Egyptian Rheumatologist最新文献_第5页

Sleep disorders in rheumatoid arthritis patients 类风湿性关节炎患者的睡眠障碍

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-04-06 DOI: 10.1016/j.ejr.2024.03.001

Mouna Brahem , Azer Chebil , Hayfa Abid , Olfa Jomaa , Rihab Sarraj , Besma Jebali , Sirine Abdellatif , Amani ben Salem , Haifa Hachfi , Khalifa Mighri , Mohamed Younes

Aim of the work

To determine the frequency of sleep disturbances in patients with rheumatoid arthritis (RA) and to identify associated factors.

Patients and methods

This study included 100 RA patients. The disease activity score (DAS28), tender joint count (TJC), swollen joint count (SJC), Visual Analog Scale (VAS)-pain and Health Assessment Questionnaire (HAQ) were assessed. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess sleep quality.

Results

The patients were 89 females and 11 males, mean age 53.2 ± 11.2 years (21–76 years) and disease duration was 11.1 ± 8.9 years (1–40 years).The meanTJC was 8.5 ± 7.9 (0–24), SJC 4 ± 4.8 (0–24) and VAS 51 ± 21 mm (10–90 mm). Their mean DAS28 was 3.9 ± 1.1 (1–6.15) and HAQ 1.3 ± 0.7 (0–2.9). The ESS was 7.9 ± 5.6 (0–24). 28 % of patients had signs of daytime sleepiness (ESS ≥ 11 points) with a significant association with female sex (p = 0.03), TJC (p = 0.03), SJC (p = 0.02), DAS28 (p = 0.05), VAS (p = 0.04) and HAQ (p < 0.01). The mean Pittsburgh score was 6.9 ± 5.1 (0–19). 51 % of patients had disturbed sleep (PSQI > 5.5 points). The most disturbed components were respectively sleep latency (1.5 ± 1.1), subjective sleep quality (1.25 ± 0.8) and sleep disorders (1.19 ± 0.8). Disturbed sleep assessed by PSQI had a significant association with TJC (p < 0.01), SJC (p < 0.01), C-reactive protein, nocturnal awakening (p < 0.01), DAS28 (p < 0.01), VAS-pain (p < 0.01), HAQ (p < 0.01), and corticosteroid intake (p = 0.01).

Conclusion

Half of the patients had sleep disorders with a significant association with disease activity parameters which underline the importance of ensuring remission or low level of activity to improve the quality of sleep of patients.

工作目的确定类风湿关节炎（RA）患者睡眠障碍的频率，并找出相关因素。对疾病活动度评分（DAS28）、关节触痛计数（TJC）、关节肿胀计数（SJC）、疼痛视觉模拟量表（VAS）和健康评估问卷（HAQ）进行了评估。结果患者中有 89 名女性和 11 名男性，平均年龄为（53.2±11.2）岁（21-76 岁），病程为（11.1±8.9）年（1-40 年），平均关节肿胀（TJC）为（8.5±7.9）（0-24），关节肿胀（SJC）为（4±4.8）（0-24），VAS 为（51±21）毫米（10-90 毫米）。他们的平均 DAS28 为 3.9 ± 1.1（1-6.15），HAQ 为 1.3 ± 0.7（0-2.9）。ESS为7.9 ± 5.6（0-24）。28% 的患者有白天嗜睡的迹象（ESS ≥ 11 分），这与女性性别（p = 0.03）、TJC（p = 0.03）、SJC（p = 0.02）、DAS28（p = 0.05）、VAS（p = 0.04）和 HAQ（p < 0.01）有显著关联。匹兹堡评分的平均值为 6.9 ± 5.1 (0-19)。51%的患者有睡眠障碍（PSQI 5.5分）。最令人不安的部分分别是睡眠潜伏期（1.5 ± 1.1）、主观睡眠质量（1.25 ± 0.8）和睡眠障碍（1.19 ± 0.8）。通过 PSQI 评估的睡眠紊乱与 TJC（p < 0.01）、SJC（p < 0.01）、C 反应蛋白、夜醒（p < 0.01）、DAS28（p < 0.01）、VAS-疼痛（p < 0.01）、HAQ（p < 0.01）和皮质类固醇摄入量（p = 0.01）有显著相关性。01）。结论半数患者存在睡眠障碍，且与疾病活动参数有显著相关性，这强调了确保缓解或低水平活动对改善患者睡眠质量的重要性。

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引用次数: 0

Rheumatoid arthritis presentation in elderly patients: How different from the usual presentation? 老年患者的类风湿性关节炎表现：与通常表现有何不同？

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-03-10 DOI: 10.1016/j.ejr.2024.02.004

Rahma A. Elziaty , Aya M. Sayed , Ahmed A. Khalifa

Aim of the work

This work aimed to compare the outcomes between elderly- and younger-onset rheumatoid arthritis (EORA and YORA, respectively).

