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Rosina S, Rebollo-Gimenez AI, Tarantola L, Pistorio A, Vyzhga Y, El Miedany Y, Lotfy HM, Abu-Shady H, Eissa M, Osman NS, Hassan W, Mahgoub MY, Fouad NA, Mosa DM, Adel Y, Mohamed SEM, Radwan AR, Abu-Zaid MH, Tabra SAA, Shalaby RH, Nasef SI, Khubchandani R, Khan A, Maldar NP, Ozen S, Bayindir Y, Alsuweiti M, Alzyoud R, Almaaitah H, Vilaiyuk S, Lerkvaleekul B, Alexeeva E, Dvoryakovskaya T, Kriulin I, Bracaglia C, Pardeo M, De Benedetti F, Licciardi F, Montin D, Robasto F, Minoia F, Filocamo G, Rossano M, Simonini G, Marrani E, Abu-Rumeleih S, Kostik MM, Belozerov KE, Pal P, Bathia JN, Katsicas MM, Villarreal G, Marino A, Costi S, Sztajnbok F, Silva RM, Maggio MC, El-Ghoneimy DH, El Owaidy R, Civino A, Diomeda F, Al-Mayouf SM, Al-Sofyani F, Dāvidsone Z, Patrone E, Saad-Magalhães C, Consolaro A, Ravelli A. Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score. Arthritis Rheumatol 2024. [PMID: 38682570 DOI: 10.1002/art.42865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. METHODS The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. RESULTS The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. CONCLUSION The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana I Rebollo-Gimenez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Letizia Tarantola
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angela Pistorio
- Direzione Scientifica - Unità di Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yulia Vyzhga
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yasser El Miedany
- Canterbury Christ Church University, UK and Egyptian College of Pediatric Rheumatology, Egypt
| | - Hala M Lotfy
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Hend Abu-Shady
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology, Kasr Elainy Cairo University, Cairo, Egypt
| | | | - Waleed Hassan
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Marwa Y Mahgoub
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Nermeen A Fouad
- Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
| | - Doaa M Mosa
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | - Yasmin Adel
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed R Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | | | - Samar A A Tabra
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Radwa H Shalaby
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Samah I Nasef
- Rheumatology & Rehabilitation, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | | | | | | | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Yagmur Bayindir
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Motasem Alsuweiti
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Raed Alzyoud
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hiba Almaaitah
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tatyana Dvoryakovskaya
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ivan Kriulin
- National Medical Research Center of Children's Health, Moscow, Russian Federation
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Francesco Licciardi
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Davide Montin
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Francesca Robasto
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli studi di Torino, Torino, Italy
| | - Francesca Minoia
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Rossano
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Simonini
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
| | | | - Mikhail M Kostik
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Konstantin E Belozerov
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Priyankar Pal
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - Jigna N Bathia
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - María M Katsicas
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Giselle Villarreal
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Achille Marino
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Flavio Sztajnbok
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo M Silva
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Maggio
- Department PROMISE "G. D'Alessandro", University of Palermo, Italy
| | - Dalia H El-Ghoneimy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Rasha El Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Adele Civino
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Federico Diomeda
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fuad Al-Sofyani
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zane Dāvidsone
- Department of Pediatrics, University Children Hospital, Riga, Latvia
| | - Elisa Patrone
- Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Ismail MA, Mounir O, Sedky A, Algahlan HA, Abda EA, Radwan AR, Abozaid HS. Exists a role for serum irisin in Egyptian Behcet's patients with subclinical atherosclerosis? Clin Rheumatol 2023; 42:179-186. [PMID: 36112245 PMCID: PMC9823020 DOI: 10.1007/s10067-022-06368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To examine the serum irisin level in a group of Behcet's disease patients, its association with illness parameters, and its utility in diagnosing subclinical atherosclerosis. METHODS This randomized case-control study included 50 patients and 50 age- and sex-matched controls. Carotid Doppler ultrasound for the measurement of the carotid artery intima-media thickness (CIMT) and ankle-brachial pressure index (ABPI) were performed. A clinical evaluation, lipogram, and serum irisin were also performed. RESULTS Between the patients and the control group, there was a significant difference in CIMT, S. irisin level, and ankle-brachial pressure index; however, gender and BMI did not significantly affect CIMT, ABPI, or S. irisin level. CIMT demonstrated a substantial negative correlation with both S. irisin and ABPI (r = - 0.62, P 0.0001). With a sensitivity of up to 94.30% and a specificity of 93.30%, the ROC analysis revealed that a decrease in S. irisin level in Behcet's patients was indicative of subclinical atherosclerosis. The drop in the ABPI level demonstrated a sensitivity of up to 94.30% and a specificity of 100%. CONCLUSION Subclinical atherosclerosis is prevalent among Egyptian Behcet's patients, and S. irisin can be employed as a biomarker for diagnosing subclinical atherosclerosis in Behcet's illness. Key Points • Serum irisin has been studied in numerous autoimmune disorders as a marker for subclinical atherosclerosis, although its importance in Behcet's disease remains unclear (BD). • We examined the change in serum irisin levels in Behcet's disease patients and healthy controls. In addition, its association with carotid artery intima-media thickness (CIMT) and ankle-brachial pressure index was investigated (ABPI). • Changes in serum irisin levels are significant in BD, and a decrease in irisin level indicates subclinical atherosclerosis.
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Affiliation(s)
- Mohamed A Ismail
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Ola Mounir
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Ahmed Sedky
- Department of Clinical Pathology, Sohag University, Sohag, Egypt
| | | | - Esam A Abda
- Department of Rheumatology and Rehabilitation, Assuit University, Asyut, Egypt
| | - Ahmed R Radwan
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Hanan Sayed Abozaid
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt.
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Malik MNH, Waqas SFH, Zeitvogel J, Cheng J, Geffers R, Gouda ZAE, Elsaman AM, Radwan AR, Schefzyk M, Braubach P, Auber B, Olmer R, Müsken M, Roesner LM, Gerold G, Schuchardt S, Merkert S, Martin U, Meissner F, Werfel T, Pessler F. Congenital deficiency reveals critical role of ISG15 in skin homeostasis. J Clin Invest 2021; 132:141573. [PMID: 34847081 PMCID: PMC8803340 DOI: 10.1172/jci141573] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Ulcerating skin lesions are manifestations of human ISG15 deficiency, a type I interferonopathy. However, chronic inflammation may not be their exclusive cause. We describe two siblings with recurrent skin ulcers that healed with scar formation upon corticosteroid treatment. Both had a homozygous nonsense mutation in the ISG15 gene, leading to unstable ISG15 protein lacking the functional domain. We characterized ISG15–/– dermal fibroblasts, HaCaT keratinocytes, and human induced pluripotent stem cell–derived vascular endothelial cells. ISG15-deficient cells exhibited the expected hyperinflammatory phenotype, but also dysregulated expression of molecules critical for connective tissue and epidermis integrity, including reduced collagens and adhesion molecules, but increased matrix metalloproteinases. ISG15–/– fibroblasts exhibited elevated ROS levels and reduced ROS scavenger expression. As opposed to hyperinflammation, defective collagen and integrin synthesis was not rescued by conjugation-deficient ISG15. Cell migration was retarded in ISG15–/– fibroblasts and HaCaT keratinocytes, but normalized under ruxolitinib treatment. Desmosome density was reduced in an ISG15–/– 3D epidermis model. Additionally, there were loose architecture and reduced collagen and desmoglein expression, which could be reversed by treatment with ruxolitinib/doxycycline/TGF-β1. These results reveal critical roles of ISG15 in maintaining cell migration and epidermis and connective tissue homeostasis, whereby the latter likely requires its conjugation to yet unidentified targets.
