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Aim of the work: To determine the frequency of depression in Behçet’s disease (BD) patients and to clarify its burden on patients’ clinical manifestations, disease activity status and quality of life (QoL). Patients and methods: 35 BD patients with 35 matched control were included in this study. Disease activity was assessed by Behçet Syndrome Activity Score (BSAS). All participants were requested to complete the Hamilton depression rating scale (HDRS), Multidimensional assessment of fatigue (MAF) questionnaire and the short form-36 (SF-36) QoL Scale. Results: The mean age of the patients was 40.3 ± 13.5 years (17–72 years) and they were 27 males and 8 females. The frequency of depression in BD patients was 74.3% with increased male frequency (p = 0.007) and major organ involvement (p = 0.04) among depressed patients. Significant differences (p

To depict the spectrum of rheumatoid arthritis (RA) in Egypt in relation to other universal studies to provide broad-based characteristics to this particular population. This work included 10,364 adult RA patients from 26 specialized Egyptian rheumatology centers representing 22 major cities all over the country. The demographic and clinical features as well as therapeutic data were assessed. The mean age of the patients was 44.8 ± 11.7 years, disease duration 6.4 ± 6 years, and age at onset 38.4 ± 11.6 years; 209 (2%) were juvenile-onset. They were 8750 females and 1614 males (F:M 5.4:1). 8% were diabetic and 11.5% hypertensive. Their disease activity score (DAS28) was 4.4 ± 1.4 and health assessment questionnaire (HAQ) 0.95 ± 0.64. The rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were positive in 73.7% and 66.7% respectively. Methotrexate was the most used treatment (78%) followed by hydroxychloroquine (73.7%) and steroids (71.3%). Biologic therapy was received by 11.6% with a significantly higher frequency by males vs females (15.7% vs 10.9%, p = 0.001). The least age at onset, F:M, RF and anti-CCP positivity were present in Upper Egypt (p 0.0001), while the highest DAS28 was reported in Canal cities and Sinai (p 0.0001). The HAQ was significantly increased in Upper Egypt with the least disability in Canal cities and Sinai (p = 0.001). Biologic therapy intake was higher in Lower Egypt followed by the Capital (p 0.0001). The spectrum of RA phenotype in Egypt is variable across the country with an increasing shift in the F:M ratio. The age at onset was lower than in other countries.

Behcet’s disease (BD), commonly seen in the Silk road countries, is a variable vessel vasculitis with no specific investigation that reflects disease activity. The Behcet’s Disease Current Activity Form (BDCAF) is the most famous and acceptable clinical activity score. 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. 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. 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). 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.

Background: Increased coronary artery atherosclerosis in rheumatoid arthritis (RA) may cause significant mortality. Tumor necrosis factor (TNF) is a potent proinflammatory cytokine that has been involved in RA pathogenesis and atherosclerosis. Aim of the work: To determine the association between TNF-α rs1800629 polymorphism and carotid atherosclerosis in RA patients. Patients and methods: This study was carried out on 50 RA patients and 40 age and sex matched healthy control. All patients were subjected to full history taking, thorough clinical examination, and assessment of disease activity score (DAS28). Carotid artery intima–media thickness (IMT) was measured by Doppler ultrasonography. TNF-α −308A/G (rs1800629) polymorphism was assessed. Results: The mean age of patients was 41.2 ± 13.2 years with disease duration of 6.1 ± 4.5 years. The mean DAS28 was 4.1 ± 0.8 and Larsen score 2.1 ± 0.9. The mean IMT was significantly higher in patients (0.78 ± 0.47 mm) compared to the control (0.44 ± 0.16 mm) (p

Aim of the work: To investigate serum and synovial fluid levels of IL-17 in rheumatoid arthritis (RA) patients, and its correlation with disease activity and severity. Patients and methods: 20 RA patients together with 20 primary knee osteoarthritis (KOA) patients and 15 healthy individuals matched for age and sex as control groups were enrolled in this study. Both RA and KOA patients presented with knee effusion. Paired samples of serum and synovial fluid (SF) were collected from RA, OA patients and serum samples from the healthy individuals. RA disease activity was assessed using DAS-28 score and power Doppler ultrasound (PDUS) according to the European League against Rheumatism (EULAR). Radiographic damage was evaluated according to Larsen score. Results: Serum levels of IL-17 were significantly elevated in RA patients compared to controls (p

