Egyptian Rheumatologist最新文献

Aim of the work

To determine the frequency of and risk factors for renal impairment in patients with axial spondyloarthritis (axSpA).

Patients and methods

Fifty axSpA patients participated in this study. In accordance with the Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria, patients were split into two groups: group 1comprised renal impairment and group 2 comprised non-renal impairment. The ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI) and estimated glomerular filtration rate were assessed.

Results

The mean age of patients was 38.9 ± 11.7 years, males were 54 % and the disease duration was 11.36 ± 6.1 years. The mean ASDAS score was 5.58 ± 1.38 and BASDAI was 5.18 ± 1.55. The eGFR was 76.4 ± 36.2 ml/min/1.73 m² and 28 % had positive human leucocytic antigen (HLA-B27). 80 % were receiving biologic therapy. Nephropathy by ultrasound and renal impairment were detected in 34 % and 52 % of the cases respectively. The cumulative dose of non-steroidal anti-inflammatory drugs (NSAIDs), C-reactive protein, erythrocyte sedimentation rate, low density cholesterol, blood urea nitrogen, creatinine, proteinuria, ASDAS and BASDAI were significantly higher in those with renal impairment(p = 0.0001, p = 0.0001, p = 0.001, p = 0.035, p = 0.0001, p = 0.0001, p = 0.0001, p = 0.001, p = 0.001 respectively) while the eGFR and high density lipoprotein were significantly lower (p = 0.001and p = 0.02). Only the cumulative dose of NSAIDs was a significantly independent variable influencing the development of renal impairment (OR=1.01, CI; 1.001–1.02, p = 0.024) at cut-off level > 1166.3 g.

Conclusions

Renal impairment is frequent in axSpA patients with decreased eGFR and high disease activity. The cumulative dose of NSAIDs is a significant predictor of renal impairment.

Introduction

Fibromyalgia often deteriorates the quality of life of patients on physical, emotional, socio-familial, and professional levels.

Aim of the work

To describe the characteristics of fibromyalgia patients and to assess the impact of fibromyalgia on their quality of life.

Patients and methods

A questionnaire was provided to the fibromyalgia patients at the pain management center of Tunis, during the last ten years and the sociodemographic data, journey characteristics and satisfaction regarding the quality of their care were recorded and the impact of fibromyalgia on the quality of life was assessed using the Fibromyalgia Impact Questionnaire (FIQ).

Results

The work included 110 patients, 93 females and 13 males (F:M 7.2:1) and a mean age of 52 ± 12 years. 65 % reported an initial pain visual analog scale (VAS) ≥ 7. The mean consultation and diagnostic delays were 75 ± 30 and 44 ± 28 months, respectively. 94 % of patients were initially misdiagnosed, despite consulting more than two different physicians. The mean FIQ total was 77.5 ± 13.Age, female gender, and manual professions were related to a more impaired physical impact of fibromyalgia (p = 0.02; p = 0.01; p = 0.03, respectively). Patients whose fibromyalgia trigger was persistent stress (n = 50) reported more impaired FIQ (p = 0.001). Patients with shorter consultation and diagnostic delays reported more improvement (p = 0.001 and p = 0.01, respectively). Patients treated with tricyclic antidepressants and vitamins felt significantly improved (p = 0.02 and p = 0.002). Non-pharmacological treatments included physical therapy, yoga, acupuncture, and thermal baths.

Conclusions

The quality of life in fibromyalgia patients is frequently impaired, and the journey is complex and ambivalent.

Aim of the work

To assess and compare depression, anxiety, and cognitive impairments in juvenile systemic erythematous lupus (JSLE) children with lupus nephritis (LN) during the induction and maintenance phases of treatment and to investigate the association with disease activity, damage and immunosuppressive medications.

Patients and methods

This study included 33 patients diagnosed as JSLE with LN. Attention and working memory were assessed by the working memory index Wechsler Intelligence Scale (WISC). Depression and anxiety were assessed by the Children Depression Inventory (CDI) and the Spence Children Anxiety Scale respectively. The SLE disease activity index 2000 (SLEDAI-2 K) was recorded.