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Affiliation(s)
- Muhammad Nasir Hayat Malik
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
| | - Syed F Hassnain Waqas
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
| | - Jana Zeitvogel
- Institute for Dermatology, Allergology and Venerology, Hannover Medical School (MHH), Hannover, Germany
| | - Jingyuan Cheng
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Robert Geffers
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | | | | | - Ahmed R Radwan
- Department of Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | - Matthias Schefzyk
- Institute for Dermatology, Allergology and Venerology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Braubach
- Institute for Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Bernd Auber
- Institute for Human Genetics, Hannover Medical School (MHH), Hannover, Germany
| | - Ruth Olmer
- LEBAO, Hannover Medical School (MHH), Hannover, Germany
| | - Mathias Müsken
- Central Facility for Microscopy, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Lennart M Roesner
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Gisa Gerold
- Institute for Experimental Virology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Sven Schuchardt
- Department of Bio and Environmental Analytics, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | | | - Ulrich Martin
- LEBAO, Hannover Medical School (MHH), Hannover, Germany
| | - Felix Meissner
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Thomas Werfel
- Genome Analytics, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Frank Pessler
- Biomarkers for Infectious Diseases, Centre for Experimental and Clinical Infection Research, Twincore, Hannover, Germany
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Eesa NN, Abdel Nabi H, Owaidy RE, Khalifa I, Radwan AR, NourEl-Din AM, Amer MA, ElShereef RR, Hassan E, Ismail F, El-Gazzar II, Khalil NM, Moshrif AH, Abualfadl E, Tharwat S, Fathi HM, Abd Elazeem MI, El-Shebini E, Samy N, Noshy N, El-Bahnasawy AS, Abdalla AM, Abousehly OS, Mohamed EF, Nasef SI, Elsaman AM, ElKhalifa M, Salem MN, Abaza NM, Fathy HM, Abdel Salam N, El-Saadany HM, El-Najjar AR, El-Hammady DH, Hammam N, Mohammed RH, Gheita TA. Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation. Lupus 2021; 30:2135-2143. [PMID: 34528835 DOI: 10.1177/09612033211043010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to present the manifestations of juvenile systemic lupus erythematosus (JSLE) across Egypt, to focus on age at onset and gender-driven influence on disease characteristics, and to compare findings to other countries. METHODS The study included 404 Egyptian children with systemic lupus erythematosus (SLE) presenting to one of the specialized rheumatology centers corresponding to 13 major governorates. Juvenile cases age was ≤ 16°years at the time of recruitment. The SLE Disease Activity Index (SLEDAI) and damage index (DI) were assessed. RESULTS The mean age was 13.2 ± 2.4°years; 355 females and 49 males (7.2:1), and the disease duration was 2.3 ± 1.6 years, while age at disease onset was 11.1 ± 2.5°years. Their SLEDAI was 13.5 ± 12.3, and DI, 0.36 ± 0.78. The overall estimated prevalence of childhood-SLE patients in the recruited cohort in Egypt was 1/100,000 population (0.24/100000 males and 1.8/100000 females). 7.4% developed pre-pubertal SLE (≤ 7 years); 73.3%, peri-pubertal; and 19.3% during early adolescence. The differences according to age group were equal for gender and clinical manifestations except skin lesions present in 59.3% of pre-pubertal onset, 74.6% of peri-pubertal, and 84.2% of adolescents (p = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents (p = 0.03). Laboratory investigations, SLEDAI, and DI were similar among age categories. Lupus nephritis was more common in Egypt compared to JSLE from other countries. CONCLUSION Our large multicenter study identified that female gender influenced disease characteristics with more frequent skin involvement. Skin lesions were significantly higher in adolescents, while renal involvement in peri-pubertal children.