Background: Fibromyalgia is the second most common disease encountered in rheumatology practice Aim: This study designed to assess the potential effect of mesotherapy in treatment of tender points in primary fibromyalgia (PFM) patients. Methods: Thirty PFM patients who fulfilled the American Colleague of Rheumatology 1990 criteria, joined this study. They were divided into 2 groups randomly according to the treatment program received; Injection mesotherapy group (Group I: No=15 patients) who received a mixture of 2 ml of Ketoprofen (100mg/2ml) added to 3 ml of Saline Solution, once cession per week for a total of 6 successive weeks and other 15 patients (Group II) who received Ketoprofen 100 mg Extended- Release capsules once daily for 2 successive weeks which represent the control group. Patients‟ pain severity, quality of life and depression were assessed using visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ) and the Hamilton Rating Scale (HDRS) respectively before treatment and after the 3rd & the 6th cession then data were recorded and compared. Results: We found significant improvements (p

Aim of the work The aim of this study was to detect changes occurring in some tendons, for example, Achilles, quadriceps, and supraspinatus tendons, using musculoskeletal ultrasound (MSUS) imaging in patients with chronic kidney disease (CKD) on regular hemodialysis and to evaluate associations of these changes with patients’ clinical status, parathyroid hormone (PTH) level as well as other laboratory parameters. Patients and methods This study was carried out on 35 patients and a group of 25 age-matched and sex-matched apparently healthy participants as a control group. All patients underwent history taking; clinical examination; and shoulder, knee, and ankle plain radiography. Laboratory investigations including PTH level were done. MSUS was performed on the selected tendons for all patients and controls. Results The ankle was the most clinically affected joint. US abnormalities most commonly affected the Achilles tendon (15.2%) having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure, followed by the quadriceps tendon (2.9%), whereas the supraspinatus tendon was the least affected (2.3%). There were highly statistically significant differences between patients with CKD and controls regarding mean tendon thickness, with the quadriceps tendon and supraspinatus tendons being thicker in the study group (P

The present work was conducted to estimate the prevalence of adult Behcet’s disease (BD) in adult Egyptian and to study the clinical pattern and influence of age at-onset and sex on disease phenotype. Also, we investigated the spectrum of presentation and frequencies along the north-to-south gradient of the country. The population-based, multicenter, cross-sectional study included 1526 adult BD patients from 26 specialized Egyptian rheumatology centers. Demographic, clinical, and therapeutic data are assessed for all patients. The mean age of patients was 35.7 ± 9.84 years, disease duration 6.58 ± 5.25 years, and age at onset 29.37 ± 8.6 years; 91 were juvenile-onset (JoBD). There were 1102 males and 424 females (M:F 2.6:1). Regarding co-morbidities, 19.92% were diabetic, and 26.05% were hypertensive. The mean body mass index was 27.57 ± 5.24 (43.1% overweight; 25.9% obese). The mean BD current activity form was 4.48 ± 4.28. Regarding the medications use, systemic steroid and colchicine were the most common drugs used (947 (90.2%) and 611 (82.7%), respectively). The overall estimated prevalence of BD in Egypt was 3.6/100,000 population being highest in the two main cities: Alexandria (15.27) and Cairo (8.72). Pathergy test was positive in 43.4%. 90.2% were receiving systemic steroids and 8.3%, biologics. Disease characteristics were comparable between JoBD and adult-onset BD cases. Central nervous system (CNS), deep venous thrombosis (DVT), and gastrointestinal (GIT) involvement were significantly higher in males (p = 0.01, p = 0.001, and p = 0.001 respectively) while joint affection (p = 0.001) and disease activity (p = 0.011) were increased in females. This study provides current prevalence of BD in Egypt; 3.6/100,000 with no remarkable north-to-south gradient. The sex influences the disease phenotype with the CNS, DVT, and GIT involvement are higher in males, while the joint affection and disease activity were increased in females. • The prevalence and phenotype of Behcet’s disease across Egypt is presented in a multicenter nationwide study. • The potential influence of the age at onset and sex on disease phenotype is highlightened. • A review of the literature worldwide is presented allowing comparisons with studies from other nations.

