Egyptian Rheumatologist最新文献_第7页

Renal remission status and long-term renal survival in lupus nephritis patients 狼疮性肾炎患者的肾功能缓解状态和长期肾功能存活率

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-11-28 DOI: 10.1016/j.ejr.2024.11.001

Rasha Gheith, Aya Embaby, Soha Abu Raya

Aim of the work

To compare long-term renal survival in lupus nephritis (LN) patients who achieved complete (CR), partial (PR), or no remission following LN induction therapy.

Patients and methods

Eligible patients with biopsy-proven LN were categorized into ordinal (CR, PR, or no remission) or binary (remission or no remission) at 6, 12, 24, 36 months post diagnosis according to modified Aspreva Lupus Management Study (mALMS) criteria. The primary endpoint was long-term renal survival.

Results

The study included 161 patients with LN, with a mean age 36.3 ± 8.2 years, age at biopsy 26.2 ± 7.4 years; 146 females and 15 males (F:M 9.3:1). All patients received induction therapy 6 months before or after biopsy with follow up duration ≥3 years. 114 (70.8 %) patients achieved long term survival, while 47 (29.2 %) ended up with end-stage renal disease (ESRD). Those with CR were more likely to have long-term survival (p < 0.001). A significant relation was found between maintenance therapies at different time points in those receiving azathioprine (AZA) (p = 0.002, p = 0.011, p = 0.016 and p = 0.003 respectively), as well as hydroxychloroquine (HCQ) (p < 0.003, p < 0.001, p = 0.011, p < 0.001 and p < 0.001 respectively) with long term survival. Cardiovascular and neuropsychiatric manifestations were significantly associated with ESRD/mortality (p = 0.003 and p = 0.002 respectively). The most significant predictor of long-term survival was complete remission at 6 months (β-3.745, p = 0.025).

Conclusion

In LN, renal remission was significantly associated with long term renal survival. Receiving AZA and HCQ have a significant association and CR at 6 months was the best predictor for long-term survival in LN patients.

患者和方法根据改良阿斯普雷瓦狼疮管理研究（mALMS）标准，在确诊后6、12、24、36个月将活检证实的符合条件的狼疮肾炎（LN）患者分为顺序型（CR、PR或无缓解）或二元型（缓解或无缓解）。研究纳入了161名LN患者，平均年龄（36.3±8.2）岁，活检年龄（26.2±7.4）岁；女性146人，男性15人（女：男9.3:1）。所有患者均在活检前后 6 个月接受了诱导治疗，随访时间≥3 年。114名患者（70.8%）获得了长期生存，47名患者（29.2%）最终死于终末期肾病（ESRD）。CR 患者更有可能获得长期生存（p < 0.001）。在接受硫唑嘌呤（AZA）（分别为 p = 0.002、p = 0.011、p = 0.016 和 p = 0.003）和羟氯喹（HCQ）（分别为 p <0.003、p <0.001、p = 0.011、p <0.001 和 p <0.001）治疗的患者中，不同时间点的维持治疗与长期存活率之间存在明显关系。心血管和神经精神表现与 ESRD/死亡率显著相关（分别为 p = 0.003 和 p = 0.002）。结论在 LN 中，肾功能缓解与长期肾功能存活率密切相关。接受 AZA 和 HCQ 与 LN 患者的长期存活率有显著相关性，6 个月完全缓解是预测 LN 患者长期存活率的最佳指标。

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引用次数: 0

Screening potential of tuberculin skin and interferon gamma release tests for latent tuberculosis prior to anti-tumor necrosis factor (TNF)-α therapy in patients with rheumatoid arthritis and spondyloarthritis 类风湿性关节炎和脊柱关节炎患者在接受抗肿瘤坏死因子（TNF）-α治疗前，结核菌素皮肤试验和干扰素γ释放试验对潜伏结核病的筛查潜力

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-11-19 DOI: 10.1016/j.ejr.2024.11.003

Ebru Yilmaz , Özge Pasin , Tuğçe Pasin

Aim of the work: To compare between tuberculin skin test (TST) and interferon-gamma release test (IGRT) for latent tuberculosis infection (LTBI) screening before anti-tumor necrosis factor (TNF)-α therapy in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) including radiographic (r)-axialSpA and psoriatic arthritis (PsA). Patients and methods: The study included 55 RA patients and 133 SpA: 93 radiographic r-axSpA (2 with PsA) and 40 PsA without axial involvement, receiving anti-TNF-α. TST and IGRT results were obtained before starting anti-TNF-α treatment. Results: The mean age for RA and SpA patients was 55.9 ± 10.7 and 46.3 ± 10.6 years, and disease duration was 9.1 ± 7.7 and 3.7 ± 2.9 years, respectively. The mean age (p < 0.001) and disease duration (p < 0.001) were significantly higher in RA patients, whereas male gender (p < 0.001) and smoking (p < 0.001) were more prominent in SpA patients. TST positivity, IGRT positivity and prophylactic antibiotic use were comparable between RA and SpA patients. Only prophylactic antibiotic use was significantly higher in r-axSpA patients (RA 18.2 %, r-axSpA 35.5 % and PsA 17.5 %, p = 0.024). The agreement between TST and IGRT was low for RA (κ = 0.34 and p = 0.003) and PsA patients (κ = 0.39 and p = 0.002) and moderate for r-axSpA (κ = 0.6 and p < 0.001). Non-smoking (p = 0.01), presence of Bacillus Calmette-Guerin vaccination (p = 0.005) and non-use of disease modifying anti-rheumatic drugs (DMARDs) (p = 0.04) were significant predictors for TST positivity, whereas non-use of DMARDs (p = 0.007) was the only significant predictor for IGRT positivity. Conclusion: The agreement between TST and IGRT was poor for RA and PsA and moderate for r-axSpA. IGRT may be more reliable in those receiving immunosuppressives.