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Affiliation(s)
- Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Abdel Nabi
- Pediatrics Department, Rheumatology and Nephrology Unit, 68782Tanta University, Gharbia, Egypt
| | - Rasha El Owaidy
- Pediatrics Department, Rheumatology Unit, 68792Ain Shams University, Cairo, Egypt
| | - Iman Khalifa
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
| | - Ahmed R Radwan
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Abeer M NourEl-Din
- Pediatrics Department, 68787National Research Centre (NRC), Cairo, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, 68789Alexandria University, Alexandria, Egypt
| | - Rawhya R ElShereef
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Eman Hassan
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 63527Cairo University, Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, 68820Al-Azhar University, Assuit, Egypt
| | - Esam Abualfadl
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
- Qena/Luxor hospitals, Qena, Egypt
| | - Samar Tharwat
- Internal Medicine, Rheumatology Unit, 68780Mansoura University, Dakahlia, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, 158405Fayoum University, Fayoum, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, 68872Menoufiya University, Menoufiya, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Nermeen Noshy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Amany S El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, 68780Mansoura University, Dakahlia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, 435387Aswan University, Aswan, Egypt
| | - Osama S Abousehly
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), 68820Al-Azhar University, Cairo, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Marwa ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, 68792Ain Shams University, Cairo, Egypt
| | - Hanan M Fathy
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | - Nancy Abdel Salam
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | | | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, 68799Zagazig University, Sharkia, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, 68900Helwan University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, 68797Assuit University, Assuit, Egypt
- Rheumatology Department, 8785University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Reem Ha Mohammed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Abd El Hamed AS, Radwan AR, Ismail MA, Ragab AE, Abdelwahab AA, Ali IK. Relation between Lymphopenia and Internal Organ Involvement in Systemic Lupus Erythematosus Patients. The Egyptian Journal of Hospital Medicine 2021; 85:3609-3615. [DOI: 10.21608/ejhm.2021.201971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Hammam N, Tharwat S, Shereef RRE, Elsaman AM, Khalil NM, Fathi HM, Salem MN, El-Saadany HM, Samy N, El-Bahnasawy AS, Abdel-Fattah YH, Amer MA, ElShebini E, El-Shanawany AT, El-Hammady DH, Noor RA, ElKhalifa M, Ismail F, Fawzy RM, El-Najjar AR, Selim ZI, Abaza NM, Radwan AR, Elazeem MIA, Mohsen WA, Moshrif AH, Mohamed EF, Aglan LI, Senara S, Ibrahim ME, Khalifa I, Owaidy RE, Fakharany NE, Mohammed RHA, Gheita TA. Rheumatology university faculty opinion on coronavirus disease-19 (COVID-19) vaccines: the vaXurvey study from Egypt. Rheumatol Int 2021; 41:1607-1616. [PMID: 34244818 PMCID: PMC8269986 DOI: 10.1007/s00296-021-04941-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the present work was to explore the perspectives of Egyptian Rheumatology staff members as regards the coronavirus disease-19 (COVID-19) vaccine. METHODS The survey is composed of 25 questions. Some questions were adapted from the global rheumatology alliance COVID-19 survey for patients. RESULTS 187 rheumatology staff members across Egypt from 18 universities and authorizations actively participated with a valid response. The mean time needed to complete the survey was 17.7 ± 13 min. Participants were 159 (85%) females (F:M 5.7:1). One-third agreed that they will be vaccinated once available, 24.6% have already received at least one dose, 29.4% are unsure while 16% will not take it. Furthermore, 70.1% agreed that they will recommend it to the rheumatic diseases (RD) patients once available, 24.1% are not sure while 5.9% will not recommend it. RD priority to be vaccinated against COVID-19 in descending order include SLE (82.9%), RA (55.1%), vasculitis (51.3%), systemic sclerosis (39.6%), MCTD (31.6%), Behcet's disease (28.3%). The most common drugs to be avoided before vaccination included biologics (71.7%), DMARDs (44.4%), biosimilars (26.7%), IVIg (17.1%) and NSAIDs (9.1%). CONCLUSIONS The results of the study and specifically the low rate of acceptability are alarming to Egyptian health authorities and should stir further interventions to reduce the levels of vaccine hesitancy. As rheumatic disease patients in Egypt were not systematically provided with the vaccine till present, making the vaccine available could as well enhance vaccine acceptance. Further studies to investigate any possible side effects, on a large scale of RD patients are warranted.
