Egyptian Rheumatologist最新文献

Background

Lupus nephritis (LN) is a common presentation for systemic lupus erythematosus (SLE) in rheumatology practice. SLE is associated with increased risk of atherosclerosis. Irisin plays a potential role in preventing atherosclerosis.

Aim of the work

This study aimed to measure serum irisin level and carotid intima media thickness (CIMT) and to unravel the possible risk factors for atherosclerosis in females with LN.

Patients and methods

This study was carried out on 55 females with LN and 55 matched controls. Laboratory investigations included urinary protein/creatinine ratio, anti-double stranded deoxyribonucleic acid (anti-ds-DNA) titre and lipid profile and carotid intima media thickness (CIMT) estimated by duplex ultrasound. The SLE disease activity index (SLEDAI) was assessed. Serum irisin level was measured by enzyme linked immunosorbent assay.

Results

CIMT was 0.8 ± 0.12 mm in cases, and serum irisin mean was 10.3 ± 3.1 ng/ml. Serum irisin significantly correlated with high density lipoprotein (HDL) (r = 0.3,p < 0.0001) and inversely with platelet count (r = -0.29, p = 0.03), anti-ds-DNA titre (r = -0.25,p = 0.05), LDL (r = -0.46,p < 0.0001) and SLEDAI (r = -0.37,p = 0.005). The CIMT significantly correlated with white blood cell count (r = 0.23,p = 0.05), platelets count (r = 0.28,p = 0.03), protein/creatinine ratio (r = 0.33,p = 0.01), anti-ds-DNA titre (r = 0.35,p = 0.007), LDL (r = 0.51,p < 0.0001) and SLEDAI (r = 0.51,p < 0.0001) and inversely with HDL (r = -0.52, p < 0.0001) and serum irisin (r = -0.47, p < 0.0001). Univariate logistic regression showed that only serum irisin level was an independent risk factor for atherosclerosis (OR = 4.5, CI = 1.5–11.1, P value 0.004).

Conclusion

Serum irisin is considered an independent risk factor for atherosclerosis in females with LN.

Aim of the work: Facial skin involvement is one of the most important features in systemic sclerosis (SSc) patients with physical, emotional and social effects. A newly developed burden of face affected (BoFA) questionnaire is available to quantify the disability associated with facial involvement in SSc patients. This study aimed to translate the BoFA questionnaire into Turkish (BoFA-T) and investigate its psychometric properties. Patients and Methods: Forty-nine SSc patients were included in the study. The translation and cross-cultural adaptation of the BoFA-T were conducted. The BoFA-T, the scleroderma mouth handicap in SSc scale (MHISS), the Rosenberg self-esteem scale (RSS), and the perceived stress scale (PSS) were applied to construct validity. The patients were re-evaluated 7 days later to assess the test–retest reliability of the BoFA-T. Results:The mean age of the 49 patients was 48.5 ± 9.97 years, age at diagnosis 40.1 ± 11.5 years,48 females and 1 male. 24 had diffuse cutaneous and 25 limited cutaneous SSc. The mean BoFA-T was 16.81 ± 22.37, MHISS was 16.93 ± 12.19, RSS was 2.04 ± 1.92 and PSS was 24.89 ± 12.31. BoFA-T has excellent internal consistency (Cronbach’s α = 0.97) and test–retest reliability (ICC = 0.94, 95 %CI = 0.88–0.97). The correlation of BoFA-T with MHISS (r = 0.56, p < 0.001), RSS (r = 0.51, p < 0.001), and PSS (r = 0.57, p < 0.001) was moderate. The BoFA-T questionnaire consists of three-factor subgroups (''self-esteem'', ''future anxiety'', and ''sexuality''), and no floor or ceiling effects were observed in relation to BoFA-T. Conclusion: The BoFA-T demonstrates appropriate psychometric properties and may be effectively utilized to assess facial involvement and disability in Turkish SSc patients.

Background

Systemic sclerosis (SSc) is an autoimmune disorder with fibrosis of the skin and internal organs. Angiotensin-converting enzyme 2 (ACE2) breaks down angiotensin II to the antifibrotic and anti-inflammatory angiotensin (1–7).

Aim of the work

To assess the serum levels of ACE2 in SSc patients and to determine the association between its levels with the clinical features and disease severity.

