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Introduction Transcranial Doppler ultrasonography (TCD) is a technique that allows measurement of blood flow from the basal intracerebral vessels. It is relatively inexpensive, non-invasive, can be performed at the bedside, and allows monitoring in acute emergency settings and for prolonged periods with a high temporal resolution, making it ideal for studying the haemodynamics within the intracranial arteries in neuro-Behcet's disease (NBD) and neuro-psychiatric lupus (NPSLE). Our aim was to assess the cerebral haemodynamic patterns in patients with NBD and NPSLE using TCD, while brain lesions were examined using magnetic resonance imaging (MRI). Material and methods Case–control prospective study of 30 neuro-Behcet's disease patients, 25 neuro-psychiatric lupus patients and 26 healthy age-matched volunteers. All patients and healthy controls were examined by TCD. Only the groups of patients underwent cranial magnetic resonance imaging (MRI). Results Transcranial Doppler (TCD) values for middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA) in NBD, NPSLE and control groups were measured. The results showed that there was a significant decrease in mean blood flow velocities in all the arteries examined in NBD and NPSLE patients. There was also a significant increase in the pulsatile index of PCA, VA and BA between NBD and NPSLE patients. The same results were obtained when comparing NBD versus controls. However, there was no significant difference between the NPSLE patients and the control group. The MRI lesions described were parenchymal lesions in 14 patients (46.7%), and vascular lesions in 4 patients (13.3%). Vascular lesions co-existed with parenchymal lesions (mixed lesion). Parenchymal lesions were in white matter (40%), thalamus (26.7%), brain stem (26.7%) and cerebellum (20%). While, in NPSLE, 23 patients were normal (92%) and only two patients had a vascular lesion (8%). Conclusion There was a significant decrease in mean blood flow and a significant increase in the pulsatile index among both NBD and NPSLE patients, according to the TCD values.

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

Introduction: Eosinophilic fasciitis (EF) is a rare scleroderma-like disease, characterized by acute onset of symmetrical swelling, induration and thickness of the skin. Laboratory findings include peripheral eosinophilia, elevated inflammatory markers and increased gammaglobulemia. Although, the diagnosis is mainly clinically, a full thickness skin/fascia/muscle biopsy remains the gold standard for the definite diagnosis. Unlike systemic sclerosis, visceral involvement, such as pulmonary affection, is rare in EF. Although, few cases of systemic involvement in adult EF have been presented, we report a rare case of juvenile EF associated with pulmonary involvement. Case report: A 12-years old boy presented with symmetrical skin thickening of bilateral upper extremity, back, trunk, neck, face, and scalp of 2-weeks duration. The laboratory tests revealed marked peripheral eosinophilia 61.9% (normal 1–3%) and elevation of the acute phase reactants (erythrocyte sedimentation rate 40 mm/1st hour and C-reactive protein 15 mg/dL). Lung imaging study showed bilateral extensive pulmonary nodules. A full thickness skin/fascia/muscle biopsy revealed an inflammatory infiltration, fibrosis in the fascial and muscle tissues. These findings were concordant with EF. An initial treatment of intravenous (IV) methylprednisolone 30 mg/kg/day for 3 successive days was started followed by oral steroid (2 mg/kg/day) plus methotrexate (20 mg/week). Follow up revealed complete improvement in the skin thickening, pulmonary affection and systemic inflammation. Conclusion: To the best of our knowledge this is the first reported co-existence of pediatric eosinophilic fasciitis with pulmonary affection. Systemic involvement should be screened in EF cases, as it may have consequences in the management and outcome. Keywords: Eosinophilic fasciitis, Eosinophilia, Skin thickness, Pulmonary affection

