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Eesa NN, Abdel Nabi H, Owaidy RE, Khalifa I, Radwan AR, NourEl-Din AM, Amer MA, ElShereef RR, Hassan E, Ismail F, El-Gazzar II, Khalil NM, Moshrif AH, Abualfadl E, Tharwat S, Fathi HM, Abd Elazeem MI, El-Shebini E, Samy N, Noshy N, El-Bahnasawy AS, Abdalla AM, Abousehly OS, Mohamed EF, Nasef SI, Elsaman AM, ElKhalifa M, Salem MN, Abaza NM, Fathy HM, Abdel Salam N, El-Saadany HM, El-Najjar AR, El-Hammady DH, Hammam N, Mohammed RH, Gheita TA. Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation. Lupus 2021; 30:2135-2143. [PMID: 34528835 DOI: 10.1177/09612033211043010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to present the manifestations of juvenile systemic lupus erythematosus (JSLE) across Egypt, to focus on age at onset and gender-driven influence on disease characteristics, and to compare findings to other countries. METHODS The study included 404 Egyptian children with systemic lupus erythematosus (SLE) presenting to one of the specialized rheumatology centers corresponding to 13 major governorates. Juvenile cases age was ≤ 16°years at the time of recruitment. The SLE Disease Activity Index (SLEDAI) and damage index (DI) were assessed. RESULTS The mean age was 13.2 ± 2.4°years; 355 females and 49 males (7.2:1), and the disease duration was 2.3 ± 1.6 years, while age at disease onset was 11.1 ± 2.5°years. Their SLEDAI was 13.5 ± 12.3, and DI, 0.36 ± 0.78. The overall estimated prevalence of childhood-SLE patients in the recruited cohort in Egypt was 1/100,000 population (0.24/100000 males and 1.8/100000 females). 7.4% developed pre-pubertal SLE (≤ 7 years); 73.3%, peri-pubertal; and 19.3% during early adolescence. The differences according to age group were equal for gender and clinical manifestations except skin lesions present in 59.3% of pre-pubertal onset, 74.6% of peri-pubertal, and 84.2% of adolescents (p = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents (p = 0.03). Laboratory investigations, SLEDAI, and DI were similar among age categories. Lupus nephritis was more common in Egypt compared to JSLE from other countries. CONCLUSION Our large multicenter study identified that female gender influenced disease characteristics with more frequent skin involvement. Skin lesions were significantly higher in adolescents, while renal involvement in peri-pubertal children.
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Affiliation(s)
- Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Abdel Nabi
- Pediatrics Department, Rheumatology and Nephrology Unit, 68782Tanta University, Gharbia, Egypt
| | - Rasha El Owaidy
- Pediatrics Department, Rheumatology Unit, 68792Ain Shams University, Cairo, Egypt
| | - Iman Khalifa
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
| | - Ahmed R Radwan
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Abeer M NourEl-Din
- Pediatrics Department, 68787National Research Centre (NRC), Cairo, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, 68789Alexandria University, Alexandria, Egypt
| | - Rawhya R ElShereef
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Eman Hassan
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, 68877Minia University, Minia, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M Khalil
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 63527Cairo University, Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, 68820Al-Azhar University, Assuit, Egypt
| | - Esam Abualfadl
- Pediatrics Department, Rheumatology and Nephrology Unit, 68900Helwan University, Cairo, Egypt
- Qena/Luxor hospitals, Qena, Egypt
| | - Samar Tharwat
- Internal Medicine, Rheumatology Unit, 68780Mansoura University, Dakahlia, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, 158405Fayoum University, Fayoum, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, 68872Menoufiya University, Menoufiya, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Nermeen Noshy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68792Ain-Shams University, Cairo, Egypt
| | - Amany S El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, 68780Mansoura University, Dakahlia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, 435387Aswan University, Aswan, Egypt
| | - Osama S Abousehly
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), 68820Al-Azhar University, Cairo, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, 68889Sohag University, Sohag, Egypt
| | - Marwa ElKhalifa
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 68789Alexandria University, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, 158411Beni-Suef University, Beni-Suef, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, 68792Ain Shams University, Cairo, Egypt
| | - Hanan M Fathy
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | - Nancy Abdel Salam
- Pediatrics Department, Rheumatology and Nephrology Unit, 68789Alexandria University, Alexandria, Egypt
| | | | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, 68799Zagazig University, Sharkia, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, 68900Helwan University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, 68797Assuit University, Assuit, Egypt
