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Østergaard M, Wetterslev M, Hadsbjerg AE, Maksymowych WP, Eshed I, Jans L, Emad Y, Pedersen SJ, Stoenoiu MS, Bird P, Foltz V, Mathew AJ, Paschke J, Carron P, De Marco G, Marzo-Ortega H, Møller-Bisgaard S, Conaghan PG, Lambert RG. The OMERACT whole-body MRI scoring system for inflammation in peripheral joints and entheses (WIPE) in spondyloarthritis - reference image atlas for the knee region. Semin Arthritis Rheum 2024; 65:152384. [PMID: 38325053 DOI: 10.1016/j.semarthrit.2024.152384] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a reference image atlas for the Outcome Measures in Rheumatology whole-body MRI scoring system for inflammation in peripheral joints and entheses (OMERACT MRI-WIPE) of the knee region. METHODS Image examples of each pathology, location and grade, were collected and discussed at web-based, interactive meetings within the OMERACT MRI in Arthritis Working Group. Subsequently, reference images were selected by consensus. RESULTS Reference images for each grade, pathology and location are depicted, along with definitions, reader rules and recommended MRI-sequences. CONCLUSION The atlas guides scoring whole-body MRIs for inflammation in joints and entheses of the knee region according to MRI-WIPE methodology in clinical trials and cohorts.
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the School of Medicine, Tel-Aviv University, Israel
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Yasser Emad
- Department of Rheumatology, Faculty of Medicine, Cairo University, Egypt
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgium
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpètrière Hospital, Paris, France
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | | | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Østergaard M, Lambert RG, Hadsbjerg AE, Eshed I, Maksymowych WP, Mathew AJ, Jans L, Pedersen SJ, Carron P, Emad Y, De Marco G, Bird P, Stoenoiu MS, Foltz V, Paschke J, Marzo-Ortega H, Møller-Bisgaard S, Conaghan PG, Wetterslev M. Hip and pelvis region MRI reference image atlas for scoring inflammation in peripheral joints and entheses according to the OMERACT-MRI WIPE scoring system in patients with spondyloarthritis. Semin Arthritis Rheum 2024; 65:152383. [PMID: 38325055 DOI: 10.1016/j.semarthrit.2024.152383] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a reference image atlas for scoring the hip/pelvis region according to the OMERACT whole-body MRI scoring system for inflammation in peripheral joints and entheses (MRI-WIPE). METHODS We collected image examples of each pathology, location and grade, discussed them at web-based, interactive meetings and, finally, selected reference images by consensus. RESULTS Reference images for each grade and location of osteitis, synovitis and soft tissue inflammation are provided, as are definitions, reader rules and recommended MRI-sequences. CONCLUSION A reference image atlas was created to guide scoring whole-body MRIs for arthritis and enthesitis in the hip/pelvis region in spondyloarthritis/psoriatic arthritis clinical trials and cohorts.
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Affiliation(s)
- Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the School of Medicine, Tel-Aviv University, Israel
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; CARE Arthritis, Edmonton, Alberta, Canada
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Centre, Ghent University, Ghent, Belgium
| | - Yasser Emad
- Department of Rheumatology, Faculty of Medicine, Cairo University, Egypt
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, Australia
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgium
| | - Violaine Foltz
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpètrière Hospital, Paris, France
| | | | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marie Wetterslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
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Emad Y, Ragab Y, Cozzi D, Ibrahim O, Abdelrahman W, Abdelali M, Kechida M, Hassanin M, Tharwat S, Salah S, Elshaarawy N, Frikha F, Hassanein S, Young P, Pankl S, Barman B, Abou-Zeid A, Rasker J. Pulmonary vasculitis in Behçet's disease: reference atlas computed tomography pulmonary angiography (CTPA) findings and risk assessment-management proposal. Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023026. [PMID: 37712377 PMCID: PMC10540716 DOI: 10.36141/svdld.v40i3.13726] [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] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD).The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. METHODS The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. RESULTS Deep venous thrombosis was observed in 31(73.8%) patients, arterial thrombosis in 13(31%), peripheral arterial aneurysms in 12(286%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8(19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13(31), true unstable PAAs in 11(26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7(16.7%), unstable PAPs in 17(40.5%), the latter were associated with perianeurysmal leaking in 26(61.9%) and bronchial indentation in 19(45.2%).In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). CONCLUSION Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictor of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.
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Affiliation(s)
- Yasser Emad
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt..
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy..
| | - Ossama Ibrahim
- 4 Morecambe Bay University Hospitals Lancaster, Ashton Rd.,Lancashire Lancaster LA1 4RP, UK.
| | - Walaa Abdelrahman
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mabrouk Abdelali
- Radiology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, FattoumaBourguiba University Hospital, University of Monastir, Ruedu 1er juin 1955, 5019 Monastir, Tunisia.
| | - Manal Hassanin
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Facultyof Medicine, Mansoura University, Mansoura, Dakahlia,Egypt.
| | - Shaimaa Salah
- 7Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt.
| | - Nashwa Elshaarawy
- 9Rheumatology and Rehabilitation Department, Facultyof Medicine, Suez Canal University, Ismailia 4.5 Km theRing Road, Ismailia 41522, Egypt.
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia..
| | - Sara Hassanein
- 11Radiology Department, Assiut University Hospitals, Assiut, Egypt.
| | - Pablo Young
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Sonia Pankl
- Servicio de Clinica Medica, Hospital Britanico de BuenosAires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
| | - Bhupen Barman
- Department of General Medicine, North Eastern IndiraGandhi Regional Institute of Health and Medical Sciences(NEIGRIHMS), Mawdiangdiang, Shillong 793018,Meghalaya, India.
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al‑Ainy St., Cairo 11562, Egypt.
| | - Johannes Rasker
- 15Faculty of Behavioral, Management and Social Sciences,Department Psychology, Health and Technology,University of Twente, Drienerloolaan 5, 7522NB Enschede,The Netherlands.
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Emad Y, El-Shaarawy N, Abdelrahman W, Ragab Y, Ibrahim O, Elyaski A, Ismail A, Hassan Y, Elnaggar A, Rasker JJ. Rheumatoid factor and anti-citrullinated protein antibodies (ACPA) in psoriatic arthritis (PsA), and skin psoriasis: Relevance and clinical implications. The Egyptian Rheumatologist 2023. [DOI: 10.1016/j.ejr.2023.01.003] [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: 01/26/2023]
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Saad AA, Ragab Y, Ahmed ES, Emad Y, Alghamdi FA, Taha I, Rasker JJ, Saad AA. Pelvi-abdominal as a complication of long-term use of intrauterine device (IUD). The important role of imaging in diagnosis and follow-up. Radiol Case Rep 2022; 17:4286-4290. [PMID: 36124319 PMCID: PMC9482080 DOI: 10.1016/j.radcr.2022.08.035] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
ACTINOMYCOSIS is a rare chronic granulomatous disease caused by anaerobic filamentous gram-positive bacteria, the most common of which is Actinomyces israelii. Actinomycetes are commensal inhabitants of the oral cavity and gastrointestinal tract, but they may become pathogenic through invasion of breached or necrotic tissue. Pelviabdominal ACTINOMYCOSIS is uncommon and can mimic a variety of disease processes, including abdominal mass mimicking malignancy, acute abdomen, asthenia, and weight loss. We describe a 38-year-old woman who presented with acute abdominal pain and tenderness, as well as constitutional manifestations and elevated inflammatory markers. On initial computerized tomography (CT) and MRI, a large fluid collection underlining the anterior abdominal wall at the false pelvic cavity, as well as parietal peritoneal enhancement and smudging of the mesenteric fat and a bulky fibroid uterus with an implanted IUD, were identified. The ultrasound guided aspiration and anaerobic culture revealed positive growth for Actinomyces bacteria. An exploratory laparoscopy revealed extensive adhesions between the abdominal wall and the small intestine, as well as hyperemic and thickened peritoneum, and peritoneal biopsy confirmed ACTINOMYCOSIS. After the diagnosis was established, the IUD was removed and the patient was given Ceftriaxone 2 gm once daily for 6 weeks before switching to oral doxycycline 100 mg twice daily for another 3 months. A significant regression of the suprapubic fluid collection, and peritoneal-mesenteric changes were confirmed on follow-up. The case is discussed, and the relevant literature reviewed and analyzed.
