Egyptian Rheumatologist最新文献

Background

Peripheral neuropathy (PN) is one of the most heterogeneous and poorly understood or characterized manifestations in systemic lupus erythematosus (SLE). The aim of this study was to describe the clinical and electrophysiological features, and neuropathic disease associations, in Cuban SLE patients.

Patients and methods

One hundred and two consecutive SLE patients admitted to the Psychoneuroimmunology service at the National Institute of Nephrology were included in the study. Patients with other disorders known to cause neuropathy were excluded. Demographic, clinical and laboratory data were obtained using a pre-defined questionnaire. Nerve conduction studies were carried out in both upper and lower limbs. Neuropathy was defined as the presence of clinical symptoms and/or signs and bilateral abnormal nerve conduction study parameters.

Results

The 102 patients were 99 females and 3 males with mean age of 46 ± 12 years and disease duration 8 ± 9 years. PN was found in 55/102 (53.9%) patients; 48 (87.3%) had clinical peripheral neuropathy manifestations and 7 (12.7%) were asymptomatic. Nerve conduction studies suggested asymmetric axonal-demyelination neuropathy pattern. Mixed sensory-motor neuropathy was the most common involvement in 23(41.8%) cases. The most frequent pattern was polyneuropathy. Compared to those without neuropathy, SLE-related polyneuropathy patients were significantly older, but had no other significant associations with demographic, disease duration or serological/immunological data.

Conclusion

Peripheral nervous system manifestations are common in SLE; may be related to an increased susceptibility of peripheral nerves to effects of aging. Nerve conduction studies are recommended, therefore, for inclusion in the follow-up of SLE patients especially in the older population.

Aim of the work

The study aimed to determine the pattern of contraceptive use in rheumatoid arthritis (RA) patients in Saudi Arabia.

Patients and methods

This study was conducted among women with RA and childbearing ability who were seen at rheumatology clinics in King Abdul-Aziz University Hospital (KAUH) through a survey on the medications received and contraceptive method used.

Results

Their mean age was 27.5 ± 4.6 years and had disease duration of 3.6 ± 0.9 years. Rheumatoid factor and anti-cyclic citrullinated peptide are positive. 29.2% of the patients were illiterate and only 8.2% attended high school. Of the 158 women, 36 (86.1%) were Saudis. Methotrexate was received alone (19.6%) or in various combinations in the rest of the patients (80.4%). 109 (69%), used combined oral pills, 38 (24%) used intra-uterine device (IUD) while 7 (11%) used non-medical methods of contraception such as using condoms, withdrawal and abstinence. Using combined oral pills were used significantly more among Saudis (72.1% vs 50%) as well as IUDs (27.2% vs 4.5%)(p < 0.0001), and those who attended middle school significantly used more combined oral pills (80.4%) while those with high school used more IUDs (38.5%) (p = 0.01).

Conclusion

The commonest contraceptive method was oral contraceptives in female RA patients. However, a considerable percentage used IUD. There is a need for effective contraceptive counseling as part of routine chronic disease care and that will improve childbearing women’s contraceptive knowledge and contraceptive choice. This could be the key to decrease unintended pregnancies among these women.

Background: The relation between malignancies and rheumatic diseases (RDs) is complex with commonly shared symptoms. Rheumatological manifestations of malignancies may present as paraneoplastic syndromes and could follow chemotherapy. Aim of the work: to investigate rheumatic manifestations of patients with hematologic or solid malignancies and the relation to immune-modulation therapy. Patients and methods: The study included 25 patients with hematological and another 25 with solid malignancies. Patients were subjected to medical history, recording medications received, musculoskeletal examination and laboratory assessment. Results: The mean age and F:M of patients with hematological (43.7 ± 16.04 y and F:M 1.5:1) was significantly lower than those with solid (53.6 ± 14.3 y and F:M 7.3:1) malignancies (p = 0.025 and p = 0.024). Rheumatological manifestations as the first presentation was significantly higher in patients with haematological (60%) compared to solid (20%) malignancies (p = 0.004). Articular involvement was the commonest rheumatological manifestation (72%) followed by mucocutaneous (18%), oral/genital ulcers (10%), thromboembolic events (10%), Raynauds (8%), dry eyes (8%), myositis (6%) and myalgia (4%). The total leucocytic count and serum uric acid were significantly lower in patients with solid tumors (p = 0.045 and p = 0.026 respectively) and autoimmune markers were similar. Dry eye (16.7%), oral/genital ulcers (20.8%) and Raynaud‘s (16.7%) was present only in patients receiving anti-cancer treatment (n = 24). Paradoxically, arthritis was more frequent in those not receiving chemotherapy (n = 17) while myalgia (25%) was evident in those receiving checkpoint inhibitors (n = 8). Conclusion: Rheumatological manifestations occur with solid and hematological malignancies before or throughout the disease course and the most frequent was articular. Myalgia was associated with checkpoint inhibitors.