Patients and methods

This study included 140 RA patients recruited from the rheumatology outpatient clinic of Ain Shams University Hospitals. The study included 70 EORA (>60 years) patients and a similar number of YORA (<60 years) cases. Both groups were compared based on demographic data, clinical manifestations, disease activity markers, and drug history.

Results

Large joint arthritis and myalgia were higher in the EORA group (p < 0.0001) while small joint arthritis was higher in the YORA (p < 0.0001). The frequency of interstitial lung disease (ILD), rheumatoid nodules, and deformities was higher in the YORA group (p = 0.03, p = 0.03, and p = 0.02 respectively). Anti-citrullinated protein antibody (ACPA) positivity and erythrocyte sedimentation rate (ESR) were higher in YORA (p = 0.01). The disease activity scores (DAS28, SDAI, and CDAI) were higher in the YORA than in the EORA (p < 0.0001). YORA were significantly receiving sulfasalazine (34.3 %) and hydroxychloroquine (84.3 %) at a higher frequency than EORA (67.1 % and 8.6 %, p < 0.0001 and p = 0.02 respectively) while EORA were more receiving leflunomide (57.1 % vs 40 %; p = 0.04). Biologic therapy was received only by YORA patients.

Conclusion

EORA presents with distinct features from YORA, including a more insidious onset with myalgia and large joint affection making the diagnosis more challenging. EORA has a lower severe course with less deformities and disease activity with a tendency to be controlled by a single DMARD rather than combinations or biologics.

工作目的这项工作旨在比较老年类风湿关节炎和年轻类风湿关节炎（分别为 EORA 和 YORA）的治疗效果。患者和方法这项研究包括从艾因夏姆斯大学医院风湿病门诊招募的 140 名 RA 患者。研究包括 70 名 EORA（60 岁）患者和相同数量的 YORA（60 岁）病例。两组患者的人口统计学数据、临床表现、疾病活动性指标和用药史进行了比较。结果EORA组患者的大关节炎和肌痛程度较高（p <0.0001），而YORA组患者的小关节炎程度较高（p <0.0001）。间质性肺病（ILD）、类风湿结节和畸形的发病率在 YORA 组中较高（分别为 p = 0.03、p = 0.03 和 p = 0.02）。YORA 组的抗瓜氨酸蛋白抗体（ACPA）阳性率和红细胞沉降率（ESR）较高（P = 0.01）。与 EORA 相比，YORA 的疾病活动评分（DAS28、SDAI 和 CDAI）更高（p = 0.0001）。青年患者接受柳氮磺胺吡啶（34.3%）和羟氯喹（84.3%）治疗的比例明显高于老年患者（分别为 67.1% 和 8.6%，p < 0.0001 和 p = 0.02），而老年患者接受来氟米特治疗的比例更高（57.1% vs 40%；p = 0.04）。结论 EORA 与 YORA 有着不同的特征，包括起病隐匿，伴有肌痛和大关节疼痛，因此诊断更具挑战性。EORA 病程较轻，畸形和疾病活动较少，倾向于通过单一 DMARD 而不是联合用药或生物制剂来控制病情。

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引用次数: 0

Estrogen receptor ß is high in the minor salivary glands of female patients with primary Sjögren's syndrome 原发性斯约格伦综合征女性患者的小唾液腺中雌激素受体 ß 含量较高

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-03-02 DOI: 10.1016/j.ejr.2024.02.005

Ahmet Kor , Aydan Kılıçarslan

Aim of the work

This study aimed to investigate the expression levels of estrogen receptor (ER) beta (ß) and alpha (α) in the minor salivary gland tissues of patients with primary Sjögren's syndrome (pSS), which has a female predominance and reaches its highest incidence at menopause.

Patients and methods

Sixty-six female pSS patients and 23 matched control were studied. The ER ß and α expressions from salivary gland tissues were immunohistochemically evaluated. The European League Against Rheumatism (EULAR) Sjögren's syndrome disease activity index was assessed.

Results

The 66 female pSS patients had a mean age of 50.1 ± 13.4 years. The ESSDAI was 7 (9–13). The ER ß expressions of the salivary gland were significantly higher in pSS patients than in control both ductal (B: 0.68, OR 1.97, 95 %CI 1.34–2.88, p = 0.001) and acinar (B: 2.18, OR 8.87, 95 %CI 2.34–33.6, p = 0.001). Lymphocytes in the salivary gland infiltrate of pSS cases expressed high levels of ER ß (8, 6–8). Expression of ERα was not detected in the minor salivary gland ductal and acini epithelium and lymphocytes of pSS and control. No significant relationship was found between ER ß expression levels and complement, rheumatoid factor, immunoglobulin G, anti-nuclear antibody, the ESSDAI and the presence of menopause in pSS patients.