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Affiliation(s)
- Ahmed Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, Cairo, 11562, Egypt
| | - Eiman Saeed Ahmed
- Internal Medicine Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, Cairo, 11562, Egypt
| | - Fahad Ali Alghamdi
- Department of Pathology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Islam Taha
- Internal Medicine Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Johannes J. Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerloolaan 5, 7522NB, Enschede, The Netherlands
- Corresponding author.
| | - Amr Ahmed Saad
- General Surgery Department, New Cairo Central Hospital, Cairo, Egypt
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Ragab Y, Emad Y, Saad MA, Rasker JJ. Contrast-enhanced magnetic resonance imaging (MRI) features of Gruberi Bursitis as a very rare cause of dorsolateral ankle pain and swelling: Case report and review of the literature. Radiol Case Rep 2022; 17:2612-2615. [PMID: 35663810 PMCID: PMC9160384 DOI: 10.1016/j.radcr.2022.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
The Gruberi sinus tarsi bursa is a dorsolateral ankle anatomic bursa that has been described in the past but is rarely mentioned in recent radiology literature. The Gruberi bursa is distinguished by its position between the extensor digitorum longus tendons and the talus. It is usually unilocular, anechoic and compressible as shown with ultrasound in a previous study. In recent literature, the enhanced MRI features of an inflamed Gruberi bursa as the underlying cause of a painful ankle joint and antalgic gait are rarely demonstrated. In this report, we present the enhanced MRI features of Gruberi bursitis in a female patient who complained of acute onset of pain and swelling along the dorsolateral aspect of her left ankle, as well as a painful limping gait after sport-related activities. Complaints improved after an intra-bursal corticosteroid injection. The case is discussed and the typical enhanced MRI features are demonstrated. The relevant literature is discussed.
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Fawzi M, Amer A, El-Makhzangy H, Ismail A, Ibrahim O, Hassan Y, Kamal A, Rasker JJ. The clinical utility of faecal calprotectin in patients with differentiated and undifferentiated spondyloarthritis: Relevance and clinical implications. Reumatol Clin (Engl Ed) 2022; 18:69-76. [PMID: 35153039 DOI: 10.1016/j.reumae.2020.10.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/22/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). CONCLUSIONS Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, AssiutUniversity, Assiut, Egypt; Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Magdy Fawzi
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Arwa Amer
- Rheumatology, Rehabilitation and Physical MedicineDepartment, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham El-Makhzangy
- Tropical Medicines Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ismail
- Dermatology Department, Faculty of Medicine, Al-Azhar University Cairo, Egypt
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, UK
| | - Yosra Hassan
- Clinical pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Kamal
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioural, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Ragab Y, Emad Y, Rasker JJ. Comment on: Behçet's disease in Emergency Department: a rare case presenting with haemoptysis and massive pulmonary arterial aneurysms. On behalf of the Hughes-Stovin syndrome (HSS) international study group. Sarcoidosis Vasc Diffuse Lung Dis 2022; 39:e2022004. [PMID: 35494171 PMCID: PMC9007025 DOI: 10.36141/svdld.v39i1.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J. Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Emad Y, Ragab Y, Robinson C, Pankl S, Young P, Fabi M, Bawaskar P, Ibrahim O, Erkan D, Barman B, Tekavec-Trkanjec J, Jayakrishnan B, Kindermann M, Kechida M, Guffroy A, Silva RS, Frikha F, Abou-Zeid A, Hassan M, Farber HW, Abdelbary MH, Tornes L, Margolesky J, El-Shaarawy N, Bennji S, Agarwala MK, Saad A, Amezyane T, Ghirardo S, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Kably I, Kim JT, Rasker JJ. Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide-a report by the HSS International Study Group. Clin Rheumatol 2021; 40:4993-5008. [PMID: 34533671 PMCID: PMC8599253 DOI: 10.1007/s10067-021-05912-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients. Results This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis. Conclusion The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis.
Key Points • The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality. • All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease. • The HSS International Study Group reference atlas classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA). • The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome. |
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair Road, Mumbai, 400008, Maharashtra, India
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Ashton Rd., LancashireLancaster, LA1 4RP, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, 793018, Meghalaya, India
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary Medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000, Zagreb, Croatia
| | | | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken Des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, 5019, Monastir, Tunisia
| | - Aurelien Guffroy
- Service D'immunologieclinique et Médecine Interne, Centre de Référence des Maladies Auto-Immunes Systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091, Strasbourg, France.,UFR Médecine Strasbourg, Université de Strasbourg, 67000, Strasbourg, France
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029, Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public Health Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al Kartoom Square, Al Azareta, Alexandria, 21526, Egypt
| | - Harrison W Farber
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Leticia Tornes
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Professional Arts Center, 1150 NW 14th St., Suite 609, Miami, FL, 33136, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, Ismailia, 41522, Egypt
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Francie van Zijl Drive Tygerberg 7505, Cape Town, South Africa
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad, 500096, India
| | - Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St., Cairo, 11562, Egypt
| | - Taoufik Amezyane
- Department of Internal Medicine, School of Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, Rabat, Morocco
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127, Trieste, TS, Italy
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, Rio de Janeiro, RJ, 20231-092, Brazil
| | - Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, 123, Al-Khoud, Muscat, Oman
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, 28222, Madrid, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Faculty of Medicine, Izmir KatipÇelebi University, Karabağlar, Izmir, Turkey
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
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Emad Y, Ragab Y, Saad MA, Rasker JJ. Transient regional osteoporosis of the hip with extensive bone marrow edema (BME): Dramatic improvement after three months of Alendronate therapy. Radiol Case Rep 2021; 16:2487-2490. [PMID: 34257785 PMCID: PMC8259220 DOI: 10.1016/j.radcr.2021.05.066] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
Transient osteoporosis of the hip, also termed transient bone marrow edema, is a painful condition often occurring after trivial trauma. It can be diagnosed with MRI in patients whose radiographs are negative or inconclusive. In this case report we describe a 39-year-old female patient with this rare entity, who was successfully treated with oral Alendronate, active vitamin D and calcium supplementation combined with avoiding of weight bearing on the affected hip. She improved clinically within three months and on contrast enhanced MRI studies, as performed before and after treatment, complete regression of bone marrow edema was shown already after three months of treatment. The literature was reviewed regarding the pathophysiology of transient osteoporosis of the hip and the beneficial effects of Alendronate in this domain. The report is important because it will increase the awareness among clinicians and radiologists about this entity, as in neglected cases transient regional osteoporosis of the hip may progress to avascular necrosis with complete loss of hip function.
