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Background: Metabolic syndrome (MetS) is characterized by insulin resistance, high blood pres-sure/sugar, dyslipidemia, and obesity. Whether MetS and its components affect the development of Behçet's Disease (BD) remains unclear. Aims: The aim was to determine the frequency of MetS among BD patients and to study its relationship with disease characteristics. Methods: The study included 1028 adult BD patients recruited from 18 specialized rheumatology centers. 51 healthy matched control were considered. Behçet Disease Current Activity Form (BDCAF) and the BD damage index (BDI) were estimated. Adult Treatment Panel-III criteria were used to define MetS. Results: The mean age of patients was 36.8 ± 10.1 years, M:F 2.7:1 and disease duration 7.01 ± 5.2 years. Their mean BDCAF was 5.1 ± 4.6 and BDI 5.5 ± 2.8. MetS was present in 22.8% of patients and in 5.9% of control (3.9 fold higher-risk). Patients with MetS had a significantly increased age at onset (31.8 ± 9.2 vs. 29 ± 8.5 years) and higher frequency of genital ulcers (96.2% vs. 79.7%), skin involvement (73.1% vs. 50.4%), arthritis (48.3% vs. 29.1%) (p Conclusion: BD patients with MetS are predisposed to mucocutaneous, musculoskeletal, neuropsychiatric and ocular manifestations with consequently increased damage. The involvement of the deeper structures of the eye should alarm rheumatologists to keep in mind that all patients should have an eye examination, especially those with MetS.

The study aimed to explore the experience of coronavirus disease-2019 (COVID-19) infection and vaccine adverse events (AEs) among rheumatologists. A validated questionnaire was distributed as a Google form to rheumatologists across the country via social networking sites from late December 2021 till early January 2022. The questionnaire included questions regarding participants' socio-demographic details, COVID-19 infection and vaccination details with special emphasis on AEs. Out of 246 responses, 228 were valid. 200 (81.3%) responders had received the vaccine. The mean age of the 228 participants was 37.9 ± 8.5 years, 196 were females and 32 males (F:M 6.1:1) from 18 governorates across the country. Comorbidities were present in 54 subjects (27%). There was a history of highly suspicious or confirmed COVID-19 infection in 66.7% that were all managed at home. The COVID-19 vaccine was received by 200 and a booster dose of 18.5%. Obesity and musculoskeletal involvement co-morbidities were present only in those with AEs (9.1% and 5.5% respectively). AEs were present in 82%; 66.7% had injection-site tenderness, 50% fatigue, 35.5% fever, 15% chills, 42.5% myalgia, 14.5% arthralgia, 8% low back pain, headache 31%, dizziness 10%, sleepliness 16% and 15% developed post-vaccine. There were no differences according to the geolocation regarding the occurrence of COVID-19 infection (p = 0.19) or AEs post-vaccine (p = 0.58). The adverse events were mostly mild to moderate and tolerable which makes this work in agreement with other studies that support the broad safety of the vaccine in favor of the global benefit from mass vaccination.

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.

Aim of the work: To investigate the association between IL and 16 genetic (rs4072111) single nucleotide polymorphism (SNP) and susceptibility to primary knee osteoarthritis (KOA) and to elaborate its connection with clinical and radiographic severity of KOA. Patients and methods: 80 primary KOA patients and 35 matched healthy controls. IL-16 gene rs4072111 SNP was genotyped in KOA patients and control using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique and verified by direct DNA sequencing. Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to assess the clinical severity of KOA and Kellgren lawrence (K/L) radiographic grading was evaluated. Results: The 80 KOA patients were 60 female and 20 male patients with mean of 55.8 ± 8.9 years (38–71 years), BMI 25.5 ± 1.8 (16.5–27) and disease duration 5.8 ± 4.3 years (1–20 years). The mean WOMAC index was 52.9 ± 17.9 and the K/L score was 2.49 ± 0.73. Patients carrying the wild (CC) genotype had a significantly higher WOMAC index compared those carrying the TT and CT genotypes (p = 0.0.046) also, KL sore had tendency to increase in patient carrying the wild (CC) compared to patients carrying the TT and CT genotypes (p = 0.08), However, no direct genetic association was detected between the SNP and KOA. On performing a regression with WOMAC as the dependant factor only the triglycerides (p = 0.001) and K/L (p