Conclusion

pSS patients have higher salivary gland ER ß expression (ductal and acinar epithelial) than controls, and lymphocytes infiltrating the salivary gland in pSS express high levels of ER ß. This study showed that salivary gland ER expression levels in pSS are different from controls, regardless of disease activity.

工作目的本研究旨在探讨雌激素受体（ER）β（ß）和α（α）在原发性斯约格伦氏综合征（pSS）患者小唾液腺组织中的表达水平。对唾液腺组织中ER ß和α的表达进行了免疫组化评估。结果 66 名女性 pSS 患者的平均年龄为 50.1 ± 13.4 岁。ESSDAI为7（9-13）。pSS 患者唾液腺导管（B：0.68，OR 1.97，95 %CI 1.34-2.88，p = 0.001）和针状（B：2.18，OR 8.87，95 %CI 2.34-33.6，p = 0.001）的ER ß表达均明显高于对照组。pSS 病例唾液腺浸润中的淋巴细胞表达高水平的 ER β（8，6-8）。在 pSS 和对照组的小唾液腺导管和腺尖上皮及淋巴细胞中未检测到 ERα 的表达。ERß表达水平与补体、类风湿因子、免疫球蛋白G、抗核抗体、ESSDAI及pSS患者是否绝经之间无明显关系。这项研究表明，无论疾病活动情况如何，pSS患者唾液腺ER的表达水平都与对照组不同。

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引用次数: 0

Retinal vasculitis in two patients with rheumatoid arthritis: A case-based review 两名类风湿性关节炎患者的视网膜血管炎：病例回顾

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-03-02 DOI: 10.1016/j.ejr.2024.02.006

Saoussen Miladi, Ons Boudriga, Alia Fazaa, Hiba Boussaâ, Kawther Ben Abdelghani, Ahmed Laatar

Background

Rheumatoid arthritis (RA) is a systemic autoimmune disease that can be associated with extra-articular manifestations including vasculitis that occurs exceptionally in the retina.

Aim of the work

To present two active RA cases with retinal vasculitis (RV) and compare them to similar cases presented worldwide.

Case presentations

The first case was a 44-year-old male patient with seropositive and erosive RA with a sudden bilateral blurred vision and myodesopsias and developed bilateral occlusive venous RV. It occurred concomitantly with an increased disease activity (disease activity score 4.4) that was treated with high doses of prednisolone. Then the patient had a recurrence of RV with another flare-up of his RA disease. Workup of RV included markers of infection, antinuclear antibody (ANA) and anti-neutrophil cytopasmic antibody (ANCA) and all were negative. The patient received pulse intravenous corticosteroids and was transitioned to oral steroids with the addition of methotrexate 20 mg/week with a favorable outcome. The second case was a 33-year-old female with history of bilateral retinal detachment treated surgically, followed for seronegative non-erosive RA. She presented with left RV complicated by a preretinal hemorrhage. Workup of RV included markers of infection and autoimmune markers were negative. A magnetic resonance imaging (MRI) hands showed bony erosions at the metacarpophalangeal joints with bilateral active synovitis. Systemic steroids were initiated with articular and visual improvement.

Conclusion

The retina should be examined for evidence of vasculitis in RA and RV should be kept in mind as an ocular complication or association.

背景类风湿性关节炎（RA）是一种全身性自身免疫性疾病，可伴有关节外表现，包括视网膜血管炎，视网膜血管炎的发生率极低。病例介绍第一例患者是一名 44 岁男性患者，血清反应阳性，患有侵蚀性 RA，突然出现双侧视力模糊和肌麻痹，并出现双侧闭塞性静脉 RV。患者在发病的同时，疾病活动度增加（疾病活动度评分 4.4），当时使用了大剂量泼尼松龙治疗。之后，患者的 RA 病症再次复发，RV 也随之复发。对 RV 的检查包括感染指标、抗核抗体（ANA）和抗中性粒细胞胞浆抗体（ANCA），结果均为阴性。患者接受了脉冲静脉皮质类固醇激素治疗，并转为口服类固醇激素，同时每周服用 20 毫克甲氨蝶呤，结果良好。第二例患者是一名 33 岁的女性，曾因双侧视网膜脱离接受过手术治疗，后因血清阴性非侵蚀性 RA 而就诊。她出现左侧视网膜裂孔，并伴有视网膜前出血。RV 的检查包括感染指标，而自身免疫指标为阴性。手部磁共振成像（MRI）显示掌指关节骨质侵蚀，并伴有双侧活动性滑膜炎。结论：应检查视网膜是否有RA血管炎的证据，并将RV作为眼部并发症或相关疾病加以注意。