工作目的比较类风湿性关节炎（RA）和脊柱关节炎（SpA）患者在接受抗肿瘤坏死因子（TNF）-α治疗前进行结核菌素皮试（TST）和干扰素-γ释放试验（IGRT）筛查潜伏结核感染（LTBI）的效果。患者和方法：研究对象包括 55 名接受抗肿瘤坏死因子-α治疗的 RA 患者和 133 名接受抗肿瘤坏死因子-α治疗的 SpA 患者：93 名放射学 r-axSpA 患者（2 名伴有 PsA）和 40 名无轴向受累的 PsA 患者。在开始接受抗肿瘤坏死因子-α治疗前已获得 TST 和 IGRT 结果。结果RA和SpA患者的平均年龄分别为（55.9±10.7）岁和（46.3±10.6）岁，病程分别为（9.1±7.7）年和（3.7±2.9）年。RA患者的平均年龄（p < 0.001）和病程（p < 0.001）明显高于SpA患者，而男性（p < 0.001）和吸烟（p < 0.001）在SpA患者中更为突出。RA 和 SpA 患者的 TST 阳性率、IGRT 阳性率和预防性抗生素使用率相当。只有 r-axSpA 患者预防性使用抗生素的比例明显更高（RA 18.2%，r-axSpA 35.5%，PsA 17.5%，P = 0.024）。TST和IGRT之间的一致性在RA（κ = 0.34，p = 0.003）和PsA患者（κ = 0.39，p = 0.002）中较低，在r-axSpA患者中为中等（κ = 0.6，p <0.001）。不吸烟（p = 0.01）、接种过卡介苗（p = 0.005）和未使用改变病情抗风湿药（DMARDs）（p = 0.04）是 TST 阳性的重要预测因素，而未使用 DMARDs（p = 0.007）是 IGRT 阳性的唯一重要预测因素。结论TST和IGRT对RA和PsA的一致性较差，对r-axSpA的一致性中等。对于接受免疫抑制剂治疗的患者，IGRT可能更为可靠。

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引用次数: 0

The role of 14.3.3 eta protein in the diagnosis of patients with early rheumatoid arthritis 14.3.3 eta 蛋白在诊断早期类风湿关节炎患者中的作用

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-11-14 DOI: 10.1016/j.ejr.2024.11.002

Walaa H. Mohammed , Nermeen Fouad , Rania H. ElKabarity , Salma A. Khalil , Lamyaa Salem

Aim of the work

To evaluate the role of 14–3-3 eta protein in diagnosing early rheumatoid arthritis (RA), and its association with disease activity.

Patients and methods

A total of 40 patients with early RA were enrolled, along with 20 controls with non-erosive arthritis (8 with systemic lupus erythematosus, 8 with osteoarthritis, and 4 with systemic sclerosis), and 20 healthy controls. The clinical disease activity index (CDAI) and simplified disease activity index (SDAI) were assessed. Measurement of rheumatoid factor (RF) titer, anti-cyclic citrullinated peptide (anti-CCP), and serum level of 14–3-3 eta was performed for all participants.

Results

The mean age of RA patients was 32.02 ± 8.31 years and they were 33 females and 7 males. Age and gender were comparable with non-erosive arthritis patients and control. Serum levels of 14–3-3 eta were significantly higher in RA patients (range 4.01–50.45, median 13.5 ng/ml) than in the non-erosive arthritis group (range 1.12–16.1, median 3.16 ng/ml) and the healthy control group (range0.88–3.44, median 1.7 ng/ml) (p < 0.001).14–3-3 eta serum levels showed significant correlations with CDAI (r = 0.979,p < 0.001) and SDAI (r = 0.975,p < 0.001). Serum 14–3-3 eta at a cut-off >5.03 ng/ml was able to diagnose early RA with a sensitivity of 97.5 % and specificity of 90 %. When combining the three markers together (RF, anti CCP, and 14–3-3 eta) sensitivity was enhanced to 98.9 % and specificity reached 100 %.

Conclusion

14–3-3 eta protein can serve as a potential diagnostic marker for early RA and when combined with RF and anti-CCP the sensitivity and specificity of diagnosis is enhanced.

