Can rheumatoid arthritis affect sleep in Egyptian patients?

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

Correlation of serum interleukin-10 level with disease activity and severity in systemic lupus erythematosus

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

Diastolic dysfunction in patients with rheumatoid arthritis

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<0.05), and disease activity was assessed by 28 Joint Disease Activity Score (P<0.05). Conclusion Among those without a history of cardiac disease, patients with RA have a higher prevalence of diastolic dysfunction than those without RA. Diastolic dysfunction in RA was associated with disease duration and disease activity. Thus, early identification of diastolic dysfunction in asymptomatic RA patients by the use of echocardiography may provide an opportunity to manage the underlying etiology to prevent progression to diastolic heart failure

Serum level of Adrenomedullin in patients with primary knee osteoarthritis; relation to disease severity

Abstract 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 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

Supplemental material - High serum leptin and adiponectin levels as biomarkers of disease progression in Egyptian patients with active systemic lupus erythematosus

Supplemental material for High serum leptin and adiponectin levels as biomarkers of disease progression in Egyptian patients with active systemic lupus erythematosus by Shaimaa M Kamel, Mervat E Abdel Azeem, Rabab A Mohamed, Mahmoud M Kamel and Enas A Abdel Aleem in International Journal of Immunopathology and Pharmacology</p

The distribution and outcome of vasculitic syndromes among Egyptians: A multi-centre study including 630 patients

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, Egyp