{"title":"Retinal vasculitis in two patients with rheumatoid arthritis: A case-based review","authors":"Saoussen Miladi, Ons Boudriga, Alia Fazaa, Hiba Boussaâ, Kawther Ben Abdelghani, Ahmed Laatar","doi":"10.1016/j.ejr.2024.02.006","DOIUrl":"https://doi.org/10.1016/j.ejr.2024.02.006","url":null,"abstract":"<div><h3>Background</h3><p>Rheumatoid arthritis (RA) is a systemic autoimmune disease that can be associated with extra-articular manifestations including vasculitis that occurs exceptionally in the retina.</p></div><div><h3>Aim of the work</h3><p>To present two active RA cases with retinal vasculitis (RV) and compare them to similar cases presented worldwide.</p></div><div><h3>Case presentations</h3><p>The first case was a 44-year-old male patient with seropositive and erosive RA with a sudden bilateral blurred vision and myodesopsias and developed bilateral occlusive venous RV. It occurred concomitantly with an increased disease activity (disease activity score 4.4) that was treated with high doses of prednisolone. Then the patient had a recurrence of RV with another flare-up of his RA disease. Workup of RV included markers of infection, antinuclear antibody (ANA) and anti-neutrophil cytopasmic antibody (ANCA) and all were negative. The patient received pulse intravenous corticosteroids and was transitioned to oral steroids with the addition of methotrexate 20 mg/week with a favorable outcome. The second case was a 33-year-old female with history of bilateral retinal detachment treated surgically, followed for seronegative non-erosive RA. She presented with left RV complicated by a preretinal hemorrhage. Workup of RV included markers of infection and autoimmune markers were negative. A magnetic resonance imaging (MRI) hands showed bony erosions at the metacarpophalangeal joints with bilateral active synovitis. Systemic steroids were initiated with articular and visual improvement.</p></div><div><h3>Conclusion</h3><p>The retina should be examined for evidence of vasculitis in RA and RV should be kept in mind as anocular complication or association.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"46 2","pages":"Pages 93-96"},"PeriodicalIF":0.9,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140014335","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

Magnetic resonance enterography in diagnosing and monitoring of adult-onset IgA vasculitis (Henoch-Schönlein purpura) with gastro-intestinal involvement: Report of two cases 磁共振肠道造影术在诊断和监测成人型 IgA 血管炎（Henoch-Schönlein 紫癜）胃肠道受累方面的应用：两个病例的报告

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-02-19 DOI: 10.1016/j.ejr.2024.02.001

Edoardo Conticini , Susanna Guerrini , Paolo Falsetti , Maria Antonietta Mazzei , Luca Cantarini , Bruno Frediani

Background

IgA vasculitis (IgAV) is a small vessel vasculitis affecting children and, less commonly, adults; in the latter, gastro-intestinal (GI) involvement occurs in up to 50% of cases. Diagnosis is made with computed tomography, ultrasonography and endoscopy, but no data have been to date published about the use of magnetic resonance enterography (MRE).

Aim of the work

This work reports two leading cases of adult-onset IgAV with GI involvement in which MRE was used at baseline and during follow-up.

Case report

The first case was for a 55-year old male presenting with microhematuria and elevated markers of inflammation at admission. MRE evidenced jejunum and proximal ileum diffuse and asymmetric thickening and hypervascularization. Leukocytoclastic vasculitis and glomerulonephritis with IgA deposit were evidenced at skin and renal biopsy, respectively. At one-year follow-up, a relapse was suspected: microhematuria and proteinuria were found at routine urinalysis, while MRE findings were similar to the ones at baseline. The second case was for a 49-year old male previously treated with methotrexate for mild seronegative arthritis, reporting hematochezia and worsening of arthralgias. Inflammatory bowel disease (IBD) was suspected and colonoscopy revealed diffuse mucosal hyperemia. Computerized tomography of the terminal ileum appeared thickened and edematous, while skin biopsy showed leukocytoclastic vasculitis with IgA infiltrate. The patient was successfully treated with oral prednisone and, after two months from discharge, MRE was negative.

Conclusion

IgAV may occur in adults and presenting with GI involvement may be particularly severe, mimicking IBD. MRE is a promising tool in diagnosing and monitoring IgAV.

背景IgA 血管炎（IgAV）是一种影响儿童的小血管炎，成人较少见；在成人病例中，胃肠道（GI）受累的比例高达 50%。诊断可通过计算机断层扫描、超声波检查和内窥镜检查进行，但迄今为止还没有关于使用磁共振肠道造影术（MRE）的数据。胃肠造影显示空肠和回肠近端弥漫性和非对称性增厚及血管增生。皮肤活检和肾活检分别发现白细胞凝集性血管炎和伴有 IgA 沉积的肾小球肾炎。随访一年时，怀疑病情复发：尿常规检查发现微量血尿和蛋白尿，而 MRE 检查结果与基线时相似。第二个病例是一名 49 岁的男性，曾因轻度血清阴性关节炎接受甲氨蝶呤治疗，报告出现血尿和关节痛恶化。怀疑是炎症性肠病（IBD），结肠镜检查发现弥漫性粘膜充血。回肠末端的计算机断层扫描显示增厚和水肿，皮肤活检显示白细胞凝集性血管炎伴有IgA浸润。患者口服泼尼松治疗成功，出院两个月后，MRE 检测结果为阴性。MRE 是诊断和监测 IgAV 的有效工具。