患者和方法共招募了 40 名早期类风湿性关节炎（RA）患者、20 名非侵蚀性关节炎对照组（8 名系统性红斑狼疮患者、8 名骨关节炎患者、4 名系统性硬化症患者）和 20 名健康对照组。对临床疾病活动指数（CDAI）和简化疾病活动指数（SDAI）进行了评估。对所有参与者进行了类风湿因子（RF）滴度、抗环瓜氨酸肽（anti-CCP）和血清 14-3-3 eta 水平的测定。结果RA 患者的平均年龄为（32.02 ± 8.31）岁，其中女性 33 人，男性 7 人。年龄和性别与非侵蚀性关节炎患者和对照组相当。RA 患者血清中 14-3-3 eta 的水平（范围 4.01-50.45，中位数 13.5 ng/ml）明显高于非侵蚀性关节炎组（范围 1.12-16.1，中位数 3.14-3-3 eta 血清水平与 CDAI（r = 0.979，p = 0.001）和 SDAI（r = 0.975，p = 0.001）呈显著相关。以5.03 ng/ml为临界值的血清14-3-3 eta能够诊断早期RA，灵敏度为97.5%，特异性为90%。结论14-3-3 eta 蛋白可作为早期 RA 的潜在诊断标志物，与 RF 和抗 CCP 结合使用时，可提高诊断的敏感性和特异性。

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引用次数: 0

Procalcitonin level in systemic lupus erythematosus patients and its relation to disease activity and infection 系统性红斑狼疮患者的降钙素原水平及其与疾病活动和感染的关系

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-11-06 DOI: 10.1016/j.ejr.2024.10.003

Caroline S. Morad , Mohamed S. Abdel Baky, Radwa A. Ahmed, Amr M. Hawwash

Aim of the work: To evaluate the role of serum procalcitonin (PCT) and compare it with other available biomarkers in differentiating flare from infection in systemic lupus erythematosus (SLE) patients. Patients and methods: Ninety SLE patients were enrolled and classified into 2 groups; group 1 included 60 active SLE patients with/without fever, and group 2 included 30 afebrile inactive SLE patients. Group 1 patients were further classified according to presence or absence of infection. Patients were subjected to detailed medical history, clinical examination, disease activity assessment, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum PCT, appropriate body fluid cultures, and radiological assessment. Results: The study included 80 (88 %) females. The mean age was 30.17 ± 9.7 years and the median disease duration 5 years. The commonest clinical manifestations of SLE were arthritis (58.9 %), skin rash (51.1 %), mucosal ulcers (37.8 %) and nephritis (36.7 %). Serum PCT, ESR, CRP, NLR and PLR were significantly higher in active SLE patients (group 1) than those in remission (group 2). Serum PCT, CRP and NLR were significantly higher in SLE patients with infection than those without infection whereas ESR and PLR showed no significant difference between both groups. PCT level significantly correlated with CRP, NLR, and PLR. Conclusion: Although serum PCT, CRP levels, and NLR rise with SLE disease activity, their levels are significantly higher when associated with infection, indicating that high levels of these inflammatory markers could differentiate between infection and disease activity in SLE patients.

工作目的评估血清降钙素原（PCT）的作用，并将其与其他可用的生物标志物进行比较，以区分系统性红斑狼疮（SLE）患者病情发作与感染。患者和方法共招募了 90 名系统性红斑狼疮患者，并将其分为两组：第一组包括 60 名发热/无发热的活动性系统性红斑狼疮患者，第二组包括 30 名无发热的非活动性系统性红斑狼疮患者。第一组患者根据有无感染进一步分类。对患者进行了详细的病史、临床检查、疾病活动性评估、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、红细胞沉降率（ESR）、C反应蛋白（CRP）、血清PCT、适当的体液培养和放射学评估。研究结果研究对象包括 80 名女性（88%）。平均年龄为（30.17 ± 9.7）岁，中位病程为 5 年。系统性红斑狼疮最常见的临床表现为关节炎（58.9%）、皮疹（51.1%）、粘膜溃疡（37.8%）和肾炎（36.7%）。活动期系统性红斑狼疮患者（第 1 组）的血清 PCT、血沉、CRP、NLR 和 PLR 明显高于缓解期患者（第 2 组）。有感染的系统性红斑狼疮患者的血清 PCT、CRP 和 NLR 明显高于无感染的患者，而血沉和 PLR 在两组患者之间无明显差异。PCT水平与CRP、NLR和PLR有明显的相关性。结论虽然血清PCT、CRP水平和NLR会随着系统性红斑狼疮疾病活动而升高，但当与感染相关时，它们的水平会明显升高，这表明这些炎症标志物的高水平可以区分系统性红斑狼疮患者的感染和疾病活动。

{"title":"Procalcitonin level in systemic lupus erythematosus patients and its relation to disease activity and infection","authors":"Caroline S. Morad , Mohamed S. Abdel Baky, Radwa A. Ahmed, Amr M. Hawwash","doi":"10.1016/j.ejr.2024.10.003","DOIUrl":"10.1016/j.ejr.2024.10.003","url":null,"abstract":"<div><div><strong>Aim of the work:</strong> To evaluate the role of serum procalcitonin (PCT) and compare it with other available biomarkers in differentiating flare from infection in systemic lupus erythematosus (SLE) patients. <strong>Patients and methods:</strong> Ninety SLE patients were enrolled and classified into 2 groups; group 1 included 60 active SLE patients with/without fever, and group 2 included 30 afebrile inactive SLE patients. Group 1 patients were further classified according to presence or absence of infection. Patients were subjected to detailed medical history, clinical examination, disease activity assessment, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum PCT, appropriate body fluid cultures, and radiological assessment. <strong>Results:</strong> The study included 80 (88 %) females. The mean age was 30.17 ± 9.7 years and the median disease duration 5 years. The commonest clinical manifestations of SLE were arthritis (58.9 %), skin rash (51.1 %), mucosal ulcers (37.8 %) and nephritis (36.7 %). Serum PCT, ESR, CRP, NLR and PLR were significantly higher in active SLE patients (group 1) than those in remission (group 2). Serum PCT, CRP and NLR were significantly higher in SLE patients with infection than those without infection whereas ESR and PLR showed no significant difference between both groups. PCT level significantly correlated with CRP, NLR, and PLR. <strong>Conclusion:</strong> Although serum PCT, CRP levels, and NLR rise with SLE disease activity, their levels are significantly higher when associated with infection, indicating that high levels of these inflammatory markers could differentiate between infection and disease activity in SLE patients.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"47 1","pages":"Pages 21-25"},"PeriodicalIF":1.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593153","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

