Egyptian Rheumatologist最新文献_第5页

Cardiac involvement in patients with polymyositis and dermatomyositis 多发性肌炎和皮肌炎患者的心脏受累

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-22 DOI: 10.1016/j.ejr.2025.04.008

Dahlia Abdel Mohsen , Nagia A Fahmy , Rasha N Thabet , Husniya M Adam , Nermeen Samy

Aim

of the work: To evaluate cardiac involvement in a cohort of idiopathic immune myopathy (IIM) patients not known to have cardiac involvement.Patients and methods: This study included 40 IIM patients. All patients underwent electrocardiography (ECG), echocardiography (ECHO) and laboratory investigations, including muscle enzymes, myositis autoantibody panel, serum troponin-I, and pro-B-type natriuretic peptide (pro-BNP). Results: Sixty-five percent of the patients were female. The mean age was 39.5 ± 15.97 years, and mean disease duration 3.2 ± 3.6 years. Palpitations and chest pain were reported in 25 % of patients, while 7.5 % had hypertension.Raynaud’swas present in 4 patients (10 %). ECG and ECHO abnormalities, primarily left ventricular hypertrophy and diastolic dysfunction, were observed in 20 % of patients. Elevated troponin-I was found in 17.5 %, and high pro-BNP levels were detected in 32.5 %. The meanejection fraction (EF%) was 66.4 ± 7.7. Patients with ECHO abnormalities were older (54.6 ± 12.4 vs 35.7 ± 14.6 years; p = 0.002), had a higher frequency of hypertension (n = 2, 25 %) vs 1, 3.1 %; p = 0.036), and were more likely to be smokers (n = 4, 50 %) vs 4, 12.5 %; p = 0.018). Troponin-I showed an inverse correlation with EF% (r = -0.32, p = 0.046) and CRP (r = -0.38,p = 0.016). Elevated serum pro-BNP was significantly associated with Raynaud’s phenomenon (p = 0.002). Conclusion: ECG and ECHO abnormalities were notably observed in IIM patients, together with elevated troponin-I and pro-BNP levels. Old age, smoking and hypertension were significantly associated with ECHO abnormalities. Troponin-I showed an inverse correlation with EF% and CRP.Initial cardiac evaluation with baseline ECG and ECHO is recommended for all IIM patients and serum troponin-I and pro-BNP may help detect subclinical cases.

工作目的：评估一组未知的特发性免疫肌病（IIM）患者的心脏受累情况。患者和方法：本研究纳入40例IIM患者。所有患者均行心电图（ECG）、超声心动图（ECHO）和实验室检查，包括肌酶、肌炎自身抗体、血清肌钙蛋白- i和b型利钠肽（bnp）。结果：65%的患者为女性。平均年龄39.5±15.97岁，平均病程3.2±3.6年。25%的患者报告心悸和胸痛，而7.5%的患者有高血压。雷诺氏病4例（10%）。心电图和回声异常，主要是左室肥厚和舒张功能障碍，在20%的患者中观察到。17.5%的人发现肌钙蛋白- i升高，32.5%的人发现亲bnp水平升高。平均射血分数（EF%）为66.4±7.7。回声异常患者年龄较大（54.6±12.4岁vs 35.7±14.6岁）；P = 0.002)，高血压发生率高于（n = 2.25% vs 1.3.1%）；P = 0.036)，更有可能成为吸烟者(n = 4.50% vs 4.12.5%；p = 0.018)。肌钙蛋白- i与EF% （r = -0.32, p = 0.046）和CRP （r = -0.38,p = 0.016）呈负相关。血清bnp前升高与雷诺现象显著相关（p = 0.002）。结论：IIM患者心电图和ECHO异常明显，肌钙蛋白- i和前bnp水平升高。老年、吸烟和高血压与ECHO异常有显著相关性。肌钙蛋白- i与EF%和CRP呈负相关。建议所有IIM患者进行基线心电图和ECHO的初始心脏评估，血清肌钙蛋白- 1和前bnp可能有助于发现亚临床病例。

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引用次数: 0

Identifying the unmet reproductive health needs for women with rheumatic diseases in Kuwait 确定科威特患有风湿性疾病的妇女未得到满足的生殖健康需求

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-17 DOI: 10.1016/j.ejr.2025.04.006

Ghaydaa Aldabie , Anwar Albasri , Mohammad Khudadah

Background

Women with rheumatic diseases (RDs) face unique challenges when it comes to family planning and pregnancy. These chronic conditions can significantly impact fertility, maternal health, and fetal outcomes.

Aim

of the work.

To better understand the specific reproductive health needs of women with RDs in Kuwait.

Patients and methods

The study was conducted in the outpatient rheumatology departments in two hospitals in Kuwait using an anonymized electronic survey. The survey consisted of 20 questions measuring patients’ demographics, rates of pregnancy counselling, and patient perceptions regarding pregnancy and breastfeeding in relation to their RD and medications. Non-pregnant females aged 21–49 with a confirmed RD diagnosis were enrolled.

