NAFLD）患者。结果患者以女性为主（85%），平均年龄39.5±9.9岁，病程8.2±4.5年，平均体重指数24.4±1.97。平均DAS28为3.64±1.34。每周MTX剂量范围为12.5 - 25mg，平均持续时间为7.8±4年，平均累积剂量为6728±3948.4 mg。所有患者的谷丙转氨酶、谷丙转氨酶、谷丙转氨酶/谷丙转氨酶、APRI和腹部超声检查均正常。纤维扫描的平均控制衰减参数（CAP）评分为170.4±38.79 dB/m，对应于脂肪变性0级（S0）。56例（93.3%）患者表现为纤维化0级（F0）， 4例（6.7%）为轻度、不显著纤维化（F1）。F0组和F1组在人口学、临床或实验室参数、MTX持续时间或累积剂量方面没有显著差异。结论在没有代谢危险因素的情况下，长期MTX治疗不会显著导致RA患者肝纤维化，支持其良好的肝脏安全性。瞬时弹性成像可能对监测有代谢合并症的高危患者最有利。

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引用次数: 0

The frequency and predictors of pulmonary hypertension in patients with sarcoidosis, connective tissue diseases and interstitial lung disease 结节病、结缔组织病和间质性肺疾病患者肺动脉高压的发生频率及预测因素

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-11-26 DOI: 10.1016/j.ejr.2025.11.004

Yosri M. Akl, Youssef M. Soliman, Mohamed S. Ismaeil, Ahmed I. Elkomy, Hadeel A. Mohamed

Background

Pulmonary hypertension (PH) is the mean of pulmonary arterial pressure (mPAP) ≥ 20 mm Hg at rest as detected by right-sided heart catheterization (RHC). It is classified into 5 grades; grade 3 is associated with hypoxia and interstitial lung diseases (ILDs) such as sarcoidosis, connective tissue diseases (CTD), hypersensitivity pneumonitis (HP) and idiopathic pulmonary fibrosis (IPF).

Aim of the work

To estimate the frequency and predictors of pH in sarcoidosis, CTDs, HP and IPF.

Patients and methods

The study included 28 patients with sarcoidosis, 21 with CTD-related ILDs, 63 were diagnosed as HP, and 18 patients with IPF. All patients were subjected to clinical examination, high resolution computed tomography (HRCT) chest, arterial blood gases, six-minute walking test, spirometry and echocardiography. RHC was performed and the probability of pH determined.

Results

The mean age of all patients was 48.5 ± 12.2 years and the F:M was 4.4:1. There were 85 (65.4 %) patients with low probability for PH, 8 (6.2 %) with intermediate probability and 37 (28.5 %) with high probability. By RHC, PH was 33.8 % in all patients: sarcoidosis 0.7 %, CTD-related ILDs 3 %, IPF 7.7 % and HP in 22.4 %. The residence (p = 0.038), raising birds (p = 0.01), dyspnea duration (p < 0.001), ILD duration (p < 0.001) and desaturation percentage (p < 0.001) are the main predictors of pH in ILD.

Conclusion

A third of the patients with ILD had PH most prominent in HP followed by IPF but less in sarcoidosis and CTDs. The residence, raising birds, dyspnea duration, ILD duration and desaturation percentage are the main predictors of pH in ILD.

肺动脉高压（PH）是指通过右侧心导管（RHC）检测到的静止时肺动脉压(mPAP)≥20 mm Hg的平均值。分为5个等级；3级与缺氧和肺间质性疾病（ild）相关，如结节病、结缔组织疾病（CTD）、过敏性肺炎（HP）和特发性肺纤维化（IPF）。目的探讨结节病、CTDs、HP和IPF中pH值的变化频率及其预测因素。患者和方法本研究纳入28例结节病患者、21例ctd相关ILDs患者、63例HP患者和18例IPF患者。所有患者均接受临床检查、胸部高分辨率计算机断层扫描（HRCT）、动脉血气、6分钟步行试验、肺活量测定和超声心动图检查。进行RHC并测定pH值的概率。结果所有患者的平均年龄为48.5±12.2岁，F:M为4.4:1。PH低概率85例（65.4%），中概率8例（6.2%），高概率37例（28.5%）。通过RHC，所有患者的PH为33.8%，结节病为0.7%，ctd相关ILDs为3%，IPF为7.7%，HP为22.4%。居住环境（p = 0.038）、饲养鸟类（p = 0.01）、呼吸困难持续时间（p < 0.001）、ILD持续时间（p < 0.001）和去饱和率（p < 0.001）是ILD患者pH的主要预测因子。结论三分之一的ILD患者有PH， HP最突出，IPF次之，结节病和CTDs较少。居住、饲养鸟类、呼吸困难持续时间、ILD持续时间和去饱和率是ILD pH值的主要预测因子。