{"title":"Magnetic resonance enterography in diagnosing and monitoring of adult-onset IgA vasculitis (Henoch-Schönlein purpura) with gastro-intestinal involvement: Report of two cases","authors":"Edoardo Conticini , Susanna Guerrini , Paolo Falsetti , Maria Antonietta Mazzei , Luca Cantarini , Bruno Frediani","doi":"10.1016/j.ejr.2024.02.001","DOIUrl":"https://doi.org/10.1016/j.ejr.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>IgA vasculitis (IgAV) is a small vessel vasculitis affecting children and, less commonly, adults; in the latter, gastro-intestinal (GI) involvement occurs in up to 50% of cases. Diagnosis is made with computed tomography, ultrasonography and endoscopy, but no data have been to date published about the use of magnetic resonance enterography (MRE).</p></div><div><h3>Aim of the work</h3><p>This work reports two leading cases of adult-onset IgAV with GI involvement in which MRE was used at baseline and during follow-up.</p></div><div><h3>Case report</h3><p>The first case was for a 55-year old male presenting with microhematuria and elevated markers of inflammation at admission. MRE evidenced jejunum and proximal ileum diffuse and asymmetric thickening and hypervascularization. Leukocytoclastic vasculitis and glomerulonephritis with IgA deposit were evidenced at skin and renal biopsy, respectively. At one-year follow-up, a relapse was suspected: microhematuria and proteinuria were found at routine urinalysis, while MRE findings were similar to the ones at baseline. The second case was for a 49-year old male previously treated with methotrexate for mild seronegative arthritis, reporting hematochezia and worsening of arthralgias. Inflammatory bowel disease (IBD) was suspected and colonoscopy revealed diffuse mucosal hyperemia. Computerized tomography of the terminal ileum appeared thickened and edematous, while skin biopsy showed leukocytoclastic vasculitis with IgA infiltrate. The patient was successfully treated with oral prednisone and, after two months from discharge, MRE was negative.</p></div><div><h3>Conclusion</h3><p>IgAV may occur in adults and presenting with GI involvement may be particularly severe, mimicking IBD. MRE is a promising tool in diagnosing and monitoring IgAV.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"46 2","pages":"Pages 90-92"},"PeriodicalIF":0.9,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139901308","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

Rheumatologic manifestations of female patients with idiopathic granulomatous mastitis 特发性肉芽肿性乳腺炎女性患者的风湿病表现

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-02-10 DOI: 10.1016/j.ejr.2024.02.002

Ahmad Elahi , Amir Eyvazi , Ali Faegh , Golbarg Mehrpoor

Background

Idiopathic granulomatous mastitis (IGM) is an infrequent inflammatory breast disease that typically presents with unilateral and sometimes bilateral breast masses, leading to pain, erythema, and nipple discharge. IGM may be accompanied by extramammary symptoms, including episcleritis and arthralgia suggesting and underlying autoimmune process.

Aim of the work

To evaluate the frequency of characteristics manifestations including rheumatologic in females with IGM referred to Imam Ali Hospital (Karaj, Iran).

Patients and methods

This study was performed on 178 females referred to the breast surgery department of Imam Ali Hospital and diagnosed with IGM based on core needle biopsy and histopathological examination. The various manifestations including rheumatic presented for those patients were recorded.

Results

The mean age of the patients was 35.17 ± 5.88 years and body mass index was 26.38 ± 2.45. 91 % of the patients were nulliparous and only 3 used oral contraceptive pills. The breast-feeding duration of parous patients was 28.91 ± 14.97 months. Associated minor thalassemia was present in 2.25 %, bronchial asthma, diabetes, psoriasis and hypothyroidism were present in 2 patients each. 7 (3.92 %) of cases had history of previous breast surgery. Twenty-five (14 %) patients with IGM had associated manifestations including arthralgia (10.11 %), arthritis (2.25 %) and erythema nodosum (2.81 %). Only one patient had peripheral and another optic neuritis. 158 (88.76 %) patients had no notable past medical history. IGM was bilateral in 21 (11.8 %) patients.

Conclusions

The coexistence of erythema nodosum and arthritis with IGM is not uncommon. They are mostly unilaterally present in nulliparous Iranian females. Optic and peripheral neuropathies are rarely associated.

