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BackgroundLower limb deformities could affect child's quality of life and may worsen with time. This work aims to study the prevalence of lower limb deformities among primary school students in our governorate.MethodsThis cross-sectional descriptive study was carried out on 4689 students attending 12 public primary schools during the academic year 2019–2020.Complete clinical examination was done for picking of cases of genu varum, genu valgum, genu recurvatum, flat foot, pes cavus, hallux valgus, in-toeing, and lower limb discrepancy, and x-ray on both feet, pelvis, and full-length lower limb was requested.ResultsThis cross-sectional descriptive study included 4689 students. The prevalence of lower limb (LL) deformities was 16.61%. One hundred twenty-three (2.62%) children had a positive history of musculoskeletal pain, 0.09% had genu varum, 0.11% had genu valgum, 0.75% had Genu recurvatum, 0.03% had LL discrepancy, 13.86% had flexible flat foot, 1.22% had rigid flat foot, 0.23% had pes cavus, 1.04 % had in-toeing, 0.06% had hallux varus, and 0.11% had hallux valgus.ConclusionsLower limb deformities are a considerable problem in primary school students that need early diagnosis because it could affect child’s future, health, and career. Further studies are needed to investigate spinal deformity, vit D level, calcium level, foot wear, and school bag weight as hidden factors.

Background This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management.

Background Albumin and derived neutrophil to lymphocyte ratio (dNLR) are known biomarkers that can reflect systemic inflammation and it has been hypothesized that combination of both markers in one score (albumin-dNLR score) can be useful in monitoring rheumatoid arthritis (RA) patients. The current study intended to measure albumin -dNLR score in patients with RA in the order to find whether these new biomarkers could reflect the activity of the disease and the articular activity detected by ultrasonography. We measured serum albumin and dNLR in blood samples obtained from 100 RA patients and from 100 apparently healthy controls (HC). Albumin -dNLR score was calculated according to the presence of hypoalbuminemia (≤ 3.76 gm/dl) and/or raised dNLR (>1.37). Results RA patients had a significantly elevated dNLR (p< 0.001) and albumin-dNLR score (p< 0.001) compared to their levels in HC, while serum albumin was significantly decreased (p< 0.001) in RA patients than its level in HC. In RA patients, albumin-dNLR score correlated significantly with DAS28 (p< 0.001), erythrocyte sedimentation rate (ESR) (p< 0.001), C-reactive protein (p< 0.001), grey scale (p< 0.001), power Doppler (p< 0.001) and total ultrasound score (p< 0.001). Also, tender joint count, ESR and albumin-dNLR score were significant predictors of DAS28 in multivariate regression analysis. Conclusions Our study settled that albumin - dNLR score is increased in RA patients than in healthy subjects. The score correlated well with DAS28, acute phase reactants, and ultrasonographic synovitis scores implying that it could be an easy valuable biomarker to monitor RA disease activity.

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

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.

Aim: Highlighting some health consequences of hypovitaminosis D on adult Egyptian population.Methods: Fifty-five apparently healthy volunteers aged from 20 to 40 years were involved in the study and by history and physical examination 40 of them had mild clinical manifestation of negligible medical importance that affect the quality of their life without interfering with their daily activity. All volunteers were subjected to vitamin D and calcium dietary intake history, sun exposure assessment, body mass index (BMI), serum vitamin D and calcium profile, bone mineral density measured by Dual-energy X-ray absorptiometry (DXA), psychometric evaluation by the Beck Depression Inventory (BDI) score and physical activity evaluation by the International Physical Activity Questionnaire (IPAQ). Results: About 73% of our subjects had hypovitaminosis D (61.8% insufficient and 10.9% deficient). The prevalence was more in the female gender (OR 4.5; p≤ 0.05), older subjects (31-40) age group (OR 4.4; p≤ 0.05), with poor sun exposure (OR 7.8; p≤ 0.05), and low vitamin D and calcium dietary intake (OR 4.6; p≤0.05). Vitamin D deficient group showed the higher prevalence of obesity (45.5%). Osteopenia was detected in seven subjects (14.3%) who had low vitamin D levels. The vitamin D status had a negative correlation (r=-0.653; p=

Background Neuromyelitis optica spectrum disorders (NMOSD) are considered as an autoantibody-mediated disorder that targets aquaporin-4 (AQP4); other autoantibodies could be detected in such spectrum of diseases, including anti-nuclear antibody and antibodies to extractable nuclear antigens. Systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjogren’s syndrome (SS), and other autoimmune diseases can overlap with NMOSD. We aimed in this review to address the current evidence describing the relation of NMOSD to systemic autoimmunity diseases, its controversy of being co-association or the same etiology, and its practical implications. Main body The current review was done using a search for related articles or case reports on PubMed until 2019. The keywords included neuromyelitis optica spectrum disorders in combination with autoimmune disease nomenclature. We described the literature background of this controversy, to summarize the evidence of NMOSD relationship to systemic autoimmune diseases. Conclusion NMOSD associated with systemic autoimmune diseases is more common in SLE and Sjogren’s syndrome rather than other autoimmune diseases, frequently affects females more than males; AQP4 antibodies should be tested for all NMOSD like manifestations associated with an autoimmune disorder; however, the clinical diagnosis of NMOSD regardless of the cord lesion length and the presence of positive AQP4 antibody can occur in systemic autoimmune diseases.