Background:Rheumatic musculoskeletal disorders (RMSDs) are a common cause of long term pain and physical disability. In developed countries, RMSDS are a major cause of absence from work and thus have a big financial burden on the country economic status. Several studies have been published the incidence and prevalence of RMSDs in different world countries and found to be widely variable. Estimation of the extend of the problem of RMSDs in developing world, especially in rural economies will help better understanding of the risk factors that contribute to the initiation and progression of these diseases and help the health care authorities to provide proper health program services in these areas to reduce the physical and financial burden of RMSDs (Bagher et al., 2011; Majumdar et al., 2015 and Usenbo, et al., 2015).Objectives:To estimate the prevalence rate of RMSDs in a rural population in Upper Egypt.Methods:A cross-sectional based study was carried out and included 3988 subjects of population (2013 females and 1975 males). Mean age of patients was (46.89±15.25ys). They proceeded 4 phases of World Health Organization/International League of Associations for Rheumatology community-oriented program for control of rheumatic diseases survey questionnaire WHO-ILAR Community Oriented Program for screening of rheumatic diseases. Modified Health Assessment Questionnaire (HAQ) was used to assess the disability severity. Individuals suspected to have any rheumatic diseases were subjected to full clinical examination, laboratory and radiological investigations to reach a final diagnosis. They were classified according to appropriate criteria of diagnosis of diseases.Results:A prevalence rate of RMSDs was 16.22%, more prevalence in females (10.38% vs. 5.84% for males, P=0.000). The mean age of patients with RRMSDSs were older (46.89±15.25 yrs) than healthy individuals (29.56±18.95 yrs) (P=0.0001) and with increasing age (≥45-≤ 55 yrs).The identified RMSDs were OA (8.5%), Soft tissue rheumatism (STR) (6.57%), spinal disorders (SD) (6.47%), fibromyalgia (FM) (0.60%), RA (0.30%), arthralgia (0.18%), SPAs (0.15%), Gout(0.6%), Pseudogout (0.08%), SLE (0.5%), JIA(0.03) and MCTD (0.03%). The prevalence rates for the majority of RRMSDSs were higher in females and with increasing age. About two thirds of the patients had grade II disability.Conclusion:The prevalence rate of RMSDs in a rural population ≥15years in Upper Egypt has been estimated to be 16.22%.The most prevalent RMSDs are OA, STR and SD causing the greatest burden of the disease. The predictive risk of RMSDs has to be assessed in future studies.References:[1]Majumdar A, Kumar SG, Nair D, Sujiv A. Musculoskeletal complaints and predictors of musculoskeletal pain among adults in rural puducherry. Indian J Palliat Care. 2015; 21(1):121-123.[2]Usenbo A, Kramer V, Young T, Musekiwa A. Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10 (8):e0133858.[3]Bagher OM, Golbarg M, Hossein S. Pattern of rheumatic diseases in two outpatient clinics in Iran: similarities with some different features. Indian J Med Sci. 2011; 65(1):7-17.Disclosure of Interests:None declared

Background:Behcet’s disease (BD) is a chronic multi-systemic autoinflammatory disease associated with increase prevalence of psychiatric comorbidity(Ilhan et al. 2016). Pro-inflammatory cytokines have been reported to be elevated in patients with depression and anxiety. IL-23/IL-17 axis has been shown to play a remarkable role in pathogenesis of BD, depression and anxiety(Sugita et al. 2012, Gheita et al. 2015). However, the relation between the serum level of interleukin (IL)-17 and IL-23 and incidence of cognitive impairment, depression and anxiety in Behcet patients are still unknown.Objectives:To evaluate the serum levels of IL-17 and IL-23 in Egyptian patients with BD and evaluate the correlations between the level of inflammatory cytokines and psychiatric manifestations as cognitive impairment, depression and anxiety.Methods:Study design and recruitmentIn a case control study, we recruited 45 BD patients, who fulfilled the modified International Criteria for Behçet’s Disease(ITR-ICBD 2014) from the Rheumatology and Rehabilitation Department, Assiut University hospital. Thirty apparently healthy sex and age matched subjects were recruited, served as controls. This study was approved by the Ethical Committee of the Assiut University, Egypt. Informed consent was obtained from all participants.Study methodologyAll patients and controls were assessed for cognitive impairment, depression and anxiety using memory assessment scale, Hamilton depression rating scale and Hamilton anxiety rating scale respectively.Serum level of proinflammatory cytokines such as IL-17 and IL-23 were measured by enzyme-linked immunosorbent assay (ELIZA).Results:Psychiatric manifestationsBD has significant lower score in all components of MAS and high prevalence of depression and anxiety in HDRS and HARS respectively compared with control group (p Serum Levels of IL-17 and IL-23The serum level of IL-17 and IL-23 levels were significantly higher among BD patients than in healthy control (There was no significant correlation between those cytokines and cognitive impairment, depression and anxiety.Conclusion:Elevated level of IL-17 and IL-23 were observed in BD patients. However, our results do not support an association between serum IL-17 and IL-23 levels and cognitive dysfunction, depression and anxiety.References:[1]Gheita, T. A., S. M. Gamal, I. Shaker, H. S. El Fishawy, R. El Sisi, O. G. Shaker and S. A. Kenawy (2015). “Clinical significance of serum interleukin-23 and A/G gene (rs17375018) polymorphism in Behcets disease: Relation to neuro-Behcet, uveitis and disease activity.” Joint Bone Spine 82(3): 213-215.[2]Ilhan, B., M. Can, F. Alibaz-Oner, S. Yilmaz-Oner, O. Polat-Korkmaz, G. Ozen, G. Mumcu, H. Maradit Kremers and H. Direskeneli (2016). “Fatigue in patients with Behcet’s syndrome: relationship with quality of life, depression, anxiety, disability and disease activity.” Int J Rheum Dis.[3]ITR-ICBD (2014). “The International Criteria for Behcet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria.” J Eur Acad Dermatol Venereol 28(3): 338-347.[4]Sugita, S., Y. Kawazoe, A. Imai, Y. Yamada, S. Horie and M. Mochizuki (2012). “Inhibition of Th17 differentiation by anti-TNF-alpha therapy in uveitis patients with Behcet’s disease.” Arthritis Res Ther 14(3): R99.Disclosure of Interests: :None declared