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Key Words
- AVN, avascular necrosis
- Alendronate
- BME, Bone marrow edema
- BMES, Bone marrow edema syndromes
- FAI, femoro-acetabular impingement
- MRI, magnetic resonance imaging
- RMO, regional migratory osteoporosis
- RSD, reflex sympathetic dystrophy
- STIR, short tau inversion recovery
- TBME, transient Bone marrow edema
- TOH, transient osteoporosis of the hip
- Transient bone marrow edema syndrome
- Transient regional osteoporosis of the hip
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy St, 11562 Cairo, Egypt.,Rheumatology Department, Dr. Erfan and Bagedo General Hospital, King Fahad St. (Al Sitteen), 21452, Jeddah, Saudi Arabia
| | - Yasser Ragab
- Radiology Department , Dr. Erfan and Bagedo General Hospital , King Fahad St. (Al Sitteen), 21452, Jeddah, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Mariam Ahmed Saad
- Medical Oncology Department, National Cancer Institute, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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11
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Ibrahim O, Gamal RM, Abd-Elsalam M, Mohammed RHA, Hawass M, Rasker JJ. Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications. Reumatol Clin (Engl Ed) 2021; 17:250-257. [PMID: 31812441 DOI: 10.1016/j.reuma.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/24/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To study the frequency of different autoantibodies to extractable nuclear antigens (ENAs) in rheumatoid arthritis (RA) patients and to correlate findings with clinical manifestations, disease activity and radiological damage. METHODS A total of 230 RA patients were included and 75 healthy controls. In all patients rheumatological assessment was done and routine laboratory investigations and immune profile were performed in both patients and controls, including: RF, ACPA, ANA and anti-ENAs (Ro/SSA, La/SSB, U1-RNP, anti-Jo-1 and anti-Sm). Radiological damage was scored using Sharp/van der Heijde, and disease activity was evaluated by DAS28-ESR and DAS28-CRP. RESULTS RF was positive in 101 (43.9%), ACPA in 220 (95.7%), ANA in 58 (25.2%), anti Ro in 31 (13.5%), anti-La in 10 (4.3%), anti-Jo1 in 5 (2.2%) and anti-RNP in 2 (0.9%). Anti-Ro/SSA positively correlated with sicca symptoms (p=.02), RF titer (p<.001), ANA (p<.001), DAS28-ESR (p=.026), and DAS28-CRP (p=.003). Anti-La antibodies correlated positively with SJC (p=.001), TJC (p=.001), ANA (p<.001), DAS-28 ESR (p=.007). Anti-Jo-1 correlated positively with interstitial lung disease (ILD) (p≤.001), RF titer (p=.037) and ANA (p≤.001). Anti-RNP antibodies correlated positively with disease duration (p≤.001), ACPA titer (p≤.001) and ANA (p=.014). In the controls ANA was positive in two (2.7%), anti-Ro in three (4%), and none of the controls tested positive for other autoantibodies. CONCLUSIONS In RA patients, positive ANA is frequent and positively associated with anti-Ro, anti-La and anti-Jo1 autoantibodies. Screening for autoantibodies against other anti-ENAs seems mandatory in RA patients especially when ANA is positive. RA cases with positive Anti-Jo-1 may develop anti synthetase syndrome and ILD.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Rheumatology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Nevin Hammam
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, UK
| | - Rania M Gamal
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Magdy Abd-Elsalam
- Chest Department, Faculty of Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt
| | - Reem H A Mohammed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Hawass
- Nephrology Department, Al-Shorta Hospital, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioural, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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12
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Ibrahim O, Gamal RM, Abd-Elsalam M, Mohammed RH, Hawass M, Rasker JJ. Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications. Reumatología Clínica (English Edition) 2021; 17:250-257. [DOI: 10.1016/j.reumae.2019.10.005] [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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13
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Emad Y, Ragab Y, Kechida M, Guffroy A, Kindermann M, Robinson C, Erkan D, Frikha F, Ibrahim O, Al-Jahdali H, Silva RS, Tornes L, Margolesky J, Bennji S, Kim JT, Abdelbary M, Fabi M, Hassan M, Cruz V, El-Shaarawy N, Jaramillo N, Khalil A, Demirkan S, Tekavec-Trkanjec J, Elyaski A, de FreitasRibeiro BN, Kably I, Al-Zeedy K, Jayakrishnan B, Ghirardo S, Barman B, Farber HW, Pankl S, Abou-Zeid A, Young P, Amezyane T, Agarwala MK, Bawaskar P, Hawass M, Saad A, Rasker JJ. A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG). Int J Cardiol 2021; 331:221-229. [PMID: 33529654 DOI: 10.1016/j.ijcard.2021.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hughes-Stovin syndrome (HSS) is a systemic disease characterized by widespread vascular thrombosis and pulmonary vasculitis with serious morbidity and mortality. The HSS International Study Group is a multidisciplinary taskforce aiming to study HSS, in order to generate consensus recommendations regarding diagnosis and treatment. METHODS We included 57 published cases of HSS (43 males) and collected data regarding: clinical presentation, associated complications, hemoptysis severity, laboratory and computed tomography pulmonary angiography (CTPA) findings, treatment modalities and cause of death. RESULTS At initial presentation, DVT was observed in 29(33.3 %), thrombophlebitis in 3(5.3%), hemoptysis in 24(42.1%), and diplopia and seizures in 1 patient each. During the course of disease, DVT occurred in 48(84.2%) patients, and superficial thrombophlebitis was observed in 29(50.9%). Hemoptysis occurred in 53(93.0%) patients and was fatal in 12(21.1%). Pulmonary artery (PA) aneurysms (PAAs) were bilateral in 53(93%) patients. PAA were located within the main PA in 11(19.3%), lobar in 50(87.7%), interlobar in 13(22.8%) and segmental in 42(73.7%). Fatal outcomes were more common in patients with inferior vena cava thrombosis (p = 0.039) and ruptured PAAs (p < 0.001). Death was less common in patients treated with corticosteroids (p < 0.001), cyclophosphamide (p < 0.008), azathioprine (p < 0.008), combined immune modulators (p < 0.001). No patients had uveitis; 6(10.5%) had genital ulcers and 11(19.3%) had oral ulcers. CONCLUSIONS HSS may lead to serious morbidity and mortality if left untreated. PAAs, adherent in-situ thrombosis and aneurysmal wall enhancement are characteristic CTPA signs of HSS pulmonary vasculitis. Combined immune modulators contribute to favorable outcomes.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Aurelien Guffroy
- Service d'immunologie clinique et médecine interne, centre de référence des maladies auto-immunes systémiques rares (RESO), hôpitaux universitaires de Strasbourg, nouvel hôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto ON, Canada
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Professional Arts Center, 1150 NW 14th St, Suite 609, Miami, FL 33136, United States
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Professional Arts Center, 1150 NW 14th St, Suite 609, Miami, FL 33136, United States
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Francie van Zijl Drive Tygerberg 7505, Cape Town, South Africa
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Mohamed Abdelbary
- Department of Radiology, Badr Hospital, Helwan University, 11790 Cairo, Egypt
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University,Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de Hierro Majadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Antoine Khalil
- Radiology Department, Bichat-Claude Bernard Hospital, HUPNVS, APHP, Paris University, 46 rue Henri Huchard, 74018 Paris, United States of America
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir Katip Çelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Ahmed Elyaski
- Department of prosthesis and orthosis technology Program, Faculty of Applied Health Sciences, Galala University 43511, Suez Governorate, Suez, Egypt
| | - B N de FreitasRibeiro
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khalfan Al-Zeedy
- Department of Medicine, Sultan Qaboos University Hospital, 123, Al-Khoud, Muscat, Oman
| | | | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong 793018, Meghalaya, India
| | - H W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, United States
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Mona Hawass