Background: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of ambiguity of measurement choice. Aim: To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a diseasespecific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity. Methods: A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated Qol. Results: Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively. Conclusion: QoL was impaired in AS patients with highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.

Objective The aim of this study was to investigate early atherosclerotic changes in juvenile-onset systemic lupus erythematosus (jSLE) patients and its relation with disease activity. Patients and methods Thirty patients suffering from jSLE diagnosed according to the 2012 SLICC SLE criteria were included in the study. Clinical and laboratory parameters, disease activity, and traditional risk factors for atherosclerosis were assessed. B-mode ultrasound was performed to measure carotid intima–media thickness (CIMT) and the number and size of plaque deposits in both the left and the right common carotid arteries. A total of 20 healthy volunteers were taken as a control group. Results The mean±SD age of the patients was 18.93±2.81. The mean±SD disease duration was 4.33±2.25. The mean±SD CIMT differed significantly between the patient and control (n=20) groups (0.74±0.21 vs. 0.38±0.05; P

Introduction The aim of this study was to determine whether there is a relation between serum prohepcidin level and disease activity of rheumatoid arthritis (RA) and systemic lupus erythematous (SLE), and to discover whether it has a role in the anaemia of chronic disease occurring in RA and SLE patients. Patients and methods This study was carried out on 30 patients suffering from RA and 30 patients suffering from SLE. In addition, 20 healthy volunteers were recruited as controls. All patients and controls were subjected to full history taking, thorough clinical examination, locomotor system examination, assessment of the disease activity in RA patients using the Disease Activity Score-28, assessment of the disease activity in SLE patients using Systemic Lupus Erythematous Disease Activity Index, laboratory investigations, including complete blood count, erythrocyte sedimentation rate (ESR), rheumatoid factor and C-reactive protein (CRP), and measurement of serum prohepcidin levels by the enzyme-linked immunosorbant assay. Results The mean serum prohepcidin concentration was 395.2 ± 551.4 ng/ml in RA patients, whereas it was 381.5 ± 88.07 in SLE patients and 121.4 ± 11.1 ng/ml in healthy volunteers. The prohepcidin concentration correlated with the rheumatoid factor, C-reactive protein, ESR, disease duration, morning stiffness, tender joint count, swollen joint count, Larsen score, haemoglobin level and Disease Activity Score-28 in RA patients .There were positive significant correlations between the mean serum prohepcidin concentration and platelets number, haemoglobin level and ESR in SLE patients and insignificant correlations between the mean serum prohepcidin concentration and Systemic Lupus Erythematous Disease Activity Index. Conclusion Prohepcidin could be considered as a useful marker for RA, but not for SLE. Prohepcidin may have a role in anaemia of chronic disease occurring in RA and SLE.

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.‎.

Aim of the work This study aimed to investigate serum levels of vitamin D in patients with Behcet’s disease (BD) and to evaluate their relationship to disease activity as well as different disease measures. Patients and methods Forty-two patients with BD were enrolled into this study. These patients were subjected to detailed history taking, thorough clinical examination including assessment of disease activity according to Behcet’s Disease Current Activity Form (BDCAF) score and performed laboratory investigations including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum calcium, serum phosphorus and serum alkaline phosphatase. Serum 25-hydroxyvitamin D (vitamin D) levels were determined using Enzyme-Linked-Immunosorbent Assay (ELISA). A control group of 41 age and sex matched healthy controls was also included. Results The mean level of 25-hydroxyvitamin D (30.65 ± 12.87 ng/ml) was significantly decreased in BD patients compared to the controls (37.98 ± 15.76 ng/ml) ( p = 0.02). Significant negative correlations of serum vitamin D levels with patients’ ages ( p = 0.03), ESR ( p p p = 0.003) were found; whereas, there was no significant correlation with disease duration ( p = 0.6). In multivariate regression analysis age ( p = 0.02), colchicine therapy (0.008), ESR (0.02) and CRP (0.03) were found to be the independent effectors on vitamin D serum levels. Conclusion Serum levels of vitamin D were significantly lower in BD patients compared to controls. Associations were found between vitamin D levels and age, BDCAF as well as ESR and CRP in BD patients. Low vitamin D may predispose BD patients to active disease, especially in older subjects.