Evaluation of functional measures and laboratory parameters to portend limitations of spinal mobility in patients with radiographic axial spondyloarthritis 评估功能测试和实验室参数，预示放射性轴性脊柱关节炎患者脊柱活动度受限的情况

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-10-24 DOI: 10.1016/j.ejr.2024.10.002

Halil Harman , Nedim Kaban

Aim of the work

To specify clinical and laboratory parameters related to limited spinal mobility in radiographic axial spondyloarthritis (r-axSpA) patients.

Patients and methods

The study included 202 adult r-axSpA patients. Clinical characteristics, medications, investigations including serum C-reactive protein (CRP) and human leukocytic antigen-B27 positivity were noted. Lateral lumbar flexion (LLF), chest expansion (CE) and tragus-to-wall distance (TWD) were measured. Values <2.5 percentile in LLF, CE and TWD were noted as reduced mobility of lumbar, thoracic and cervical spine, respectively.

Results

The median age of patients was 43 years, male:female was 3.7:1. The time to diagnosis was 7.5 (3–40) years and were followed-up for 7.2 (4–22) years. Disease duration and high baseline CRP (>10 mg/L) were critical risk factors for reduced spinal mobility (p = 0.001 and p < 0.01). The duration to impaired LLF was significantly shorter in smokers (n = 105) (10.3;0–30.5 years) vs non-smokers (15.2;4.5–35 years) (p = 0.001) and in those with positive family history (n = 50) (9.7;0–20 years) compared to those without (12.9;4–35 years) (p = 0.09). LLF, CE and TWD were impaired in 40 % vs 75 %, 10 % vs 55 % and 12 % vs 60 % of patients with symptom duration of 10 vs 30 years respectively. Those with delayed introduction of biologics had significantly more impaired LLF, CE and TWD: 10.1(2–25) vs 14(3–33) years; 10.4(3–26) vs 17.5(8–33) years; 10.7(3–27) vs 16.7(5–33) years; p = 0.001 for all, respectively).

Conclusions

The most prominent factors affecting spinal mobility were the duration of symptoms and high serum CRP levels. The decreased spinal mobility was markedly less in patients with the early introduction of biologic therapy.

研究目的明确与放射性轴性脊柱关节炎（r-axSpA）患者脊柱活动受限有关的临床和实验室参数。研究记录了患者的临床特征、用药情况以及包括血清 C 反应蛋白（CRP）和人类白细胞抗原-B27 阳性在内的检查结果。测量了侧腰屈（LLF）、胸廓扩张（CE）和耳廓到墙壁的距离（TWD）。结果患者的中位年龄为 43 岁，男女比例为 3.7:1。确诊时间为 7.5（3-40）年，随访时间为 7.2（4-22）年。病程和高基线 CRP（10 毫克/升）是脊柱活动度降低的关键风险因素（p = 0.001 和 p <0.01）。吸烟者（n = 105）（10.3;0-30.5 年）与非吸烟者（15.2;4.5-35 年）相比（p = 0.001），以及有阳性家族史者（n = 50）（9.7;0-20 年）与无阳性家族史者（12.9;4-35 年）相比（p = 0.09），LLF 受损的持续时间明显较短。症状持续时间为 10 年和 30 年的患者中，LLF、CE 和 TWD 受损的比例分别为 40% 对 75%、10% 对 55% 和 12% 对 60%。延迟使用生物制剂的患者的LLF、CE和TWD受损程度明显更高：分别为10.1（2-25）年 vs 14（3-33）年；10.4（3-26）年 vs 17.5（8-33）年；10.7（3-27）年 vs 16.7（5-33）年；P = 0.001。结论：影响脊柱活动度的最主要因素是症状持续时间和高血清CRP水平。

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引用次数: 0

Clinical signficance of human leucocytic antigen (HLA-B27) in patients with early and late-onset axial spondyloarthritis 人类白细胞抗原（HLA-B27）在早发和晚发轴性脊柱关节炎患者中的临床意义

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-10-18 DOI: 10.1016/j.ejr.2024.10.001

Ebru Yilmaz , Özlem Toluk

Aim of the work

To compare the clinical, laboratory and radiological features of patients with positive human leucocytic antigen (HLA)-B27 in patients with early-onset (EOSpA) and late-onset (LOSpA) axial spondyloarthritis.

Patients and methods

The study included 195 axial-SpA patients with positive HLA-B27 divided into those ≤45 years (EOSpA) and those >45 years (LOSpA). Characteristics of the patients, medications received as well as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Radiological Index (BASRI), Ankylosing Spondylitis Disease Activity Score (ASDAS) scores were recorded.