Segmental midface paresis with or without synkinesis reflects incomplete recovery from Bell's palsy, operations on the cranial base or parotid, or trauma, in 25%-30% of cases. To correct the deficit, the masseteric nerve was used to deliver a powerful stimulus to the zygomatic muscle complex, with the addition of a cross-face sural nerve graft to ensure more spontaneous smiling. By doing this, the orbicularis oculi muscle continues to have an appropriate stimulus from the facial nerve, and the zygomatic muscle complex is separately innervated, which considerably reduces synkinesis between the two muscle compartments. For those patients with muscular contractures of the midface, the new healthy neural stimulus relaxes muscles at rest. From January 2011 to March 2017, 20 patients presented with segmental facial paresis of the midface and were operated on using this new technique. All patients were evaluated before and after operation using Clinician-Graded Electronic Facial Paralysis Assessment (eFACE), and they showed considerable postoperative improvements in static, dynamic, and synkinetic variables. Our proposed use of the masseteric nerve to treat segmental facial paresis produces favourable results, but our initial data require confirmation by further studies.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple systems and is associated with an inflammatory status. The aim of our study is to estimate the serum level of vitamin D and bone mineral density (BMD) in SLE patients and their relation to disease activity. Patients and methods: Ninety SLE patients, fulfilling the updated American College of Rheumatology criteria 2012 and 60 age-matched and sex-matched controls were included in this study. The level of serum 25-hydroxyvitamin D (25(OH)D3) and dual-energy radiograph absorptiometry were done for patients and controls. Results: There was significant difference between systemic lupus erythematosus disease activity index (SLEDAI) score and vitamin D (P Conclusion: Vitamin D deficiency and low BMD are common in SLE patients. There was significant difference between SLE patients and control group regarding vitamin D, BMD, and T score at different sites.

Objectives This study aims to assess the frequency rates of sexual problems and associated factors in a cohort of married females with rheumatoid arthritis (RA). Patients and methods The study included 200 female RA patients (mean age 44.2±9.1 years; range 18 to 55 years) and 100 age matched healthy control females (mean age 42.5±6.3 years; range 18 to 55 years). Mean duration of RA was 5.8±4.1 years. All participants were assessed by Health Assessment Questionnaire Disability Index, Numerical Rating Pain Scale, Sexual Disability Scale, psychiatric interview, Beck Depression Inventory, and Spielberger's State-Trait Anxiety Inventory. Results Majority of the patients had grade II physical disability (62%), moderate pain (55%), depression (46%), and anxiety (77%). Sexual disability and loss of sexual desire and satisfaction were reported in 4% to 77.8% of patients which varied with age, duration of RA, degree of physical disability, and psychiatric comorbidities. Multiple regression analysis showed that scores of sexual disability and loss of sexual desire and satisfaction were significantly associated with scores of Health Assessment Questionnaire Disability Index (β=0.347; p=0.018; β=0.501; p=0.001) and depression (β=0.304; p=0.043; β=0.550; p=0.001). Conclusion We may conclude that the frequencies of sexual problems in females with RA are high and closely related to physical disability and psychiatric comorbidities.