Aim This study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables. Patients and methods This study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants. Results The mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P

Introduction: Mesostyle is a needle free mesotheraputic device that is able to insert analytical pure active substance to the deep layers of skin within cell levels using the most modern electroporation procedure. Objectives: this study aimed to assess electroporation "as a method of transdermal administration of medications" in treatment of corticosteroid induced striae in systemic lupus erythematosus patients. Methods: Twenty female Systemic lupus erythematous (SLE) patients suffering from corticosteroid induced striae in different body parts, were included in this study. Patients were subjected to full history taking, complete clinical examination, and assessment of disease activity using systemic lupus erythematosus disease activity index (SLEDAI) score. Each patient received treatment in the form of six weekly successive cessions using electroporation device "Mesostyle" and photos were obtained after each cession. Results: We found marked improvement of striae appearance with noticeable patients’ satisfaction without any adverse effects. Conclusion: This study supports the role of electroporation which is safe, tolerable, non-invasive, and effective method for transdermal administration of medications.

Objectives The aim of the present work was to explore the perspectives of Egyptian Rheumatology staff members as regards the coronavirus disease-19 (COVID-19) vaccine. Methods The survey is composed of 25 questions. Some questions were adapted from the global rheumatology alliance COVID-19 survey for patients. Results 187 rheumatology staff members across Egypt from 18 universities and authorizations actively participated with a valid response. The mean time needed to complete the survey was 17.7 ± 13 min. Participants were 159 (85%) females (F:M 5.7:1). One-third agreed that they will be vaccinated once available, 24.6% have already received at least one dose, 29.4% are unsure while 16% will not take it. Furthermore, 70.1% agreed that they will recommend it to the rheumatic diseases (RD) patients once available, 24.1% are not sure while 5.9% will not recommend it. RD priority to be vaccinated against COVID-19 in descending order include SLE (82.9%), RA (55.1%), vasculitis (51.3%), systemic sclerosis (39.6%), MCTD (31.6%), Behcet's disease (28.3%). The most common drugs to be avoided before vaccination included biologics (71.7%), DMARDs (44.4%), biosimilars (26.7%), IVIg (17.1%) and NSAIDs (9.1%). Conclusions The results of the study and specifically the low rate of acceptability are alarming to Egyptian health authorities and should stir further interventions to reduce the levels of vaccine hesitancy. As rheumatic disease patients in Egypt were not systematically provided with the vaccine till present, making the vaccine available could as well enhance vaccine acceptance. Further studies to investigate any possible side effects, on a large scale of RD patients are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04941-0.

Background Behcet'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.

Objectives: This study aimed to assess the reliability and safety of extracorporeal shockwave therapy (ESWT) versus local corticosteroid injection on pain intensity and functional disability, as treatment modalities of patients suffering from chronic plantar fasciitis (PF). Patients and methods: This study was conducted on 45 patients suffering from chronic PF who failed to respond to conservative treatments. Patients were divided into 3 groups: 15 patients treated with ESWT once per week for 6 successive sessions (Group I), 15 patients treated with a local corticosteroid injection (Group II) and 15 patients taking acetaminophen 500mg/6 hrs for 7 days and exercises, as controls (Group III). All patients were subjected to history taking, clinical examination and assessment of foot pain, disability and activity limitations using the Foot Function Index (FFI) at the beginning of the study and after 6 weeks. Results: At the beginning of the study, no significant differences were reported between the studied groups regarding the FFI (p value = 0.23). However, at the end of the study, a highly statistically significant difference was reported between the three groups regarding the outcome variables (p value =0.001). Improvement occurred in group I and II but it was superior among group I patients. Skin reddening occurred in 11 patients (73.3%) of group I and 2 patients (13%) of group II with a statistically significant difference (p < 0.001) between the 2 groups. Pain was reported in 4 patients (26.7%) and 15 patients (100%) in group I and group II respectively with a highly significant difference (p < 0.001). None of the cases reported allergy or fat bad atrophy. Conclusion: Both ESWT and local corticosteroid injection treatments improved pain and functional ability in patients with chronic PF. Improvement of the FFI total scores was superior with the ESWT therapy that seems to be an unconventional but a safe method for the management of chronic PF.