Results

The mean age of the patients was 43.6 ± 13.3 years and 121 (62.1 %) were females. Shoulder pain, peripheral arthritis, and adhesive capsulitis were significantly more common in LOSpA (20 %,13.7 % and 5.3 %; p = 0.001, p = 0.017, and p = 0.026) whereas dorsal and low back pain were significantly more prominent in EOSpA (20 % and 61 %; p = 0.011 and p = 0.001). There was a significant difference between the two groups in terms of gender, body mass index (BMI), smoking, anti-tumor necrosis factor (TNF)-α use, C-reactive protein (CRP), BASFI, BASDAI, ASDAS, MASES and BASRI scores (p < 0.001, p < 0.001, p = 0.016, p < 0.001, p < 0.001, p = 0.009, p < 0.001, p = 0.018, p < 0.001, p < 0.001, respectively). On regression analysis, male gender and high CRP were associated with EOSpA (p = 0.011, and p = 0.001), while early-stage sacroiliitis, non-steroidal anti-inflammatory drug (NSAID) use, high BASFI and BASRI were related to LOSpA (p = 0.004, p = 0.003, p < 0.0001 and p < 0.0001).

Conclusion

LOSpA was associated with female gender, peripheral involvement, lower levels of inflammatory markers, higher functional status and disease activity, higher enthesitis and radiological scores, and less use of anti-TNF-α.

工作目的比较早发（EOSpA）和晚发（LOSpA）轴性脊柱关节炎患者中人类白细胞抗原（HLA）-B27阳性患者的临床、实验室和放射学特征。患者和方法该研究纳入了195例HLA-B27阳性的轴性脊柱关节炎患者，分为≤45岁（EOSpA）和45岁（LOSpA）患者。记录患者的特征、接受的药物以及巴斯强直性脊柱炎疾病活动指数（BASDAI）、巴斯强直性脊柱炎功能指数（BASFI）、马斯特里赫特强直性脊柱炎关节炎评分（MASES）、巴斯强直性脊柱炎放射学指数（BASRI）、强直性脊柱炎疾病活动评分（ASDAS）。肩痛、外周关节炎和粘连性关节囊炎在 LOSpA 中明显更常见（20%、13.7% 和 5.3%；p = 0.001、p = 0.017 和 p = 0.026），而背痛和腰痛在 EOSpA 中明显更突出（20% 和 61%；p = 0.011 和 p = 0.001）。两组患者在性别、体重指数（BMI）、吸烟、抗肿瘤坏死因子（TNF）-α 的使用、C 反应蛋白（CRP）、BASFI、BASDAI、ASDAS、MASES 和 BASRI 评分方面存在明显差异（p < 0.001，p < 0.001，p = 0.016，p < 0.001，p < 0.001，p = 0.009，p < 0.001，p = 0.018，p < 0.001，p < 0.001）。回归分析显示，男性性别和高 CRP 与 EOSpA 相关（p = 0.011 和 p = 0.001），而早期骶髂关节炎、使用非甾体抗炎药（NSAID）、高 BASFI 和 BASRI 与 LOSpA 相关（p = 0.004、p = 0.003、p < 0.结论LOSpA与女性性别、外周受累、较低的炎症标志物水平、较高的功能状态和疾病活动度、较高的关节炎和放射学评分以及较少使用抗肿瘤坏死因子-α有关。

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引用次数: 0

Cardiovascular risk assessment in female patients with rheumatoid arthritis 类风湿关节炎女性患者的心血管风险评估

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-10-04 DOI: 10.1016/j.ejr.2024.09.002

Dalia A. ElSherbiny , Eman A. Hafez , Wessam S. Shokry , Ahmad M. Mohamady , Nermeen N. Aziz

Background

Rheumatoid arthritis (RA) is one of the most common rheumatological disorders, that not only affect the synovial joints, but also, it has several extra-articular complications related to heart, and other organs.

Aim of the work:

To assess the cardiovascular risk in RA female patients.

Patients and methods:

60 RA female patients, were subjected to full medical history, clinical examination, laboratory assessment, disease activity score (DAS-28), ultrasonography on both common carotid and common femoral arteries, and cardiovascular risk score (QRISK®3).

Results:

The patients age was 48.4 ± 7.2 years (40–70 years), median disease duration of 7 years and 20 (33.3 %) were passive smokers. Disease activity was 4.6 ± 1.47 (1.5–7.8).Duration of steroid, methotrexate (MTX) and hydroxychloroquine (HCQ) 1–240 months, leflunomide 6–240 months, sulphasalazine 3–156 months and baricitinib 0–9 months. QRISK®3 was significantly correlated with age (p < 0.001), total cholesterol (p = 0.017), right and left carotid and right femoral intima media thickness (IMT) (p = 0.027, p = 0.006, and p = 0.009 respectively). Regarding the IMT, a significant correlation was found with age in all territories (bilateral carotid and bilateral femoral arteries), where anti CCP and QRISK®3 was correlated with the right carotid IMT (p = 0.039, and p = 0.027 respectively), While the duration of using baricitinib was negatively correlated and significant with right carotid (r = -0.285,p = 0.027).Regressions analysis of right carotid was significant with age, left carotid with CRP and right femoral with Q risk.