- Nephrology Department, El Agouza Police Hospital, El Nil St. Agouza, Giza, Governorate, Egypt
| | - Ahmed Saad
- Internal medicine Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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14
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Emad Y, Ragab Y, Hammam N, El-Shaarawy N, Fawzi M, Amer A, El-Makhzangy H, Ismail A, Ibrahim O, Hassan Y, Kamal A, Rasker JJ. The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications. Reumatol Clin (Engl Ed) 2020; 18:S1699-258X(20)30238-2. [PMID: 33234498 DOI: 10.1016/j.reuma.2020.10.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001). CONCLUSIONS Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, AssiutUniversity, Assiut, Egypt; Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Magdy Fawzi
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Arwa Amer
- Rheumatology, Rehabilitation and Physical MedicineDepartment, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham El-Makhzangy
- Tropical Medicines Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ismail
- Dermatology Department, Faculty of Medicine, Al-Azhar University Cairo, Egypt
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, UK
| | - Yosra Hassan
- Clinical pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Kamal
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioural, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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15
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Emad Y, Ragab Y, Abd-Elsalam M, Rasker JJ. Antisynthetase syndrome complicating the course of established case with rheumatoid arthritis: A rare and under-recognized overlapping disease. Reumatol Clin (Engl Ed) 2020; 16:419-422. [PMID: 30120021 DOI: 10.1016/j.reuma.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022]
Abstract
A 52-year-old male patient developed RA in March 2009 at the age of 43, with symmetric polyarthritis and active synovitis affecting hands, knees, ankles and both feet without symptoms or signs suggestive of extra-articular features. Laboratory investigations showed negative RF and positive anti-CCP antibodies, negative ANA, negative anti-dsDNA antibodies; the X-rays of both hands showed typical erosive changes in RA and fulfilled the new ACR/EULAR (2010) criteria of RA. The patient achieved remission on a combination of DMARDs. He did well until January 2017 when he developed acute onset of progressive chest pain, dyspnea, and acute respiratory failure. High-resolution CT of the lung showed extensive areas of ground glass veiling, and interstitial subpleural infiltrates were found consistent with aggressive interstitial lung disease (ILD). Autoantibodies against extractable nuclear antigens were screened and showed positive results for anti-RO and anti-Jo1 autoantibodies. The positive anti-Jo1was an expression of anti-synthetase syndrome complicating the RA course and explained the rapidly aggressive course of ILD.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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16
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Emad Y, Ragab Y, Abd-Elsalam M, Rasker JJ. Antisynthetase syndrome complicating the course of established case with rheumatoid arthritis: A rare and under-recognized overlapping disease. Reumatología Clínica (English Edition) 2020; 16:419-422. [DOI: 10.1016/j.reumae.2018.06.011] [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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Khalifa M, Zakaria F, Ragab Y, Saad A, Bamaga A, Emad Y, Rasker JJ. Guillain-Barré Syndrome Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Detection and Coronavirus Disease 2019 in a Child. J Pediatric Infect Dis Soc 2020; 9:510-513. [PMID: 32652520 PMCID: PMC7454732 DOI: 10.1093/jpids/piaa086] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/08/2020] [Indexed: 12/29/2022]
Abstract
Coronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Physicians in China reported what is believed to be the first adult case of a SARS-CoV-2 infection associated with acute Guillain-Barré syndrome (GBS), followed by 5 adult Italian patients and another case in the United States. In the current report, we present one of the first descriptions of an association of GBS and SARS-CoV-2 infection in a child. In our facility, an 11-year-old boy presented with typical features of GBS and, after 5 days, a morbilliform skin rash over the palms of both hands. Three weeks before the start of the neurological symptoms, the boy had experienced an episode of mild febrile illness with mild respiratory manifestations and a persistent cough. The diagnosis of SARS-CoV-2 infection was confirmed by oropharyngeal swab on reverse-transcription polymerase chain reaction assay. The disease course of our patient strongly suggests a possible relationship between the development of GBS and SARS-CoV-2 infection. The case is discussed in view of previous case reports regarding the association of GBS and COVID-19.
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Affiliation(s)
- Maher Khalifa
- Pediatric Neurology Department, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Fairouz Zakaria
- Pediatric Neurology Department, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Bamaga
- Pediatric Department, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands,Correspondence: Maher Khalifa, FRCP, FRCPCH, Pediatric Neurology Department, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail:
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Mathew AJ, Krabbe S, Eshed I, Lambert RG, Laredo JD, Maksymowych WP, Gandjbakhch F, Emad Y, Stoenoiu MS, Foltz V, Bird P, Carron P, Paschke J, Conaghan PG, Pedersen SJ, Glinatsi D, Østergaard M. Atlas of the OMERACT Heel Enthesitis MRI Scoring System (HEMRIS). RMD Open 2020; 6:rmdopen-2019-001150. [PMID: 32568094 PMCID: PMC7046972 DOI: 10.1136/rmdopen-2019-001150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/15/2019] [Revised: 12/30/2019] [Accepted: 01/05/2020] [Indexed: 01/28/2023] Open
Abstract
Objective Assessment of enthesitis, a key feature in spondyloarthritis (SpA) and psoriatic arthritis (PsA), using objective and sensitive methods is pivotal in clinical trials. MRI allows detection of both soft tissue and intra-osseous changes of enthesitis. This article presents an atlas for the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis Magnetic Resonance ImagingMRI Scoring System (HEMRIS). Methods Following a preliminary selection of potential examples of each grade, as per HEMRIS definitions, the images along with detailed definitions and reader rules were discussed at web-based, interactive meetings between the members of the OMERACT MRI in Arthritis Working Group. Results Reference images of each grade of the MRI features to be assessed using HEMRIS, along with reader rules and recommended MRI sequences are depicted. Conclusion The presented reference images can be used to guide scoring Achilles tendon and plantar fascia (plantar aponeurosis) enthesitis according to the OMERACT HEMRIS in clinical trials and cohorts in which MRI enthesitis is used as an outcome.
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Affiliation(s)
- Ashish J Mathew
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Gw Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Jean-Denis Laredo
- Service de Radiologie, Hôpital Lariboisiére, APHP & Université Paris-Diderot, Paris, France
| | - Walter P Maksymowych
- CaRE (Canadian Research Education) Arthritis, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Frederique Gandjbakhch
- Department of Rheumatology, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Yasser Emad
- Rheumatology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maria Simona Stoenoiu
- Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain La Faculte de Medecine, Brussels, Belgium
| | - Violaine Foltz
- Department of Rheumatology, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Joel Paschke
- CaRE (Canadian Research Education) Arthritis, Edmonton, Alberta, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark
| | - Daniel Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.,Rheumatology, Skaraborg Hospital Skövde, Skovde, Sweden
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Emad Y, Ragab Y, El-Marakbi A, Saad A, Ibrahim O, Abd-Elhalim A, El-Santawi H, Rasker JJ. Erratum zu: A case of Hughes-Stovin syndrome (incomplete Behçet’s disease) with extensive arterial involvement. Z Rheumatol 2019:10.1007/s00393-019-0640-9. [PMID: 31001652 DOI: 10.1007/s00393-019-0640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kairo, Ägypten.
