Mortality in a cohort of Egyptian systemic lupus erythematosus patients: retrospective two-center study

Abstract Background Systemic lupus erythematosus is a debilitating autoimmune disease with major contribution to the worldwide morbidity and mortality. This study aimed to investigate the causes of mortality in systemic lupus erythematosus (SLE) patients and the relation between clinical activity, disease-associated end-organ damage, laboratory markers and mortality. Results Among the 771 patients who were successfully followed up, 34 patients (4.4%) died. The leading causes of death were infectious causes (35.29%), cardiopulmonary causes (26.48%), renal causes (14.7%), unknown causes (14.7%), neuropsychiatric causes (5.88%), and lastly gastrointestinal causes (2.94%). Subjects who died had lower complement 3 level, more anemia, lymphopenia, neutropenia, leukocytosis, thrombocytopenia, decreased glomerular filtration rate, higher incidence of infection, end-stage renal disease, and cardiopulmonary complications. Higher glucocorticoid dosage with more immunosuppressant (mofetil and cyclophosphamide) treatment was observed in patients who died. SLE disease Activity Index and Systemic Lupus International Collaborating Clinics damage index were both significantly higher in deceased persons. Multivariable hazards regression analysis revealed that lymphopenia (p = 0.017), decreased glomerular filtration rate 40 mg (p = 0.016) were independent risk factors for the mortality of SLE patients. Conclusion Infections and cardiopulmonary complications are the leading causes of death in two centers caring for Egyptian SLE patients. Lymphopenia, end-stage renal failure, and high steroid daily use were associated with poor outcomes

Hospitalization and outcome of systemic lupus erythematosus patients admitted to the Rheumatology ward of Kasr Al-Ainy University Hospital

Aim of the work: To determine the frequency, causes and disease features affecting outcome of hospitalized systemic lupus erythematosus (SLE) patients, length of hospital stay and the risk factors. Patients and methods: 132 SLE patients accounting for 167 hospitalizations were recruited from the Rheumatology outpatient clinic, Faculty of Medicine, Cairo University Hospitals during 2019. SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics damage index (SLICC-DI) were assessed. Data concerning admission was recorded. Results: The mean age of the patients was 31.4 ± 10.7 years and disease duration of 91.5 ± 84.3 months. Their mean SLEDAI was 8.7 ± 7.2 and SLICC-DI was 0.87 ± 1.2. The frequency of hospitalization was 167/1456 follow up visits (11.5%): 127 single admissions and 40 recurrent admissions. 137 hospital admissions were females and 30 males (F:M 4.6:1).The most common causes of hospitalization were disease activity in 115/167 hospital admissions (68.9%), infection in 39/167 (23.4%), comorbidities in 33/167 (19.8%). Outcome of hospitalization was improvement in 154/167 (92.2%), morbidity in 7/167 (4.2%), and mortality in 5/167 (3%). Readmission occurred in 40/167 (24%). Higher SLEDAI and gastrointestinal involvement were risk factors for longer hospital stay (p = 0.001 and p = 0.003 respectively). Morbidity was related to higher SLEDAI and SLICC-DI while mortality was related to prolonged azathioprine intake and cardiovascular involvement. Conclusion: Disease flare and infection were the most common causes of hospitalization among SLE patients. Higher disease activity and damage as well as cardiovascular involvement were the factors associated with worse outcome. Higher SLEDAI and gastrointestinal involvement were risk factors for longer hospital stay

Risk factors for sexual dysfunction in Egyptian patients with rheumatoid arthritis and its relation to disease activity

Aim of the work: To assess risk factors for sexual dysfunction in married rheumatoid arthritis (RA) patients. Patients and methods: 216 RA (187 females and 29 males) and 187 matched healthy controls were included. Sexual function in male was assessed by modified International Index of Erectile Function Questionnaire (IIEF questionnaire) including: erectile function, sexual desire (libido), orgasmic and ejaculatory problems. For females, in addition to questions about libido, orgasmic problems, frequency of sexual intercourse and dyspareunia were considered. Disease activity scores (DAS-28) and modified health assessment questionnaire (mHAQ) were calculated. Results: The mean age of the patients was 45.2 ± 12.1 years and disease duration was 8.2 ± 7.6 years. All sexual dysfunction parameters were significantly higher in RA than in the controls. Patients with sexual dysfunction were older (p = 0.008), illiterate (p = 0.04), diabetics (p = 0.004), hypercholesterolemics (p = 0.002), had high ESR (45.1 ± 21.6 mm/1st h) (p < 0.001), longer MS duration (39.3 ± 40.9 minutes) (p = 0.01), had high DAS28 (p < 0.001) and mHAQ (p = 0.004) and used higher doses of leflunomide (p = 0.01). Multivariate regression analysis revealed that the presence of DM (OR 5.1; 95%CI 1.3–19.4), hypertension (OR 3.5; 95%CI 1.9–6.1), hypercholesterolemia (OR 3.6; 95%CI 1.5–8.2), older age (⩾45 years) (OR 2.4; 95%CI 1.3–4.5) (p = 0.003), active RA patients were associated with a higher risk of sexual dysfunction (OR 2.7; 95%CI 1.09–6.5) (p = 0.03); OR increased to 5.6 (95%CI 2.7–11.8) in patients with severe disease activity. Conclusion: DM, hypertension, hypercholesterolemia, older age and high disease activity in RA increase the risk of sexual dysfunction

