Pattern of Uveitis in a Tertiary Hospital in North Jordan and the Impact of Behcet's Disease

Aim

The purpose of this study is to assess the prevalence of autoimmune-mediated uveitis in relation to other diseases and to describe the clinical patterns of uveitis in a single tertiary hospital in north Jordan.

Methods

A cross-sectional retrospective review was performed. We included all patients diagnosed with uveitis in King Abdullah University Hospital (KAUH) ophthalmology clinic and/or patients referred to KAUH rheumatology clinics for evaluation of suspected autoimmune mediated uveitis or for difficult to treat uveitis. This included patients from January 2015 to January 2019. Data collected about patients' age, sex, anatomical location of the disease, etiology, treatment, complications, and outcomes on vision loss were analyzed.

Results

A total of 221 patients were included in our study. The mean (±SD) age was 36 (±16) years. A total of 111 patients were female and 110 were male with a ratio of 1 : 1. Noninfectious uveitis was found to be more common than infectious uveitis (95% vs. 5% respectively). Autoimmune-mediated uveitis accounted for 40% of the total cases. The most common causes of autoimmune-mediated uveitis included Behcet's disease (n = 41, 19%) and seronegative spondyloarthropathy (n = 29, 13%). The majority of patients (n = 207, 94%) were treated with ophthalmic eye drops, cDMARDs (n = 101, 46%), biologics (n = 33, 15%), and colchicine (n = 30, 14%).

Conclusion

Autoimmune-mediated uveitis, most commonly associated with Behcet's disease and seronegative spondyloarthropathy, represents a high percentage of uveitis in our area. This implies the need for a high index of suspicion at the time of evaluation.

Prevalence of rheumatoid arthritis among hospital workers in the north of Jordan: Preliminary report of a hospital-based cohort study

Background

Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults. Prevalence estimates of rheumatoid arthritis vary in the world. Occupational factors and geographical location might contribute to a higher risk of developing the disease, however the exact etiology remains unknown.

The aim of our study was to estimate the prevalence of RA among hospital workers in the North of Jordan and to compare this prevalence with that in the general population. In addition to describing the characteristics of RA patients.

Methods

The study was performed in two stages; during the first stage a specially designed questionnaire was conducted by trained residents with 2569 hospital workers from 6 government hospitals to identify individuals with RA. Suspected individuals of having RA identified in stage one were invited and examined further by two rheumatologists for confirmation of the diagnosis.

Results

A total of 2569 employees were interviewed; among them 1240 (48.5%) were males and 1318 (51.5%) were females. The mean (SD) age was 34±(8.4) years. In the second stage the diagnosis of RA according to ACR criteria 1987 was confirmed in 8 individuals (2 males and 6 females). Male: Female (M: F) ratio was 1:3 with mean (SD) age 43.38 (7.52) years. The estimated prevalence of RA among hospital workers in the North of Jordan was 8/2569 = 0.00311, 31.1:10.000, 0.31%, (95% confidence interval, 9.6–52.7:10.000).

Conclusion

The prevalence of RA among hospital workers in the North of Jordan is 0.31%, similar to that of other parts of Jordan and neighboring regions.

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Rheumatoid arthritis is a chronic disabling disease.

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Data regarding RA in Jordan is very limited. We conducted this study to shed light on how widespread RA.

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Our study showed similar prevalence of RA in surrounding regions, suggesting influence of environmental and occupational factors.

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We hope this may help advance patient care and management.

Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study

Background

Rheumatoid arthritis (RA) is a common rheumatological disease which can involve a variety of different renal manifestations. This may be explained by disease effect itself or by medications used for treatment that may lead to renal dysfunction and its complications.

We aimed to identify the prevalence and factors that played a role in renal dysfunction among RA Jordanian patients.

Method

285 patients with RA visiting outpatient clinic between March 2016 and March 2017 were included in a retrospective study design. Age, gender, comorbidities, duration of the disease, medications and laboratory results were gathered and scoring of RA activity was done.

