Prevalence of Osteoporosis in 100 Iraqi Patients with Systemic Lupus Erythematosus: A Case Control Study

Back ground: In recent years, survival of patients with systemic lupus erythematous (SLE) has raised significantly so long-term complications, as osteoporosis, are currently of major importance. Objective: To assess the prevalence of osteoporosis in Iraqi patients with SLE. Patients and Methods: This case control study was conducted on 100 SLE patients and 100 healthy controls matched in age, sex, and body mass index. Bone mineral density (BMD) obtained at the lumber spine (L1-L4) and right and left femurs using dual energy X-ray absorptiometry (DXA) machine (Dexxum). Osteoporosis was diagnosed according to WHO guidelines criteria for diagnosis of osteoporosis and Z-scores was used in premenopausal women and men younger than 50 years. Results: Mean age of SLE patients was 32.01±10.14 years and 32.46±6.29 years in the control group. Females represented 91% of patients and 92% of controls. The mean BMI of patients was 27.41±6.04 kg/m2 compared to 28.8±5.26 kg/m2 of controls. There was no statistical significant differences between both groups in demographic characteristics (P>0.05). BMD at lumbar spine was significantly lower in SLE patients than controls (82(82%) vs 61(61%), p< 0.001, OR (95%CI): 3.04(1.59-5.81).Of those patients with low BMD, 46% had osteoporosis. Additionally, BMD at total femur was significantly lower in SLE patients than controls (59 (59%) vs 24(24%), p<0.001, OR (95%CI): 4.56(2.48-8.37). Of those patients with low BMD at total femur, 15 (15%) had osteoporosis. Multiple logistic regression analysis showed non-significant association between low BMD in SLE patients and various baseline characteristics (P>0.05). Conclusions: Prevalence of osteoporosis in Iraqi patients with SLE was 46% at lumbar spine and 15 % at total femur. This may suggest to do early screening for low BMD in patients with SLE for early diagnosis and appropriate treatment. Keywords: SLE, Osteoporosis, Dual x-ray absorptiometry, Bone mineral densit

Prevalence and Predictors of Pulmonary Arterial Hypertension in a Sample of Iraqi Patients with Systemic Sclerosis: A Cross-Sectional Study

Background: Pulmonary arterial hypertension (PAH) is now the most frequent cause of death in systemic sclerosis (SSc). Aims: The aims of the present study were to evaluate the prevalence of pulmonary arterial hypertension (PAH) and predictors in SSc among Iraqi patients. Materials and Methods: A cross-sectional study conducted on 56 patients with SSc diagnosed according to the criteria developed by the American College of Rheumatology. Baseline characteristics [age, sex, body mass index (BMI), duration of SSc, type of SSc, duration of Raynaud’s phenomenon, and presence of telangiectasia] were documented.  Antiscleroderma 70 (anti-SCL70) and anticentromere antibodies were measured. Doppler echocardiography was done to diagnose PAH. A risk score was obtained from 7 criteria, namely: Anti-Centromere Ab, Limited disease type, short duration of Raynaud's phenomena (<2.5 years), older age group (40+ years), absence of Telangiectasia, female gender, and absence of anti SCL70 Ab.  Results: We found that PAH was present in 11 (19.6%) SSc patients with a 95% confidence interval of (9.2% to 30.0%). Risk score in addition to anti-centromere antibodies were enough to diagnose PAH with accuracy level of 89.3%. Conclusions: PAH in SSc occurs in significant proportion of patients. Risk score and anti-centromere antibodies had high accuracy level in predicting PAH. Screening of patients with SSc for PAH will help in early diagnosis and appropriate timely therapeutic intervention before significant endorgan damage occurs. Key words Systemic sclerosis. Connective  tissue. Pulmonary hypertension