Results

The mean age of the patients was 36 ± 7.5 years. Out of the 150 participants, the majority had rheumatoid arthritis (RA)(40 %) or systemic lupus erythematosus (SLE)(37.3 %). Half of the respondents were hoping to get pregnant in the future. About 63.3 % were advised about the importance of controlling their disease before pregnancy, but only 26 % had received guidance on contraception from their rheumatologists (regardless of their disease activity or treatment, including teratogenic medications). Many expressed a willingness to continue their rheumatic medications during pregnancy (64.7 %) and breastfeeding (57.3 %) if they were deemed safe. 57.5 % of patients were counselled regarding the need for regular antenatal follow-up once pregnancy is confirmed.

Conclusion

Significant gaps in the reproductive health counselling for women with RDs in Kuwait are revealed. Further research is needed to understand the barriers that prevent rheumatologists from providing this important guidance to their patients.

患有风湿性疾病的女性在计划生育和怀孕方面面临着独特的挑战。这些慢性疾病会严重影响生育能力、孕产妇健康和胎儿结局。工作的目的。更好地了解科威特患有rd的妇女的具体生殖健康需求。患者和方法本研究在科威特两家医院的风湿病门诊进行，采用匿名电子调查。该调查包括20个问题，测量患者的人口统计数据，妊娠咨询率，以及患者对妊娠和母乳喂养与RD和药物相关的看法。年龄21-49岁确诊RD的未怀孕女性被纳入研究。结果患者平均年龄36±7.5岁。在150名参与者中，大多数患有类风湿性关节炎（RA）（40%）或系统性红斑狼疮（SLE）（37.3%）。一半的受访者希望在未来怀孕。约63.3%的人在怀孕前被告知控制疾病的重要性，但只有26%的人从他们的风湿病学家那里获得了避孕指导（无论他们的疾病活动或治疗，包括致畸药物）。许多人表示愿意在怀孕期间（64.7%）和哺乳期间（57.3%）继续使用风湿病药物，如果它们被认为是安全的。57.5%的患者被告知，一旦确认怀孕，需要定期进行产前随访。结论科威特妇女生殖健康咨询存在较大差距。需要进一步的研究来了解阻止风湿病学家向患者提供这一重要指导的障碍。

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引用次数: 0

Effect of probiotic supplementation on disease activity in rheumatoid arthritis patients 补充益生菌对类风湿关节炎患者疾病活动性的影响

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-16 DOI: 10.1016/j.ejr.2025.04.009

Ahmed A. Khalifa, Sabrina M. Hany, Nashwa A. Morshedy, Adel M. Elsayed

Background

Rheumatoid arthritis (RA) is the most prevalent inflammatory arthritis. Alterations in the typical gastrointestinal microflora and dysregulation of the mucosal immune response to these pathogens may contribute to autoimmune diseases like RA. Aim of the work: To assess the effects of probiotic supplementation on the clinical status and disease activity of patients with RA.

Patients and methods

This randomized clinical trial was conducted on 60 RA patients receiving methotrexate (MTX); 30 patients also received 1 daily capsule of probiotic (Group A), and the other 30 were on MTX only (Group B). Disease activity score (DAS28), clinical disease activity index (CDAI); and simplified disease activity index (SDAI) were assessed.

Results

The mean age of the patients was 44.7 ± 9.3 years; they were 51 females and 9 males with a median disease duration of 7 (4.5–14.5) years. Following an eight-week intervention, the ESR significantly decreased in both groups (Group A: 48.6 ± 21.7 to 42.9 ± 23.2; p = 0.01 and (Group B: 45.5 ± 17.1 to 37.6 ± 15.3; p < 0.0001). The median tender joint count (TJC) and swollen joint count significantly decreased in group A (10 to 8; p < 0.0001 and 4 to 2; p < 0.0001, respectively). The reduction in median TJC was significantly greater in group A compared to group B (−2 vs 0; p = 0.01). No significant changes in activity scores were observed in either group following the intervention.

Conclusion

The use of probiotic therapy has no clear benefit as an add-on therapy to the standard of care in patients with RA. However, a notable improvement in TJC was observed, suggesting a potential avenue for future research.

背景类风湿性关节炎（RA）是最常见的炎症性关节炎。典型胃肠道微生物菌群的改变以及粘膜对这些病原体的免疫反应失调可能会导致类风湿性关节炎等自身免疫性疾病。工作目标患者和方法这项随机临床试验针对60名接受甲氨蝶呤（MTX）治疗的RA患者，其中30名患者每天服用一粒益生菌胶囊（A组），另外30名患者只服用MTX（B组）。结果患者的平均年龄为（44.7 ± 9.3）岁，其中女性 51 人，男性 9 人，中位病程为 7（4.5-14.5）年。经过八周的干预，两组患者的血沉均明显下降（A 组：48.6 ± 21.7 降至 42.9 ± 23.2；P = 0.01；B 组：45.5 ± 17.1 降至 37.6 ± 15.3；P < 0.0001）。A 组的关节压痛计数（TJC）和关节肿胀计数中位数显著下降（分别为 10 降至 8；p < 0.0001 和 4 降至 2；p < 0.0001）。与 B 组相比，A 组 TJC 中位数的下降幅度明显更大（-2 vs 0; p = 0.01）。结论：使用益生菌疗法作为 RA 患者标准治疗的附加疗法并无明显益处。但是，观察到TJC有明显改善，这为今后的研究提供了潜在的途径。