- Rheumatology Department, 8785University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Reem Ha Mohammed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Gheita TA, Hammam N, Fawzy SM, Abd El-Latif E, El-Gazzar II, Samy N, El-Hammady DH, Abdel Noor R, El-Shebini E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Senara S, Fathi HM, Sallam RA, El Shereef RR, Abd Elazeem MI, Fawzy RM, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa M, Nasef SI, Abdalla AM, Noshy N, Said EA, Saad E, Moshrif AH, El-Shanawany AT, Abdel-Fattah YH, Raafat HA, Khalil HM. Development and validation of a Behçet's Disease Damage Index for adults with BD: An Explicit, Composite and Rated (ECR) tool. Int J Rheum Dis 2021; 24:1071-1079. [PMID: 34288457 DOI: 10.1111/1756-185x.14166] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a chronic multisystem variable vessel vasculitis. Disease damage is irreversible and permanent. Validated tools evaluating damage are limited. Enhancements in the clinical treatment of vasculitis will take place from the development of refined and exclusive indices for individual vasculitic syndromes including BD and attempting their international validation. OBJECTIVES This aim was to develop and validate a simple BD Damage Index (BDI). METHODS This was a nationwide study including 1252 BD patients. The work consisted of 3 stages. Stage 1: items generation for score content. Stage 2: items selection for the draft score was performed by an expert rheumatologist. Stage 3: the content validity of the draft score was assessed and BDI, Vasculitis Damage Index (VDI), Antineutrophil cytoplasmic antibody-associated Vasculitis Index of Damage (AVID) and Combined Damage Assessment Index (CDAI) were calculated and compared. RESULTS The mean age of the BD patients was 36.1 ± 9.9 years. Stages 1 and 2 resulted in a BDI instrument containing 73 items with a maximum score of 100. Stage 3, the VDI, CDAI, AVID, and BDI were 2.9 ± 2.2, 3.1 ± 2.3, 3.1 ± 2.3 and 5.1 ± 2.9, respectively. High correlations (r = .9) between comparable damage scores assured acceptable concurrent validity. CONCLUSION The proposed BDI represents a new robust and potentially useful tool when dealing with BD chronic status.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.,Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA
| | - Samar M Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eiman Abd El-Latif
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Dina H El-Hammady
- Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rasha Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, Menoufia University, Menoufia, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N Salem
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Soha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina F El-Essawi
- Rheumatology Unit (NCRRT), Internal Medicine Department, Atomic Energy Authority (AEA), Cairo, Egypt
| | - Ahmed M Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rehab A Sallam
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Rawhya R El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Noha M Khalil
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Shahin
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marwa ElKhalifa
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.,Division of Rheumatology, Internal Medicine Department III, Medical University of Vienna, Vienna, Austria
| | - Nermeen Noshy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Emtethal A Said
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Egypt
| | - Ehab Saad
- Rheumatology Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Amira T El-Shanawany
- Rheumatology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hala A Raafat
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam M Khalil
- Ophthalmology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Gheita TA, Fathi HM, Eesa NN, El-Shebini E, Tharwat S, Hammam N, Fawzy RM, El-Shereef RR, Abd El-Samea MH, Abdel Noor RA, Salem MN. Development of an Arabic version of the Behçet's Disease Current Activity Form (Ar-BDCAF): cross-cultural adaptation and validation initiative in Egypt. Clin Rheumatol 2021; 40:4609-4618. [PMID: 34170444 DOI: 10.1007/s10067-021-05817-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Behçet's disease (BD), commonly seen in the Silk road countries, is a variable vessel vasculitis with no specific investigation that reflects disease activity. The Behçet's Disease Current Activity Form (BDCAF) is the most famous and acceptable clinical activity score. PURPOSE To develop a cross-cultural adaptation of the BDCAF to the Arabic language (Ar-BDCAF)-Egyptian dialect-across the country and to consider preliminary evaluation of its reliability in assessment of BD activity. PATIENTS AND METHODS The score was translated to Arabic language and revised by 3 rheumatology consultants. Reliability of Ar-BDCAF was tested among 88 BD patients from 9 Egyptian main city centers. Patients were questioned by two specialists at 30 min interval to evaluate inter-observer rating and twice by the same physician within 24 h to assess the intra-observer rating. RESULTS Patients were 64 males and 24 females (2.7:1) with a mean age of 35 ± 10.3 years. The average time required by the consultant to fill in the form was 5.1 ± 2.2 min (1.5-15 min). The mean Ar-BDCAF scores were 9.81 ± 6.22 (0-25) and 9.53 ± 6.13 (0-28) with an intra-observer concordance (p = 0.28) and was 9.95 ± 6.47 (0-29) for the inter-observer rating (p = 0.89 and p = 0.66, respectively). CONCLUSION The Ar-BDCAF is a measurable, easy to calculate, and reliable index for assessing disease activity in Egyptian BD. The Ar-BDCAF score can be used in daily clinical practice to assess BD activity and its use can be extended to other Arab countries for possible regional validation and adaptations. Key Points • The Arabic version of the BDCAF can be extended to other Arab countries for development of a Pan-Arab score. • This is the first study to provide a reliable and valid Arabic version of the BDCAF-Egyptian dialect for measuring current disease activity in BD patients.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad El-Shebini
- Internal Medicine Department, Rheumatology Unit, Menoufia University, Menoufia, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nevin Hammam
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rawhya R El-Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mona H Abd El-Samea
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Rasha A Abdel Noor
- Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Immunology Division, Beni-Suef University, Beni-Suef, Egypt
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