During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p

The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.

Background Behçet’s disease (BD) is an autoinflammatory disorder. Disease activity could be detected by changes in peripheral blood cell components. The aim of this study was to assess the relationship between neutrophil-to-lymphocyte ratio (NLR) with disease activity and carotid intima-media thickness (cIMT) in patients with BD. Patients and methods This study was conducted on 20 adult patients with BD (group І). This group was subdivided according to cIMT into group Іa, which included patients with increased cIMT, and group Іb, which included patients with cIMT within normal ranges. Moreover, 20 age-matched and sex-matched apparently healthy volunteers were included as a control group (group ІІ). Patients with BD were subjected to full history taking, thorough clinical examination, and assessment of disease activity according to Behçet’s Disease Current Activity Form score. The white blood cell count, neutrophil count, and lymphocytes count were recorded, and NLR was calculated. cIMT assessment was done for all participants. Results There were statistically significant differences (P

Aim of the work To study the relation between neutrophil-lymphocyte ratio (NLR) with disease activity indices and with musculoskeletal ultrasonographic findings in recent onset rheumatoid arthritis (RA) patients. Patients and methods The study consisted of 40 recently diagnosed RA patients and 40 matched control. Patients’ disease activity was assessed clinically by the disease activity score (DAS-28). Musculoskeletal ultrasound was performed to detect synovitis by Power-Doppler ultrasound (PDUS). The association of NLR with the disease activity indices and the PDUS score were analyzed. Results The mean age of the patients was 44.5 ± 2.7 years, disease duration 9.4 ± 4.5 months and the female:male ratio was 2.3:1. Their disease activity was 4.7 ± 1.33 and the PDUS score was 10.24 ± 4.56. The NLR was significantly increased in the RA patients (3.28 ± 0.59) compared to the control (1.7 ± 0.23) (p 0.0002 ). There was a significant correlation between NLR with the disease duration (p 0.015 ), tender joint count (p 0.022 ), swollen joint count (p 0.018 ), morning stiffness (p 0.045 ), visual analogue scale (p 0.026 ), DAS-28 (p 0.049 ), erythrocyte sedimentation rate (p 0.032 ), C-reactive protein (p 0.017 ) and PDUS score (p 0.037 ). NLR was significantly elevated in highly active RA patients compared to patients with moderate and low disease activity (p 0.014 ). Conclusion NLR significantly correlated with disease activity indices in recent onset RA patients thus reflecting systemic inflammation with its advantages of being available, easy and cost accessible being as reliable as the DAS-28 hence it could be used as a marker of disease activity.

OBJECTIVE This study aimed to investigate the relations between calreticulin (CRT) serum level and both disease activity and severity parameters in juvenile idiopathic arthritis (JIA). MATERIAL AND METHODS In this study, 60 children with JIA and 50 age-and-sex-matched healthy subjects were enrolled. The assessment of the disease activity was done using juvenile arthritis disease activity score 27 (JADAS-27). The assessment of disease severity was done via gray-scale ultrasonography (US) and power Doppler US (PDUS). Enzyme-linked immunosorbent assay (ELISA) was used to assay the serum level of human CRT. RESULTS The mean serum CRT levels in JIA patients was 8.6±1.2 ng/mL and showed a highly significant increase (p=0.001) as compared to the mean serum levels in the controls (5.02±0.77 ng/mL). There were statistically significant positive correlations between the serum CRT levels and disease duration, tender joint count, swollen joint count, visual analog scale, erythrocyte sedimentation rate, JADAS-27, C-reactive protein, rheumatoid factor titer, and ultrasonographic grading for synovitis and neovascularization. CONCLUSION Elevated serum CRT levels in JIA patients and its correlations with JIA disease activity and severity parameters signified that CRT might be used as a novel biomarker for disease activity and severity in JIA.