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引用次数: 0

Cognitive function impairment in patients with antiphospholipid syndrome: Association with clinical, laboratory and brain magnetic resonance imaging findings 抗磷脂综合征患者的认知功能障碍：与临床、实验室和脑磁共振成像结果的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-14 DOI: 10.1016/j.ejr.2025.04.005

Noha A. Azab , Esraa Soliman , Nehal Mostafa , Doaa A. Teleb

Background

Cognitive dysfunction is frequent in patients with antiphospholipid syndrome (APS) although not included in the classification criteria.

Aim of the work

To assess the cognitive function in APS patients and to study any relation to clinical, laboratory and brain magnetic resonance imaging (MRI) findings.

Patients and methods

This study was conducted on 113 patients: 30 with primary APS, 44 secondary APS and 39 systemic lupus erythematosus (SLE) patients without APS. Cognitive function was assessed using Mini-Mental State Examination (MMSE) and Montreal cognitive assessment-Basic (MOCA-B). APS clinical manifestations, disease damage indices, APS immunological profile and MRI abnormalities were recorded.

Results

Of the 74 APS patients, 70 (94.6 %) were females. Their mean age was 32.3 ± 8 years and mean disease duration was 9.4 ± 5.9 years. Cognitive impairment was significantly higher in APS patients (n = 44, 59.9 %) than in SLE patients without APS (n = 2, 5.1 %) when assessed by MOCA-B (p < 0.001). There was no significant difference between primary and secondary APS subtypes as regards cognitive impairment assessed by MMSE (0 vs 3) and MOCA-B (17 vs 27p = 0.81). The presence of cognitive impairment was associated with neuropsychiatric manifestations (p < 0.0001); seizures (p = 0.01), TIAs (p = 0.04), migraine/headache (p = 0.03), ACL (p = 0.02), anti-β2GP (p < 0.001), triple positivity of APL (p = 0.002), abnormal brain MRI (p = 0.002) and brain infarcts. A significant negative correlation was found between MOCA-B and cumulative damage of APS (r = 0.5, p < 0.001).

Conclusion

Cognitive impairment was detected in APS patients especially those with neuropsychiatric manifestations, positive ACL, anti- β2GP and triple positivity of APL or abnormal brain MRI.

背景：认知功能障碍在抗磷脂综合征（APS）患者中很常见，但不包括在分类标准中。目的评估APS患者的认知功能，并研究其与临床、实验室和脑磁共振成像（MRI）结果的关系。患者与方法本研究共纳入113例患者，其中原发性APS患者30例，继发性APS患者44例，无APS的系统性红斑狼疮（SLE）患者39例。认知功能评估采用简易精神状态检查（MMSE）和蒙特利尔认知评估-基本（MOCA-B）。记录APS临床表现、疾病损害指标、APS免疫学特征及MRI异常。结果74例APS患者中，女性70例（94.6%）。平均年龄32.3±8岁，平均病程9.4±5.9年。经MOCA-B评估，APS患者的认知功能障碍（n = 44, 59.9%）明显高于无APS的SLE患者（n = 2, 5.1%） (p <；0.001)。在MMSE （0 vs 3）和MOCA-B （17 vs 27p = 0.81）评估的认知障碍方面，原发性和继发性APS亚型之间无显著差异。认知障碍的存在与神经精神表现相关(p <；0.0001);发作(p = 0.01), tia (p = 0.04),偏头痛、头痛(p = 0.03), ACL (p = 0.02),反-β2 gp (p & lt;0.001)， APL三阳性（p = 0.002），脑MRI异常（p = 0.002）和脑梗死。MOCA-B与APS累积损伤呈显著负相关(r = 0.5, p <；0.001)。结论APS患者存在认知功能障碍，尤其是有神经精神表现、ACL阳性、抗β2GP、APL三重阳性或脑MRI异常的患者。

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引用次数: 0

Fractional excretion ratio of activated leukocyte cell adhesion molecule (ALCAM) as a potential biomarker in lupus nephritis patients 活化白细胞粘附分子（ALCAM）分数排泄比作为狼疮肾炎患者潜在的生物标志物

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-12 DOI: 10.1016/j.ejr.2025.04.003

Mona I. Nabih , Dina Mahmoud , Marwa A. Mohamed , Mohamed H. Tarabay , Sarah A. Hassan

Aim of the work

To investigate the use of fractional excretion ratio (FE) of activated leukocyte cell adhesion molecule (ALCAM) in patients with lupus nephritis (LN) and whether, in comparison to the absolute urine levels, they demonstrate improved diagnostic performance.