Patients and methods

Serum from 44 patients with SSc and 35 age and sex matched controls were assayed for ACE2 concentrations by enzyme linked immunosorbent assay. The modified Rodnan skin score (mRSS) was evaluated.

Results

Patients were 41 females and 3 males (F:M 13.7:1) with a mean age of 40.4 ± 11.3 years, and median disease duration of 5 years. Thirty-four patients had limited cutaneous SSc (lcSSc) and 10 had diffuse cutaneous SSc (dcSSc). Interstitial lung disease was present in 30 (68.2 %) patients. The median mRss was 11 (4–35). The antiscleroderma-70 and anticentromere antibodies were positive in 36.4 % and 29 %, respectively. The ACE2 level was significantly lower in SSc (1.02 ng/ml; 0.13–4.25 ng/ml) compared to control (1.57 ng/ml; 0.24–23.69 ng/ml) (p = 0.026) and in females compared to males (0.8; 0.13–4.15 ng/ml vs 3.33; 1.32–4.25 ng/ml) (p = 0.04) while the levels were comparable between lcSSc and dcSSc (p = 0.88). The level was lower in those with telangiectasia (n = 24), (p = 0.048) and in those receiving cyclophosphamide (n = 11), (p = 0.038) compared to those without. There was a non-significant correlation between ACE2 level and mRss (p = 0.16).

Conclusions

Serum ACE2 levels are decreased in patients with SSc and related to telangiectasias and the use of cyclophosphamide.

Aim of the work: To investigate the mortality risk in a random sample of community-dwelling adult Americans with rheumatoid arthritis (RA), depression, or both. Patients and methods: National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 on American adults aged 30 years and older were analyzed after linking individual participant data with mortality files from the National Death Index (NDI) up to December 31, 2019. Sociodemographic and health-related variables were accounted for in the multivariable analysis. The average duration of follow-up to mortality for participants was 9.6 years. Results: A total of 22,155 adult Americans were included in the final sample where 1,670 had RA. Females, older, widowed or divorced, and those with lower education or income levels were statistically significantly more likely to have RA. Individuals with RA were also more likely to smoke, have higher BMI, or history of hypertension, cancer, or cardiovascular diseases (CVD). In adjusted analysis, no significant difference was found for mortality between those with and without RA (HR = 1.24, 95 % CI = 0.60–2.59). However, the risk of mortality was statistically significantly higher in participants with both RA and depression (HR = 2.44, 95 %CI = 1.14–5.21). Smoking, age, and income were consistent moderators for the relationship between RA or depression and mortality. Conclusions: Depression increases the likelihood of premature mortality among those with RA. Psychotherapeutic and pharmacotherapy interventions should be implemented using collaborative and interdisciplinary care teams for those with RA and depression. Aggressive management of comorbidities and providing smoking cessation interventions are also warranted for people with both RA and depression.

Background

Fasting has been well-reported as an adjunctive therapeutic approach in some chronic pain syndromes.

Aim of the work

To study the effect of Ramadan intermittent fasting (RIF) on the severity of neuropsychiatric symptoms in patients with fibromyalgia.

Patients and methods

This prospective observational study was conducted on 130 females with primary fibromyalgia eligible to fast the first week of Ramadan. The included patients were requested to answer the Revised Fibromyalgia Impact Questionnaire twice; the first targets the last week of Shaaban, while the second targets the first week of Ramadan.

Results

The mean age of the patients was 42.3 ± 11.03 years. The percentage of patients who improved in pain scores was 47.7%, depression (58.5%) and anxiety (55.4%) after the first week of RIF. The median value for the percent of improvement in pain, depression, and anxiety scores were 20%, 25%, and 25%, respectively. On the other hand, most patients showed worsening in the scores of energy level (56.9%) and sleep quality (60%) after the first week of RIF. The median value for the percent of worsening in the energy level and sleep quality scores were 33.3% and 36.7%, respectively. The percentage of patients who showed no change in stiffness scores was 40%, memory problems (67.7%), tenderness to touch (60.8%), balance problems (88.5%), or sensitivity to loud noises, bright lights, odors, and cold (66.9%) after the first week of RIF.