| | - Y Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kairo, Ägypten
| | - A El-Marakbi
- Vascular Surgery Department, Faculty of Medicine, Cairo University, Kairo, Ägypten
| | - A Saad
- Internal medicine Department, Faculty of Medicine, Cairo University, Kairo, Ägypten
| | - O Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Großbritannien
| | - A Abd-Elhalim
- Vascular Surgery Department, Dr.Erfan and Bagedo General Hospital, Dschidda, Saudi-Arabien
| | - H El-Santawi
- Vascular Surgery Department, Dr.Erfan and Bagedo General Hospital, Dschidda, Saudi-Arabien
| | - J J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, Niederlande
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Emad Y, Gheita T, Darweesh H, Klooster P, Gamal R, Fathi H, El-Shaarawy N, Gamil M, Hawass M, El-Refai RM, Al-Hanafi H, Abd-Ellatif S, Ismail A, Rasker J. Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: correlations with clinical manifestations and disease activity. Reumatismo 2018; 70:85-91. [PMID: 29976042 DOI: 10.4081/reumatismo.2018.1027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 06/03/2017] [Revised: 10/30/2017] [Accepted: 12/28/2017] [Indexed: 11/22/2022] Open
Abstract
The aim was to explore possible correlations of antibodies to extractable nuclear antigens (ENA) with clinical manifestations and disease activity indices in systemic lupus erythematosus (SLE) patients. A total of 70 consecutive SLE patients (64 females) were included. Disease activity was assessed by SLE activity index (SLEDAI), and British Isles Lupus Assessment Group (BILAG). Anti-Ro/SSA correlated positively with, headache (r=0.24, p=0.04), blurring of vision (r=0.25, p=0.03) and SLEDAI (r=0.25, p=0.04) and negatively with C3 (r=-0.35, p=0.003). Anti-Ro/SSA correlated with anti La/SSB antibodies (r=0.69, p<0.001), but not with anti-DNA, anti-RNP and anti-Sm antibodies. Anti-La/SSB antibodies correlated with headache (r=0.26, p=0.03), SLEDAI (r=0.25, p=0.03) and negatively with C3 (r=-0.34, p=0.004). Anti-La/SSB did not correlate with anti-RNP or anti-Sm antibodies. Anti-Sm antibodies correlated with disease duration (r=0.34, p=0.003), 24 hours urinary proteins (r=0.31, p=0.008), SLEDAI (r=0.31, p=0.009), BILAG renal score (r=0.29, p=0.02) and negatively with age at onset (r=-0.27, p=0.02), WBCs (r=-0.29, p=0.014) and C4 (r=-0.25, p=0.049). In multivariate analyses, anti-Ro/SSA antibodies remained associated with headache, blurring of vision and C3 and anti-La/SSB antibodies remained associated with C3 and with headache. Anti-Sm antibodies were independently associated with disease duration and total SLEDAI scores, while anti-RNP antibodies remained significantly associated with BILAG mucocutaneous scores only. Antibodies to ENAs are associated with clinical aspects of SLE and may play a role in the assessment of disease activity. Insight into these ENAs may lead to new approaches to diagnostic testing, accurate evaluation of disease activity and lead to target approach for SLE.
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Affiliation(s)
- Y Emad
- Rhumatology Department, Faculty of Medicine, Cairo University Cairo.
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Emad Y, Ragab Y, Rasker JJ. Mycophenolate mofetil for induction and maintenance of remission in naïve patients with granulomatosis with polyangiitis without renal involvement. ACTA ACUST UNITED AC 2018; 16:294-297. [PMID: 29778666 DOI: 10.1016/j.reuma.2018.03.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/24/2022]
Abstract
Antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides include granulomatosis with polyangiitis (GPA, previously called Wegener's), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss). In this report we used mycophenolate mofetil (MMF) and steroids to induce and maintain remission in two newly diagnosed cases with c-ANCA associated GPA. The two patients' maintained remission with no disease relapses during one year follow-up.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Gamal RM, Gamal WM, Abozaid HSM, Ghandour AM, Mohamed ME, Emad Y, Galeel AA. 201 Study of the osteoprotegerin receptor activator of nuclear factor kB ligand system association with inflammation and atherosclerosis in systemic sclerosis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rania M Gamal
- Rheumatology & Rehabilitation, Assuit University, Assuit, EGYPT
| | - Walid M Gamal
- Vascular Surgery, Qena University Hospital, South Valley University, Qena, EGYPT
| | | | | | - Mona E Mohamed
- Microbiology & Immunology, Assuit University, Assuit, EGYPT
| | - Yasser Emad
- Rheumatology, Cairo University, Cairo, EGYPT
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Gamal RM, Gamal WM, Ghandour AM, Abozaid HSM, Mohamed ME, Emad Y, Abdel Galeel A. Study of the osteoprotegerin/receptor activator of nuclear factor-kB ligand system association with inflammation and atherosclerosis in systemic sclerosis. Immunol Invest 2018; 47:241-250. [DOI: 10.1080/08820139.2017.1423499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rania M. Gamal
- Rheumatology& Rehabilitation department, Assuit University , Assuit, Egypt
| | - Walid M. Gamal
- Vascular Surgery department, Qena university hospital, South Valley University , Qena, Egypt
| | - Abeer M. Ghandour
- Rheumatology& Rehabilitation department, Assuit University , Assuit, Egypt
| | | | | | - Yasser Emad
- Rheumatology& Rehabilitation department, Cairo University , Egypt
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Emad Y, Ragab Y, Alaaabou-Zeid, Rasker J. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. Hamdan Med J 2018. [DOI: 10.4103/hmj.hmj_82_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ragab Y, Nabih M, Aly I, Kamal A, Abd-Allah MA, El-Refai R, Emad Y, El-Naggar A, El-Shaarawy N, Rasker J. Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population. Reumatismo 2015; 67:68-77. [DOI: 10.4081/reumatismo.2015.830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/30/2015] [Accepted: 09/02/2015] [Indexed: 11/23/2022] Open
Abstract
Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%), sciatic nerve injury in 1 (1.4%), leukemia with BME in 1 (1.4%), coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%), and a benign bone cyst in 1 (1.4%). MRI studies showed hip effusion in a total of 51 patients (70.8%), joint space narrowing in 9 (12.5%), and BME in 15(20.8%). MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.
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Anbar A, Emad Y, Zeinhom F, Ragab Y. Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol 2014; 25:689-97. [PMID: 25274205 DOI: 10.1007/s00590-014-1545-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the sensitivity, specificity and accuracy of MR arthrography, as opposed to shoulder arthroscopy, in diagnosing individual rotator interval (RI) structures lesions at different levels of severity. MATERIALS AND METHODS Seventy-five patients were enrolled in a prospective study. All the patients were diagnosed with full-thickness rotator cuff tendon tears on unenhanced MRI and had complimentary MR arthrography to search for obscure RI lesions. All the patients then underwent shoulder arthroscopy. The arthroscopist was blinded about the MR arthrography results. RESULTS At arthroscopy, 42 patients (56 %) were found to have RI lesion(s) and represented the study group. The remaining 33 patients represented the control group. The sensitivity, specificity and accuracy of MR arthrography for detecting individual RI lesions varied widely depending on the location and severity of the lesions. MR arthrography showed intermediate sensitivity of 67-80 %, specificity of 83-89 % and accuracy of 89-92 % for diagnosing subtle RI lesions; and perfect (100 %) sensitivity, specificity and accuracy for diagnosing biceps long head tendon dislocation. For the rest of RI lesions, MR arthrography showed high sensitivity, specificity and accuracy. Inter-observer agreement was found to be almost perfect (K = 0.81-1.0). CONCLUSION Shoulder arthroscopy remains the gold standard for diagnosing subtle RI lesions. Although MR arthrography has proved to be a valuable tool for diagnosing established RI lesions, it is of intermediate sensitivity for diagnosing subtle RI lesions resulting in early insufficiency of the biceps pulley system.