Urological comorbidities in Egyptian rheumatoid arthritis patients: Risk factors and relation to disease activity and functional status

Aim of the work: To assess the urological disorders in rheumatoid arthritis (RA) patients, analyse the risk factors and to find their relation to disease activity and functional status. Patients and methods: 291 RA patients (253 females and 38 males; F:M 6.7:1) and 242 matched controls were included. Urological disorders in the form of urinary tract infections (UTI), urolithiasis and acute urine retention (AUR) were assessed, risk factors were analysed. Disease activity score (DAS-28) and modified health assessment questionnaire (mHAQ) were calculated. Results: RA patients had more frequent urological disorders (38.14%) than controls (20.66%), more UTI (p < 0.001) and this difference persisted in females (p < 0.001). Urolithiasis tended to be more frequent in RA patients (p = 0.3); the difference was significant between the female patients and controls (p = 0.04). Urinary stones were comparable between the male patients and controls (p = 0.2). RA patients had more AUR (4.8%) than the controls (2.1%) (p = 0.07). Asthmatic patients particularly the females had more UTI (p = 0.001 and p < 0.001 respectively). UTIs were observed with higher steroid doses (p = 0.04) and urolithiasis were noticed more in hypertensive female patients (p = 0.03). Patients with higher DAS-28 and mHAQ developed more urological comorbidities (p0.49 and p = 0.82 respectively). UTI and urolithiasis were detected in patients with higher DAS 28 (p = 0.1 and p = 0.4 respectively). Conclusion: RA patients were found to have more urological disorders. Bronchial asthma, hypertension and higher steroid doses may increase risk for urinary comorbidities in RA. Patients with higher DAS28 and mHAQ had more urological comorbidities, however without statistically significant difference

Osteoarthritis knee hip quality of life questionnaire assessment in Egyptian primary knee osteoarthritis patients: Relation to clinical and radiographic parameters

Aim of the work: To evaluate health-related quality of life (HRQoL) in primary knee osteoarthritis (KOA) patients using the osteoarthritis knee hip quality of life (OAKHQoL) questionnaire and study its relation to clinical and radiographic parameters. Patients and methods: One hundred patients with primary KOA were studied. Knee radiography was evaluated using Kellgren Lawrence (K-L) score and the OAKHQoL questionnaire assessed. Results: The patients were 75 females and 25 males; F:M 3:1. Their mean age was 54.6 ± 10.4 years, disease duration 4.6 ± 2.7 years and body mass index (BMI) 28.6 ± 2.7. 17 patients were hypertensive and 26 diabetics. 84 patients presented with bilateral KOA disease, joint stiffness in 43%, knee deformities in 18% and K-L score grade 3 in 56%. Pain component was found to have the least normalized OAKHQoL questionnaire score (49.8 ± 15.4), while mental health domain scored the highest (60.1 ± 8.2). Female gender, older age, obesity, hypertension, diabetes, bilateral KOA disease and K-L grade 3 were associated with lower questionnaire domains. Regression analysis revealed that disease duration and bilateral disease were predictors for lower scores of all OAKHQoL domains, while knee joint stiffness for four domain. Hypertension, knee deformity and K-L classification were good predictors for lower scores of two subscales. Conclusion: Egyptian patients with primary KOA have relatively poor HRQoL; reflected mainly by pain component of the OAKHQoL questionnaire. Disease duration and bilaterality were predictors for lower scores of all questionnaire domains, knee stiffness for four subscales. Hypertension, knee deformity and K-L classification were good predictors for lower scores of two subscales. Keywords: Knee osteoarthritis, Health-related quality of life, OAKHQoL questionnaire, Clinical features, K-L scor

Fibromyalgia syndrome in medical students

Aim of the work: To investigate the frequency of fibromyalgia syndrome (FMS) among medical students and its stratifications. Patients and methods: The work included 513 medical students from Kafrelsheikh University. The 2010 and 2016 American College of Rheumatology (ACR) fibromyalgia classification criteria were used to determine the presence of FMS. The chronic pain grade questionnaire was used to assess pain severity and impact on daily activities, recreational, social and family activities, and ability to work. Results: The students were 296 females (57.7 %) and 217 males (42.3 %). 64 (12.5 %) fulfilled the 2010 criteria (F:M 2.8:1) (p = 0.015). The frequency of female affection was 15.9 % (47/296) compared to 7.83 % (17/217) in male. 37 (7.2 %) fulfilled 2016 criteria and only six cases (9.3 %) were known to have FMS. The frequency of FMS in students of the first 3 years (basic science) and the following 3 years (clinical) was 14.1 % and 9.5 %, respectively. Considering the chronic pain grade, there was a significant difference (p < 0.0001) in all pain items, daily recreational, social, family activities, and ability to work between those with and without FMS. 213 (41.5 %) had knowledge about FMS and the source of their information was from social media (39.4 %), their academic study (26.8 %), web pages (25.4 %) and friends (8.5 %). Conclusion: Fibromyalgia is highly frequent among medical students, especially females of basic years with a high impact on recreational, social, family activities, and ability to work. Medical students should be considered a “high-risk” group for FMS and should be educated about it and managed accordingly