Patients and methods

42 systemic lupus erythematosus (SLE) patients; Group 1: 14 inactive SLE patients, Group 2: 14 active non-renal SLE, Group 3: 14 active lupus nephritis. All participants were evaluated as regards the following: Thorough medical history and clinical evaluation, disease activity and renal activity assessment using the SLE disease activity index 2000 (SLEDAI-2 K), LN histological class, activity and chronicity index were evaluated using International Society of Nephrology/Renal Pathology Society Criteria (ISN/RPS). Serum and urine ALCAM levels were assayed using ELISA. FE ratio was calculated as follows: (urinary biomarker/urinary creatinine)/ (serum biomarker/serum creatinine).

Results

The mean age of the patients was 26.6 ± 10.4 years and were 36 females and 6 males (F:M 6:1). Groups were comparable for age (p = 0.65) and gender (p = 1). Active LN patients had a greater FE of ALCAM (0.08 ± 0.04) compared to inactive (0.01 ± 0.01) and active non-renal (0.02 ± 0.02) (p < 0.001). FE significantly correlated with 24-hour urinary proteins (r = 0.67, p < 0.001), erythrocyte sedimentation rate (r = 0.51, p < 0.001) and SLEDAI-2 K (r = 0.71, p < 0.001), negatively with both C3 and C4 (r = -0.52 and r = -0.56, p < 0.001) and with hemoglobin (p = 0.008). They had 100 % sensitivity and 92.2 % specificity for detection of active LN.

Conclusion

The FE ratio provides a potentially diagnostic value in LN assessment, since the FE of ALCAM performed better in active LN and is significantly related to the disease activity.

目的探讨活化白细胞粘附分子（ALCAM）分数排泄比（FE）在狼疮性肾炎（LN）患者中的应用，以及与绝对尿水平相比，它们是否显示出更高的诊断性能。患者与方法系统性红斑狼疮（SLE）患者42例；组1：非活动性SLE 14例，组2：活动性非肾性SLE 14例，组3：活动性狼疮性肾炎14例。对所有参与者进行以下评估：全面的病史和临床评估，使用SLE疾病活动指数2000 （SLEDAI-2 K）进行疾病活动性和肾脏活动评估，使用国际肾脏病学会/肾脏病理学会标准（ISN/RPS）评估LN组织学分级、活动性和慢性指数。ELISA法检测血清和尿液ALCAM水平。FE比值计算公式为：（尿生物标志物/尿肌酐）/（血清生物标志物/血清肌酐）。结果患者平均年龄26.6±10.4岁，女性36例，男性6例（男女比例为6:1）。各组在年龄（p = 0.65）和性别（p = 1）上具有可比性。活动性LN患者的ALCAM FE（0.08±0.04）高于不活动性LN患者（0.01±0.01）和活动性非肾性LN患者（0.02±0.02）(p <；0.001)。FE与24小时尿蛋白显著相关(r = 0.67, p <；0.001)，红细胞沉降率(r = 0.51, p <；0.001)和SLEDAI-2 K (r = 0.71, p <；0.001)， C3和C4呈负相关(r = -0.52和r = -0.56, p <；血红蛋白（p = 0.008）。检测活动性LN的灵敏度为100%，特异性为92.2%。结论FE比值在LN评估中具有潜在的诊断价值，因为ALCAM的FE在活动性LN中表现更好，并且与疾病活动性显著相关。

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引用次数: 0

Sleep, depression, anxiety and quality of life in patients with systemic lupus erythematosus 系统性红斑狼疮患者的睡眠、抑郁、焦虑和生活质量

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-12 DOI: 10.1016/j.ejr.2025.04.001

Leonardo W. Franco, Isabela S. Bauer, Thiago A.F.G. dos Santos, Renato Nisihara, Thelma L. Skare

Aim of the work

To study the frequency of sleep quality in a cohort of Brazilian Systemic lupus erythematosus (SLE) patients and to investigate its associations with clinical characteristics, disease activity, mood disorders (anxiety and depression) and quality of life (QoL).

Patients and methods

A sample of 59 SLE patients and 76 controls answered the Pittsburg Sleep Quality Index (PSQI), Center for epidemiological studies-depression (CES-D) questionnaire, Hamilton rating scale for anxiety (HAM-A), and the 12-item short form (SF-12) survey for QoL. Clinical characteristics, SLEDAI (SLE disease activity index) and comorbidities were recorded.

Results

The mean age of the patients was 42.3 ± 12.6 years and 55 were females (F:M 13.8:1). 62.7 % were Caucasian, 23.7 % were tobacco exposed, 30.5 % hypertensive, 22 % had dyslipidemia, 16.9 % hypothyroid and 10.1 % diabetic. The median SLEDAI was 0 (0–2), CES-D 17 (14–25), HAM-A 20.6 ± 10.2, SF-12 physical component was 38.4 (30.1–52.2) and mental 42.4 ± 12.3. 78.2 % (43/59) of patients were poor sleepers vs 50 % (38/76) of controls (p = 0.01). PSQI correlated with HAM-A (p = 0.0006), CES-D (p = 0.0005) and SF-12 (both components: mental p = 0.009 and physical p = 0.004) but not with SLEDAI (p = 0.25). Regarding Pittsburg domains, a significant correlation was found with between HMA-A and subjective sleep (r = 0.38; p = 0.03), sleep disturbances (r = 0.44 and p = 0.0004) and daytime dysfunction (r = 0.48; p = 0.0005) and between CES-D and sleep latency (r = 0.38; p = 0.02), sleep disturbances (r = 0.3; p = 0.01) and day time dysfunction (r = 0.5; p < 0.0001).