Objective The aim of this study was to present the epidemiology, clinical manifestations and treatment pattern of systemic lupus erythematosus (SLE) in Egyptian patients over the country and compare the findings to large cohorts worldwide. Objectives were extended to focus on the age at onset and gender driven influence on the disease characteristics. Patients and method This population-based, multicenter, cross-sectional study included 3661 adult SLE patients from Egyptian rheumatology departments across the nation. Demographic, clinical, and therapeutic data were assessed for all patients. Results The study included 3661 patients; 3296 females and 365 males (9.03:1) and the median age was 30 years (17–79 years), disease duration 4 years (0–75 years) while the median age at disease onset was 25 years (4–75 years). The overall estimated prevalence of adult SLE in Egypt was 6.1/100,000 population (1.2/100,000 males and 11.3/100,000 females).There were 316 (8.6%) juvenile-onset (Jo-SLE) and 3345 adult-onset (Ao-SLE). Age at onset was highest in South and lowest in Cairo (p Conclusion SLE in Egypt had a wide variety of clinical and immunological manifestations, with some similarities with that in other nations and differences within the same country. The clinical characteristics, autoantibodies and comorbidities are comparable between Ao-SLE and Jo-SLE. The frequency of various clinical and immunological manifestations varied between gender. Additional studies are needed to determine the underlying factors contributing to gender and age of onset differences.

Objectives Brain-derived neurotrophic factor (BDNF) is an important mediator of neuronal development, survival, and function. It is related to the pathogenesis of several neuropsychiatric disorders. The aim of this study was to determine the relationship between serum BDNF (sBDNF) level and neuropsychiatric status in systemic lupus erythematosus (SLE) patients. Patients and methods This study included the following groups: group I included 35 SLE patients with neuropsychiatric systemic lupus erythematosus (NPSLE) manifestations, group II included 30 SLE patients without neuropsychiatric manifestations, group III included 15 patients with neuropsychiatric disorders due to causes other than SLE, and group IV included 15 apparently healthy volunteers. All groups were matched for age and sex. SLE disease activity was assessed using the SLE Disease Activity Index. A Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Axis I was used for the assessment of psychiatric disorders, whereas neurological disorders were assessed by an expert neurologist. sBDNF was measured by the enzyme-linked immunosorbent assay. Results There was a statistically significant increase (P

Background Matrix metalloprotein ase-3 (MMP-3) is one of the MMPs produced in rheumatoid arthritis (RA) joints. Aim The aim of this study was to evaluate serum and synovial fluid (SF) MMP-3 as markers of disease activity in early RA. Patients and methods Thirty early RA patients together with age-matched and sex-matched 12 primary knee osteoarthritis patients and 12 apparently healthy individuals as control groups were enrolled in this study. MMP-3 was measured in serum and SF samples using enzyme-linked immunosorbent assay. Assessment of disease activity in RA patients was carried out using disease activity score-28 (DAS-28), and radiographs of the hands, wrists, and forefeet were obtained and evaluated according to Larsen score. Results As regards mean serum levels of MMP-3, there was a statistically significant elevation in RA patients compared with the control groups (P