{"title":"The frequency and predictors of pulmonary hypertension in patients with sarcoidosis, connective tissue diseases and interstitial lung disease","authors":"Yosri M. Akl, Youssef M. Soliman, Mohamed S. Ismaeil, Ahmed I. Elkomy, Hadeel A. Mohamed","doi":"10.1016/j.ejr.2025.11.004","DOIUrl":"10.1016/j.ejr.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) is the mean of pulmonary arterial pressure (mPAP) ≥ 20 mm Hg at rest as detected by right-sided heart catheterization (RHC). It is classified into 5 grades; grade 3 is associated with hypoxia and interstitial lung diseases (ILDs) such as sarcoidosis, connective tissue diseases (CTD), hypersensitivity pneumonitis (HP) and idiopathic pulmonary fibrosis (IPF).</div></div><div><h3>Aim of the work</h3><div>To estimate the frequency and predictors of pH in sarcoidosis, CTDs, HP and IPF.</div></div><div><h3>Patients and methods</h3><div>The study included 28 patients with sarcoidosis, 21 with CTD-related ILDs, 63 were diagnosed as HP, and 18 patients with IPF. All patients were subjected to clinical examination, high resolution computed tomography (HRCT) chest, arterial blood gases, six-minute walking test, spirometry and echocardiography. RHC was performed and the probability of pH determined.</div></div><div><h3>Results</h3><div>The mean age of all patients was 48.5 ± 12.2 years and the F:M was 4.4:1. There were 85 (65.4 %) patients with low probability for PH, 8 (6.2 %) with intermediate probability and 37 (28.5 %) with high probability. By RHC, PH was 33.8 % in all patients: sarcoidosis 0.7 %, CTD-related ILDs 3 %, IPF 7.7 % and HP in 22.4 %. The residence (p = 0.038), raising birds (p = 0.01), dyspnea duration (p < 0.001), ILD duration (p < 0.001) and desaturation percentage (p < 0.001) are the main predictors of pH in ILD.</div></div><div><h3>Conclusion</h3><div>A third of the patients with ILD had PH most prominent in HP followed by IPF but less in sarcoidosis and CTDs. The residence, raising birds, dyspnea duration, ILD duration and desaturation percentage are the main predictors of pH in ILD.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"48 1","pages":"Pages 90-94"},"PeriodicalIF":1.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fundamental skills and knowledge to optimize Nursing-led care for autoimmune rheumatic diseases in geriatric patients: Rheumatology-Nursing perspective 优化老年患者自身免疫性风湿病护理的基本技能和知识：风湿病学护理观点

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-11-24 DOI: 10.1016/j.ejr.2025.11.003

Eman Harraz , Inshrah Roshdy , Elsayed Satour , Khalid Alhusseiny , Ohud Abukammas , Samar Tharwat , Yasser Ragab , Farida Yasser , Yasser Emad

Background

Efforts should focus on enhancing rheumatology nurse-led care (NLC) to better meet the evolving needs of geriatric patients with rheumatic diseases (RDs) and improve their outcomes.

Aim of the work

The current review aimed to provide an overview of NLC in rheumatology, with an emphasis on rheumatic disorders that often afflict the elderly. Prevalent RDs in elderly including late onset rheumatoid arthritis (RA) (LORA), polymyalgia rheumatica (PMR), osteoarthritis (OA), gout and pseudogout were added as comprehensive educational components.

Review of literature

Search strategy: The Web of Science, Scopus, and Medline/PubMed databases were explored, without time-restrictions, using the following search phrases; EULAR NLC, rheumatology NLC, rheumatology nurse specialists and RDs in geriatrics. Special emphasis was considered for NLC in the common RDs affecting the elderly: LORA, PMR, OA and gout/pseudogout. English-language articles deemed pertinent to the review topic were included. The search revealed 19 papers pertaining to NLC in RA, chronic inflammatory arthritis (CIA) and others that address educational aspects to enhance NLC in rheumatology as well as one article focused on NLC in PMR, four articles related to NLC in knee and hand OA, and another four related to NLC in gout.