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Affiliation(s)
- Ashraf Anbar
- Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Emad Y, Al- Sherbeni H, Ragab Y, Abo-El-Youn I, El-Shaarawy N, Nassar DY, Fathy A, Al-Hanafi H, Rasker JJ. Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries. Joint Bone Spine 2014; 81:433-7. [DOI: 10.1016/j.jbspin.2014.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Emad Y, Shehata M, Ragab Y, Saad A, Hamza H, Abou-Zeid A. Prevalence and predictive value of anti-cyclic citrullinated protein antibodies for future development of rheumatoid arthritis in early undifferentiated arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0286-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Emad Y, Ragab Y, Khalifa M, Bassyouni I, El-Shaarawy N, Rasker JJ. Axial involvement with facet joint arthropathy and bony ankylosis in a case of camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome. Joint Bone Spine 2013; 80:520-2. [PMID: 23931850 DOI: 10.1016/j.jbspin.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 11/15/2012] [Accepted: 01/14/2013] [Indexed: 11/16/2022]
Abstract
Familial arthropathy associated with congenital camptodactyly has been previously recognized as a definite clinical entity in the literature. The clinical spectrum of this disease seems to be variable. The typical features of congenital camptodactyly, arthropathy, coxa vara and pericarditis (CACP syndrome) appear to be a more frequent presentation in children from the Middle East and North Africa. Musculoskeletal presentation of this rare familial form of arthropathy is unique and heterogeneous. In all previous reports, non-inflammatory pattern of arthropathy involving the peripheral joints with typical coxa vara deformity were described, and in a few cases spine abnormalities, including kyphosis, lordosis, or scoliosis. We describe the first case of axial involvement in a typical case of CACP syndrome with facet joint arthropathy and ankylosis at L5/S1 levels.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
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Emad Y, Ragab Y, El-Shaarawy N, Rasker JJ. Transient osteoporosis of the hip, complete resolution after treatment with alendronate as observed by MRI description of eight cases and review of the literature. Clin Rheumatol 2012; 31:1641-7. [PMID: 22933125 DOI: 10.1007/s10067-012-2060-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/09/2012] [Indexed: 01/03/2023]
Abstract
Transient osteoporosis of the hip (TOH), also referred to as transient bone marrow edema syndrome, is most common in middle-aged men and often after trivial trauma or sport-related injuries. Diagnosis is usually made by eliminating other possible causes of hip pain. Magnetic resonance imaging (MRI) plays an important role in diagnosis and demonstrates a typical pattern of bone marrow edema (BME) in the form of diffuse low signal on T1-weighted images and high signal on T2 fat-suppressed or short T1 inversion recovery images. No consensus exists about the management of TOH, as it may progress to avascular necrosis. We describe eight cases of TOH treated with alendronate resulting in improvement of pain and function and complete resolution of BME on MRI. The literature is reviewed regarding TOH and the relationship with bone marrow edema syndrome, avascular necrosis of the hip, and regional migratory osteoporosis. To our knowledge, this is the first report describing the improvement of this condition after of alendronate with documented radiological improvement on follow-up MRI.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Emad Y, Ragab Y, Gheita T, Anbar A, Kamal H, Saad A, Darweesh H, El-Shaarawy N, Azab A, Ismail A, Rasker JJ. Knee enthesitis and synovitis on magnetic resonance imaging in patients with psoriasis without arthritic symptoms. J Rheumatol 2012; 39:1979-86. [PMID: 22859349 DOI: 10.3899/jrheum.120301] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. METHODS In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. RESULTS Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). CONCLUSION Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic arthritis.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Radiology Department, Orthopedic Department, and Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Gheita TA, Bassyouni IH, Emad Y, el-Din AMN, Abdel-Rasheed E, Hussein H. Elevated BAFF (BLyS) and APRIL in Juvenile idiopathic arthritis patients: relation to clinical manifestations and disease activity. Joint Bone Spine 2011; 79:285-90. [PMID: 21733733 DOI: 10.1016/j.jbspin.2011.05.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/18/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the level of B-cell activating factor belonging to the tumor necrosis factor family (BAFF) also known as B-lymphocyte stimulator (BLyS) and A proliferation-inducing ligand (APRIL) in the serum of Juvenile idiopathic arthritis (JIA) patients and to detect their relation to the clinical manifestations and disease activity in the different subtypes of the disease. METHODS Seventy-four consecutively recruited JIA patients were clinically examined, the Juvenile arthritis disease activity score in 27 joints (JADAS-27) calculated and Childhood Health Assessment Questionnaire (CHAQ) used to measure the functional status. Thirty-four healthy matched children served as controls. Routine laboratory examinations were recorded and serum BAFF and April were determined. RESULTS The JIA patients were 20 systemic-onset, 31 oligoarticular and 23 polyarticular. Serum BAFF and APRIL were elevated in JIA patients being higher in systemic onset and both significantly correlated. APRIL significantly correlated with both JADAS-27 and CHAQ scores while BAFF correlated only with JADAS-27. The APRIL serum levels were significantly associated with the presence of RF and ANA. The BAFF serum levels were significantly higher in oligoarticular onset JIA patients with uveitis compared to those without. CONCLUSION Our results suggest increased BAFF and APRIL serum levels in JIA patients denoting their possible role in the disease and calling for additional research to elucidate the intrinsic mechanisms explaining APRIL and BAFF over expression.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Kasr EL-Aini hospitals, 12613 Cairo, Egypt
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Bassyouni IH, Emad Y, Rafaat HA, Dabbous AO. Relationship between nailfold capillary abnormalities and vestibular dysfunction in systemic sclerosis. Joint Bone Spine 2011; 78:266-9. [DOI: 10.1016/j.jbspin.2010.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
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Emad Y, Shehata M, Ragab Y, Saad A, Hamza H, Abou-Zeid A. Prevalence and predictive value of anti-cyclic citrullinated protein antibodies for future development of rheumatoid arthritis in early undifferentiated arthritis. Mod Rheumatol 2010; 20:358-65. [PMID: 20364358 DOI: 10.1007/s10165-010-0286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study is to evaluate the prevalence and predictive value of anti-cyclic citrullinated protein (CCP) antibodies as a diagnostic marker for future development of rheumatoid arthritis (RA) in a cohort of patients presenting with undifferentiated arthritis (UA). The study comprised 69 patients (22 males and 47 females) presenting with UA, and 66 healthy subjects as control group. For all patients the following parameters were assessed: swollen joint count (SJC), tender joint count (TJC), and duration of morning stiffness in minutes. Baseline laboratory investigations included erythrocyte sedimentation rate (ESR) first hour, C-reactive protein (CRP), complete blood count, complete liver and kidney function tests, urine analysis, anti-nuclear antibodies, rheumatoid factor (RF), and anti-CCP antibodies. Positive correlations were observed between anti-CCP versus SJC, TJC (p = 0.001), duration of morning stiffness (p = 0.04), ESR first hour, and bone erosive changes (p = 0.001). Anti-CCP showed sensitivity of 57%, specificity of 37.9%, positive predictive value of 65.1%, and negative predictive value of 39.3%. Sensitivity and positive predictive values of anti-CCP are close to those observed for RF. In patients presenting with UA, anti-CCP antibodies may allow prediction of RA, thereby allowing early individualized therapeutic decisions.