Objective To ascertain a relationship between Toxoplasma gondii ( T. gondii ) infection and rheumatoid arthritis (RA) disease among Egyptian patients. Methods One hundred RA patients and 50 healthy subjects participated in this study. The patients were classified into three groups, namely GI, G2 and G3. Patients in G1 were recently diagnosed with RA with the disease duration of less than one year (prior treatment); G2 included RA patients receiving anti-tumor necrosis factor agents and RA patients in G3 received disease modifying anti-rheumatic drugs (methotrexate, antimalarial, corticosteroids). Serum samples of all participants were examined for the presence of anti- Toxoplasma immunoglobulin G ( IgG) antibodies and positive samples were further analyzed for anti- Toxoplasma IgM antibodies to detect the possibility of reactivation of latent toxoplasmosis. Also, the association between Toxoplasma seropositivity and clinical, laboratory and radiological features of these patients were determined. Results There was a significantly higher percentage of T. gondii IgG positivity in RA patients (54%) than in the controls (32%). At the same time, 20.40% of T. gondii IgG positive patients had anti- T. gondii IgM antibodies with a statistically significant difference as comparing to T. gondii IgG positive controls. Out of T. gondii seropositive patients, 20.37% had a lower IgG level with a mean titer of (65.3 ± 17.7) IU/mL, 46.29% had moderate level with a mean titer of (184.2 ± 60.0) IU/mL and 33.33% had higher level with a mean titer of (404.3 ± 50.0) IU/mL. A positive correlation was found between disease activity and Toxoplasma seropositivity. T. gondii seropositive RA patients had longer disease duration, longer time morning stiffness, higher numbers of tender and swollen joints and also increase in disease severity markers (erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, anti-cyclic citrullinated peptide anti-bodies, rheumatoid factor) than T. gondii seronegative patients. As regards radiological findings, Larsen score was found significantly higher in T. gondii seropositive RA patients. Conclusions The positive correlation between T. gondii infection and RA disease among Egyptian patients indicated the need to improve awareness of this parasitic infection and its management in this risk group.

Rheumatoid arthritis (RA) is a common chronic inflammatory disease, affecting about 1% of the general population. Conflicting data are available regarding the etiologic association of human parvovirus B19 (B19) infection with RA. This study aimed to determine the prevalence of B19 infection in patients with RA compared to healthy controls and to assess its possible association with disease activity or severity. The study included 40 RA patients and 40 age and sex matched apparently healthy controls. Detection of B19 DNA by nested PCR and the detection of anti-B19 IgM and IgG by ELISA) were performed for patients and controls. It was found that B19 infection is more prevalent in patients with RA than healthy controls as the frequency of detection of B19 DNA and anti-B19 IgG was significantly higher in RA patients than healthy controls (P=0.003 and P=0.04, respectively) but not IgM. It was concluded that B19 infection may have a role in the etiopathogenesis of RA but not involved in disease activity or severity.

The author wishes to correct the record and clarify that in the original version of this article in the Discussion section under "Prevalence over the country governorates" inadvertently presented incorrect data cited in the reference [30].

Background Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disorder. Musculoskeletal involvement represents a major cause of disability in SSc, which is localized especially at the level of the hands and feet. Musculoskeletal ultrasound (MSUS) had become a reference imaging tool in the evaluation of joint and soft-tissue abnormalities in rheumatic diseases. Aim of the work This study aimed to characterize ultrasonographic changes of the hand and wrist in patients with SSc as compared with patients with rheumatoid arthritis (RA), as well as determine the relation of these changes with clinical, laboratory, and radiographic findings in SSc. Patients and methods Twenty SSc patients and 20 control RA patients were included in this study. All patients underwent history taking, clinical examination, hand/wrist plain radiography, and MSUS performed on both hand and wrist joints. Results MSUS was more sensitive than radiographies in detecting soft-tissue calcifications in SSc patients and also in detecting erosions with no statistically significant difference (P > 0.05). In SSc patients, the prevalence of synovitis and tenosynovitis detected by ultrasound was found to be statistically significantly higher than that found by clinical examination (P = 0.025 and 0.011, respectively). Patients with higher values of erythrocyte sedimentation rate and C-reactive protein were more likely to have synovitis and/or tenosynovitis and inflammatory activity on power Doppler assessment. Conclusion Ultrasound was more accurate than clinical examination and conventional radiography in the detection of subclinical synovitis, tenosynovitis, and the underlying fibrotic changes of tendon friction rub. In SSc patients, on using MSUS, articular involvement was found to be less frequent compared with that in RA patients, with specific appearance of sclerosing tenosynovitis in SSc patients.