Background Adrenomedullin (AM) is a peptide which was suggested to be involved in the pathogenesis of osteoarthritis through its anti-inflammatory and anti-apoptotic effect. AM was found to be elevated in some inflammatory rheumatic diseases as rheumatoid arthritis and ankylosing spondylitis. The current study was performed to measure serum Adrenomodullin (AM) concentrations in patients with primary knee osteoarthritis (KOA) and to assess association with severity of the disease. The study was performed on 50 patients with primary KOA diagnosed according to American College of Rheumatology (ACR) Revised Criteria for Early Diagnosis of Knee Osteoarthritis and 20 age- and sex-matched controls with no clinical features of KOA. The Kellgren and Lawrence (KL) classification was used to evaluate the disease severity of knee OA. Disease activity was assessed by The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Blood samples had been collected from patients with OA and controls for assessing Adrenomodullin in patients’ sera by ELISA. Results There were a significant increase in serum Adrenomedullin concentrations in KOA patients compared to controls (10.64 ±19.2 ng/ml vs. 1.39 ±1.6 ng/ml in cases and controls respectively) (p value = 0.036). There was positive significant correlation of serum Adrenomedullin levels with KL grades (r=0.608, p value 6 have significantly higher serum Adrenomedullin levels than OA patients with VAS Score p values >0.05). Conclusion This study concluded that serum Adrenomedullin (AM) level is elevated in patients with KOA and is positively correlated with the severity of disease.

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.

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.

Objective The aim of this study was to evaluate left ventricular diastolic function parameters as an early predictor of cardiac involvement in patients with rheumatoid arthritis (RA) without any evidence of hypertension, diabetes mellitus, rheumatic fever or underlying cardiac disease, detected by Doppler echocardiography and to correlate diastolic function in RA patients with different RA disease characteristics. Patients and methods Seventy-five RA patients were diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA and another 38 age-matched and sex-matched healthy participants were included. All patients and the control groups were submitted to M-mode, two-dimensional, Doppler (continuous and pulsed wave) echocardiography. Diastolic dysfunction was defined as when transmitral flow E/A ratio is less than one. Results Left ventricular diastolic dysfunction was found in 28 (37.3%) of 75 RA patients and four (10.5%) of 38 controls with a P value of less than 0.05. In the patients’ group, a statistically significant correlation was found between diastolic dysfunction and duration of the disease (P

Aim of the work.: Studies describing the epidemiology of vasculitis in the Middle East and Africa are limited. The aim of this multi-centre study is to describe the distribution and outcome of vasculitic syndromes among Egyptian vasculitis patients seen by rheumatologists. Patients and Methods: The files of patients diagnosed with vasculitis between January 2002 and December 2016 were reviewed and were classified according to The Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis CHCC 2012 and disease- specific criteria. The vasculitis damage index (VDI) was calculated for all patients at the last visit. Results: Six hundred and thirty patients with ages ranging from of 9 months-74 years, including 264 (41.9%) males and 366 (58.1%) females were studied. Vasculitis associated with hepatitis C virus (HCV) infection was detected in 151 (24%), Behçet’s disease in 148 (23.5%), Immunoglobulin A vasculitis in 101 (16%), vasculitis associated with systemic lupus erythematosus in 93 (14.8%), Takayasu’s arteritis in 33 (5.2%), Kawasaki’s disease in 22 (3.5%) patients, respectively. Other vasculitic syndromes were uncommon and each accounted for less than 2% of the studied cases. The VDI ranged from 0 to 13. Only 109/630 (17.3%) patients had no vasculitis-related damage (VDI = 0). Mortality was recorded in 36 (5.7%) patients; out of these, 27 deaths were vasculitis-related. Conclusion: HCV-associated vasculitis and Behçet’s disease were the most frequently diagnosed vasculitic syndromes. Keywords: Vasculitis damage index, Vasculitis, Behçet’s disease, HCV-associated vasculitis, Egypt