Conclusion:

RA patients have multiple risk factors that increase cardiovascular events. Age, Anti cyclic citrullinated peptide (Anti-CCP) levels, MTX, HCQ, and leflunomide may aggravate atherosclerosis, while baricitinib may be a protective factor.

背景类风湿性关节炎（RA）是最常见的风湿性疾病之一，它不仅影响滑膜关节，而且还有一些与心脏和其他器官有关的关节外并发症。患者和方法：对60名女性RA患者进行全面病史、临床检查、实验室评估、疾病活动度评分（DAS-28）、颈总动脉和股总动脉超声波检查以及心血管风险评分（QRISK®3）。患者使用类固醇、甲氨蝶呤（MTX）和羟氯喹（HCQ）的时间为1-240个月，来氟米特为6-240个月，柳氮磺胺吡啶为3-156个月，巴利昔替尼为0-9个月。QRISK®3 与年龄（p < 0.001）、总胆固醇（p = 0.017）、左右颈动脉和右股骨内膜厚度（IMT）（分别为 p = 0.027、p = 0.006 和 p = 0.009）显著相关。在所有部位（双侧颈动脉和双侧股动脉）的内膜厚度（IMT）中，抗 CCP 和 QRISK®3 与年龄有显著相关性，其中抗 CCP 和 QRISK®3 与右侧颈动脉内膜厚度（IMT）相关（分别为 p = 0.039 和 p = 0.027）。右侧颈动脉与年龄、左侧颈动脉与 CRP、右侧股动脉与 Q 风险的回归分析显著相关。年龄、抗环瓜氨酸肽（Anti-CCP）水平、MTX、HCQ和来氟米特可能会加重动脉粥样硬化，而巴利昔替尼可能是一个保护因素。

{"title":"Cardiovascular risk assessment in female patients with rheumatoid arthritis","authors":"Dalia A. ElSherbiny , Eman A. Hafez , Wessam S. Shokry , Ahmad M. Mohamady , Nermeen N. Aziz","doi":"10.1016/j.ejr.2024.09.002","DOIUrl":"10.1016/j.ejr.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatoid arthritis (RA) is one of the most common rheumatological disorders, that not only affect the synovial joints, but also, it has several extra-articular complications related to heart, and other organs.</div></div><div><h3>Aim of the work:</h3><div>To assess the cardiovascular risk in RA female patients.</div></div><div><h3>Patients and methods:</h3><div>60 RA female patients, were subjected to full medical history, clinical examination, laboratory assessment, disease activity score (DAS-28), ultrasonography on both common carotid and common femoral arteries, and cardiovascular risk score (QRISK®3).</div></div><div><h3>Results:</h3><div>The patients age was 48.4 ± 7.2 years (40–70 years), median disease duration of 7 years and 20 (33.3 %) were passive smokers. Disease activity was 4.6 ± 1.47 (1.5–7.8).Duration of steroid, methotrexate (MTX) and hydroxychloroquine (HCQ) 1–240 months, leflunomide 6–240 months, sulphasalazine 3–156 months and baricitinib 0–9 months. QRISK®3 was significantly correlated with age (p < 0.001), total cholesterol (p = 0.017), right and left carotid and right femoral intima media thickness (IMT) (p = 0.027, p = 0.006, and p = 0.009 respectively). Regarding the IMT, a significant correlation was found with age in all territories (bilateral carotid and bilateral femoral arteries), where anti CCP and QRISK®3 was correlated with the right carotid IMT (p = 0.039, and p = 0.027 respectively), While the duration of using baricitinib was negatively correlated and significant with right carotid (r = -0.285,p = 0.027).Regressions analysis of right carotid was significant with age, left carotid with CRP and right femoral with Q risk.</div></div><div><h3>Conclusion:</h3><div>RA patients have multiple risk factors that increase cardiovascular events. Age, Anti cyclic citrullinated peptide (Anti-CCP) levels, MTX, HCQ, and leflunomide may aggravate atherosclerosis, while baricitinib may be a protective factor.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"47 1","pages":"Pages 1-5"},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417739","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

Characteristics of patients with connective tissue disease-associated interstitial lung diseases 结缔组织病相关间质性肺疾病患者的特征

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-10-04 DOI: 10.1016/j.ejr.2024.09.001

Fatma M Aboud , Mervat E Behiry , Tamer MA Ibraheem , Asmaa M.M. Salama , Shaimaa A. Abdalgaleel , Dina M. Abd EL-Khalik

Aim of the work

To characterize the clinical features and outcome in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD).

Patients and methods

The study included 74 adult patients with CTD-ILD following-up at the rheumatology and pulmonology outpatient clinics of two healthcare centers in Egypt between 2018 and 2023. Demographic, clinical, radiological and treatment data were collected. High-resolution computed tomography (HRCT), spirometer and 6-minute walk test (6MWT) were analyzed.

Results

The patients mean age was 41.8 ± 6.5 years, 89.2 % were females, systemic sclerosis (SSc) (44.6 %) and rheumatoid arthritis (RA) (33.8 %) were the most common diagnosed CTDs. 54.1 % of patients had nonspecific interstitial pneumonia (NSIP), and 33.8 % had usual interstitial pneumonia (UIP). 93.2 % showed abnormal spirometer. Established diagnosis of ILD was preceded and coincided with CTD diagnosis in 40.6 %. 35.1 % had lung affection ≥ 20 % which was significantly associated with RA (p = 0.001), onset of ILD before/with the diagnosis of CTD (p = 0.027), lower CTD duration (p = 0.01) and desaturation in 6MWT (p-0.006). Shorter CTD duration and 6MWT desaturation independently affected the extent of lung affection (p = 0.004 and p = 0.001 respectively).