Conclusion

RIF may improve pain, anxiety, and depression, while it has deleterious effects on sleep and fatigue among patients with fibromyalgia.

Aim of the work

To examine early mitigation and conservative effects of low-dose gamma radiation (LDR) or spirulina (SPR) algae on inflammation, oxidative stress and liver function in experimentally-induced arthritis in rats, and comparing such effects to conventionally used rheumatoid arthritis (RA) drugs; methotrexate (MTX) and hydroxychloroquine (HCQ) in an attempt to unleash a safer remedy/therapeutic modality for RA management.

Materials and methods

Male Wister albino rats were rendered arthritic by sub-plantar injection of 0.1 ml Freund's complete adjuvant (FCA). Adjuvant-induced arthritis (AIA) rats were treated with each of LDR (0.5 Gy at day 0 of arthritis induction), MTX (1 mg/kg/week, intra-peritoneal), HCQ sulphate (15 mg/kg/day, orally), MTX + HCQ, and SPR (1 g/kg/day, orally) for 28 days.

Results

Sub-plantar injection of FCA led to marked increase in paw volume accompanied with increased serum level of C-reactive protein (CRP) and oxidative stress markers including malondialdehyde (MDA) and nitric oxide (NO) levels. Exposure to LDR did not induce any significant alteration in the estimated parameters. Treatment with MTX and HCQ alone or combined induced deterioration in liver function (transaminases), insignificantly reduced paw edema, yet failed to attenuate CRP, MDA and NO levels. Instead, treatment with SPR significantly guarded against changes in nearly all measured parameters and kept liver function at normal level.

Conclusion

This is a leading work showing the hepato-preservative impact of spirulina as a promising alternative therapy during the course management of RA. It could thus be considered as a potential option in the management armamentarium of RA.

Aim of the work

To investigate the frequency, characteristics, and associated factors of systemic lupus erythematosus-related peripheral neuropathy (SLE-PN) using nerve conduction study (NCS).

Patients and methods

A retrospective chart review was conducted at the Rheumatology clinics of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from 2016 to 2020. Eligibility included systemic lupus erythematosus (SLE) diagnosed patients with at least one NCS result in their clinical records. Demographic, clinical, and biological characteristics were collected.

Results

Among 101 female SLE patients, abnormal NCS findings were observed in 11 (10.9%) patients. Of those with abnormal NCS, 27.3% showed mixed axonal and demyelinated motor neuropathy, 18.2% had sensory-motor axonal neuropathy, another 18.2% presented with axonal left common peroneal neuropathy, and the same percentage was observed for axonal sensory neuropathy. Comparisons between abnormal and normal NCS groups in a study population revealed that the abnormal NCS group had significantly higher proportions of non-Saudi nationality, lupus nephritis, seizures, and high SLICC DI. Furthermore, this group was associated with higher ANA titers and exhibited a non-significant trend towards increased positive anti-DNA frequency. Multivariate analysis identified non-Saudi nationality and the presence of end-organ damage as two significant predictors of SLE-related PN.

Conclusion

Peripheral neuropathy in SLE patients in Saudi Arabia is not uncommon, specifically those with heightened disease activity, organ damage, or disadvantaged socioeconomic backgrounds. Predominantly, the condition presents as axonopathy impacting sensory nerves, with possible motor involvement. The critical role of electrophysiological studies in early detection and improved patient management is high lightened.

Introduction

Seronegative spondyloarthritis (SpA) patients are at an increased risk of developing silent inflammatory bowel disease (IBD). Early diagnosis may help avoid future complications and choose the most effective treatment.

Aimof the work

to screen for silent IBD in SpA patients.

Patients and methods

This study included 41 SpA patients subjected to clinical assessment regarding gastrointestinal symptoms, laboratory data and ileo-colonoscopy with tissue histopathology.Fecal calprotectin levels were measured by enzyme linked-immunosorbant assay (ELISA). The Bath ankylosing spondylitis disease activity index (BASDAI) and psoriatic arthritis disease activity score (PASDAS) were assessed.