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Affiliation(s)
- Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
- Rheumatology Department, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Samar Tharwat
- Rheumatology Unit, Internal Medicine, Mansoura University, Dakahlia, Egypt
| | - Rawhya R El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany S El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Emad ElShebini
- Internal Medicine Department, Rheumatology Unit, Menoufia University, Menoufia, Egypt
| | - Amira T El-Shanawany
- Rheumatology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rasha Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt
| | - Marwa ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Zahraa I Selim
- Rheumatology Department, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed R Radwan
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mervat IAbd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Wael Abdel Mohsen
- Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Loay I Aglan
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Maha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Iman Khalifa
- Pediatrics Department, Rheumatology and Nephrology Unit, Helwan University, Cairo, Egypt
| | - Rasha El Owaidy
- Pediatrics Department, Rheumatology Unit, Ain Shams University, Cairo, Egypt
| | - Noha El Fakharany
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Elsaman AM, Hamed A, Radwan AR. Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. Korean J Pain 2021; 34:114-123. [PMID: 33380574 PMCID: PMC7783858 DOI: 10.3344/kjp.2021.34.1.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Evaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients. METHODS A total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound-guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows: visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165. RESULTS There was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes. CONCLUSIONS Epidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.
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Affiliation(s)
- AM Elsaman
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt
| | - A Hamed
- Department of Rheumatology and Rehabilitation, Minia University Hospital, Elminia, Egypt
| | - AR Radwan
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt
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Elsaman AM, Sayed A, Radwan AR. Hand dominance in early and established rheumatoid arthritis: evaluation by dynamometer, Ritchie index and musculoskeletal ultrasound: a cross sectional study. Reumatismo 2020; 72:131-144. [PMID: 33213126 DOI: 10.4081/reumatismo.2020.1273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) usually occurs as a symmetrical disease, which mainly affects the small joints of the hands and feet. The correlation of handedness with radiological changes shows significantly greater radiological changes in the dominant hand than in the non-dominant one. Additionally, the dominant hand is more severely affected in terms of strength, function and deformity. Our objective is to evaluate the influence of handedness on musculoskeletal ultrasound (US), Ritchie articular index (RAI) and digital dynamometer findings in patients with active RA (early, group B, vs. established, group A). A total number of 113 patients with established RA and 44 patients with early RA with active disease (DAS28-ESR >3.2) were included in the study. US assessments of both hands were performed to assess synovitis, tenosynovitis, and erosions. RAI was used to evaluate three joint groups in each hand. Handgrip strength was measured with a digital dynamometer. The US5 score showed that the dominant hand was more affected than the non-dominant one. This was significant in group A for the synovitis Power Doppler (PD) mode (p=0.032) and tenosynovitis PD (p=0.005) scores, and in group B for synovitis Grey Scale (GS) mode (p<0.001), synovitis PD (p=0.037) and erosions (p=0.027) scores. RAI was significantly higher in the dominant hand (p=0.013) in group A and even greater in group B (p=0.011). The dominant hand was stronger than the non-dominant hand in both groups. The dominant hand is generally affected in early RA. Subsequently, the disease tends to become more symmetrical with disease progression.
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Affiliation(s)
- A M Elsaman
- Associate Professors of Rheumatology, Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag University, Sohag.
| | - A Sayed
- Consultant of Pain Management, Armed Forces Specialized Center of Rehabilitation, Altaif.
| | - A R Radwan
- Associate Professors of Rheumatology, Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag University, Sohag.