Conclusion

There is a high frequency of sleep disturbances in the SLE group that was worse in individuals with depression and anxiety, suggesting a reduction in QoL.

研究巴西系统性红斑狼疮（SLE）患者的睡眠质量频率，并探讨其与临床特征、疾病活动性、情绪障碍（焦虑和抑郁）和生活质量（QoL）的关系。59例SLE患者和76例对照者分别填写了匹兹堡睡眠质量指数（PSQI）、流行病学研究中心抑郁问卷（CES-D）、汉密尔顿焦虑量表（HAM-A）和生活质量问卷（SF-12）。记录临床特征、SLE疾病活动指数（SLEDAI）及合并症。结果患者平均年龄42.3±12.6岁，女性55例（男13.8:1）。白人占62.7%，吸烟占23.7%，高血压占30.5%，血脂异常占22%，甲状腺功能减退占16.9%，糖尿病占10.1%。中位SLEDAI为0 (0 - 2)，CES-D为17 (14-25)，HAM-A为20.6±10.2，SF-12生理评分为38.4(30.1-52.2)，心理评分为42.4±12.3。78.2%（43/59）的患者睡眠质量较差，对照组为50% (38/76)（p = 0.01）。PSQI与HAM-A （p = 0.0006）、CES-D （p = 0.0005）和SF-12（心理p = 0.009，生理p = 0.004）相关，但与SLEDAI无关（p = 0.25）。在匹兹堡域，HMA-A与主观睡眠之间存在显著相关(r = 0.38；P = 0.03)、睡眠障碍（r = 0.44和P = 0.0004）和白天功能障碍(r = 0.48；p = 0.0005)， ses - d与睡眠潜伏期之间(r = 0.38；P = 0.02)，睡眠障碍(r = 0.3；P = 0.01)和日间功能障碍(r = 0.5；p & lt;0.0001)。结论SLE患者睡眠障碍发生率高，且伴抑郁和焦虑的患者睡眠障碍发生率更低，提示SLE患者生活质量降低。

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引用次数: 0

Distinct capillaroscopic findings in a patient with systemic sclerosis: Possible association with a benign disease course 系统性硬化症患者的独特毛细血管镜检查结果：可能与良性病程有关

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-12 DOI: 10.1016/j.ejr.2025.04.002

Angelo Nigro , Dell’Edera Domenico , Nicoletti Giuseppe

Background

Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular abnormalities and fibrosis. Capillaroscopy is a key tool for assessing microvascular changes in SSc, often revealing characteristic patterns with prognostic significance. While the presence of a “scleroderma pattern” is well-documented, its localization to a single digit without systemic involvement is an unusual finding.

Aim of the work

This report highlights a unique capillaroscopic presentation in a patient with anti-centromere antibody-positive SSc, emphasizing its potential prognostic significance.

Case report

A 66-year-old Caucasian female was diagnosed with anti-centromere antibody-positive SSc six years ago. The diagnosis was supported by ANA positivity (1:1280, centromeric pattern), Raynaud’s phenomenon, and transient hand edema. Capillaroscopic examination revealed a “scleroderma pattern” with prominent megacapillaries exclusively on the second finger of the right hand, with no microhemorrhages. The remaining fingers showed a non-specific capillaroscopic pattern. Clinically, the patient has a benign disease course, with no skin sclerosis, digital ulcers, or systemic involvement.

Conclusion

This case highlights the relevance of localized capillaroscopic abnormalities in SSc. The absence of systemic involvement despite the capillaroscopic findings raises questions about their prognostic significance. Further research is needed to clarify their implications.

背景：系统性硬化症（SSc）是一种以血管异常和纤维化为特征的自身免疫性疾病。毛细管镜检查是评估SSc微血管变化的关键工具，通常可以揭示具有预后意义的特征性模式。虽然“硬皮病模式”的存在是有案可查的，但其定位于单指而不累及全身是一种不寻常的发现。本报告强调了抗着丝粒抗体阳性SSc患者的独特毛细血管镜表现，强调了其潜在的预后意义。病例报告一名66岁的白人女性在6年前被诊断为抗着丝粒抗体阳性的SSc。ANA阳性（1:1280，着丝点型）、雷诺现象和短暂性手部水肿支持诊断。毛细血管镜检查显示“硬皮病型”，仅在右手食指有明显的大毛细血管，未见微出血。其余手指显示非特异性毛细血管镜模式。临床表现为良性病程，无皮肤硬化、指部溃疡或全身受累。结论本病例强调了SSc的局限性毛细血管镜异常的相关性。尽管有毛细血管镜检查结果，但没有全身性累及，这引起了对其预后意义的质疑。需要进一步的研究来澄清它们的含义。

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引用次数: 0

The relation between rheumatoid arthritis activity and dry eye disease 类风湿关节炎活动性与干眼症的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-10 DOI: 10.1016/j.ejr.2025.04.004

Salma A. Khalil , Mahmoud A. Shafeek , Nouran M. Bahig Elmihi , Samar H. Hussein , Ayah Abdel-Zaher

Aim of the work

To investigate the relationship between dry eye disease severity and disease activity in patients with rheumatoid arthritis (RA), emphasizing the role of non-contact meibography.