Results

The mean age of the children was 11.6 ± 2.2 years, 88 % were females and 12 % males with disease duration of 16.9 ± 9.2 months and age at onset of 10.2 ± 2.3 years. Mean anxiety scores were higher among patients during the induction phase than those during maintenance phase (62.1 ± 7.2 and 40.2 ± 8.8 respectively; p < 0.001). The depression score was higher in the induction (19 ± 5.5) than in the maintenance group (12.4 ± 5.6) (p = 0.002). Mean anxiety scores significantly correlated with SLEDAI-2 K and corticosteroids dose (r = 0.58 and r = 0.43, p = 0.0004 and p = 0.013 respectively) and a significant negative correlation with duration of corticosteroids and number of cyclophosphamide doses (r = 0.46 and r = 0.69, p = 0.008 and p = 0.0001 respectively).

Conclusion

Depression and anxiety levels were higher in children with LN during the induction phase of treatment than those in the maintenance phase. Mental health problems must be screened among children with LN and treating these problems can improve the medical and psychosocial outcomes.

Aim of the work

Behҫet’s syndrome is a disease that causes inflammation of small, medium, and large vessels in a lot of body organs. Microribonucleic acid-9 (miRNA-9) is an important regulator of inflammation through negative feedback inhibition of the Nuclear Factor Kappa B pathway. This work objective was to assess the expression level of miRNA-9 in Behҫet’s syndrome patients and to study its relation to different activity domains.

Patients and methods

Sixty adult Behҫet’s syndrome patients with sixty matched controls were recruited. The activity scores of patients were calculated using Behcet’s Disease Current Activity Form (BDCAF), and the Behcet Syndrome Activity Score (BSAS). Gene expression of miRNA-9 was assessed using real-time PCR.

Results

The mean age of the cases was 33.8 ± 7.92 years. Male to female ratio was 6.5:1. The most frequent manifestations of activity were new eye involvement (58.3 %) followed by arthralgia (55 %) and then mouth ulcerations (41.7 %). The median activity scores were 7/20 on the BDCAF and 23/100 on the BSAS. The mean miRNA-9 showed a 53.4 fold change among cases compared to controls (p < 0.001). Using the receiver operating characteristic (ROC) curve, a miRNA-9 cutoff value fold change of 1.035 would significantly discriminate patients from controls (p < 0.001) with 71.7 % sensitivity and 100 % specificity. There was no statistically significant relation between miRNA-9 fold changes and the studied activity scores or the different domains of disease activity.

Conclusions

miRNA-9 is over-expressed in Behҫet’s syndrome and may be considered as a potential diagnostic marker and a future therapeutic target in Behcet’s syndrome.

Aim of the work

To detect ultrasonographic findings in the knees of end stage kidney disease (ESKD) patients on regular hemodialysis.

Patients and methods

Thirty adult ESKD patients on regular hemodialysis for more than one year were studied. Patients with gout, knee joint replacement or injection with steroids were excluded. Knee ultrasonography was done to evaluate the femoral cartilage as regards its thickness, sharpness or urate crystal deposition.

Results

This study included 13 male (43.3 %) and 17 females (56.7 %) with mean age 45 ± 12 years, body mass index (BMI) 26.4 ± 5.4 Kg/m2, duration of hemodialysis 1.5–27 years and serum uric acid 3.6 (1–10). Femoral cartilage double contour sign was present in 11 (36.7 %) patients, suprapatellar effusion in 20 (66.7 %), suprapatellar aggregates in 10 (33.3 %), medial patellar effusion in 8 (26.7 %), lateral patellar effusion in 12 (40 %) and lateral patellar aggregate was in 6 (20 %). Serum uric acid (SUA) level tended to correlate with body mass index (BMI), total cholesterol, LDL, fasting blood sugar (FBS), and platelet counts without significance and negatively correlated to age, hemoglobin (Hb) level, total leucocytic count (TLC), size of suprapatellar effusion and duration of hemodialysis.

Conclusion

Effusion, urate crystal deposition, double contour and aggregate were frequently observed in knee ultrasound in ESRD patients on hemodialysis. Both double contour and aggregates were the most common combined ultrasound finding. The ultrasonographic findings were not related to the duration of hemodialysis or uric acid level.