Results

The median age of patients was 40 years (23–58 years) with 27 males and 14 females (M: F 1.9:1); 28 had axial SpA and 13 psoriatic arthritis (PsA); 25 (61%) patients were active. Only 19.5% received non-steroidal anti-inflammatory drugs (NSAIDs) while 61% received biologics. Median fecal calprotectin was 88 mcg/g and was elevated in 71% of patients. Patients receiving biologics had significantly lower median levels of fecal calprotectin than those who did not (72.7 vs 436.7mcg/g; p = 0.012). Abnormal colonoscopy was seen in 14.6% of patients (three Crohn’s disease and three ulcerative colitis). 17 (41.5%) showed abnormal histopathology; 9 had moderate colitis and activity while five patients had moderate colitis with minimal activity. There was a significant relation between platelet count and abnormal colonoscopy findings (p = 0.01).

Conclusion

SpA patients can have macroscopic or microscopic silent IBD changes. Fecal calprotectin may be used for screening of silent IBD among those patients, however, it should be supported by ileo-colonoscopic examination and histopathological assessment.

Background

Rheumatoid arthritis (RA) is a commonly diagnosed chronic inflammatory arthritis. Bone erosion can occur early during RA and is considered as an important predictor of a severe clinical course.

Aim of the work

To assess ultrasound-detected bone erosions in RA patients and establish their associations with clinical and laboratory variables.

Patients and methods

This study included sixty RA patients. The dorsal and volar joint aspects of the wrist (midcarpal and radiocarpal joints), the first to the fifth metacarpophalangeal (MCP) and proximal interphalangeal joints were scanned in the long and short axes for synovial hypertrophy, tenosynovitis, and erosions. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP) were performed. The disease activity score (DAS28) and health assessment questionnaire (HAQ) was evaluated

Results

The mean age of the patients was 43 ± 11.04 years with median disease duration of 5 (0.1–20) years and there were 57 females. Forty-one patients had bone erosions and 19 did not. Erosions were most frequently found in the MCP joints (48.3 % of examined patients). There was no significant difference between the two groups regarding age (p = 0.36), gender (p = 1), RF (p = 0.4), and anti-CCP (p = 0.6). The bone erosion scores significantly correlated with swollen joint count (p = 0.001), tender joint count (p = 0.018), patient global health (p = 0.024), DAS28 (p = 0.003), HAQ (p = 0.032), ESR (p = 0.005), presence of synovitis (p = 0.005), and synovitis score (p < 0.001).

Conclusions

The US-detected bone erosions are predominant in RA, most frequently at the MCP joints, and are associated with disease activity, inflammatory markers, and synovitis.

Aim of the work

To evaluate the levels of serum Galactin-9 (Gal-9) in systemic lupus erythematosus (SLE) patients and to assess its association with disease activity, severity, and renal affection.

Patients and methods

The study included 50 SLE patients and 50 matched controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into active (SLEDAI > 4) and inactive (SLEDAI ≤ 4). Renal affection in SLE patients was assessed by rSLEDAI. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) was assessed.Serum Gal-9 levels were measuredby Enzyme-Linked Immunosorbent Assay (ELISA).

Results

The mean age of SLE patients was 31.1 ± 8.7 years and the majority of studied groups were females. Gal-9 was significantly higher in SLE patients in comparison to healthy control (890.1 ± 1740.4 vs. 266.8 ± 37.9 ng/L); p < 0.0001) and in active compared to inactive LN patients (1377.9 ± 2273.8 vs. 317.6 ± 40.4, P < 0.001) was detected. Serum Gal-9 correlated with anti-dsDNA positivity (r = 0.29, p = 0.04), SLEDAI (r = 0.61, p ≤ 0.0001), and rSLEDAI (r = 0.61, p ≤ 0.0001). At a cut-off value of 299 ng/l Gal-9 can significantly differentiate SLE patients from controls (AUC 0.97; p < 0.0001) at a sensitivity of 88 %, specificity of 75 %, and accuracy of 83.3 %. Gal-9 at a cut-off value 335 ng/l can significantly differentiate active from inactive SLE patients (AUC 0.94; p < 0.0001) at a sensitivity of 90 %, specificity of 84.2 %, and accuracy of 88 %. Gal-9 was significant predictor for SLE activity.

Conclusion

The serum Gal-9 levels were significantly high in SLE patients compared to healthy controls and these high levels were associated with disease activityand renal affection in SLE patients.