Introductions

Ankylosing spondylitis (AS), spondyloarthritis (SpA) prototype characteristically involves the axial skeleton and enthesis. The pathogenesis of AS is multifactorial, however it has been reported that one important factor that might contribute is vitamin D deficiency. Vitamin D and platelets share specific roles in immune response, bone health and mineral metabolism.

Aim of the work

To evaluate the serum vitamin D levels in AS patients and to study the relationship to clinical manifestations, disease activity, mobility and functionality.

Patients and methods

The study included 33 male AS patients and 33 matched control. Bath AS metrology index (BASMI), Bath AS disease activity index (BASDAI) and Bath AS functional index (BASFI) were evaluated. Serum 25-hydroxy vitamin D3 level was measured.

Results

The 33 patients had a mean age of 37.2 ± 10.7 years, disease duration of 12.7 ± 6.8 years. 3 were ex-smokers, 15 currently and 15 never smoke. The mean BASDAI was 4.2 ± 2.1, 19 (57.6%) had BASDAI score ≥ 4 (active). The BASMI was 5.7 ± 1.4 and BASFI was 5.3 ± 2.6. Patient’s vitamin D level (7.2 ± 5.2 ng/ml) was lower significantly than in the control (21.3 ± 10.1 ng/ml) (p < 0.001). There were no differences in the level of vitamin D according to the smoking status (p = 0.9). A significant inverse relation was detected between vitamin D level and BASFI (r = -0.35, p = 0.045) and a significant correlation with the platelet level (r = 0.38, p = 0.027).

Conclusion

Low vitamin D level may contribute significantly to the pathogenesis of AS. It is significantly related to the impaired function in the disease and to low platelet count.

Background

Ankylosing spondylitis (AS) is a disease of young adulthood and without adequate treatment it dramatically reduces physical activity.

Aim of the work

To present a case with AS that successfully returned to professionally playing sports after treatment.

Case presentation

A 19-year-old Eastern European Russian professional male soccer player with AS complained of right ankle joint pain not related to any trauma or injury and gradually intensified. The player's regular medical tests during the preceding years and were unremarkable. He would occasionally complain of discomfort in the ankle joints, sacroiliac area and symphysis but did not limit his regular training activity. He received the standard treatment of sports injuries that included: 14 days of limited physical activity, ibuprofen 200 mg twice/day, cryotherapy and joint taping. Examination revealed mobile joints, regular in shape without any swelling. Erythrocyte sedimentation rate (ESR) was 60 mm/1st hr and C-reactive protein (CRP) 50 mg/dl. AS was diagnosed as he fulfilled the classification criteria. HLA-B27 was positive, left sacroiliitis was present on magnetic resonance imaging (MRI). The Bath AS disease activity index (BASDAI) was 5.9. Treatment also included golimumab 50 mg/month. He improved, returned to regular training and continued playing sports professionally amid supportive therapy. The last BASDAI was 1.5.

Conclusions

AS patients with initially high levels of physical activity may restore professionally playing of sports when a proper management plan is provided. Further monitoring is warranted and the creation of a database for athletes with rheumatic diseases is recommended in order to standardize treatment protocols.

Aim of the work

To evaluate the clinical features and associated comorbidities of psoriatic arthritis (PsA) patients from a single rheumatology centre in Malaysia.

Patients and methods

247 PsA patients in rheumatology clinic, Raja Permaisuri Bainun Hospital were included. Clinical and laboratory data were retrieved from the medical record.