Background: The C-reactive protein /albumin ratio (CAR) has emerged as a novel biomarker in inflammatory conditions. Aim of the work: To assess the association of CAR with disease activity and its possible role as a biomarker for improvement among Axial spondyloarthritis (axSpA) and Psoriatic Arthritis (PsA) patients. Patients and methods: The study was conducted on 85 axSpA and 51 PsA patients. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, CAR, and the AS disease activity score (ASDAS) as well as the disease activity PsA (DAPSA) score measures were calculated at baseline and after three months during the follow-up visit. Results: The CAR significantly correlated with the ASDAS in axSpA patients (r = 0.58, p < 0.001) and had a tendency to correlate with the DAPSA in the PsA group. (r = 0.1, p = 0.47). There was a fair agreement between CAR and ASDAS improvements. However, CAR was not suitable for the assessment of improvement in axSpA patients compared to both ASDAS and ASDAS clinically important improvement (ASDAS-CII) (sensitivity:86 %, specificity:46.9 %, accuracy:70.7 %, and sensitivity: 14 %, specificity: 75 %, accuracy: 37.8 %, respectively) or in PsA patients compared to both DAPSA improvement and response (sensitivity: 90 %, specificity: 30 %, accuracy: 78 % and sensitivity: 30 %, specificity: 70 %, accuracy: 38 %, respectively). Conclusion: The CAR is a simple rapid inexpensive objective test for evaluating the disease activity in axSpA rather than in PsA. On follow-up, the CAR improvement was unsuitable to assess improvement among axSpA and PsA patients.

Aim of the work

To study hand and wrist musculoskeletal changes among systemic sclerosis (SSc) patients.

Patients and methods

Thirty adult SSc patients were enrolled and subjected to detailed medical history, clinical examination, laboratory investigations, and imaging studies including X-ray and musculoskeletal ultrasound (MSUS) on both hands and wrists.

Results

The mean age of the studied patients was 40 ± 9.9 years, disease duration 5.4 ± 4.1 years and 28 (93.3 %) were females. Joint space narrowing (JSN) was the commonest finding in plain X-ray being detected in 9 (30 %) patients affecting mostly metacarpophalangeal joints (MCPs). Other X-ray findings included erosions (13.3 %), osteophytes (6.7 %), calcinosis (10 %), acro-osteolysis (13.3 %), and flexion contractures (3.3 %). Tenosynovitis was the most prevalent finding in MSUS detected in 43.3 % with the sclerosing pattern being the dominant type affecting mainly extensor tendons. 23.3 % of patients had active wrist synovitis, while 13.3 % of patients had wrist effusion, 13.3 % had MCP erosions, 13.3 % had MCP JSN, and 10 % had osteophytes. Patients who had no arthritis on presentation had a higher frequency of digital ulcers and tenosynovitis. Regression analysis showed that lack of hydroxychloroquine and methotrexate intake, absence of digital ulcers, presence of morning stiffness, erythrocyte sedimentation rate (ESR) > 27 mm/h and C-reactive protein (CRP) > 9 mg/dL, JSN by X-ray and absence of tenosynovitis by US were associated with arthritis.

Conclusion

Articular involvement in SSc is frequent and could be the main presenting symptom. Clinical examination, ESR and CRP testing, along with plain radiography, and musculoskeletal ultrasonography are important to detect arthritis early and treat accordingly.

Aim of the work

To ascertain the frequency of enteropathic arthritis among patients diagnosed with inflammatory bowel disease (IBD) and to investigate the relation between spondyloarthritis (SpA) and patients treated for IBD.

Patients and methods

This study examined 124 adult patients with IBD. The evaluation encompassed both axial and peripheral SpA. Information pertaining to the patients’ age, gender, age at the time of IBD and SpA diagnosis, symptoms of inflammatory low back pain (iLBP), dactylitis, peripheral arthritis, history of uveitis, pelvic X-ray, sacroiliac joint magnetic resonance imaging (MRI), ankylosing spondylitis disease actviity score (ASDAS) and Bath ankylosing spondylitis disease actvity index (BASDAI) were compiled.