Background SLE is clinically and immunologically heterogeneous. Type I interferons (IFN-I) are pathogenic but expression of IFN-I stimulated genes varies. Many existing reports on clinical phenotype and IFN-I were limited by using categorical measures of IFN-I and disease activity scores that were not organ-specific. IFN-I targeted therapies are in development. Objectives To define the clinical phenotype of IFN-I mediated SLE. Methods 108 SLE patients and 20 age and sex matched healthy controls were studied. Activity was measured using BILAG-2004. PBMCs were collected for gene expression analysis using TaqMan. Relative expression of 7 interferon stimulated genes was In-transformed, normalized to healthy control and summed to derive a 7-gene IFN-I score. Results The most common activity was mucocutaneous and musculoskeletal, which were analysed in detail (Table 1). The relationship between activity and IFN-I score differed between these domains. Overall, IFN-I scores were higher in active mucocutaneous disease. Scores were more variable for BILAG B: this was explained by subtype of BILAG B disease. IFN-I score was increased in subacute and discoid forms (25.3 (16.8–32.9), n=7) compared to acute forms (18.4 (4.9–31), n=15). Score was also higher in patients with anti-Ro60. In contrast, there was no relationship between musculoskeletal disease activity and IFN-I score. Numbers of patients with renal, haematological and neuropsychiatric activity were limited but there was a trend to higher IFN-I scores with disease activity. Conclusions We identify a relationship between clinical presentation of SLE and IFN-I. High IFN-I activity is linked to anti-Ro60 and non-acute forms of skin disease. We previously reported a worse response to rituximab in this subgroup, whilst response in musculoskeletal disease was consistently good. Measurement of B cell and interferon biomarkers may therefore be important in the selection of the most appropriate targeted therapy for SLE. Disclosure of Interest None declared

This study was aimed to assess: (1) the additive diagnostic utility of diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) over conventional MRI in detecting brain lesions in patients with acute primary neuropsychiatric systemic lupus erythematosus (NPSLE), and (2) the relevance of their findings to the associated NP manifestations. Included were 34 patients with acute NPSLE with mean age of 33.26 ± 10.14 years and duration of illness of 3.33 ± 1.71 years. Clinical interviewing and psychiatric and cognitive evaluations were performed by applying the criteria of the diagnostic and statistical manual of mental health disorders criteria (DSM–IV), Stanford Binet Subset Testing, Mini-Mental State Examination and Wechsler Memory Scale-Revised. Serologic tests included looking for antinuclear antibodies, anti-double strand DNA, anti-phospholipid antibodies. Radiologic evaluation included conventional MRI, DWI and MRA. One or more NP manifestations were diagnosed in 28 patients, in which cognitive deficits were reported with headache, psychosis and CVS. Anti-phospholipid antibodies were reported in patients with CVS. Twenty patients (71.43 %) with primary NPSLE (n = 28) had MRI abnormalities in which hyperintense signals at subcortical and periventricular white matter and at the junction between the gray and white matter represented 75 % (n = 15) and with headache (n = 6), psychosis (n = 6) and acute confusional state (n = 3) with and without cognitive deficits, respectively. Moderate-sized infarctions with restricted diffusion in the distribution of middle cerebral arteries were represented in 35 % (n = 7) and with CVS, of them, 71.43 % (n = 5) had beading and focal narrowing of carotid arteries were consistent with vasculitis. Brain atrophy represented 20 % (n = 4) and with psychosis. Compared to those with normal MRI, patients with MRI abnormalities were older (P < 0.050) and had longer duration of illness (P < 0.050). To conclude, although DWI and MRA are helping in more precise etiopathologic diagnosis compared to conventional MRI, but their relevance to the present NP manifestations is still limited.