Patients and methods

A total of 40 patients with RA were enrolled. The disease activity score (DAS28) was assessed. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) titer, anti-cyclic citrullinated peptide (anti-CCP) titer, anti-SSA (anti-Ro) and anti-SSB (anti-La) antibodies were measured. Ophthalmological evaluations included the ocular surface disease index (OSDI) questionnaire, non-contact meibography scan, tear breakup time test (TBUT), and tear meniscus height (TMH).

Results

The patients’ age was 41.6 ± 8.2 years; 31 were females Patients with moderately and severely active RA exhibited significantly higher total meiboscore (3.4 ± 0.7 and 4.5 ± 0.5 respectively) than those in remission or with low disease activity (2.3 ± 0.5 and 2.6 ± 0.8 respectively) (p < 0.001). Similar results were noted on comparing TBUT (p = 0.01) and TMH (p = 023). There was no significant difference regarding dry eye symptomatology (p = 0.337). Total meiboscore significantly correlated with age (r = 0.36,p = 0.021), disease duration (r = 0.44,p = 0.005), DAS28-ESR (r = 0.82,p < 0.001), ESR (r = 0.68,p < 0.001), CRP (r = 0.53,p < 0.001), and RF titer (r = 0.52,p < 0.001). On linear regression, only DAS28 could predict the total meiboscore. An increase in DAS28 by one unit was associated with increase of total meiboscore by 0.5 with 95 %CI 0.35–0.64.

Conclusion

Rheumatoid arthritis patients with more active disease and prolonged duration of illness should be closely monitored for development of dry eye disease. Non-contact meibography is a valuable and innovative modality for evaluating meibomian gland dysfunction in RA patients, providing objective measurement of dry eye parameters.

目的探讨类风湿关节炎（RA）患者干眼症严重程度与疾病活动度的关系，强调非接触式meibography的作用。患者和方法共纳入40例RA患者。评估疾病活动度评分（DAS28）。测定红细胞沉降率（ESR）、c反应蛋白（CRP）、类风湿因子（RF）滴度、抗环瓜氨酸肽（抗ccp）滴度、抗ssa（抗ro）和抗ssb（抗la）抗体。眼科检查包括眼表疾病指数（OSDI）问卷、非接触性meibography扫描、泪液破裂时间测试（TBUT）和泪液半月板高度（TMH）。结果患者年龄为41.6±8.2岁；中度和重度活动性RA患者的总meiboscore（分别为3.4±0.7和4.5±0.5）明显高于缓解期或低活动性RA患者（分别为2.3±0.5和2.6±0.8）(p <；0.001)。TBUT （p = 0.01）与TMH （p = 023）比较结果相似。两组干眼症状差异无统计学意义（p = 0.337）。总meiboscore与年龄（r = 0.36,p = 0.021）、病程（r = 0.44,p = 0.005）、DAS28-ESR (r = 0.82,p <；0.001), ESR (r = 0.68,p <；0.001), CRP (r = 0.53,p <；0.001)，射频滴度(r = 0.52,p <；0.001)。在线性回归中，只有DAS28能够预测总meiboscore。DAS28每增加一个单位与总meiboscore增加0.5相关，95% CI为0.35-0.64。结论类风湿关节炎患者病情活动度高，病程长，应密切监测其干眼病的发展情况。非接触式睑板造影是评估RA患者睑板腺功能障碍的一种有价值的创新方式，它提供了干眼参数的客观测量。