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Affiliation(s)
- Yasser Emad
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Hegazy M, Darwish H, Darweesh H, El-Shehaby A, Emad Y. Raised serum level of APRIL in patients with systemic lupus erythematosus: Correlations with disease activity indices. Clin Immunol 2010; 135:118-24. [DOI: 10.1016/j.clim.2009.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/03/2009] [Accepted: 12/30/2009] [Indexed: 01/05/2023]
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Emad Y, Ragab Y, Hamza H, Abou‐Zeid A, Rasker J. 439 CHARACTERISTIC ENHANCED MRI DIFFERENCES IN RHEUMATOID ARTHRITIS (RA) AND PSORIATIC ARTHRITIS (PsA) OF THE KNEE JOINT. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Y. Emad
- Rheumatology and Rehabilitation Department Faculty of Medicine Cairo University & Dr. Erfan and Bagedo General Hospital Jeddah, KSA., Jeddah, Egypt
| | - Y. Ragab
- Department of Radiology, Cairo University, Cairo, Egypt
| | - H. Hamza
- Radiology Department Faculty Ain Shams University & Dr. Erfan and Bagedo General Hospital, Cairo, Egypt
| | - A. Abou‐Zeid
- Department of Public Health, Cairo University, Cairo, Egypt
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Emad Y, Ragab Y, Zeinhom F, Saad A, Abou‐Zeid A, Rasker J. 500 HIPPOCAMPUS DYSFUNCTION MAY EXPLAIN SYMPTOMS OF FIBROMYALGIA SYNDROME. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Y. Emad
- Rheumatology and Rehabilitation Department Faculty of Medicine Cairo University & Dr. Erfan and Bagedo General Hospital Jeddah, KSA, Jeddah, Egypt
| | - Y. Ragab
- Department of Radiology, Cairo University, Cairo, Egypt
| | - F. Zeinhom
- Department of Radiology, Cairo University, Cairo, Egypt
| | - A. Saad
- Internal Medicine Department, Cairo University, Cairo, Egypt
| | - A. Abou‐Zeid
- Department of Public Health, Cairo University, Cairo, Egypt
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Ragab Y, Emad Y, Gheita T, Mansour M, Abou-Zeid A, Ferrari S, Rasker JJ. Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging. Eur J Radiol 2008; 72:125-33. [PMID: 18672340 DOI: 10.1016/j.ejrad.2008.06.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 06/09/2008] [Accepted: 06/12/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to establish the cut-off value of the signal intensity drop on chemical shift magnetic resonance imaging (MRI) with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine. PATIENTS AND METHODS All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensity after (in-phase and out-phase) images were obtained. A DXA was performed in all. RESULTS A total of 40 patients were included, 20 with osteoporotic wedging (group 1) and 20 neoplastic (group 2). They were 21 males and 19 females. Acute vertebral collapse was observed in 15 patients in group 1 and subacute collapse in another 5 patients, while in group 2, 11 patients showed acute collapse and 9 patients (45%) showed subacute vertebral collapse. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups (P<0.05). At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%. CONCLUSION A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process.
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Affiliation(s)
- Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Egypt.
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Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy. J Rheumatol 2008; 35:1371-1377. [PMID: 18484688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE (1) To investigate dysfunction of hippocampus in patients with fibromyalgia syndrome (FM) using proton magnetic resonance spectroscopy (1H-MRS), and to compare these findings with healthy controls. (2) To correlate levels of metabolites obtained with aspects of cognition, depression, and sleep symptoms in the patient group. METHODS The case-control study was performed in 15 female patients, who met American College of Rheumatology criteria for classification of FM, and 10 healthy age-matched female controls. Patients and controls were receiving no medications known to affect cognitive functioning or central nervous system metabolites before their participation in the study. In all patients and controls, 1H-MRS was used to assess N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Levels of metabolites and their ratios were determined and the findings compared between the groups. All patients and controls underwent psychological assessment to assess cognitive function, depression, and structured sleep interview with sleep diary; Fibromyalgia Impact Questionnaire (FIQ), number of tender points, and visual analog scale (VAS) for pain were assessed in all patients. RESULTS NAA levels of right and left hippocampi differed significantly between patients and controls (p < 0.05). Cho levels in the right hippocampus were higher in the patient group than in controls (p = 0.005), while no differences were found with respect to Cr levels in both hippocampi. NAA/Cho and NAA/Cr ratios differed significantly between patients and controls (p <0.05), while the Cho/Cr ratio showed no differences. Significant correlations were found between language score and right Cho and right Cr levels (p = 0.041, p = 0.006, respectively), while no significant correlations were found between metabolites and their ratios with FIQ, VAS for pain, or number of tender points. CONCLUSION The hippocampus was dysfunctional in patients with FM, as shown by lower NAA levels compared to controls, representing neuronal or axonal metabolic dysfunction. As the hippocampus plays crucial roles in maintenance of cognitive functions, sleep regulation, and pain perception, we suggest that metabolic dysfunction of hippocampus may be implicated in the appearance of these symptoms associated with this puzzling syndrome.
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Affiliation(s)
- Yasser Emad
- Department of Rheumatology and Rehabilitation, Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Azab N, Bassyouni I, Emad Y, Abd El-Wahab G, Hamdy G, Mashahit M. CD4+CD25+ regulatory T cells (TREG) in Systemic Lupus Erythematosus (SLE) patients: The possible influence of treatment with corticosteroids. Clin Immunol 2008; 127:151-7. [DOI: 10.1016/j.clim.2007.12.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 12/06/2007] [Accepted: 12/14/2007] [Indexed: 01/05/2023]
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Ragab Y, Emad Y, Abou-Zeid A. Bone marrow edema syndromes of the hip: MRI features in different hip disorders. Clin Rheumatol 2007; 27:475-82. [PMID: 17902011 DOI: 10.1007/s10067-007-0731-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 08/28/2007] [Accepted: 08/28/2007] [Indexed: 01/17/2023]
Abstract
The objectives of this study were to describe the essential magnetic resonance imaging (MRI) features of bone marrow edema syndromes affecting the hip joint. In addition, to evaluate the role of MRI in the assessment of hip joint involvement in different clinical settings that may share similar clinical findings. Thirty-four patients who complained of hip pain were studied consecutively. Of these, 21 were men (61.8%) and 13 were women (38.2%). After clinical assessment of possible hip disease, plain radiograph and MRI study of both hips were performed. The literature was searched using keywords: bone marrow edema, hip, and MRI. All patients had antalgic gait and limping. Initial clinical examination revealed painful limited internal and external rotation of the affected hip/hips suspect for hip disease. Unilateral hip involvement was identified in 31 patients (91.2%), and bilateral hip involvement was found in three patients (8.8%), with a total of 37 hips evaluated by MRI. The final diagnoses in our patients were: reactive arthritis (1), transient osteoporosis (7), avascular necrosis (10), osteoarthritis (2), tuberculous arthritis (4), septic arthritis (2), osteomyelitis (2), sickle cell anemia (2), lymphocytic leukemia (1), and femoral stress fracture (3). Bone marrow edema affecting the hip is neither a specific MR imaging finding nor a specific diagnosis and may be encountered in a variety of hip disorders due to different etiologies. MR imaging is the modality of choice when clinical examination is suspect for hip disease and plain radiographs are normal or equivocal. Early diagnosis and treatment is important in many of the disorders. The literature is reviewed regarding bone marrow edema of the hip.
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Affiliation(s)
- Yasser Ragab
- Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Emad Y, Ragab Y, Shawki AEH, Gheita T, El-Marakbi A, Salama MH. Hughes–Stovin syndrome: is it incomplete Behçet’s? Clin Rheumatol 2007; 26:1993-6. [PMID: 17457658 DOI: 10.1007/s10067-007-0609-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 03/13/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
In this report, we described two male patients with Hughes-Stovin syndrome. The first patient was a 26-year-old male who initially presented with deep vein thrombosis (DVT) in the right lower limb followed shortly by hemoptysis. Pulmonary CT angiography revealed bilateral pulmonary artery aneurysms secondary to underlying pulmonary vasculitis. While the second case was a 16-year-old male patient who initially presented with generalized fits due to sagittal sinus thrombosis and later followed by DVT in the left lower limb. Pulmonary CT angiography showed small pulmonary artery aneurysms with thrombosis of peripheral pulmonary artery branches. Both patients were treated successfully with steroids and immunosuppressive therapy and showed clinical improvement.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Ragab Y, Emad Y, El-Marakbi A, Gheita T. Clinical utility of magnetic resonance angiography (MRA) in the diagnosis and treatment of Takayasu’s arteritis. Clin Rheumatol 2007; 26:1393-5. [PMID: 17332978 DOI: 10.1007/s10067-007-0577-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 01/29/2007] [Indexed: 11/28/2022]
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Ragab Y, Emad Y, Banakhar A. Inflammatory synovitis due to underlying lipoma arborescens (gadolinium-enhanced MRI features): report of two cases. Clin Rheumatol 2007; 26:1791-4. [PMID: 17225055 DOI: 10.1007/s10067-006-0523-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 12/20/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
Lipoma arborescens (synovial lipomatosis) is a rare, benign intra-articular lesion of unknown etiology. It is a very rare primary benign tumour of the synovium, which usually affects the knee joint and can lead to slowly progressive chronically swollen knee. In this report we described two cases with this rare entity with initial presentation of inflammatory synovitis. We also described the Gadolinium (Gd-DTPA)-enhanced MRI features. To the best of our knowledge, this is the first report that described inflammatory synovitis in association with this rare entity.