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Elsaman AM, Mostafa ES, Radwan AR. Ankle Evaluation in Active Rheumatoid Arthritis by Ultrasound: A Cross-Sectional Study. Ultrasound Med Biol 2017; 43:2806-2813. [PMID: 28987543 DOI: 10.1016/j.ultrasmedbio.2017.08.928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
Ankle joint evaluation is underestimated in many clinical and sonographic scores used for evaluation and follow-up of rheumatoid arthritis (RA) patients. Agreement on examination parameters is poor among sonographic scores that include the ankle joint. More effort is needed to detect the value of ankle joint examination in RA and assessment of ultrasonographic signs according to frequency, disease duration and activity. The objective of this study was to use ultrasound (US) to detect ankle involvement in active RA and to compare findings with disease duration, disease activity and assessment of ankle bone erosion. A total of 63 RA patients with active disease and 20 controls were included in the study. The tibiotalar and talonavicular joints were examined by US for synovitis and/or effusion in gray-scale and power Doppler modes. The anterior, lateral and posterior ankle tendons were examined for tenosynovitis and tendinosis. Mean age was 35.1 ± 8.3 y, mean disease duration was 22.7 ± 9.6 mo and the mean 28-joint Disease Activity Score-erythrocyte sedimentation rate was 3.05 ± 0.66. Ankle involvement was seen in 28 patients (44.4%). The most frequent pathologies detected were tenosynovitis (30.2%), followed by synovitis (18.3%), erosion (8.7%) and tendinosis (4%). The earliest sonographic signs were tenosynovitis, followed by synovitis, erosion and tendinosis. The right ankle exhibited greater involvement than the left ankle, which was significant with respect to erosions (p = 0.009). The most common tendon affected by tenosynovitis was the tibialis anterior (22.2%), followed by the tibialis posterior (20.6%). Tenosynovitis, especially of the tibialis anterior and posterior, tibiotalar synovitis and erosions should be considered in future US ankle scores for the assessment of RA.
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Affiliation(s)
- Ahmed M Elsaman
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt.
| | - Ehab Saad Mostafa
- Department of Rheumatology and Rehabilitation, South Valley University Hospital, Qena, Egypt
| | - Ahmed R Radwan
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag, Egypt
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Elsaman AM, Radwan AR, Mohammed WI, Ohrndorf S. Low-dose Spironolactone: Treatment for Osteoarthritis-related Knee Effusion. A Prospective Clinical and Sonographic-based Study. J Rheumatol 2016; 43:1114-20. [PMID: 27036390 DOI: 10.3899/jrheum.151200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of spironolactone as a treatment for osteoarthritis (OA)-related knee effusion in comparison to ibuprofen, cold compresses, and placebo. METHODS This study was carried out on 200 patients, aged 40 years or older, attending the outpatient clinic of the Rheumatology Department of Sohag University Hospital with unilateral knee effusion related to OA based on clinical examination, musculoskeletal ultrasonography (US), and synovial fluid analysis. In group 1, 50 patients received spironolactone 25 mg daily for 2 weeks; in group 2, 50 patients took ibuprofen 1200 mg daily for 2 weeks; in group 3, 50 patients used cold compresses 2 times daily for 2 weeks; and in group 4, 50 patients received placebo for the same duration. Fluid > 4 mm was considered as effusion. Decrease in fluid to reach below 4-mm thickness was considered complete improvement, and any decrease that did not reach below 4 mm thickness was considered partial improvement. RESULTS The mean age of the participants was 51.2 ± 8.1 years. The mean duration of effusion was 16.5 ± 3.6 days. In group 1, 66% had complete improvement, 20% partial improvement, and 14% no response. In group 2, 24% had complete improvement, 12% partial improvement, and 64% no response. In group 3, 28% had complete improvement, 14% partial improvement, and 58% no response. In group 4, only 6% had complete improvement, 10% partial improvement, and 84% no response. CONCLUSION Low-dose spironolactone is a safe and effective medical treatment for OA-related knee effusion.