Aim of the work This study aimed to assess serum levels of some adipocytokines (leptin, adiponectin and resistin) and IL-6 in patients with ankylosing spondylitis (AS) to evaluate their relationship to disease activity and functional capacity. Patient and method Twenty-five AS patients were enrolled. Body mass index (BMI), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were assessed. Serum leptin, adiponectin, resistin and interleukin (IL)-6 levels were determined using enzyme-linked immunosorbent assay (ELISA). Results The mean levels of leptin (9.1 ± 3.9 ng/ml), resistin (2.27 ± 1.15 ng/ml) and IL-6 (9.2 ± 5.8 pg/ml); were significantly elevated in patients with AS compared to the controls (p = 0.000, p = 0.0028 and p = 0.000, respectively). Only serum leptin levels correlated significantly with IL-6 (p = 0.004), and both serum leptin and IL-6 levels correlated significantly with BASDAI (p = 0.02 and p = 0.005, respectively), ESR (p = 0.04) and CRP (p = 0.01 and p = 0.006, respectively) in AS patients. Serum resistin did not correlate with any of the AS disease parameters, whereas, serum adiponectin neither significantly elevated nor correlated with any of these parameters. Conclusion The associations of significantly increased levels of serum leptin and IL-6 with AS disease activity parameters give clues to their role in the inflammatory process of the disease. Failure to find any correlation between high serum resistin levels and AS disease activity parameters is suggestive of its role in the pathogenesis rather than disease activity.

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that occurs in genetically prone individuals. Autoimmunity could not be simply explained by Th1/Th2 cell paradigm. T helper 17(Th17) cells producing the cytokine interleukin-17 (IL-17) may explain the promotion and progression of autoimmune phenomena. This study aimed to investigate the role of Th17cells, IL-17 and interleukin-23 (IL-23) in the pathogenesis of SLE and their correlation with disease activity. The frequencies of circulating Th17 cells in 15 patients with active SLE, 15 patients with inactive disease and 15 healthy control subjects were measured using Flowcytometry after stimulation with phorbol myristate acetate (PMA) and ionomycin for 4 hours. Serum levels of IL-17 and IL-23 were measured using the enzyme linked immunosorbent assay (ELISA). Significantly higher mean frequencies of circulating Th17 cells were found in active SLE patients (1.54 +/- 0.38%, P0.001) and inactive SLE patients (1.23 +/- 0.25%, P = 0.009) compared to the control group (0.88 +/- 0.41%). The frequencies of circulating Th17 cells positively correlated with the SLEDAI score (r = 0.812, P0.001). The serum levels of IL-17 and IL-23 were significantly higher in active SLE (P0.001) and inactive SLE patients (P0.001) than the control group while, serum levels of both cytokines correlated positively with SLEDAI score (r = 0.661, P0.01 and r = 0.701, P0.01 respectively). There was significant positive correlation between the frequency of circulating Th17 cells and plasma levels of IL-17 and IL-23 (r = 0.789, P0.001) and (r = 0.792, P0.001) respectively. Results of this study provides evidence of a role of Th17 cells in the pathogenesis of SLE, and offer scientific rationale for the utility of Th17 cells, IL-17 and IL-23 as biological markers for SLE disease activity. This would raise the possibility of anti-IL-17 and anti-IL-23 as innovative therapeutic options in controlling disease activity of SLE.

Aim of the workTo study peroxisome proliferator activated receptor gamma (PPARγ) expression levels in the peripheral monocytes from rheumatoid arthritis (RA) patients and to clarify its relation with disease activity, functional disability and drug therapy.Patients and methodsThirty RA patients (Group 1) were divided into two subgroups: Group 1A: patients with moderate to high disease activity (n=15); Group 1B: patients in remission or with low disease activity (n=15). Thirty healthy volunteers were included as control group. Disease activity score in 28 joints (DAS-28) and Health Assessment Questionnaire (HAQ) were assessed in patients. PPARγ gene expression levels were assessed by real-time PCR in peripheral blood monocytes.ResultsThe mean fold increase in monocyte PPARγ expression levels was significantly higher (p0.001) and with swelling joint count, erythrocyte sedimentation rate and platelet count (p0.05).ConclusionsOur findings support the role of PPARγ in the pathophysiology of RA and suggest that over-expression of PPARγ protein may have anti-rheumatic effects.

Aim of the workThis study aimed to investigate serum levels of vascular endothelial growth factor (VEGF) and to measure common carotid intima media thickness (cc-IMT) in Egyptian patients with Behçet’s disease (BD) to evaluate their relations to disease activity and different clinical manifestations.Patients and methodsSeventy patients with BD and 70 healthy controls participated in this study. Behçet’s disease patients were subjected to detailed history taking, thorough clinical examination, disease activity assessment using the BD Current Activity Form (BDCAF) and laboratory investigation. Vascular endothelial growth factor levels were measured using ELISA. The carotid arteries were assessed for cc-IMT and plaques with a carotid high-resolution B-mode ultrasound.ResultsThe mean cc-IMT showed a significant difference in BD patients compared to controls (p