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Affiliation(s)
- Y Ragab
- Faculty of Medicine, Department of Radiology, Cairo University, Cairo, Egypt
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Emad Y, Abdel-Razek N, Gheita T, el-Wakd M, el-Gohary T, Samadoni A. Multislice CT pulmonary findings in Behçet's disease (report of 16 cases). Clin Rheumatol 2006; 26:879-84. [PMID: 17024317 DOI: 10.1007/s10067-006-0408-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 07/08/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
Pulmonary artery aneurysm is the best-defined type of pulmonary disease in Behçet's disease (BD) with an important morbidity and mortality. The objective of this study was to assess the contribution of high-resolution dynamic chest CT imaging for one of the most serious aspects of BD: pulmonary artery aneurysm and other pulmonary parenchymal involvement. Sixteen BD patients were recruited for this study, (14 men, 87.5%, and 2 women, 12.5%). All patients fulfilled the 1990 American College of Rheumatology criteria for classification of BD [International Study Group for Behçet's Disease, Lancet 335:1078-1080, (1990)]. All patients underwent thorough history taking, full clinical examination, and routine laboratory investigations. Plain chest X-rays and pulmonary CT angiography were performed on all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Pulmonary vascular abnormalities were as follows: pulmonary artery aneurysms of varying sizes in nine patients (56.3%), main pulmonary artery ectasia in two patients (12.5%), pulmonary artery embolism in two patients (12.5%), venacaval thrombosis in seven patients (43.8%), and pulmonary venous varices in four patients (25%). Pulmonary parenchymal abnormalities were as follows: three patients (18.8%) with mild central bronchiectasis, one patient (6.3%) with atelectasis, one patient (6.3%) with subpleural nodule, and four patients (25%) with interstitial lung disease. Eight of the male patients were smokers. Multislice CT is useful in demonstrating the entire spectrum of thoracic manifestations of BD. Multislice CT is noninvasive and provides excellent delineation of the vessel lumen and wall and perivascular tissues, as well as detailed information concerning the lung parenchyma, pleura, and mediastinal structures.
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Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Emad Y, El Yasaki A, Ragab Y, Khalifa M, Moawayh O, Salama M. Arthritis in a child secondary to congenital insensitivity to pain and self-aggression. Why and when pain is good? Clin Rheumatol 2006; 26:1164-6. [PMID: 16770519 DOI: 10.1007/s10067-006-0290-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 03/12/2006] [Accepted: 03/13/2006] [Indexed: 11/30/2022]
Abstract
A 9 year-old female child presented with recurrent arthritis of ankles, left knee and unequal leg length. Clinical examination revealed mild valgus deformity in her left knee with grade 2 effusion, arthritis of both ankles and deformity in her left wrist. Examination of the affected joints showed no evidence of tenderness upon active or passive movements and the patient did not show any limping upon gait analysis. Past history of the patient revealed evidence of previous dislocation of her left hip and previous fibular fracture. Revision of her previous x-rays showed left hip dislocation, fracture left fibula and fracture of right metatarsal bone after repetitive trauma which pass unnoticed. Recent x-ray of her left knee showed osteochondral injury. Laboratory investigations were done to rule out common causes of childhood arthritis and revealed: ESR 12 1st hours, CRP negative, negative rheumatoid factor, and negative ANA. Neurological evaluation of the patient documented congenital insensitivity to pain and EMG studies confirmed evidence of sensory neuropathy. Traumatic arthritis resulting from congenital insensitivity to pain with self-aggression is rarely encountered in children but should be considered in the differential diagnosis specially if radiological features point to repetitive trauma with attempts of healing.
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Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Emad Y, Ragab Y. Liposynovitis prepatellaris in athletic runner (Hoffa's syndrome): case report and review of the literature. Clin Rheumatol 2006; 26:1201-3. [PMID: 16736123 DOI: 10.1007/s10067-006-0339-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 05/02/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
A 37-year-old male patient, who is an athletic runner, developed anterior knee pain of acute onset after prolonged running and swelling of his right knee. The patient experiences more pain when he flexes the knee and a sense of catching together with grade 1 effusion. The patient was clinically suspected to have internal derangement and MRI study of his right knee was ordered to exclude such possible diagnosis. The MRI study revealed the following: a hypointense lesion in the infrapatellar pad of fat in T2-weighted images (WI), postcontrast T1 WI with fat saturation demonstrated no enhancement, and STIR sequence showed slightly hyperintense lesion with minimal knee effusion. The MRI findings supported the diagnosis of Hoffa's syndrome, and arthroscopic resection of the fat pad was performed. There was a significant improvement in the symptoms and function after the surgery.
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Affiliation(s)
- Y Emad
- Rheumatology & Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Emad Y, Basaffar S, Ragab Y, Zeinhom F, Gheita T. A case of polyarteritis nodosa complicated by left central retinal artery occlusion, ischemic optic neuropathy, and retinal vasculitis. Clin Rheumatol 2006; 26:814-6. [PMID: 16575492 DOI: 10.1007/s10067-006-0270-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 08/31/2005] [Accepted: 08/31/2005] [Indexed: 01/17/2023]
Abstract
A 23-year-old single female patient developed constitutional manifestations in the form of fever, weight loss, anorexia, malaise, fatigue, and generalized aches in January 1995, 2 weeks after an attack of German measles. This was followed by painful, reddish, macular skin lesions over both legs which healed by dark pigmentation (leucocytoclastic vasculitis), mononeuritis multiplex, and Raynaud's phenomena of both hands and feet. Angiography of lower limbs was done to visualize the arterial tree of both lower limbs and revealed typical beading of distal arterial branches, a diagnosis compatible with polyarteritis nodosa (PAN). At that time, the patient received prednisone (45 mg/day) and azatioprin (100 mg/day) and responded well to treatment. In a second presentation in June 2005, the patient developed sudden attack of loss of vision in her left eye. Ophthalmological examination of the patient revealed evidence of left central retinal artery occlusion, ischemic optic neuropathy. The patient received methyl prednisolone, 1 g IV infusion, daily infusion for three consecutive days followed by oral prednisolone, 30 mg/day. The patient received pulse cyclophosphamide IV infusion (0.6 g/m2) on the fourth day. One week after receiving therapy, the patient progressed from having light perception to counting of fingers from a distance of 1 m.
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Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Emad Y, Gheita T, Ragab Y, Zeinhom F. Pauciarticular severe destructive arthropathy in a child secondary to synovial osteochondromatosis. Clin Rheumatol 2006; 26:604-6. [PMID: 16429238 DOI: 10.1007/s10067-005-0183-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 12/03/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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