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Affiliation(s)
- Ahmed M Elsaman
- From the Department of Rheumatology and Rehabilitation, and the Department of Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt; Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany.A.M. Elsaman, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; A.R. Radwan, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; W.I. Mohammed, MD, Lecturer of Pharmacology, Department of Pharmacology, Faculty of Medicine, Sohag University; S. Ohrndorf, MD, Specialist in Internal Medicine/Rheumatology, Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin
| | - Ahmed R Radwan
- From the Department of Rheumatology and Rehabilitation, and the Department of Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt; Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany.A.M. Elsaman, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; A.R. Radwan, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; W.I. Mohammed, MD, Lecturer of Pharmacology, Department of Pharmacology, Faculty of Medicine, Sohag University; S. Ohrndorf, MD, Specialist in Internal Medicine/Rheumatology, Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin
| | - Walaa I Mohammed
- From the Department of Rheumatology and Rehabilitation, and the Department of Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt; Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany.A.M. Elsaman, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; A.R. Radwan, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; W.I. Mohammed, MD, Lecturer of Pharmacology, Department of Pharmacology, Faculty of Medicine, Sohag University; S. Ohrndorf, MD, Specialist in Internal Medicine/Rheumatology, Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin
| | - Sarah Ohrndorf
- From the Department of Rheumatology and Rehabilitation, and the Department of Pharmacology, Faculty of Medicine, Sohag University, Sohag, Egypt; Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany.A.M. Elsaman, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; A.R. Radwan, MD, Lecturer of Rheumatology, Department of Rheumatology and Rehabilitation, Faculty of Medicine, Sohag University; W.I. Mohammed, MD, Lecturer of Pharmacology, Department of Pharmacology, Faculty of Medicine, Sohag University; S. Ohrndorf, MD, Specialist in Internal Medicine/Rheumatology, Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin.
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Yassin FEZSD, Meghezel EM, Abd Elfattah MSAI, Radwan AR. Histopathological predictors of virological response in chronic hepatitis C patients. Egyptian Journal of Pathology 2015; 35:68-75. [DOI: 10.1097/01.xej.0000465416.29750.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Elsaman AM, Radwan AR, Akmatov MK, Della Beffa C, Walker A, Mayer CT, Dai L, Nativ S, Rygg M, Atsali E, Saijo K, Ogdie AR, Srinivasulu N, Fathi N, Schumacher HR, Pessler F. Amyloid arthropathy associated with multiple myeloma: a systematic analysis of 101 reported cases. Semin Arthritis Rheum 2013; 43:405-12. [PMID: 23992800 DOI: 10.1016/j.semarthrit.2013.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/29/2013] [Accepted: 07/08/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Amyloid deposition in multiple myeloma (MM) may lead to an arthropathy resembling rheumatoid arthritis (RA). Since a systematic description of its natural history is lacking, we have performed a systematic analysis of all published cases. METHODS Literature review featuring backward and forward database searches and direct inspection of reference lists. Inclusion criteria were as follows: publication between 1931 and 2012, diagnosis of multiple myeloma, and demonstration of light chain amyloid (AL) in any organ or in synovial fluid, arthritis, or synovitis. RESULTS Overall, 101 cases were identified. Median age was 59 years and the male-to-female ratio was 1:1. A systemic manifestation of MM was reported in 88 cases. In 53 of these, characteristic physical findings (carpal tunnel syndrome, macroglossia, shoulder pad, and soft tissue swelling/masses) were present. Arthritis manifested before the diagnosis of MM in 63 cases, with 33 cases initially misdiagnosed as RA. There were 72 cases of poly-, 17 of oligo-, and three of monoarthritis. The shoulder joint was most commonly affected, followed by knees and small hand joints. Median synovial fluid leukocyte count was 2460 cells/mm(3), and was normal in seven cases. Synovial histopathology often featured mild synovitis without plasma cell infiltration. Imaging revealed articular or periarticular inflammation in many cases and bone lesions near 22% of affected joints. Treatments varied but led to some improvement in the majority of cases. CONCLUSIONS These results solidify previous experience that MM arthropathy tends to feature a symmetric RF-negative nonerosive polyarthritis. However, the results also highlight the diversity of its presentations and stress the importance of arthropathy as a potentially under-recognized presenting manifestation of MM.
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Affiliation(s)
- Ahmed M Elsaman
- Department of Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
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