Egyptian Rheumatologist最新文献

{"title":"Effect of first week-intermittent fasting during Ramadan on the severity of neuropsychiatric symptoms in patients with fibromyalgia: A prospective study","authors":"Mona Hussein ,&nbsp;Wael Fathy ,&nbsp;Mohamed Abdelghaffar ,&nbsp;Mohamed T. Hegazy ,&nbsp;Doaa A. Teleb ,&nbsp;Shaden Adel ,&nbsp;Dina Y. Kassim ,&nbsp;Rehab Magdy","doi":"10.1016/j.ejr.2023.09.006","DOIUrl":"10.1016/j.ejr.2023.09.006","url":null,"abstract":"<div><h3>Background</h3><p>Fasting has been well-reported as an adjunctive therapeutic approach in some chronic pain syndromes.</p><p>Aim of the work</p><p>To study the effect of Ramadan intermittent fasting (RIF) on the severity of neuropsychiatric symptoms in patients with fibromyalgia.</p><p>Patients and methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusion</p><p>RIF may improve pain, anxiety, and depression, while it has deleterious effects on sleep and fatigue among patients with fibromyalgia.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1110116423000807/pdfft?md5=67656edb59543570ee4d0e42ba21820b&pid=1-s2.0-S1110116423000807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spirulina as a promising agent in rheumatoid arthritis with no observed hepatic injury","authors":"Noha A. Fadel ,&nbsp;Maha M. Aziz,&nbsp;Ghada M. Shafey,&nbsp;Rasha R. Rashed,&nbsp;Heba A. Gheita","doi":"10.1016/j.ejr.2023.12.001","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.12.001","url":null,"abstract":"<div><h3>Aim of the work</h3><p><span><span>To examine early mitigation and conservative effects of low-dose gamma radiation (LDR) or spirulina (SPR) algae on inflammation, </span>oxidative stress<span> and liver function in experimentally-induced arthritis in rats, and comparing such effects to conventionally used rheumatoid arthritis (RA) </span></span>drugs<span><span>; methotrexate (MTX) and </span>hydroxychloroquine (HCQ) in an attempt to unleash a safer remedy/therapeutic modality for RA management.</span></p></div><div><h3>Materials and methods</h3><p><span>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), </span>HCQ sulphate (15 mg/kg/day, orally), MTX + HCQ, and SPR (1 g/kg/day, orally) for 28 days.</p></div><div><h3>Results</h3><p>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<span><span> (MDA) and nitric oxide<span> (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 </span></span>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.</span></p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033631","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}

{"title":"Nerve conduction study findings in females with systemic lupus erythematosus","authors":"Ibtisam M. Jali ,&nbsp;Hind A. Alnajashi ,&nbsp;Omar A. Ayoub ,&nbsp;Sami M. Bahlas ,&nbsp;Yasser M. Bawazir ,&nbsp;Mohammad A. Mustafa","doi":"10.1016/j.ejr.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.12.002","url":null,"abstract":"<div><h3>Aim of the work</h3><p>To investigate the frequency, characteristics, and associated factors of systemic lupus erythematosus-related peripheral neuropathy<span> (SLE-PN) using nerve conduction study (NCS).</span></p></div><div><h3>Patients and methods</h3><p>A retrospective chart review was conducted at the Rheumatology<span> 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.</span></p></div><div><h3>Results</h3><p>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<span><span><span>, 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 </span>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, </span>lupus nephritis<span><span>, 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. </span>Multivariate analysis identified non-Saudi nationality and the presence of end-organ damage as two significant predictors of SLE-related PN.</span></span></p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033653","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}

