Hypophosphatemia and Hyponatremia in Systemic Lupus Erythematosus Patients and Its Relation to Clinical Characteristic and Disease Activity

Background: Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disease with diverse manifestations, ranging from mild rash or arthritis to severe organ-threatening involvement.Objective: The aim of the work was to find-out the possible association of hypophosphatemia and hyponatremia with disease activity in SLE patients.Patients and methods: A total of 100 patients with SLE were involved in this study and the serum level of sodium and phosphorus, erythrocyte sedimentation rate (ESR), leucocytic and platelet counts, and 24 hr. protein were measured. SLE disease activity index (SLEDAI) score was assessed,Results: The majority of patients were females; 94 (94%) and 6 males (6%) (F:M 15.7:1). The age of the patient ranged from 17 to 63 years with a mean age of 34.23 ±11.19 years. The disease duration was 48±55.7 months. 7. 41% of SLE patients were hyponatremic and 49% showed normonatremic. There was a significant correlation between Na level, SLEDAI score, vasculitis and arthritis and insignificant correlation with ESR. 47 patients were hypophosphatemic  (47%) and 53 (53%) were normophophatemic. There was a significant correlation between phosphate level and SLEDAI, oral ulcers p=0.001 and arthritis p<0.0004 but negatively related with ESR.Conclusion: It could be concluded that hyponatremia and hypophosphatemia are significantly related to SLEDAI, so it could be used as indicators of SLE activity and sever inflammation

A longitudinal study of the 28 joints of disease activity score by ultrasonographical examination in rheumatoid arthritis patients

Background: The damaging effect of rheumatoid arthritis (RA) on cartilage, bone, ligaments, and tendons has raised the importance of the disease activity and severity assessment to enable therapeutic decisions and to evaluate disease outcome. Aim: The aim is to compare the clinical examination of the Disease Activity Score (DAS)-28 with the musculoskeletal ultrasonography (US) examination in RA patients. Moreover, finding if we can use ultrasonographical results as a tool for predicting subsequent radiological damage. Patients and Methods: It is a longitudinal study included 60 adult RA patients. Patients were under assessment at baseline, 6 months, and 12 months from the recruitment time. Twenty-eight joints of DAS were assessed for tenderness and swelling. US gray scale (GS) and US power Doppler (PD) score also was done at each visit. Results: DAS-28, with its parameters, is positively and highly significantly correlated to synovitis severity both by US GS and US-PD score along the study follow-up visits. There was highly significant difference between the number of 28 swollen and tender joints by clinical examination with both US GS and US-PD. Linear regression analysis to predict the number of swollen and tender joints after 12 months showed significance between US PD with swollen and tender joints' numbers. The correlation was positive and significant between Larsen score at 12 months with GS US and PD US assessment, but linear regression analysis was only significant for Larsen score with only GS US. Conclusion: GS US and PD is a sensitive and reliable noninvasive method complementary to standard clinical assessment and could be a tool for predicting subsequent joints' damage

Is It the Age at Disease Onset or the Disease Radiological Severity That Affects Cervical Spine Involvement in Patients With Rheumatoid Arthritis?

Background: Cervical spine involvement in patients with rheumatoid arthritis (RA) can cause pain and disability, with a variety of neurologic signs and symptoms. Objectives: To investigate the relationship between structural cervical spine involvement in patients with RA with the age at disease onset and the degree of radiologic severity of RA measured by Larsen scoring. Patients and methods: This cross-sectional study included 50 adult patients with RA. Patients who complained or not complained from symptoms of cervical spine involvement in RA were included; we did X-ray of the cervical spine, hands, and feet; Larsen scoring method; disease activity score (DAS28); and Neck Disability Index. Results: The results revealed that patients with cervical involvement tend to be younger at their disease onset than those with no cervical involvement, as detected by cervical X-ray. The relation was significant P  < .05 regarding all cervical involvements except for basilar invagination. Disease radiological severity (measured by Larsen score) significantly increases the risk for subaxial subluxation, P  = .040. All other cervical complications of RA tend to have nonsignificant relation with disease severity. Using univariate binary regression analysis for risk factors for cervical involvement showed that the only probable risk factor for cervical involvement (detected by X-ray) in patients with RA is age at disease onset. Conclusions: The early age at disease onset tends to affect cervical spine involvement in patients with RA more than the disease radiological severity