Results

Data gathered from the 285 patients showed a female predominance with 88.4% female and 11.6% male. The average disease duration was 6.7 years. Age, DM, HTN, and serum CRP were associated with worse renal function on univariate analysis. 44 patients (18.8%) presented with microscopic hematuria, 16 (6.9%) with proteinuria and only 5 (2.1%) patients presented with both microscopic hematuria and proteinuria. Patients with eGFR <60 ml/min had longer disease duration with a mean of 11 years (±7.7) in comparison to 6.4 years (±6.1) for those with eGFR>90 ml/min (P = 0.001).

Conclusion

Renal dysfunction is not common in RA Jordanian population and has variable presentations. Age and the duration of illness play a major role in the progression of CKD if present. Future prospective studies evaluating renal biopsies in RA patients are needed.

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First study in the country to discuss the prevalence of renal involvement in rheumatoid arthritis.

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Renal involvement is rare in rheumatoid arthritis patients.

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Different drugs can affect renal outcome in a different ways.

Diaphragmatic Lipoma in a Woman with Rheumatoid Arthritis: A Case Report and Literature Review

Patient: Female, 52-year-old

Final Diagnosis: Diaphragmatic lipoma

Symptoms: Shortness of breath

Medication: —

Clinical Procedure: CT scan

Specialty: Radiology • Rheumatology

The prevalence of Behçet's disease in the north of Jordan: a hospital-based epidemiological survey

OBJECTIVES

To estimate the prevalence of Behçet's disease (BD) in Jordan, with the additional aim of comparing this prevalence among hospital workers in other geographical areas.

METHODS

In the first stage of our survey, 2,569 employees from 6 hospitals in north Jordan were interviewed using a screening questionnaire to identify individuals with recurrent oral ulcers (ROU), a previous diagnosis of BD (PDBD) and/or any major symptom related to BD. In the second stage, all individuals with ROU or PDBD identified at stage 1, were examined by 2 rheumatologists for the presence/confirmation of BD according to the International Study Group (ISG) criteria. Pathergy test was performed according to recommendations.

RESULTS

ROU were present in 210 (8.2%) individuals. BD was confirmed in 10 employees with PDBD. Seven more BD patients were found. Mean age of 17 BD patients was 38.6±10.7 (range 26-65 y). M: F was 2.4:1. Pathergy test was positive in 8/17. A family history of ROU or BD was noted in 9 (52%) and 3 (25.0%), respectively, compared to 227 (8.9%) and 62 (2.6%) in the whole group, excluding the BD patients (p<0.001 and 0.008, respectively). The prevalence rate of BD in the north of Jordan was estimated as 66:10.000 (95% CI 34.8 to 97.5:10000).

CONCLUSIONS

The results of this first ever survey indicated that the prevalence of BD in the north of Jordan is among the highest in the world. This prevalence can now be compared to hospital workers in other geographical areas.

Comparison if the addition of multilevel vertebral augmentation to conventional therapy will improve the outcome of patients with multiple myeloma

Background

This was a prospective study to evaluate the effect of multilevel vertebral augmentation in addition to conventional therapy in multiple myeloma patients.

Methods

We treated 27 patients, whom were recently diagnosed to have multiple myeloma by two ways of treatment. Thirteen patients (group I) were treated with conventional therapy and 14 patients (group II) with adding vertebroplasty and kyphoplasty. Patients were evaluated pre-treatment and at half, one, two and 3-years post-treatment by using Oswestry Disability Index (ODI), the Stanford Score (SS) and the Spinal Instability Neoplastic Score (SINS).

Results

Mean values of ODI, SS and SINS were 31.9 (63.8%), 4.3 and 13.8 for group I and 33.2 (66.4%), 4.6 and 12.8 for group II before starting treatment. Group II showed improvement better than group I at all follow-up intervals with best results at first 6 months. P-values at the end of the study were ODI = 0.047, SS = 0.180 and SINS = 0.002. Mortality rates were equal of both groups (four patients of each group).