背景特发性肉芽肿性乳腺炎（IGM）是一种不常见的炎症性乳腺疾病，通常表现为单侧乳房肿块，有时为双侧乳房肿块，导致疼痛、红斑和乳头溢液。工作目的评估转诊至伊玛目阿里医院（伊朗卡拉杰）的 IGM 女性患者的特征表现（包括风湿病）的频率。患者和方法本研究的对象是转诊至伊玛目阿里医院乳腺外科的 178 名女性患者，根据核心针活检和组织病理学检查确诊为 IGM。结果患者的平均年龄为（35.17 ± 5.88）岁，体重指数为（26.38 ± 2.45）。91%的患者为未婚先孕，只有 3 人使用口服避孕药。准妈妈的哺乳期为（28.91 ± 14.97）个月。2.25%的患者伴有轻微地中海贫血，支气管哮喘、糖尿病、银屑病和甲状腺功能减退症各占 2 例。7例（3.92%）患者曾接受过乳腺手术。25 名（14%）IGM 患者伴有关节痛（10.11%）、关节炎（2.25%）和结节性红斑（2.81%）等表现。只有一名患者患有周围神经炎，另一名患者患有视神经炎。158名患者（88.76%）没有明显的既往病史。结论结节性红斑和关节炎与 IGM 并存的情况并不少见。结节性红斑和关节炎与 IGM 并存的情况并不少见。视神经和周围神经病很少伴发。

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引用次数: 0

An Egyptian rheumatology legend: The prosperous journey of late prof. Tahsin El-Hadidi 埃及风湿病学传奇：已故 Tahsin El-Hadidi 教授的辉煌历程塔赫辛-哈迪迪

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-02-03 DOI: 10.1016/j.ejr.2024.01.006

Tamer A. Gheita

引用次数: 0

Extra-articular calcification of the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis: A case-based review 外侧副韧带（LCL）关节外钙化伴有复发性急性膝关节周围炎：病例回顾

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-01-23 DOI: 10.1016/j.ejr.2024.01.005

Yasser Ragab , Khalid Alhusseiny , Amr A. Saad , Yasser Emad , Farida Y. Emad , Johannes J. Rasker

Aim of the work

To present a case with extra-articular calcification of the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis.

Case presentation

A 53-year-old Saudi male patient presented with acute onset of right-sided knee pain, localized swelling and tenderness along the lateral aspect after sport related activity. He reported a similar attack at the same knee joint a few years earlier. Plain X-ray and magnetic resonance imaging (MRI) after the initial attack showed calcification along the LCL. On examination, the patient had mild knee effusion, painful knee extension, and localized swelling along the LCL. A recent MRI and complementary computerized tomography (CT) showed a fragmented calcific shadow along the LCL. The latter was associated with soft tissue hyperintensity, which indicated extensive local inflammatory reaction. After ruling out internal derangement and infection, it was concluded that the patient had an acute episode of peri-arthritis caused by calcification along the LCL of the affected knee joint. Intramuscular (IM) betemetazone sodium dipropionate/phosphate was used to treat the peri-arthritis and as such deposits may cause a potent neutrophilic chemotactic response and intense inflammation, colchicine was added for its anti-inflammatory properties and other known mechanisms that are effective in treating crystal-induced arthritis. On the second day following treatment, a significant improvement was seen. A case-based review was presented.

Conclusion

Despite the rare incidence of symptomatic LCL calcification, fragmentation of the calcific deposits may lead to acute intense inflammatory exacerbation and peri-arthritis. Successful and optimum management may involve IM steroid with oral colchicine.

病例介绍一位 53 岁的沙特籍男性患者在参加完体育相关活动后出现急性右侧膝关节疼痛、局部肿胀和外侧压痛。几年前，他曾报告过同一膝关节的类似症状。初次发病后的 X 光平片和磁共振成像（MRI）显示，LCL 出现钙化。经检查，患者膝关节轻度积液，膝关节伸展疼痛，LCL沿线局部肿胀。最近的核磁共振成像（MRI）和辅助计算机断层扫描（CT）显示，LCL沿线有碎裂的钙化阴影。后者伴有软组织高密度，表明局部有广泛的炎症反应。在排除了内脏病变和感染的可能性后，得出的结论是，患者患上的膝关节LCL钙化导致了急性关节周围炎。肌肉注射（IM）倍他米松二丙酸钠/磷酸酯被用于治疗关节周围炎，由于这些沉积物可能会引起强烈的中性粒细胞趋化反应和强烈的炎症，因此加入了秋水仙碱，因为秋水仙碱具有抗炎特性和其他已知机制，可有效治疗晶体诱发的关节炎。在治疗后的第二天，患者的病情有了明显改善。结论尽管无症状的 LCL钙化很少发生，但钙化沉积物的碎裂可能会导致急性剧烈炎症加重和关节炎周围炎。成功和最佳的治疗方法可能是在使用 IM 类固醇的同时口服秋水仙碱。

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引用次数: 0

The impact of corona virus disease-2019 (COVID-19) vaccination on patients with systemic rheumatic diseases attending a tertiary care university-based hospital 科罗娜病毒病-2019（COVID-19）疫苗接种对在大学附属三级医院就诊的系统性风湿病患者的影响

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-01-15 DOI: 10.1016/j.ejr.2024.01.004

Rasha E. Gheith , Eman Elsebaie , Abeer Kandeel , Shaimaa Badran

Background

Safety and efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine among systemic rheumatic diseases (SRDs) remain a serious concern.