Aim of the work To investigate sleep problems in rheumatoid arthritis (RA) patients and to correlate sleep scores with disease characteristics and activity. Patients and methods 100 RA patients and 40 matched controls were included. Disease activity score (DAS28), visual analogue scale (VAS) for pain, modified health assessment questionnaire (MHAQ) and medical outcomes study short form-36 (SF-36) were assessed and the van der Heijde-modified Sharp score (vdHSS) calculated. The Pittsburgh Sleep Quality Index (PSQI) was used to investigate the sleeping habits, sleep difficulty was assessed using the Athens Insomnia Scale (AIS) and daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS). Results The patients were 84 females and 16 males (F:M 5.25:1) with mean age of 48.1 ± 12.4 years, disease duration of 6.9 ± 5.9 years, DAS28 was 4.3 ± 1.4, MHAQ was 0.95 ± 0.6 and VAS was 45.2 ± 21.1. The sleep scores PSQI, AIS and ESS were significantly increased in patients (6.98 ± 2.8, 9.6 ± 4.4 and 7.4 ± 2.6) compared to control (2.6 ± 1.9, 2.7 ± 1.8 and 3.3 ± 2.03 respectively; p = 0.01 each). Sleep scores tended to be lower in females and were significantly higher in those with positive C-reactive protein. Rheumatoid factor positive patients and those not receiving methotrexate had significantly higher PSQI and AIS scores. Sleep scores significantly correlated with age, erythrocyte sedimentation rate, DAS28, VAS, MHAQ and vdHSS and negatively with SF-36 physical component score (PCS) (p = 0.01 for all). Disease duration, DAS28, VAS and SF36 (PCS) were significant risk factors for sleep problems. Conclusion A high frequency of sleep disturbances in RA patients was observed. Interplay of pain, fatigue, activity and disability may lead to poor sleep quality.

Background Systemic lupus erythematosus (SLE, lupus) is a syndrome of multifactorial etiology, characterized by widespread inflammation, most commonly affecting women during the childbearing years. Virtually, every organ and/or system of the body may be involved. Interleukin-10 (IL-10) production is increased in SLE. Objective The aim of the study was to assess serum levels of IL-10 in SLE patients and their relationship with disease activity and severity parameters. Patients and methods Totally, 50 patients with SLE and 20 healthy controls were investigated in this study diagnosed according to Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Clinical assessment of the disease activity was performed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. Assessment of SLE disease severity was carried out using the SLICC/American College of Rheumatology Damage Index and laboratory parameters, including erythrocyte sedimentation rate, C-reactive protein (CRP), 24 h urinary proteins, anti-dsDNA antibodies, complement 3, and complement 4 levels. The serum IL-10 levels were determined using enzyme-linked immune sorbent assay technique. Results The serum IL-10 levels were significantly higher in SLE patients (mean: 23.07±33.19 pg/ml) compared with the controls (0.52±0.86 pg/ml, P=0.000FNx01). The increase in serum levels IL-10 significantly correlated with the SLEDAI scores (P=0.016FNx01) and CRP (P=0.042FNx01) in the studied patients. There were no significant correlations between IL-10 and SLICC, age, disease duration, erythrocyte sedimentation rate, 24 h urinary protein, anti-DNA, and complement 3–complement 4 (P=0.735; r=0.05, P=0.890, P=0.521, P=0.529; r=0.09, P=0.430; r=0.11, P=0.263; r=0.16, P=0.195; r=0.19, respectively). There was no significant difference between mean IL-10 levels in different classes of lupus nephritis (P=0.702). Conclusion The circulating IL-10 concentrations were significantly elevated in SLE patients and correlated with the SLEDAI score and CRP.

Background Lupus nephritis (LN) is a prominent feature in systemic lupus erythematosus (SLE), present in 15–30% of patients with lupus at the time of the initial diagnosis and in 30–50% during the disease progression. Objectives The aim of this study was to determine the significance of anti-ribosomal P protein (anti-P) antibodies and LN and their relation to disease activity and other SLE manifestations. Patients and methods Fifty active LN patients were subjected to full clinical examination (assessment of SLE disease activity using the systemic lupus erythematosus disease activity index and assessment of SLE disease severity using Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), routine laboratory investigations, anti-dsDNA antibodies, and anti-P antibodies. Results Comparison between the data of LN in both groups (anti-P positive/anti-dsDNA negative and anti-P negative) shows that there was a statistically significant difference in age (P=0.042), hypertension (P=0.00), and psychiatric manifestations (P=0.004). On comparison of both groups as regards vasculitis, there was a borderline statistical significance (P=0.050). Comparison of both groups as regards creatinine level or biopsy class V showed a statistically significant difference with a higher percentage in the anti-P positive/anti-dsDNA negative group (P=0.024 and 0.040, respectively). Conclusion Anti-P antibody-positive patients have younger ages, lower creatinine level, lower incidence of hypertension, usually class V in renal biopsy, but more susceptible to have psychiatric manifestations compared with anti-P antibody negative patients.