Results

The mean age was 56 ± 13.5 years, 56.1% were female, and 38.9% were Indians. The onset of psoriasis and PsA was significantly earlier among Malays (P < 0.01) whilst Indians had longer disease duration (P < 0.05). The mean duration of progression from psoriasis to PsA was 8.7 years. Alcohol and nail dystrophy were common among Indians (P < 0.05). Plaque psoriasis was the commonest subtype (81%) in nails (pitting, 42.5%; onycholysis, 20.7%), scalp (35.6%) and limbs (32.8%). Pustular psoriasis and onycholysis were common in males (P = 0.05 and 0.002, respectively) whilst scalp psoriasis in females (P < 0.05). Peripheral arthritis was the highest (92.7%) compared to axial (8.1%); 14.6% had both. 38.9% were oligoarthritis and mostly asymmetrical (35.6%). 24% had enthesitis, 14.6% dactylitis, and 0.8% uveitis. 52.2% had hypertension, followed by dyslipidemia (44.1%), diabetes mellitus (34%), obesity (30%), ischemic heart disease (9.7%), cancer (2.4%), and tuberculosis (0.4%). No significant relationship between the pattern of arthritis and these comorbidities (P > 0.05).

Conclusion

PsA was more prevalent in Indians. Malays have younger disease onset. Pustular psoriasis and onycholysis were common in males, while scalp psoriasis in females. Asymmetrical oligoarthritis and plaque psoriasis were the commonest pattern and psoriasis subtype respectively. Comorbidities were not associated with the pattern of arthritis in PsA patients.

Aim of the work

To explore the differential expression of tumor necrosis factor-α (TNF-α), its related immunoregulatory long non-coding RNA (THRIL), and microRNA145 (MIR145) in systemic lupus erythematosus (SLE) patients and their diagnostic utility in lupus nephritis (LN).

Patients and methods

The study included 60 SLE patients; 30 with LN, 30 without LN (NN), and 30 matched controls. SLE disease activity index was assessed. Serum TNF-α level was determined by enzyme linked immunosorbent assay. Serum fold change (FC) in expression of THRIL and MIR145 were assayed by real time polymerase chain reaction.

Results

The patients mean age was 32.6 ± 6.8 years and were 52 females and 8 males (F:M 6.5:1). Serum TNF-α level was significantly higher in SLE patients (108.6 ± 47.8 pg/ml) compared to control (39.6 ± 3.7 pg/ml) (p < 0.001). THRIL expression was upregulated (8.3 ± 6.9 vs. 1.02 ± 0.06 FC, p < 0.001) and MIR145 downregulated (0.39 ± 0.36 vs. 0.92 ± 0.94 FC, p < 0.001) in SLE patients versus controls. THRIL correlated with disease activity (r = 0.27, p = 0.035) and MIR145 with C3 (r = −0.32, p = 0.04) and C4 (r = −0.36, p = 0.016) levels in SLE patients. In LN patients, TNF-α and THRIL were increased while MIR145 downregulated (p < 0.001 each) and proteinuria significantly correlated with TNF-α (r = −0.4,p = 0.028), THRIL (r = 0.48, p = 0.007) and MIR145 (-0.42, p = 0.02). In NN patients, TNF-α and THRIL (p < 0.001 both) were increased while MIR145 downregulated (p = 0.023). TNF-α (cutoff ≥ 122.5 pg/ml, AUC 0.67, p = 0.003), and MIR145 (cutoff ≤ 0.22 FC, AUC 0.71, p = 0.026) discriminated LN from NN. The combination of TNF-α and MIR145 discriminated better than either alone (AUC 0.75, p = 0.002).

Conclusion

TNF-α and MIR145 are potential biomarkers of LN in SLE.

Aim of the work

To assess galectin-9 (Gal-9) level in the serum of systemic lupus erythematosus (SLE) patients with and without renal involvement and clarify its relation with disease activity.

Patients and methods

50 SLE patients; 25 with lupus nephritis (LN) and 25 without as well as 25 controls were studied. Systemic Lupus International Collaborating Clinics (SLICC) renal activity score and SLE disease activity index 2000 (SLEDAI-2 K) were determined. Serum Gal-9 was measured in all participants.