Conclusion

Both SSc and RA were the most frequent CTDs associated ILD. Spirometer, HRCT and 6MWT are valuable for early diagnosis. NSIP and UIP were the most frequent ILD patterns with variable outcomes. Severe lung affection was linked to RA, lower CTD duration, ILD onset before/with the CTD and desaturation in 6MWT. Shorter CTD duration and desaturation with 6MWT independently affected the percentage of lung affection.

工作目的探讨结缔组织病相关间质性肺病（CTD-ILD）患者的临床特征和预后。患者和方法研究纳入了 2018 年至 2023 年期间在埃及两家医疗中心的风湿病学和肺病学门诊随访的 74 名 CTD-ILD 成年患者。研究收集了人口统计学、临床、放射学和治疗数据。结果患者平均年龄为（41.8 ± 6.5）岁，89.2%为女性，系统性硬化症（SSc）（44.6%）和类风湿性关节炎（RA）（33.8%）是最常见的确诊CTD。54.1%的患者患有非特异性间质性肺炎（NSIP），33.8%患有普通间质性肺炎（UIP）。93.2%的患者肺活量计显示异常。40.6%的患者在确诊 ILD 之前就已确诊 CTD。35.1%的患者肺部病变≥20%，这与RA（p = 0.001）、CTD诊断前/诊断时出现ILD（p = 0.027）、CTD持续时间较短（p = 0.01）和6MWT不饱和（p-0.006）显著相关。较短的 CTD 持续时间和 6MWT 饱和度对肺部病变的程度有独立影响（分别为 p = 0.004 和 p = 0.001）。肺活量计、HRCT 和 6MWT 对早期诊断很有价值。NSIP和UIP是最常见的ILD模式，其结果各不相同。严重的肺部病变与 RA、较短的 CTD 持续时间、ILD 在 CTD 之前/同时发病以及 6MWT 饱和度降低有关。较短的 CTD 持续时间和 6MWT 时的不饱和程度会单独影响肺部感染的比例。

{"title":"Characteristics of patients with connective tissue disease-associated interstitial lung diseases","authors":"Fatma M Aboud , Mervat E Behiry , Tamer MA Ibraheem , Asmaa M.M. Salama , Shaimaa A. Abdalgaleel , Dina M. Abd EL-Khalik","doi":"10.1016/j.ejr.2024.09.001","DOIUrl":"10.1016/j.ejr.2024.09.001","url":null,"abstract":"<div><h3>Aim of the work</h3><div>To characterize the clinical features and outcome in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD).</div></div><div><h3>Patients and methods</h3><div>The study included 74 adult patients with CTD-ILD following-up at the rheumatology and pulmonology outpatient clinics of two healthcare centers in Egypt between 2018 and 2023. Demographic, clinical, radiological and treatment data were collected. High-resolution computed tomography (HRCT), spirometer and 6-minute walk test (6MWT) were analyzed.</div></div><div><h3>Results</h3><div>The patients mean age was 41.8 ± 6.5 years, 89.2 % were females, systemic sclerosis (SSc) (44.6 %) and rheumatoid arthritis (RA) (33.8 %) were the most common diagnosed CTDs. 54.1 % of patients had nonspecific interstitial pneumonia (NSIP), and 33.8 % had usual interstitial pneumonia (UIP). 93.2 % showed abnormal spirometer. Established diagnosis of ILD was preceded and coincided with CTD diagnosis in 40.6 %. 35.1 % had lung affection ≥ 20 % which was significantly associated with RA (p = 0.001), onset of ILD before/with the diagnosis of CTD (p = 0.027), lower CTD duration (p = 0.01) and desaturation in 6MWT (p-0.006). Shorter CTD duration and 6MWT desaturation independently affected the extent of lung affection (p = 0.004 and p = 0.001 respectively).</div></div><div><h3>Conclusion</h3><div>Both SSc and RA were the most frequent CTDs associated ILD. Spirometer, HRCT and 6MWT are valuable for early diagnosis. NSIP and UIP were the most frequent ILD patterns with variable outcomes. Severe lung affection was linked to RA, lower CTD duration, ILD onset before/with the CTD and desaturation in 6MWT. Shorter CTD duration and desaturation with 6MWT independently affected the percentage of lung affection.</div></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":"47 1","pages":"Pages 6-11"},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417740","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

Genetic variations of interleukin 32(rs28372698) and interleukin 37 (rs3811047), and their serum levels in systemic lupus erythematosus patients 系统性红斑狼疮患者白细胞介素 32（rs28372698）和白细胞介素 37（rs3811047）的基因变异及其血清水平

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-08-28 DOI: 10.1016/j.ejr.2024.08.004

Wafaa Gaber , Noha M. Abdel Baki , Shaimaa Badran , Walaa Abdelfattah , Marwa K. Sallam , Alkhateeb Alkemary , Mai Samir , Marwa H. Niazy

Background

Systemic lupus erythematosus (SLE) is a complex autoimmune disease. The underlying pathogenesis still needs to be elucidated.