Aim of the work

To explore different corona virus disease-2019 (COVID-19) vaccine adverse reactions, post-vaccination COVID-19 infection, disease flare and acceptability of vaccine among patients with SRDs.

Patients and methods

This study was conducted on 750 patients with SRDs attending the Rheumatology Department, Cairo University Hospitals (December 2022 – February 2023). All patients were subjected to full clinical history, COVID-19 infection, vaccine history, adverse events, disease flare and assessment of their acceptability to the vaccine.

Results

The mean age of the patients was 41.6 ± 11.7 years with a female:male 8.4:1 and 52.5 % were educated. 414 (55.2 %) received COVID-19 vaccine. Only 26 (6.3 %) suffered from post-vaccination COVID- 19 infection (one mild attack). The causes for not receiving the vaccine were either due to unacceptability (78.9 %) or doctors’ advice (21.1 %). 64.8 % received inactivated virus vaccines (64.8 %) and 87.9 % received two doses. The commonest local and systemic side effects were pain (73.9 %) and headache (30.2 %). Only four (0.96 %) patients reported disease flare. There was a significant difference between the diagnosis, type of vaccines and some of the adverse effects of the vaccines such as pain (p = 0.019) and fever (p = 0.021), redness (p = 0.007) and swelling (p = 0.013).

Conclusion

The efficacy and safety of SARS-CoV-2 vaccine among Egyptian patients with SRDs is confirmed. There were significant differences in certain vaccine side effects especially pain, fever, redness and swelling. Most patients well tolerated the COVID-19 vaccine providing reassurance.

背景严重急性呼吸系统综合征冠状病毒-2（SARS-CoV-2）疫苗在全身性风湿性疾病（SRD）患者中的安全性和有效性仍然是一个令人严重关切的问题。工作目的探讨不同的冠状病毒病-2019（COVID-19）疫苗不良反应、接种后 COVID-19 感染、疾病复发以及 SRD 患者对疫苗的接受程度。患者和方法本研究以开罗大学医院风湿病科就诊的 750 名 SRD 患者为对象（2022 年 12 月至 2023 年 2 月）。所有患者均接受了全面的临床病史、COVID-19感染、疫苗接种史、不良事件、疾病复发以及疫苗接受度评估。结果患者的平均年龄为41.6±11.7岁，男女比例为8.4:1，52.5%受过教育。414人（55.2%）接种了COVID-19疫苗。只有 26 人（6.3%）在接种 COVID-19 后感染（一次轻微感染）。未接种疫苗的原因是无法接受（78.9%）或医生建议（21.1%）。64.8%的人接种了灭活病毒疫苗（64.8%），87.9%的人接种了两剂疫苗。最常见的局部和全身副作用是疼痛（73.9%）和头痛（30.2%）。只有四名患者（0.96%）报告疾病复发。诊断、疫苗类型和疫苗的某些不良反应（如疼痛 (p = 0.019) 和发烧 (p = 0.021)、发红 (p = 0.007) 和肿胀 (p = 0.013)）之间存在明显差异。某些疫苗副作用，尤其是疼痛、发热、红肿等副作用存在明显差异。大多数患者都能很好地耐受 COVID-19 疫苗，这让他们感到放心。

{"title":"The impact of corona virus disease-2019 (COVID-19) vaccination on patients with systemic rheumatic diseases attending a tertiary care university-based hospital","authors":"Rasha E. Gheith , Eman Elsebaie , Abeer Kandeel , Shaimaa Badran","doi":"10.1016/j.ejr.2024.01.004","DOIUrl":"https://doi.org/10.1016/j.ejr.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Safety and efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine among systemic rheumatic diseases (SRDs) remain a serious concern.</p></div><div><h3>Aim of the work</h3><p>To explore different corona virus<span> disease-2019 (COVID-19) vaccine adverse reactions, post-vaccination COVID-19 infection, disease flare and acceptability of vaccine among patients with SRDs.</span></p></div><div><h3>Patients and methods</h3><p>This study was conducted on 750 patients with SRDs attending the Rheumatology Department, Cairo University Hospitals (December 2022 – February 2023). All patients were subjected to full clinical history, COVID-19 infection, vaccine history, adverse events, disease flare and assessment of their acceptability to the vaccine.</p></div><div><h3>Results</h3><p>The mean age of the patients was 41.6 ± 11.7 years with a female:male 8.4:1 and 52.5 % were educated. 414 (55.2 %) received COVID-19 vaccine. Only 26 (6.3 %) suffered from post-vaccination COVID- 19 infection (one mild attack). The causes for not receiving the vaccine were either due to unacceptability (78.9 %) or doctors’ advice (21.1 %). 64.8 % received inactivated virus vaccines (64.8 %) and 87.9 % received two doses. The commonest local and systemic side effects were pain (73.9 %) and headache (30.2 %). Only four (0.96 %) patients reported disease flare. There was a significant difference between the diagnosis, type of vaccines and some of the adverse effects of the vaccines such as pain (p = 0.019) and fever (p = 0.021), redness (p = 0.007) and swelling (p = 0.013).</p></div><div><h3>Conclusion</h3><p>The efficacy and safety of SARS-CoV-2 vaccine among Egyptian patients with SRDs is confirmed. There were significant differences in certain vaccine side effects especially pain, fever, redness and swelling. Most patients well tolerated the COVID-19 vaccine providing reassurance.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"46 2","pages":"Pages 73-77"},"PeriodicalIF":0.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139467889","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

