Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity

Background and objective The relationship between thyroid disease and rheumatic disorders has been the subject of considerable debate. Thyroid abnormal function and/or autoimmune thyroid disease were observed in patients with rheumatoid arthritis (RA), which could be attributed to the natural feature of autoimmune diseases and their tendency to overlap. Consideration of the fact that autoimmunity plays a role in the pathogenesis of both RA and hypothyroidism has raised the need to study the frequency of hypothyroidism and thyroid antibodies in RA patients and their relation to disease activity. Patients and methods One hundred and fifty RA patients and 50 control participants were included in this study. RA patients were subjected to a full assessment of medical and rheumatological history, and examination as well as routine lab tests. Patients and controls underwent thyroid function testing including thyroid antibodies. Patients′ disease activity was determined using the Modified Disease Activity Score and their functional status was assessed using the Modified Health Assessment Questionnaire. Results The most common thyroid dysfunction was hypothyroidism, which was found in 36 (24%) RA patients, followed by subclinical hypothyroidism in six (4%) patients, whereas subclinical hyperthyroidism was present in two (1.3%) patients. Autoimmune thyroid disease was present in 10 (6.6%) patients and absent in the controls. There was a significant positive correlation between thyroid stimulating hormone levels and RA disease activity parameters. Conclusion Hypothyroidism was the most common thyroid disorder associated with RA, present in 24%, with a significant association with RA disease activity parameters

Atherosclerosis in Egyptian patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a systemic inflammatory disorder with extra-articular features including cardiovascular diseases. Objective The objective of this study was to assess the presence of atherosclerosis in Egyptian patients with AS and its relation to disease activity. Patients and methods Thirty patients with AS of at least 18 years of age and 30 age-matched and sex-matched controls were included. Assessment of medical history, clinical examinations, and assessment of AS disease activity using BASDAI, BASMI, and BASFI as well as dobutamine echocardiography were performed only for patients. Complete blood count, ESR, C-reactive protein, lipid profile, serum von Willebrand factor (vWF) Ag level by ELISA, ECG, and carotid duplex were performed for all participants. Results In patients, 11 had active disease and 19 were in remission. A hypertensive response (HTNR) appeared in eight patients; six of them had active disease. There was a significant increase in the level of vWF in actively diseased patients than inactive patients and controls. Carotid intima-media thickness (IMT) was significantly increased in AS patients than controls. Levels of low-density lipoprotein were significantly higher in AS patients than the controls and in AS patients receiving biologics than those not receiving biologics. In the inactive group, vWF and IMT were significantly increased in patients receiving biologics. vWF correlated positively with BASDI, BASMI, BASFI scores, ESR, and carotid IMT and negatively with high-density lipoprotein. Conclusion Patients with AS are more susceptible to atherosclerosis, which is related to disease activity, and receiving biologics may place them at a higher risk. vWF, as a useful marker of atherosclerosis in AS patients, was correlated positively with disease activity scores and IMT

Vitamin D Deficiency in Egyptian Systemic Lupus Erythematosus Patients: How Prevalent and Does it Impact Disease Activity?

Background The emerging role of vitamin D in immunology and autoimmune disorders has been a worldwide interest in the last decade. Systemic lupus erythematosus (SLE) patients are particularly at a delicate position predisposing them to suffer from vitamin D deficiency due to the multiple risk factors accompanying the disease. Whether vitamin D deficiency is also involved as a risk factor for developing SLE and affecting its course is a considerable concern. Objectives The objective of this study was to estimate the prevalence of vitamin D deficiency in SLE patients and its relation to disease. MATERIALS AND METHODS: In our observational cross-sectional study, serum levels of vitamin D [25(OH)D] in 60 SLE patients and 30 age- and sex-matched healthy controls were assessed and estimated for deficiency and insufficiency at 10 and 30 ng/mL, respectively. Disease activity was evaluated by SLE disease activity index (SLEDAI), irreversible organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI), and severity by Severity of Disease Index. Fatigue was measured by visual analog scale. Results Significantly lower levels of 25(OH)D were found in SLE patients (17.6 ± 6.9 ng/mL) in comparison to controls (79.0 ± 28.7 ng/mL), with a statistically high significant difference ( t = -11.2, P < 0.001). High prevalence of vitamin D insufficiency and deficiency was detected as 73.3% and 23.3%, respectively. Vitamin D had a highly significant negative correlation with SLEDAI ( r = -0.495, P < 0.001), SLICC ( r = -0.431, P < 0.05), and fatigue ( r = -0.436, P < 0.05). Conclusion Vitamin D deficiency and insufficiency were found to be prevalent in SLE patients in our study and related to disease activity and fatigue. If needed, routine screening and consequent repletion of vitamin D are recommended in SLE patients. Restoring adequate vitamin D levels in SLE patients should be more explored as a potential yet simple measure to their usual management to improve their condition

Progressive systemic sclerosis in Egyptian patients: Clinical characteristics and nail fold capillaroscopy

Aim of the work: To present the clinical and laboratory disease characteristics in Egyptian patients with progressive systemic sclerosis (SSc) and their nail fold capillaroscopy findings. Patients and methods: 50 SSc patients were included. For all patients detailed history taking and clinical and rheumatological examination were performed. The modified Rodnan skin score (mRSS) and nail fold capillaroscopy were assessed. Results: The mean age was 41.4 ± 12.7 years (range 16–67 years) and median disease duration was 5 years (range 1–40 years). Eight patients (16%) were males and 42 (84%) females (M:F 1:5.25). Skin tightness was present in all patients; mean mRSS was 17.5 ± 10.4 (ranges 4–45). 44 (88%) patients had abnormal pulmonary function tests; 42 (84%) restrictive and 2 (4%) obstructive; 25 (50%) presented with interstitial lung disease. Pulmonary artery hypertension was recorded in 9 (18%) patients. Renal manifestations were the least common recorded system involvement (20%). Antinuclear antibodies were positive in 98%, rheumatoid factor in 4%, antitopoisomerase I in 36% and anticentromere in 8% of patients. 96% of patient had abnormal nail fold capillaroscopy. There was a significant negative correlation between mRSS with forced expiratory volume (r = −0.46, p = 0.001), forced volume capacity (r = −0.47, p = 0.001) and positively with the FEV1/FVC (r = 0.3, p = 0.035). Conclusion: Almost all patients have ANA seropositivity, abnormal PFTs and abnormal nailfold capillaroscopy. Antitopoisomerase I antibody seropositivity, ILD, abnormal PFT, worsening skin score, late pattern of nailfold capillaroscopy are more common in dcSSc. Extensive clinical examination and investigations should be considered for early diagnosis and follow up of Egyptian SSc patients. Keywords: Systemic sclerosis, Modified Rodnan skin score, Nailfold capillaroscopy, Diffuse cutaneous, Limited cutaneou