CD64 is a type of integral membrane glycoprotein known as FC receptor that binds monomeric IgG-type antibodies with high affinity. It is more commonly known as FC gamma receptor 1 (FC?R1) and it is expressed on monocytes surface. The goal of this study was to investigate the association of CD64 expression on the surface of peripheral blood monocytes of systemic lupus erythematosus patients with disease activity, and lupus nephritis. 30 SLE patients were enrolled into this study. They were subdivided into: 15 SLE patients with lupus nephritis and 15 SLE patients without lupus nephritis. In addition,Together with 25 age and sex matched healthy volunteers were enrolled as controls group. Disease activity was defined by SLE Disease Activity Index (SLEDAI) score and the renal Systemic Lupus Erythematosus Disease Activity Index (rSLEDAI) score. Surface expression of CD64 on peripheral blood monocytes was evaluated by Flowcytometry. Renal biopsies of Lupus nephritis patients was obtained and evaluated using the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification scheme. There was a statistically significant difference in surface expression of CD64 on circulating monocytes (P0.001) in SLE patients with nephritis especially those with class II/III as compared to SLE without nephritis and healthy controls. The mean fluorescent intensity of CD64 staining correlated positively with markers of systemic inflammation, lupus nephritis, SLEDAI and rSLEDAI scores. In conclusions, surface expression of CD64 on circulating monocytes reflects systemic inflammation, renal injury and could be used as a rapid approach and good biomarker for disease activity and lupus nephritis in SLE patients.

Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by a ‎‎course of remissions and exacerbations of unpredictable frequency and duration‎. Pro-‎inflammatory cytokines seem to be responsible for the enhanced inflammatory ‎‎response in BD.This study aimed to investigate serum levels of IL-33 in patients with Behcet's disease (BD) and their relationship to disease activity and clinical manifestations. Thirty patients with BD were enrolled and subjected to assessment of disease activity according to Behcet's Disease Current Activity Form (BDCAF) score. Serum IL-33 levels were determined using Enzyme-Linked-Immunosorbent Assay (ELISA). Thirty age and sex matched rheumatoid arthritis patients and thirty healthy volunteers were included in this study as control groups. Serum IL-33 level was 132.5±19 pg\ml, 101.2±20.1 pg\ml and 31.5±10.5 pg\ml in RA, BD and healthy control groups respectively. IL-33 was significantly higher in BD patients (101.2±20.1pg/ml) as compared to healthy controls (31.5±10.5 pg/ml) but lower than rheumatoid arthritis patients (132.5±19.1 pg/ml). Levels of IL-33 were significantly increased in BD patients with skin lesions (Erythema nodosumAcneiform lesions) and ocular lesions (retinal vasculitis) (P0.05), and a positive correlation was found between BDCAF score and IL-33serum levels (r=0.9, P0.001). In conclusions, serum IL-33 level is elevated in active BD patients with skin and ocular affection and correlates with disease activity.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton.Interleukin-37 (IL-37) is a member of IL-1 family cytokines, that downregulate expression of pro-inflammatory cytokines in chronic inflammatory diseases. The aim of the work is to investigate role of IL-37 in AS disease activity and osteoporosis. Twenty-five patients with AS and 25 controls were enrolled into this study. They were subjected to full clinical examination including assessment of disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Serum IL-37 levels and IL-37 mRNA relative concentration were measured by enzyme-linked immunosorbent assay (ELISA)‎ and quantitative reverse transcriptase- polymerase chain reaction (RT-PCR) respectively. Bone mineral density (BMD) was determined using dual energy X-ray absorptiometry (DEXA). Spine radiographs were scored using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Mean serum IL-37 level was significantly higher in AS patients compared with the ‎controls (P0.001) and significantly elevated in AS ‎patients with osteoporosis (P0.05). IL-37 mRNA gene expression showed a significant increase expression in active AS patient (25 folds) as well as in inactive patient (12 folds) as compared to ‎controls‎.‎ In conclusion, serum IL-37 and its mRNA expression is increased in ‎AS patients with special ‎consideration in patient with Osteoporosis and ‎correlates with disease activity and ‎BMD which indicate that IL-37 may provide a novel research ‎target for pathogenesis and therapy of AS.‎.