Conclusion

Rheumatology NLC and nursing clinics in rheumatology (NCR) compose a beneficial and valuable addition to the management of RDs, particularly in vulnerable geriatric patients. In addition to the principal physician-led care, NLC provides a supplementary potential advantage that supports optimal management, patient education, care satisfaction, quick access to care, medication adherence, and tracking drug adverse effects.

背景：应加强风湿病护士主导护理（NLC），以更好地满足老年风湿病患者（rd）不断变化的需求并改善其预后。本综述旨在提供风湿病学NLC的概述，重点是经常困扰老年人的风湿病。老年人常见的rd包括晚发性类风湿关节炎（RA）（LORA）、风湿性多肌痛（PMR）、骨关节炎（OA）、痛风和假性痛风作为综合教育内容。文献综述研究策略：在没有时间限制的情况下，使用以下搜索短语对Web of Science、Scopus和Medline/PubMed数据库进行了探索；EULAR NLC，风湿病学NLC，风湿病学护士专家和老年病学rd。特别强调了影响老年人的常见rd中的NLC: LORA， PMR， OA和痛风/假性痛风。被认为与评论主题相关的英文文章被纳入其中。检索结果显示，有19篇论文涉及RA、慢性炎症性关节炎（CIA）的NLC，以及其他涉及风湿性疾病NLC教育方面的文章，还有一篇文章关注PMR中的NLC，四篇文章涉及膝关节和手部OA中的NLC，另外四篇文章涉及痛风中的NLC。结论风湿病学NLC和风湿病学护理诊所（NCR）是对rd管理的有益和有价值的补充，特别是对易感老年患者。除了主治医生主导的护理之外，NLC还提供了一个补充的潜在优势，支持最佳管理、患者教育、护理满意度、快速获得护理、药物依从性和跟踪药物不良反应。

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引用次数: 0

Peripheral joint manifestations in patients with ulcerative colitis from the middle east: systematic review and meta-analysis 中东溃疡性结肠炎患者的外周关节表现：系统回顾和荟萃分析

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-11-13 DOI: 10.1016/j.ejr.2025.11.002

Abdulaziz S. Alshahrani

Background

Ulcerative colitis (UC) is an inflammatory bowel disease and a chronic gastrointestinal disorder with extraintestinal manifestations commonly involving the peripheral joints and contributing to patients’ morbidity.

Aim of the work

This study aimed to systematically analyze the prevalence of peripheral joint manifestations among patients with UC in the Middle East, providing insights into regional variations and potential clinical implications.

Patients and methods

A comprehensive search was performed in electronic databases for studies on the prevalence of peripheral joint manifestations in patients with UC in Middle Eastern countries. Twelve studies involving 2086 patients with UC were selected for quantitative synthesis. Random-effects meta-analysis was performed, and the prevalence of peripheral joint manifestations was calculated.

Results

The overall prevalence of peripheral joint manifestations in Middle Eastern patients with UC was 18 % (95 % CI: 12 %–24 %). The prevalence rates ranged from 3.2 % to 52.3 %. A symmetrical funnel plot indicated the absence of significant publication bias. Heterogeneity among the studies was substantial (I² = 95 %). Regional variations among the findings were observed, with Saudi Arabian studies reporting relatively higher prevalence rates than studies from Kuwait and Turkey. Gender disparities were noted but were not consistent across all the studies.

Conclusions

This meta-analysis reveals that peripheral joint manifestations are common extraintestinal complications in Middle Eastern patients with UC. Recognizing regional differences and gender disparities is essential for healthcare providers in the region. Further research is needed to explore the underlying factors and improve patient care. The findings contribute to a good understanding of the clinical burden of UC in the Middle East.