{"title":"The relation between rheumatoid arthritis activity and dry eye disease","authors":"Salma A. Khalil , Mahmoud A. Shafeek , Nouran M. Bahig Elmihi , Samar H. Hussein , Ayah Abdel-Zaher","doi":"10.1016/j.ejr.2025.04.004","DOIUrl":"10.1016/j.ejr.2025.04.004","url":null,"abstract":"<div><h3>Aim of the work</h3><div>To investigate the relationship between dry eye disease severity and disease activity in patients with rheumatoid arthritis (RA), emphasizing the role of non-contact meibography.</div></div><div><h3>Patients and methods</h3><div>A total of 40 patients with RA were enrolled. The disease activity score (DAS28) was assessed. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) titer, anti-cyclic citrullinated peptide (anti-CCP) titer, anti-SSA (anti-Ro) and anti-SSB (anti-La) antibodies were measured. Ophthalmological evaluations included the ocular surface disease index (OSDI) questionnaire, non-contact meibography scan, tear breakup time test (TBUT), and tear meniscus height (TMH).</div></div><div><h3>Results</h3><div>The patients’ age was 41.6 ± 8.2 years; 31 were females Patients with moderately and severely active RA exhibited significantly higher total meiboscore (3.4 ± 0.7 and 4.5 ± 0.5 respectively) than those in remission or with low disease activity (2.3 ± 0.5 and 2.6 ± 0.8 respectively) (p < 0.001). Similar results were noted on comparing TBUT (p = 0.01) and TMH (p = 023). There was no significant difference regarding dry eye symptomatology (p = 0.337). Total meiboscore significantly correlated with age (r = 0.36,p = 0.021), disease duration (r = 0.44,p = 0.005), DAS28-ESR (r = 0.82,p < 0.001), ESR (r = 0.68,p < 0.001), CRP (r = 0.53,p < 0.001), and RF titer (r = 0.52,p < 0.001). On linear regression, only DAS28 could predict the total meiboscore. An increase in DAS28 by one unit was associated with increase of total meiboscore by 0.5 with 95 %CI 0.35–0.64.</div></div><div><h3>Conclusion</h3><div>Rheumatoid arthritis patients with more active disease and prolonged duration of illness should be closely monitored for development of dry eye disease. Non-contact meibography is a valuable and innovative modality for evaluating meibomian gland dysfunction in RA patients, providing objective measurement of dry eye parameters.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"47 3","pages":"Pages 117-121"},"PeriodicalIF":1.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807838","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, immunological features and relation to clinical phenotypes in patients with antiphospholipid syndrome 抗磷脂综合征患者的临床、免疫学特征及其与临床表型的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-04-08 DOI: 10.1016/j.ejr.2025.03.001

Adel M. Ali , Eman A. Hafez , Shafica I. Ibrahim , Mahmoud F. Mahmoud , Noha H. Shedid

Aim of the work

To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a cohort of patients and to evaluate the possible clinical-immunologic association of individual antiphospholipid antibodies (aPL) with clinical phenotypes.

Patients and methods

The clinical and immunologic features of APS in 70 patients (17 with primary and 53 with secondary APS) were analyzed. The association between the different aPL and APS clinical phenotypes (venous thrombosis, arterial thrombosis, obstetric morbidity, thrombocytopenia, livedo reticularis) was investigated.

Results

The APS patients were 63 (90%) females, with a mean age of 28.6±6.9 years and a mean disease duration of 3.1±2.6 years. Of the females only 55 were pregnant. Obstetric morbidity was the most common clinical manifestation (87.2%), particularly late fetal death (54.6%), followed by deep venous thrombosis (48.6%), constitutional manifestations (48.6%), thrombocytopenia (24.3%), stroke (15.7%) and livedo reticularis (15.7%). Anticardiolipin (ACL) antibodies were the most common aPL detected (82.9 %). Patients with primary APS had significantly more frequent late abortion/stillbirth (76.5% vs. 44.7%, p= 0.03) compared to secondary APS patients. Lupus anticoagulant (LA) and anti-β2 glycoprotein-I antibodies were significantly associated with arterial thrombosis (p= 0.009 and p< 0.001, respectively), thrombocytopenia (p= 0.01 and p= 0.02, respectively) and livedo reticularis (p= 0.02 and p< 0.001, respectively), while only LA was significantly associated with obstetric complications (p= 0.004). Triple aPL positivity was significantly associated with arterial thrombotic events (p< 0.001) and obstetric complications (p= 0.01).

Conclusion

Patients with APS demonstrated a high frequency of pregnancy complications. Detection of aPL may help in the identification of different clinical phenotypes in APS.

目的分析一组抗磷脂综合征（APS）患者的临床和免疫学表现，并评价个体抗磷脂抗体（aPL）与临床表型之间可能的临床-免疫学关联。患者与方法分析70例APS患者（17例为原发性APS， 53例为继发性APS）的临床及免疫学特征。研究了不同aPL与APS临床表型（静脉血栓形成、动脉血栓形成、产科发病率、血小板减少症、网状活动性）之间的关系。结果APS患者中女性63例（90%），平均年龄28.6±6.9岁，平均病程3.1±2.6年。雌性中只有55只怀孕了。产科发病是最常见的临床表现（87.2%），尤其是晚期胎儿死亡（54.6%），其次是深静脉血栓形成（48.6%）、体质表现（48.6%）、血小板减少（24.3%）、脑卒中（15.7%）和网状纤维化（15.7%）。抗心磷脂（ACL）抗体是最常见的aPL（82.9%）。与继发性APS患者相比，原发性APS患者晚期流产/死产的发生率明显更高（76.5% vs. 44.7%, p= 0.03）。狼疮抗凝血剂（LA）和抗β2糖蛋白- 1抗体与动脉血栓形成显著相关(p= 0.009, p= 0.009；血小板减少症（p= 0.01和p= 0.02）和网状活线虫(p= 0.02和p= lt；分别为0.001)，而只有LA与产科并发症显著相关（p= 0.004）。三重aPL阳性与动脉血栓事件显著相关(p<；0.001)和产科并发症（p= 0.01）。结论APS患者妊娠并发症发生率高。检测aPL可能有助于鉴别APS的不同临床表型。

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引用次数: 0

Understanding fibromyalgia: A comprehensive review of the literature 理解纤维肌痛：文献综述

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2025-02-17 DOI: 10.1016/j.ejr.2025.02.001

Nora Y. Elsaid

Background

Fibromyalgia (FM) is a complex and debilitating chronic pain condition affecting millions of people worldwide. It is characterized by widespread musculoskeletal pain often accompanied by fatigue, cognitive dysfunction, sleep disturbance, psychiatric issues, and various somatic symptoms. It is more prevalent in women between 30 and 60 years.