Results

Gal-9 level was significantly elevated in SLE patients with (16.7; 11.6–33.7 ng/ml) and without (15.9; 11.8–25 ng/ml) compared to controls (3.9; 2.8–5.4 ng/ml) (p < 0.001) but was comparable between the patients groups (p = 0.83). In LN patients, serum Gal-9 and SLICC renal activity score significantly correlated (r = 0.48, p = 0.016). Serum Gal-9 significantly correlated with SLEDAI-2 K in patients with (r = 0.71, p < 0.001) and without (r = 0.95, p < 0.001) LN, with anti-double stranded deoxyribonucleic acid (anti-ds-DNA) titers (with r = 0.57, p < 0.001 and without r = 0.79, p < 0.001) and inversely with C3 (with r = -0.44, p = 0.027 and without r = -0.63, p < 0.001) and C4 (with r = -0.47, p = 0.018 and without r = -0.43, p = 0.03). Gal-9 had an area under the curve (AUC) of 0.96 to distinguish SLE cases from control. However, AUC between LN group and non-nephritic SLE was 0.48. On regression, SLEDAI-2 K was the only significant factor associated with serum Gal-9 (p < 0.001).

Conclusion

In SLE patients, significantly raised Gal-9 levels and relation with disease activity were detected indicating its clinical relevance as biomarker of disease activity and its potential value in the disease diagnosis. Its value in discriminating LN from non-nephritic SLE is limited.

Aim of the work

To determine the frequency, causes and disease features affecting outcome of hospitalized systemic lupus erythematosus (SLE) patients, length of hospital stay and the risk factors.

Patients and methods

132 SLE patients accounting for 167 hospitalizations were recruited from the Rheumatology outpatient clinic, Faculty of Medicine, Cairo University Hospitals during 2019. SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics damage index (SLICC-DI) were assessed. Data concerning admission was recorded.

Results

The mean age of the patients was 31.4 ± 10.7 years and disease duration of 91.5 ± 84.3 months. Their mean SLEDAI was 8.7 ± 7.2 and SLICC-DI was 0.87 ± 1.2. The frequency of hospitalization was 167/1456 follow up visits (11.5%): 127 single admissions and 40 recurrent admissions. 137 hospital admissions were females and 30 males (F:M 4.6:1).The most common causes of hospitalization were disease activity in 115/167 hospital admissions (68.9%), infection in 39/167 (23.4%), comorbidities in 33/167 (19.8%). Outcome of hospitalization was improvement in 154/167 (92.2%), morbidity in 7/167 (4.2%), and mortality in 5/167 (3%). Readmission occurred in 40/167 (24%). Higher SLEDAI and gastrointestinal involvement were risk factors for longer hospital stay (p = 0.001 and p = 0.003 respectively). Morbidity was related to higher SLEDAI and SLICC-DI while mortality was related to prolonged azathioprine intake and cardiovascular involvement.

Conclusion

Disease flare and infection were the most common causes of hospitalization among SLE patients. Higher disease activity and damage as well as cardiovascular involvement were the factors associated with worse outcome. Higher SLEDAI and gastrointestinal involvement were risk factors for longer hospital stay.

Background

Genu varum is not uncommon among young adults and adolescents and may increase the risk of knee osteoarthritis (OA).

Aim of the work

To analyse the ability to correct and achieve osseous union of genu varum with high tibial osteotomy (HTO) using a dynamic axial fixator (DAF) and to evaluate knee function and pain.

Patients and methods

Fifteen knees in 13 patients with genu varus and medial compartment knee pain underwent open wedge HTO using DAF. Clinical evaluation was done using Modified Lysholm score and new Knee Society score (KSS). Long-standing X-rays were performed.

Results

The mean age of the patients was 21.9 ± 2.57 years (18–28 years) and they were 8 males and 5 females. The mean medial proximal tibial angle (MPTA) improved from 78.9 ± 4.35 (69–84) pre-operative to 91.7 ± 2.37 (88–96) post-operative. The mean mechanical tibiofemoral angle (mTFA) improved from 168.5 ± 4.06 (160–176) pre-operative to 180.4 ± 3.11 (176–186) post-operative. The target correction was achieved in 12 knees (80%) and under-correction occurred in three (20%). Significant post-operative improvements in pain and function of daily life were seen. All osteotomies healed before 4 months. The mean Modified Lyshlom and KSS scores improved from 66.4 ± 24.02 and 135.1 ± 43.95 preoperatively to 95.5 ± 9.51 and 236.9 ± 11.38 respectively (p < 0.0001 both). 6/15 (40%) knees showed complications in the form of superficial pin tract infection that all resolved without any sequela.

Conclusion

For the treatment of proximal tibia vara, HTO with DAF was safe and effective, allowing for correct post-operative alignment modification with high union rates and trivial sequelae.