Objective Osteoarthritis (OA) is a multifactorial, degenerative, and inflammatory disorder of joints causing damage of the articular cartilage, formation of osteophytes, and eburination of the subchondral bone. Matrilin-3 (MATN-3) is a non-collagenous oligomeric extracellular matrix protein (ECM), which is the smallest member of the matrilin family. This study was conducted to identify the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in a series of Egyptian patients with primary knee OA. Material and methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine genotypes of MATN-3 SNP6 for 50 primary knee OA patients in addition to 50 healthy subjects of the same sex and age range. Full history was obtained from OA patients, followed by clinical examination, together with clinical assessment of the severity of knee OA using Lequesne Algofunctional Index score and radiological grading using the Kellgren-Lawrence grade scale (KL). Results With regard to genotypes of MATN-3 gene SNP6 (rs8176070), a statistically significant difference between OA patients and healthy control subjects was found for the B\b genotype and b allele (p=0.046 and 0.042 respectively), with the prevalence being higher in OA patients with a high risk to develop OA (Odds Ratio [OR]=2.250, 95% CI=1.011-5.008). Patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotypes. Conclusion The investigated polymorphism in the MATN-3 gene may reflect the risk and severity of knee OA in Egyptian patients, particularly with the B\b genotype.

OBJECTIVE This study aimed to evaluate the effect of one dose of intra-articular injection of (PRP) in the knee joint on a specific osteoarthritis (OA) serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), over a short period of 3 months. The aim extended to clarify the effect of PRP on the functional status of the osteoarthritic knee joint. MATERIAL AND METHODS Sixty patients with primary unilateral knee OA were enrolled in this study. They were subdivided according to Kellgren-Lawrence grading scale (KL) into (Group I): including patients with KL grade < 3 and (Group II): including patients with KL grade ≥3. Patients were asked to complete the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Score. PRP was prepared and injected immediately into the affected knee. Serum Coll2-1 (S.Coll2-1) concentration was measured by enzyme-linked immunosorbent assay (ELISA) kit pre and 3 months after PRP injection. RESULTS Significant reduction in S.Coll2-1 concentration in primary knee OA patients; (p

In the article titled “Musculoskeletal ultrasound on the hand and wrist in systemic sclerosis”, which appeared in the pages 95–101, issue 3, vol. 43 of Egyptian Rheumatology and Rehabilitation[1], the names of the three authors of the article and their affiliations are missing. The author names are “Gamal Abd elghafar Hamad”, “Osama Taha Galal”, and “Amani Omar Abd elftah”. The affiliations of the authors are as follows: Gamal Abd elghafar Hamad: Rheumatology and Rehabilitation Department, Benha Faculty of Medicine, Benha University, Benha, Egypt Osama Taha Galal: Diagnostic Radiology, Benha Faculty of Medicine, Benha University, Benha, Egypt Amani Omar Abd elftah: Rheumatology and Rehabilitation Department, Benha Faculty of Medicine, Benha University, Benha, Egypt The author names in order should read correctly as follows: Rasha Mohamed Fawzy, Gamal Abd elghafar Hamad, Osama Taha Galal, Amani Omar Abd elftah The “How to cite this article” section information is written incorrectly and should read correctly as “Fawzy MR, Hamad AG, Galal TO, Abd elftah OA. Musculoskeletal ultrasound on the hand and wrist in systemic sclerosis. Egypt Rheumatol Rehabil 2016;43:95–101”

SLE is a heterogeneous disease, characterized by variation in clinical and serological manifestations. This study intended to verify the role of anti-nucleosome (anti-NCS) antibodies in diagnosis of SLE and lupus nephritis and to establish the correlation between antibody reactivity and disease activity. Study subjects included 35 patients diagnosed as SLE and two control groups. While the first is a group with other collagen diseases (n = 80), the second included 50 matched apparently healthy subjects. Serum IgG anti-NCS antibodies in all subjects were detected by ELISA. Serum anti-NCS were higher in SLE than in the two control groups (P0.001). Serum anti-NCS antibody levels were higher in SLE patients with renal affection (P0.001), malar rash and with hematological disorders (P0.05). Anti-NCS antibodies showed a higher diagnostic sensitivity (74.7%) and specificity (96%) than anti-dsDNA. Combining data of anti-NCS and anti-dsDNA antibodies increased the diagnostic specificity to 97.3%. In conclusion, serum anti-NCS antibodies have diagnostic value and play role in the assessment of disease activity especially active renal disease and may predict disease outcome.