The clinical characteristics of Malaysian patients with Takayasu Arteritis: A retrospective study of 3 decades 马来西亚高安动脉炎患者的临床特征：三十年的回顾性研究

IF 0.9 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-01-10 DOI: 10.1016/j.ejr.2024.01.003

Ping S. Ong , Chiew G. Khor , Sow L. Kan , Ee L. Lai , Malehah M. Noh , Shereen S. Ch'ng , Liza B. Isa , Chong H. Lim , Swee G. Ong , Cheng L. Teh , Ahmad Z. Bin Othman , Suhaida A. Maulana , Shahrul S. Shaharir , Guo R. Ling , Ruhaila Abdul Rahim , Nurulraziquin M. Jamid , Siti M. Ab Rahim , Swee M. Liau , Asmahan M. Ismail , Hwee C. Chong , Fariz Yahya

Aim of the work

To understand the clinical features, angiographic involvement patterns and outcomes of Takayasu Arteritis (TA) in Malaysian patients.

Patients and methods

This was a retrospective study of 85 TA patients from 20 tertiary rheumatology centers in Malaysia from 1990 until 2020. Demographic information, clinical features, angiographic patterns, treatment and comorbidities were analyzed.

Results

The female-to-male ratio was 13.1:1. The age at disease onset was 27.47 ± 10.4 years. The duration of delay in diagnosis was 6 ± 27.5 months. 48.2 % were Malay, 12.9 % Chinese, 23.5 % Indian and 14.3 % other ethnicities. Hypertension emerged as the most common comorbidity (52.9 %), followed by dyslipidemia (29.4 %). The most prevalent angiographic pattern was Type V (55.3 %), with left subclavian artery (65.9 %) and left carotid (55.3 %) being the most commonly involved vessels. Glucocorticoids constituted the mainstay of treatment; however, approximately half of the patients required treatment with methotrexate and azathioprine. There were six deaths, primarily attributed to coronary artery disease and infections. Surgical interventions, including angioplasty and bypass surgery, were performed on 11 patients. Out of 44 pregnancies, 79.5 % were successful.

Conclusion

This study revealed a pattern of TA disease in Malaysia that aligns with findings from other cohort studies. The most prevalent angiographic type observed was type V, with the subclavian and carotid arteries being the most commonly involved vessels among TA patients in Malaysia. This research contributes to a better understanding of the clinical presentations observed over the past three decades, offering valuable insights for the improved management of TA patients in Malaysia.

工作目的了解马来西亚患者高安动脉炎（TA）的临床特征、血管造影受累模式和预后。患者和方法这是一项回顾性研究，研究对象为马来西亚20家三级风湿病中心的85名TA患者，时间跨度从1990年至2020年。研究分析了人口统计学信息、临床特征、血管造影模式、治疗和合并症。发病年龄为（27.47 ± 10.4）岁。延迟诊断的时间为（6 ± 27.5）个月。48.2%为马来人，12.9%为华人，23.5%为印度人，14.3%为其他种族。高血压是最常见的合并症（52.9%），其次是血脂异常（29.4%）。最常见的血管造影模式是 V 型（55.3%），最常受累的血管是左锁骨下动脉（65.9%）和左颈动脉（55.3%）。糖皮质激素是主要的治疗手段，但约有一半的患者需要使用甲氨蝶呤和硫唑嘌呤。共有六例死亡病例，主要归因于冠状动脉疾病和感染。11 名患者接受了包括血管成形术和搭桥手术在内的手术治疗。这项研究揭示了马来西亚 TA 疾病的模式，与其他队列研究的结果一致。在马来西亚的TA患者中，最常见的血管造影类型是V型，锁骨下动脉和颈动脉是最常受累的血管。这项研究有助于更好地了解过去三十年中观察到的临床表现，为改善马来西亚TA患者的管理提供了宝贵的见解。

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引用次数: 0