Aim of the work

To investigate interleukin-32 (IL-32) (rs28372698) and interleukin-37 (IL-37) (rs3811047) genetic variations, measure their serum levels in SLE patients, and evaluate their relation with disease parameters.

Patients and methods

This work included 46 SLE patients and 43 matched controls. The SLE disease activity index (SLEDAI) and SLE damage index (SDI) were recorded. Genetic variations were assessed by real-time polymerase chain reaction (RT-PCR), and serum levels of IL-32 and IL-37 were measured by enzyme-linked immune-sorbent assay (ELISA).

Results

The mean age of the patients was 29.2 ± 6.1 years, and the female: male ratio was 45:1. IL-37 genetic variation (rs3811047) GG was significantly more frequent in SLE patients (24/46,52.2 %) (p = 0.024), those with lupus nephritis (LN)(18/27,66.7 %) (p = 0.038), and active disease (15/21,68.2 %) (p = 0.002). The IL-37 G allele was significantly more represented in lupus patients (68/92,73.9 %)(p = 0.008), with IL-37 serum levels significantly increased in SLE patients (855.7 ± 465.4) compared to the control (504.1 ± 553.8) (p = 0.002). Although serum IL-32 was significantly higher in patients who received cyclophosphamide (CYC),and significantly correlated with total cholesterol, on regression analysis neither CYC nor cholesterol were significant factor for serum IL-32. The area under the curve for IL-37 serum levels to distinguish SLE patients from controls was 0.71, (CI 0.601–0.827; p = 0.001).

Conclusion

The IL-37 genetic variation (rs3811047) GG was significantly elevated in SLE, LN, and active patients. G allele was significantly more represented in lupus patients. IL-37 serum levels were significantly increased in SLE patients.

背景系统性红斑狼疮（SLE）是一种复杂的自身免疫性疾病。研究目的研究白细胞介素-32（IL-32）（rs28372698）和白细胞介素-37（IL-37）（rs3811047）的遗传变异，测量系统性红斑狼疮患者血清中这两种基因的水平，并评估它们与疾病参数的关系。记录系统性红斑狼疮疾病活动指数（SLEDAI）和系统性红斑狼疮损害指数（SDI）。结果患者的平均年龄为 29.2 ± 6.1 岁，男女比例为 45:1。IL-37基因变异（rs3811047）GG在系统性红斑狼疮患者（24/46，52.2%）（p = 0.024）、狼疮肾炎（LN）患者（18/27，66.7%）（p = 0.038）和活动性疾病患者（15/21，68.2%）中的发生率明显更高（p = 0.002）。IL-37 G 等位基因在狼疮患者中的比例明显更高（68/92,73.9 %）（p = 0.008），与对照组（504.1 ± 553.8）相比，系统性红斑狼疮患者血清中的 IL-37 水平明显升高（855.7 ± 465.4）（p = 0.002）。虽然接受环磷酰胺（CYC）治疗的患者血清 IL-32 水平明显升高，且与总胆固醇有显著相关性，但在回归分析中，CYC 和胆固醇都不是影响血清 IL-32 的重要因素。IL-37 血清水平区分系统性红斑狼疮患者和对照组的曲线下面积为 0.71（CI 0.601-0.827；P = 0.001）。G等位基因在狼疮患者中的比例明显更高。系统性红斑狼疮患者的 IL-37 血清水平明显升高。

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引用次数: 0

Egyptian patients with axial spondyloarthritis: The frequency and predictors of renal impairment 埃及轴性脊柱关节炎患者：肾功能损害的频率和预测因素

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist

Pub Date : 2024-08-25 DOI: 10.1016/j.ejr.2024.08.001

Dina M. Abd EL-Khalik , Adel M. Elsayed , Aya A. Abdallah , Nashwa A. Morshedy

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.

研究目的确定轴性脊柱关节炎（axSpA）患者肾功能损害的频率和风险因素。根据肾脏疾病结果质量倡议（K/DOQI）标准，患者被分为两组：第一组包括肾功能损害，第二组包括非肾功能损害。对强直性脊柱炎（AS）疾病活动度评分（ASDAS）、巴斯强直性脊柱炎疾病活动度指数（BASDAI）和估计肾小球滤过率进行评估。ASDAS平均评分为（5.58±1.38）分，BASDAI平均评分为（5.18±1.55）分。eGFR 为 76.4 ± 36.2 ml/min/1.73 m2，28% 的患者人类白细胞抗原（HLA-B27）呈阳性。80%的患者正在接受生物治疗。34%和52%的病例分别通过超声检查发现肾病和肾功能损害。肾功能受损者的非甾体抗炎药（NSAIDs）累积剂量、C反应蛋白、红细胞沉降率、低密度胆固醇、血尿素氮、肌酐、蛋白尿、ASDAS和BASDAI均显著高于肾功能受损者（P = 0.0001、p = 0.0001、p = 0.001、p = 0.035、p = 0.0001、p = 0.0001、p = 0.001、p = 0.001），而 eGFR 和高密度脂蛋白则明显较低（p = 0.001 和 p = 0.02）。在截断水平为 1166.3 g 时，只有非甾体抗炎药的累积剂量是影响肾功能损害发生的一个显著的独立变量（OR=1.01，CI; 1.001-1.02，p = 0.024）。非甾体抗炎药的累积剂量是预测肾功能损害的重要指标。

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引用次数: 0