Conclusion

Adding vertebral augmentation to conventional therapy improves multiple myeloma patients’ quality of life, but didn’t affect the mortality rate.

Two novel mutations of FBN1 in Jordanian patients with Marfan syndrome

Marfan syndrome is an autosomal dominant inheritance disorder with a 1/5000-live-birth prevalence. More than 3000 mutations have been characterized thus far in the FBN1 gene. The goal of this study is to facilitate Marfan syndrome diagnosis in Jordanian patients using a molecular genetic testing. All of the 65 coding exons and flanking intronic sequences of the FBN1 gene were amplified using polymerase chain reaction and were subjected to sequencing in five unrelated Jordanian patients suspected of having Marfan syndrome. Four different mutations were identified, including two novel mutations: the c.1553dupG frame-shift (p.Tyr519Ilefs*14) and the c.6650G>A (p.Cys2217Tyr) missense mutations. Two other missense mutations, c.2243G>A (p.Cys748Tyr) and c.2432G>A (p.Cys811Tyr), have been previously detected. Patient number five was heterozygous for the synonymous substitution variant c.1875T>C (p.Asn625Asn; rs#25458). Additionally, eight variants in the intronic sequence of the FBN1 gene were identified, of which the c.2168-46A>G mutation was a new variant. The data provide molecular-based evidence linking Marfan syndrome to pathogenic mutations in the FBN1 gene among Jordanians for the first time. Thus, our results will contribute to the better management of the disease using molecular tools and will help in genetic counseling of the patients' families.

Low prevalence of malignancy in patients with idiopathic inflammatory myopathies in Jordan

OBJECTIVES

To estimate the frequency of malignancy among patients with idiopathic inflammatory myopathies (IIM) in Jordan.

METHODS

This was a retrospective review of case records of patients with IIM in Jordan.

RESULTS

We identified 94 cases of IIM, (47 polymyositis (PM) and 47 dermatomyositis (DM)). Sixty-seven (71%) were females and 27 (29%) were males. The mean age at diagnosis was 39.7± 15.7 years (range 17-72), median 40 years and the mean follow-up was 5.05±4.03 years (0.2-19). Malignancy was diagnosed in only 4 patients (4.25%) with IIM. Among patients with DM, malignancy was found in three patients (6.4%).The age-standardised rate was 2.7% (95% confidence interval: 0. 6% to 7.1%). The standardised incidence ratio was 0.998. Diagnosis of associated malignancy was made close to the time of IIM diagnosis. Two male patients had nasopharyngeal carcinoma at the ages of 51 and 59 years, while the other two were female with breast and ovarian cancer at the ages of 40 and 45 years, respectively.

CONCLUSIONS

Malignancy in association with IIM was found to be low in our cohort in comparison to reports from other countries. The observed number of cancer cases in this group of patients is similar to the expected number of cases that would occur in general population of Jordan. This could be related to younger age of disease onset. The benefits of long-term screening for malignancy in our population are not clear.

Rheumatoid arthritis in Jordan: a cross sectional study of disease severity and associated comorbidities

Treating rheumatoid arthritis (RA) to target is advocated using disease activity measures. The impact of RA on the general health status of affected patients in Jordan is not well described. This study reported the severity of RA in Jordan and its association with consequent disabilities and comorbidities. A cross-sectional, observational study was conducted at King Abdullah University Hospital in the north of Jordan. All patients who were diagnosed with RA were included. Patients’ demographics, comorbidities, disease activity score (DAS 28), and clinical disease activity index (CDAI) were collected. Both DAS 28 and CDAI were utilized to categorize RA disease activity. A total of 465 patients with RA were included: 82% were females; mean age ± standard deviation (SD) was 47.62±14.6 years; and mean disease duration ± SD was 6±4.45 years. The mean ± SD for the DAS 28 and CDAI was 5.1±1.5 and 23±14.2, respectively. According to the DAS 28, 51% of the patients were in the high disease activity category and only 5% were in remission. On the other hand, according to the CDAI, 44% were in the high disease activity category and only 1% were in remission. In Jordan, patients with RA have a high severe disease rate and a low remission rate. The disease is often progressive and associated with comorbidities that need to be managed.