{"title":"Screening of silent inflammatory bowel disease in seronegative spondyloarthritis patients: Fecal calprotectin, ileo-colonoscopy and histopathology assessment","authors":"Shaimaa Badran ,&nbsp;Andrew Saweres ,&nbsp;Hadeel GamalEldeen ,&nbsp;Mohamed B. Hashem ,&nbsp;Dalia Abdel-kareem ,&nbsp;Fatma H. Abdelraouf ,&nbsp;Wafaa Gaber ,&nbsp;Tamer Elbaz","doi":"10.1016/j.ejr.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.10.001","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Aimof the work</h3><p>to screen for silent IBD in SpA patients.</p></div><div><h3>Patients and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1110116423000893/pdfft?md5=7531fb6dcd66da5a4e3113c2ad352e4d&pid=1-s2.0-S1110116423000893-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonographic study of hand joints erosions in rheumatoid arthritis: Relation to clinical characteristics, disease activity and functional status","authors":"Samar Tharwat ,&nbsp;Ali Youssef ,&nbsp;Mohammed K Nassar ,&nbsp;Mostafa Mansour ,&nbsp;Mona K Nassar ,&nbsp;Fatma Hamdy","doi":"10.1016/j.ejr.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.11.003","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Aim of the work</h3><p>To assess ultrasound-detected bone erosions in RA patients and establish their associations with clinical and laboratory variables.</p></div><div><h3>Patients and methods</h3><p><span><span>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, </span>tenosynovitis, and erosions. </span>Erythrocyte sedimentation rate<span> (ESR), C-reactive protein (CRP), rheumatoid factor<span><span> (RF), and anti-cyclic citrullinated peptide (anti-CCP) were performed. The disease activity score (DAS28) and </span>health assessment questionnaire (HAQ) was evaluated</span></span></p></div><div><h3>Results</h3><p><span>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), </span>DAS28<span> (p = 0.003), HAQ (p = 0.032), ESR (p = 0.005), presence of synovitis (p = 0.005), and synovitis score (p &lt; 0.001).</span></p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138550086","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}

{"title":"Clinical utility of serum Galactin-9 in evaluation of systemic lupus erythematosus patients","authors":"Mona H. Abd Elsamea ,&nbsp;Mohamed Raouf Abdel Razik ,&nbsp;Reem H. Abd Alrahman ,&nbsp;Dalia T. Kamal ,&nbsp;Essam Ahmed Abda","doi":"10.1016/j.ejr.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.11.005","url":null,"abstract":"<div><h3>Aim of the work</h3><p>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.</p></div><div><h3>Patients and methods</h3><p>The study included 50 SLE patients and 50 matched controls. SLE disease activity index<span> (SLEDAI) was assessed and patients subdivided into active (SLEDAI &gt; 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).</span></p></div><div><h3>Results</h3><p>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 &lt; 0.0001) and in active compared to inactive LN patients (1377.9 ± 2273.8 vs. 317.6 ± 40.4, P &lt; 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 &lt; 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 &lt; 0.0001) at a sensitivity of 90 %, specificity of 84.2 %, and accuracy of 88 %. Gal-9 was significant predictor for SLE activity.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138474708","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}