背景溃疡性结肠炎（UC）是一种炎症性肠病和慢性胃肠道疾病，通常表现为外周关节，并导致患者发病。本研究旨在系统分析中东地区UC患者周围关节表现的患病率，为地区差异和潜在的临床意义提供见解。患者和方法在电子数据库中进行了全面的检索，以研究中东国家UC患者周围关节表现的患病率。我们选择了12项涉及2086例UC患者的研究进行定量综合。进行随机效应荟萃分析，并计算外周关节表现的患病率。结果中东UC患者中外周关节表现的总体患病率为18% （95% CI: 12% - 24%）。患病率为3.2% ~ 52.3%。对称漏斗图表明没有显著的发表偏倚。研究间的异质性很大（I2 = 95%）。研究发现存在地区差异，沙特阿拉伯的研究报告的患病率相对高于科威特和土耳其的研究。性别差异被注意到了，但在所有的研究中并不一致。结论：本荟萃分析显示，外周关节表现是中东地区UC患者常见的肠外并发症。认识到区域差异和性别差异对该地区的医疗保健提供者至关重要。需要进一步的研究来探索潜在的因素并改善患者的护理。研究结果有助于更好地了解中东地区UC的临床负担。

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引用次数: 0

Pyoderma gangrenosum in a patient with rheumatoid arthritis treated with adalimumab: A case-based review 阿达木单抗治疗的类风湿性关节炎患者坏疽性脓皮病：基于病例的回顾

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-11-06 DOI: 10.1016/j.ejr.2025.11.001

Dilara B Gökten, Rıdvan Mercan

Background

Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that may accompany systemic inflammatory diseases such as rheumatoid arthritis (RA). Owing to its nonspecific presentation and overlap with other ulcerative disorders, diagnosis is often delayed, and the optimal management, particularly in RA-associated PG, remains uncertain.

Aim of the work

To present a rare case of PG occurring in a seropositive RA patient successfully treated with adalimumab (ADA) and to provide a concise literature-based review of ADA use in similar contexts.

Case presentation

A 63-year-old female with seropositive RA, initially controlled on methotrexate (MTX) and low-dose corticosteroid, developed bilateral painful ulcerative thigh lesions. Histopathology revealed dense neutrophilic infiltration consistent with PG. High-dose corticosteroid therapy achieved only partial improvement; therefore, ADA 40 mg every two weeks was initiated after negative tuberculosis screening. Within three months, rapid ulcer healing and remission of joint symptoms were observed, allowing steroid withdrawal. At six months, complete epithelialization and stable control of RA were achieved without adverse events. A systematic search of PubMed, Scopus, Web of Science, and DOAJ identified seven studies reporting favorable outcomes with ADA in steroid-refractory or biologic-switched RA-related PG.

Conclusion

Treatment with ADA demonstrates potential dual efficacy in controlling both PG and RA, particularly in corticosteroid-resistant or anti-TNF-switched cases. Given the paucity of prospective data, further multicenter randomized studies are required to validate its long-term safety and therapeutic role in this rare overlap setting. Early recognition and targeted immunomodulation remain essential to prevent chronic ulceration and recurrence.

背景：坏疽性脓皮病（pyoderma gangrenosum， PG）是一种罕见的中性粒细胞性皮肤病，可伴随系统性炎症性疾病，如类风湿关节炎（RA）。由于其非特异性表现和与其他溃疡性疾病的重叠，诊断经常延迟，最佳治疗，特别是ra相关性PG，仍然不确定。本研究的目的是报道一例罕见的PG发生在一名血清阳性的RA患者中，该患者成功地接受了阿达木单抗（ADA）治疗，并提供了一份基于ADA在类似情况下使用的简明文献综述。一例63岁女性RA血清阳性，最初使用甲氨蝶呤（MTX）和低剂量皮质类固醇进行控制，出现双侧疼痛性大腿溃疡性病变。组织病理学显示致密的中性粒细胞浸润，与PG一致。大剂量皮质类固醇治疗仅部分改善；因此，在结核筛查呈阴性后，每两周开始服用ADA 40 mg。三个月内，观察到溃疡迅速愈合，关节症状缓解，允许类固醇停用。6个月时，完全的上皮化和稳定的RA控制实现无不良事件。通过对PubMed、Scopus、Web of Science和DOAJ的系统检索，我们发现了7项研究报告了ADA治疗类固醇难治性或生物开关RA相关的PG的有利结果。结论ADA治疗在控制PG和RA方面具有潜在的双重疗效，特别是在皮质类固醇耐药或抗tnf开关的病例中。鉴于前瞻性数据的缺乏，需要进一步的多中心随机研究来验证其在这种罕见的重叠情况下的长期安全性和治疗作用。早期识别和有针对性的免疫调节仍然是预防慢性溃疡和复发的必要条件。

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引用次数: 0