Aim of the work

To provide a comprehensive overview on FM, covering its pathophysiology, diagnostic criteria, the role of artificial intelligence (AI), and available treatment options.

Review

The pathophysiology of FM remains poorly understood and may involve a combination of genetic, environmental, and psychological factors that lead to abnormal pain processing in the central nervous system. Diagnosis is primarily clinical after exclusion of other conditions. The overlap between FM, chronic pain syndromes and post-coronavirus disease 2019 (COVID-19) syndrome or “long COVID-19” is still debatable. Till now there have been no definitive laboratory tests or imaging studies to diagnose FM. Management, often a multidisciplinary approach, includes pharmacological treatments, physical therapy, cognitive-behavioral therapy, and lifestyle modifications such as exercise and stress management techniques. The adoption of AI in its diagnosis and management is a new area of interest in FM. Ongoing research is focused on elucidating the pathophysiological mechanisms underlying FM and developing innovative therapeutic strategies.

Conclusion

This review highlights the importance of a multidimensional approach to FM management, including pharmacological interventions, non-pharmacological therapies, and psychological support. Furthermore, it urges the need for further research to unravel the underlying mechanisms contributing to FM, to improve the diagnosis and management of this challenging condition.

纤维肌痛（FM）是一种复杂的、使人衰弱的慢性疼痛状况，影响着全世界数百万人。其特征是广泛的肌肉骨骼疼痛，常伴有疲劳、认知功能障碍、睡眠障碍、精神问题和各种躯体症状。它在30至60岁的女性中更为普遍。提供FM的全面概述，包括其病理生理学，诊断标准，人工智能（AI）的作用，以及可用的治疗方案。FM的病理生理学仍然知之甚少，可能涉及遗传、环境和心理因素的组合，导致中枢神经系统异常的疼痛处理。排除其他情况后，诊断主要是临床诊断。FM、慢性疼痛综合征和2019冠状病毒后疾病（COVID-19）综合征或“长型COVID-19”之间的重叠仍然存在争议。到目前为止，还没有明确的实验室测试或影像学研究来诊断FM。管理，通常是一个多学科的方法，包括药物治疗，物理治疗，认知行为治疗，和生活方式的改变，如运动和压力管理技术。人工智能在其诊断和管理中的应用是FM的一个新领域。目前的研究主要集中在阐明FM的病理生理机制和开发创新的治疗策略。结论本综述强调了从多方面进行FM治疗的重要性，包括药物干预、非药物治疗和心理支持。此外，它敦促需要进一步的研究来揭示导致FM的潜在机制，以改善这一具有挑战性的疾病的诊断和管理。

{"title":"Understanding fibromyalgia: A comprehensive review of the literature","authors":"Nora Y. Elsaid","doi":"10.1016/j.ejr.2025.02.001","DOIUrl":"10.1016/j.ejr.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia (FM) is a complex and debilitating chronic pain condition affecting millions of people worldwide. It is characterized by widespread musculoskeletal pain often accompanied by fatigue, cognitive dysfunction, sleep disturbance, psychiatric issues, and various somatic symptoms. It is more prevalent in women between 30 and 60 years.</div></div><div><h3>Aim of the work</h3><div>To provide a comprehensive overview on FM, covering its pathophysiology, diagnostic criteria, the role of artificial intelligence (AI), and available treatment options.</div></div><div><h3>Review</h3><div>The <em>pathophysiology</em> of FM remains poorly understood and may involve a combination of genetic, environmental, and psychological factors that lead to abnormal pain processing in the central nervous system. <em>Diagnosis</em> is primarily clinical after exclusion of other conditions. The overlap between FM, chronic pain syndromes and post-coronavirus disease 2019 (COVID-19) syndrome or “long COVID-19” is still debatable. Till now there have been no definitive laboratory tests or imaging studies to diagnose FM. <em>Management</em>, often a multidisciplinary approach, includes pharmacological treatments, physical therapy, cognitive-behavioral therapy, and lifestyle modifications such as exercise and stress management techniques. The adoption of AI in its diagnosis and management is a new area of interest in FM. Ongoing research is focused on elucidating the pathophysiological mechanisms underlying FM and developing innovative therapeutic strategies.</div></div><div><h3>Conclusion</h3><div>This review highlights the importance of a multidimensional approach to FM management, including pharmacological interventions, non-pharmacological therapies, and psychological support. Furthermore, it urges the need for further research to unravel the underlying mechanisms contributing to FM, to improve the diagnosis and management of this challenging condition.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"47 2","pages":"Pages 90-97"},"PeriodicalIF":1.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422421","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