{"title":"Cardiac manifestations in patients with systemic lupus erythematosus and rheumatoid arthritis: Relation to long-term use of hydroxychloroquine","authors":"Amina Badr El Din ,&nbsp;Samah A. Elbakry ,&nbsp;Elham Shabaan ,&nbsp;Mohamed A Teama ,&nbsp;Ahmed Ibrahim El Desoky ,&nbsp;Nehal Abdelbaky","doi":"10.1016/j.ejr.2023.11.004","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.11.004","url":null,"abstract":"<div><h3>Aim of the work</h3><p><span>to investigate and record cardiac side effects of long-term use of </span>hydroxychloroquine<span> (HCQ) in patients<span><span> with systemic lupus erythematosus (SLE) and </span>rheumatoid arthritis (RA).</span></span></p></div><div><h3>Patients and methods</h3><p><span>This study included 25 patients with RA and 25 with SLE. The study population was either in remission or demonstrated low disease activity, as assessed by the SLE disease activity index 2000 (SLEDAI-2 K) for SLE patients and the </span>disease activity score 28<span> (DAS28) for RA patients. All patients had been receiving HCQ for at least two years. They did not exhibit any symptoms of coronavirus disease-2019 (COVID-19) and received COVID-19 vaccination. Cardiac adverse events were assessed through electrocardiogram (ECG) and echocardiography (ECHO) examinations.</span></p></div><div><h3>Results</h3><p>94 % (n = 47) were females and 6 % (n = 3) were males. The age of the subjects ranged from 20 to 60 years, with a mean age of 41.6 ± 11.2 years. Out of the 50 ECGs assessed, 84 % (n = 42) exhibited no abnormalities. Additionally, all ECGs showed QTc within the normal range. Only 2 RA patients had heart failure characterized by reduced ejection fraction (EF). There was no significant association between the cumulative dosage of HCQ administered in SLE patients and the ECG abnormalities (p = 0.76), QTc (p = 0.228) or EF (p = 0.96). Moreover, there was no significant association between the cumulative dosage of HCQ administered in RA patients and the ECG abnormalities (p = 0.479), QTc (p = 0.85) or EF (p = 0.69).</p></div><div><h3>Conclusion</h3><p>This study affirms the cardiac tolerability of HCQ in the sustained therapeutic management of SLA and RA patients.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138467936","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}

{"title":"Damage in rheumatic diseases: Contemporary international standpoint and scores emerging from clinical, radiological and machine learning","authors":"Samar Tharwat ,&nbsp;Iman I. El-Gazzar ,&nbsp;Rawhya El Shereef ,&nbsp;Faten Ismail ,&nbsp;Fatma Ali ,&nbsp;Hanan Taha ,&nbsp;Ahmed Elsaman ,&nbsp;Amany El-Bahnasawy ,&nbsp;Yousra Hisham ,&nbsp;Marwa Amer ,&nbsp;Amany El Najjar ,&nbsp;Hanan M. Fathi ,&nbsp;Nahla Eesa ,&nbsp;Reem H. Mohammed ,&nbsp;Noha M. Khalil ,&nbsp;Nouran M. Shahaat ,&nbsp;Nevin Hammam ,&nbsp;Samar Fawzy","doi":"10.1016/j.ejr.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.11.002","url":null,"abstract":"<div><p><span>In rheumatic diseases, damage is a major concern and reflects irreversible organ scarring or tissue degradation. Quantifying damage or measuring its severity is an indispensable concern in determining the overall outcome. Damage considerably influences both longterm prognosis and </span>quality of life<span>. Rheumatic diseases (RD) represent a significant health burden. Organ damage is consistently associated with increased mortality. Monitoring damage is critical in the evaluation of patients and in appraising treatment efficacy. Proper assessment and early detection of damage paves way for modifying the disease course with effective medications and regimens may reduce organ damage, improve outcomes and decrease mortality. With the exception of systemic lupus erythematosus and vasculitis, most RDs lack an established damage index making it an ongoing demand to develop effective scores and prediction models for damage accrual early in the disease course. A better understanding of machine learning with the increasing availability of medical large data may facilitate the development of meaningful precision medicine for patients with RDs. An updated spectrum of clinical and radiological damage scores and indices as well as the role of machine learning are presented in this review for the key RDs.</span></p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447923","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}