Results

The IBD patients were 82 having ulcerative colitis (UC) and 42 Crohns disease (CD). 58 (46.8 %) were female and 66 (53.2 %) males. 36 (29 %) were diagnosed with SpA, 18 males and 18 females. The age of the patients was 49 ± 11.2 years (18–74 years). The duration of IBD was 5.96 ± 5.54 years (1–29 years). Sacroiliitis was assessed in 60 (48.3 %) patients using MRI. None of the patients had psoriasis or uveitis. Dactylitis was present in 1.6 % and enthesitis in 8 % of patients with IBD. In UC group, 18 (21.9 %) were diagnosed with SpA and in CD group, 18 (42.8 %) had SpA. No significant relationship was found between the diagnosis of UC/CD and the general SpA group.

Conclusion

A considerable number of individuals with IBD also experience SpA. Any delay in diagnosing enteropathic arthritis could lead to functional limitations. Therefore, timely diagnosis is crucial to facilitate optimal treatment.

Background

Adhesive capsulitis, or frozen shoulder, causes pain and reduces glenohumeral joint motion.

Aim of the work

This study aims to assesses ultrasound-guided hydrodistention with rehabilitation in hospital versus home settings.

Patients and methods

Forty patients with adhesive capsulitis were split into two groups: one received hydrodistention with hospital-assisted rehabilitation, and the other with home-based rehabilitation, following the same exercise protocol. Clinical assessments included range of motion (ROM), numeric pain rating scale (NPRS), shoulder pain and disability index (SPADI), disability of the arm, shoulder and hand (DASH), and assessment shoulder and elbow scale (ASES)

Results

The hospital-based group showed more rapid and substantial improvements in ROM and NPRS scores compared to the home-based group. The hospital-based group had a mean flexion ROM of 104.3 ± 31.6°, which increased to 149.5 ± 20.6° at the final follow-up. The home-based group started with a mean flexion ROM of 103.3 ± 29.2°, improving to 161.3 ± 23.2° by the end of the study. Both groups showed significant improvements, with the home-based group slightly outperforming in flexion ROM by the third follow-up. Initial NPRS scores were 4.7 ± 1.92 for the hospital-based group and 6.6 ± 1.63 for the home-based group. By the six-month mark, the hospital-based group’s SPADI score dropped to 17.4 ± 19.5, while the home-based group’s score was 10.5 ± 13.03. Both groups demonstrated significant improvements, with the hospital-based group showing slightly better outcomes at various follow-ups.

Conclusion

Hydrodistention combined with supervised rehabilitation is optimal for treating frozen shoulder, though home-based therapy is also effective. Both methods significantly benefit from hydrodistention, highlighting its importance in treatment strategies.

Aim of the work

To evaluate the association of dry eye disease (DED) subtypes (aqueous deficient dry eye, ADDE and evaporative dry eye, EDE) and the presence of rheumatoid arthritis (RA) in patients.

Patients and methods

260 volunteer DED participants were recruited for an observational cross-sectional study based on the Tear Film Ocular Society Dry Eye Workshop II criteria, which included tear film osmolarity, fluorescence break-up time, and ocular surface damage assessment. Participants were recruited using QR linked to designated mobile forms to obtain symptomatology status, demographics, and RA diagnosis by their medical doctor. Tear meniscus and lipid layer were also evaluated to differentiate between ADDE, EDE, or mixed dry eye in addition to the DED diagnostic criteria. Participants with mixed dry eye were excluded from the analysis to avoid bias.

Results

After initial recruitment, 149 eligible participants with an ADDE or EDE diagnosis were included in the final analysis, where 12,1% have an RA diagnosis. The ADDE group had a higher likelihood of having RA (OR = 4.69, 95 %CI = 1.46–15.01) than the EDE group. Additionally, the number of participants with RA in the ADDE group was statistically higher than those in the EDE group (all p = 0.006). Furthermore, a correlation was obtained between RA and a diagnosis of ADDE (p = 0.005).

Conclusion

There was a significant association between ADDE and the presence of RA in patients and the association was more likely compared to those with EDE. This finding underscores the need for specific diagnostic and management strategies for RA patients presenting with DED.