Anti-TNF therapy in Jordan: a focus on severe infections and tuberculosis

Background

A high rate of infection has been reported in patients receiving treatment with anti-tumor necrosis factor (anti-TNF). This study describes the rate of and risk factors for serious infections in patients receiving anti-TNF agents in Jordan.

Methods

This retrospective observational study was conducted at a large tertiary referral center in the north of Jordan. Between January 2006 and January 2012, 199 patients who received an anti-TNF agent (infliximab, adalimumab, or etanercept) were included. Patients received the anti-TNF treatment for rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, or other conditions. A serious infection was defined as any bacterial, viral, or fungal infection that required hospitalization, administration of appropriate intravenous antimicrobial therapy, and temporary withholding of anti-TNF treatment.

Results

The mean duration of anti-TNF treatment was 26.2 months. Steroids were used in 29.1% of patients, while 54.8% were given additional immunosuppressant therapy (methotrexate or azathioprine). Only one anti-TNF agent was given in 70.4% of patients, while 29.6% received different anti-TNF agents for the duration of treatment. Serious infections were documented in 39 patients (19.6%), including respiratory tract infections (41%), urinary tract infections (30.8%), and skin infections (20.5%), and extrapulmonary tuberculosis in three patients (7.7%). Exposure to more than one anti-TNF agent was the only factor associated with a significant increase in the rate of infection (relative risk 1.9, 95% confidence interval 1.06–4.0, P=0.03).

Conclusion

Serious infections, including tuberculosis, were a common problem in patients receiving anti-TNF agents, and exposure to more than one anti-TNF agent increased the risk of serious infection.

Effects of different Familial Mediterranean Fever gene mutations and in vitro Colchicine treatment on Peripheral Blood Mononuclear Cells production of IL-6

Rationale: We wanted to study the effects of Familial Mediterranean Fever (FMF) genetic mutations in Northern Jordan population and in vitro Colchicine treatment on the peripheral blood mononuclear cells (PBMN) production of IL-6 as a marker of disease activity. Methods: - 17 FMF patients and 9 controls were studied. (4 patients had exon 10 mutations only (M680I and V726A), 5 patients had exon 2 mutations (R202Q and E148Q) only and 8 patients with both exon mutations (compound homozygous or heterozygous M694V and R202Q). PBMN cells were incubated with Lipopolysaccharide at 100ng/ml or colchicine 10 ng/ml alone or both. Results: The results showed higher IL-6 levels in the FMF group than control for all treatment modalities, (108.97 vs. 56.49 ng/ml for unstimulated cells) with the highest levels when both exons are involved. Exon 10 mutations were associated with a higher IL-6 level than exon 2 mutations only. Exon 2 mutations alone also were associated with a higher than control IL-6 levels suggesting that it is not a polymorphism phenomenon and is involved in the pathogenesis. In vitro Colchicine treatment caused an increase in the production of IL-6 - although not as high as with LPS - for all groups. Conclusions: Mutations occurring in exon 10 are more significant than mutations occurring in exon 2, although both are contributing to the disease. However colchicine was associated with a paradoxical increase in IL-6 levels. This observation needs confirmation with different colchicine levels in the culture medium and warrants thinking about its exact mechanism of action. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16659Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 370-377

Candida albicans-induced chronic thrombocytopenic purpura

We present 2 patients with chronic immune thrombocytopenic purpura (ITP) secondary to Candida albicans infection. Neither patient responded to standard ITP therapy including splenectomy. Appropriate antifungal treatment of the C. albicans infection was followed by sustained improvement in platelet count in both patients. To our knowledge, this is the first report of ITP in association with C. albicans infection.