{"title":"Modern determinants of cardiovascular risk factors in patients with psoriatic arthritis: Relation to disease activity and severity","authors":"Svitlana I. Smiyan ,&nbsp;Anastasia V. Bilukha ,&nbsp;Bohdan O. Koshak","doi":"10.1016/j.ejr.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.11.001","url":null,"abstract":"<div><h3>Aim of the work</h3><p>To evaluate the frequency of cardiovascular (CV) risk factors in psoriatic arthritis (PsA) patients.</p></div><div><h3>Patients and methods</h3><p>The study included 97 PsA patients and 30 control. Lipid profile and serum homocysteine level were assessed. The endothelium-dependent vasodilation (EDVD) evaluated. The QRISK-3 scale was used to assess CV risk. Disease activity PsA (DAPSA) and psoriasis area and severity index (PASI) were recorded.</p></div><div><h3>Results</h3><p>Reduced EDVD (&lt;10 %) was significantly more frequent in PsA compared to control (75.3 % vs. 6.7 %, p &lt; 0.001), with significant differences in lipid profile (p &lt; 0.001), homocysteine (p &lt; 0.001), QRISK (p &lt; 0.001), CRP (p &lt; 0.001), DAPSA (p &lt; 0.001), and disease duration (p &lt; 0.001) between PsA patients with reduced and normal EDVD. Average CV risk was 7.7 times higher than in control, and the classical risk factors did not account for the reduced EDVD. Linear regression analysis identified disease duration (β 0.5; OR 1.65, p &lt; 0.001) and disease activity (β 0.09; OR 1.09, p &lt; 0.001) as significant predictors of CV risk in PsA patients. The predictive accuracy of DAPSA (sensitivity 69 %, specificity 86.4 %, 95 % CI: 0.7–0.9; p &lt; 0.001) and disease duration (sensitivity 91 %, specificity 55 %, 95 % CI: 0.95–1; p &lt; 0.001) for CV risk was determined.</p></div><div><h3>Conclusion</h3><p>A heightened CV risk in PsA patients is highlightened independent of traditional risk factors. The significance of disease activity and disease duration as robust predictors of CV risk in PsA patients is emphasized. The data on hyperhomocysteinemia and its association with endothelial dysfunction emphasize the intricate link between PsA, homocysteine levels, and increased CV risk.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S111011642300090X/pdfft?md5=a3afc620119305fa7a6cd62c52aa644e&pid=1-s2.0-S111011642300090X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138423317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral extensive steroid-associated osteonecrosis (SAON) of femur, tibia and patella: Successful early management with combined antiresorptive and anabolic bone agents","authors":"Yasser Ragab ,&nbsp;Yasser Emad ,&nbsp;Khalid Alhusseiny ,&nbsp;Ahmed Elnaggar ,&nbsp;Amr A Saad ,&nbsp;Omar A Saad ,&nbsp;Farida Y Emad ,&nbsp;Johannes J. Rasker","doi":"10.1016/j.ejr.2023.09.002","DOIUrl":"https://doi.org/10.1016/j.ejr.2023.09.002","url":null,"abstract":"<div><h3>Aim of the work</h3><p>To present a case of bilateral extensive steroid-associated osteonecrosis (SAON) of femur, tibia and patella that was successfully managed with combined antiresorptive and anabolic bone agents.</p></div><div><h3>Case presentation</h3><p>A 38-year-old female patient encountered an aggressive coronavirus disease 2019 (COVID-19) infection and was given systemic steroids for six months. The patient then began to experience bilateral lower limb pain. Tenderness over the knee joint margins was found, as well as tenderness of the lower end of the femur, upper tibia, and patella on both sides. The initial plain x-ray of the lower limb bones revealed subtle areas of sclerosis at the proximal metaphysis of tibial bones. The patient did not improve despite stopping steroids and repeated courses of simple analgesics, and the pain became progressive and more intense, to the point where the patient was unable to bear any weight and became wheel chair bound. Magnetic resonance imaging (MRI) was done revealing extensive osteonecrotic lesions involving the distal metaphysis of the femur with posterior extension into the medial and lateral condyles abutting the articular surfaces. Two anti-osteoporotic drugs were used; alendronate, used weekly to inhibit osteoclastic activity and limit the progression of the osteonecrotic lesions and teriparatide, an anabolic agent that increases osteoblasts, resulting in new trabecular and cortical bone growth. Clinical improvement, pain and ambulation, occurred after one month of initiation of treatment and follow up MRI study after 10 months showed marked radiological improvement.</p></div><div><h3>Conclusion</h3><p>Combined antiresorptive and anabolic bone agents remarkably reversed SAON.</p></div>","PeriodicalId":46152,"journal":{"name":"Egyptian Rheumatologist","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49790392","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}