Background Interleukin-23 (IL-23) is a proinflammatory cytokine that is thought to be central to the development of autoimmune diseases. This study was conducted to determine whether or not serum concentration of IL-23 is elevated in patients with rheumatoid arthritis (RA) and to determine the relationship between the IL-23 level and disease activity in patients with RA. Patients and methods Serum samples were obtained from 100 patients with RA and 50 healthy controls. Clinical parameters of the disease were determined, including 28-Joint Disease Activity Score, Clinical Disease Activity Index, Health Assessment Questionnaires, C-reactive protein, rheumatoid factor levels, anti-cyclic citrullinated peptide antibodies, and degree of bony erosions based on radiographs. The levels of IL-23 were determined by enzyme-linked immunosorbent assay (ELISA). The correlations between the serum levels of IL-23 and disease activity parameters of patients with RA were determined. Results Serum IL-23 level was significantly elevated in patients with RA, 0.00–49.30 pg/ml (19.12±13.45 pg/ml) compared with healthy controls, 0.00–1.40 pg/ml (0.90±0.63 pg/ml) (P=0.0001). Serum IL-23 levels in patients with RA correlated with Clinical Disease Activity Index (r=0.952, P=0.000), Health Assessment Questionnaires (r=0.953, P=0.000), and 28-Joint Disease Activity Score (r=0.967, P=0.000). Moreover, serum IL-23 levels in patients with RA correlated with erythrocyte sedimentation rate (r=0.950, P=0.000), C-reactive protein (r=0.954, P=0.001), and rheumatoid factor (r=0.917, P=0.000). There was a statistically significant difference between IL-23 mean values associated with different radiograph classes in patients with RA (P=0.001). Conclusion Levels of serum IL-23 in patients with RA were significantly higher than in healthy controls. Moreover, elevated serum IL-23 levels were correlated with clinical and laboratory parameters of disease activity. It should be considered as a useful marker to detect active RA. IL-23 is involved in disease progression and bony erosions in patients with RA. Anti-IL-23 drugs could have a potential role in the treatment of RA.

Genome-wide association studies have led to the involvement of multiple susceptibility genes in the development of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The present case control study was conducted to determine the possible association of DNAM-1(C/T, rs 763361) single nucleotide polymorphism (SNP) with RA and SLE in the Egyptian population. This study aimed to determine the possible genetic influence of SNP on disease activity in SLE (represented by SLEDAI score) and in RA patients (represented by DAS28). Fifty SLE patients compared to 43 healthy controls and 35 RA patients compared to 30 healthy controls were included in the study. The PCR-RFLP technique was used to detect DNAM-1(C/T rs 763361) gene polymorphism. Analysis of the frequency distribution of both allele and genotype frequency distribution of SLE and RA patients compared to healthy control subjects did not reveal a significant association between SLE and RA patients and the rs763361. Analysis of the disease activity status in lupus nephritis (LN) and non-lupus nephritis patients revealed a significant association between DNAM-1(C/T) SNP and LN patients carrying the TT and CT genotypes (P = 0.009 and 0.004; respectively). DNAM-1(C/T rs763361) SNP is not associated with the development of SLE and RA in Egyptian population. The SNP might be associated with disease activity status represented by SLEDAI score in LN patients carrying CC and CT genotypes, respectively.

Aim of workTo investigate osteopontin (OPN) levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and their relationship with radiological grade.Patient and methodsSixty patients had knee OA and 30 control subjects were included. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren–Lawrence grading. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay and compared.ResultsOA patients had higher plasma osteopontin concentrations compared to healthy controls (p

Aim of the WorkTo evaluate the role of MRI in diagnosing hip arthritis and correlating it with clinical and laboratory assessments in juvenile idiopathic arthritis (JIA).Patients and MethodsThe study included 30 patients with JIA with mean age of 13.5±4.5. Disease activity was evaluated by DAS28 score, physician’s global assessment (PGA–VAS), patient’s global assessment (VASglobal) and the assessment of functional ability by (CHAQ). Hip joint evaluation was assessed by hip pain on movement and the degree of limitation of motion (score 0–3). Plain radiography and MRI of the hip joint were performed for all patients. MRI score was done.ResultsMRI of hips was abnormal in 12 (40%) of all patients: 2/8 (25%) of the oligoarticular group, 4/13 (30.8%) of the polyarticular group, 5/7 (71.4%) of the systemic onset group and 1/2(50%) of the enthesitis related group. Comparing mean values of MR scores of the four clinical subsets showed significant difference (p