Importance of patient education in management of patients with rheumatoid arthritis: an intervention study

Background People living with chronic diseases such as rheumatoid arthritis (RA) are extremely in need of patient education (PE) to adapt and cope with the effects of the disease and treatments. PE comprises all educational activities provided for patients, including aspects of therapeutic education, health education, and health promotion. Objective The aim of this study was to evaluate the effect of PE program following the eight evidence-based EULAR-2015 recommendations in the management of patients with RA. Patients and methods A randomized controlled clinical trial with two parallel arms was carried out at the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Fayoum University, Egypt. One hundred patients (both sexes) having RA were included in the study, and their mean age was 39.23±11.28 years, with range from 19 to 71 years. Patients were randomly allocated into two comparable groups: group I received health education through designed PE program and group II did not receive PE program. Disease activity and disability were assessed at the start of study and at two visits later, that is, after 3 months and 6 months, by using the 28 joint disease activity score 28 and the Health Assessment Questionnaire disability index. Results On comparing laboratory investigation and outcome scores at follow-up visits, although there were no significant differences between the two study groups regarding laboratory investigation, disease activity score 28 and Health Assessment Questionnaire scores at the start of the study, comparative differences were reported in the follow-up visits. Significant decreases in the laboratory values and scores were reported in group I, whereas no difference was reported in group II. Conclusion PE interventions in patients with RA documented significant improvements in behavior, pain, and disability among these patients

Critically ill systemic lupus erythematosus patients referred to the intensive care unit of Fayoum University Hospital: Frequency, complications and outcome

Aim of the work: To determine the frequency of critical complications of systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU), study the risk factors and outcome. Patients and methods: Fifty SLE patients consequently admitted to the ICU were prospectively studied. The SLE Disease Activity Index (SLEDAI) was assessed. Results: The mean age of the patients was 29.3 ± 8.7 years; they were 42 females (84%) and disease duration of 4.9 ± 3.4 years. The overall mortality was 24% (12 patients) and tended to be higher in males (37.5% vs 21.5%). The commonest causes of death were infection (p < 0.001) and pulmonary complications (p = 0.04) in all non-survivors. Metabolic acidosis was significantly increased in deceased patients (75%) compared to survivors (23.7%) (p = 0.003). Cardiac and CNS complications were significantly increased in non-survivors (p = 0.04 and p = 0.03 respectively). Acute renal failure was significantly more frequent in mortality case 9/12 compared to survivors (28.9%) (p = 0.007) as well as abnormal arterial blood gases (100% vs 57.9%; p = 0.005). The SLEDAI was significantly increased in non-survivors (41.8 ± 8.2) compared to survivors (21.4 ± 5.1) (p = 0.001). There was a significant correlation between mortality and SLEDAI (r = 0.58, p = 0.001) and inversely with the pH (r = −0.38, p = 0.01). On multiple regression, only increasing SLEDAI was a significant predictor of mortality (β0.26, OR 1.29, 95%CI 1.12–1.49; p < 0.0001). Mortality prediction by SLEDAI showed at a cut-off of 28.5; sensitivity 84% and specificity 90% (p = 0.001). Conclusion: SLE patients admitted to the ICU are at an increased risk of mortality especially those with high disease activity. The main causes of mortality were infection, respiratory, cardiac and neurological complications. Keywords: Systemic lupus erythematosus, Intensive care unit, Mortality rate, Critical complication

Diagnostic value of matrix metalloproteinases-1, −3 and −13 in patients with primary knee osteoarthritis: Relation to radiological severity

Background: Knee osteoarthritis (KOA) is an important cause of disability in elderly. Aim of the work: to study the expression of matrix metalloproteinases (MMP-1, MMP-3 and MMP-13) in serum of patients with KOA and relation to radiological findings. Patients and methods: One hundred patients with KOA and 80 matching control were studied. The Kellegren Lawrence (KL) scale was assessed. The mRNA and protein expressions of MMP-1, MMP-3 and MMP-13 were assessed by “quantitative real-time polymerase chain reaction (qRT-PCR)” and western blotting, respectively. Results: There was a significant increase in the mRNA expression of MMP-1, MMP-3 and MMP-13 in patients (18.5 ± 3.4, 3 ± 0.5 and 2 ± 0.2, respectively) compared to controls (2.6 ± 0.4, 0.7 ± 0.3 and 0.3 ± 0.06, respectively)(all p < 0.001) and in the protein expression of MMP-1, MMP-3 and MMP-13 in patients (2.89 ± 0.01, 2.37 ± 0.07, 2.56 ± 0.02, respectively) relative to controls (1.15 ± 0.04, 0.79 ± 0.01, 1.02 ± 0.08 respectively (all p < 0.001). A significant correlation was found between the age of patients and mRNA expression of MMP-1 (r = 0.19, p = 0.01) and MMP-3 (r = 0.17, p = 0.019) and between the BMI and mRNA expression of MMP-1 (r = 0.16, p = 0.028). No significant correlation was found between mRNA expression of MMP-1, MMP-3 and MMP-13 and grade of KOA. At cut off values 5.5, 1.7 and 0.8, MMP-1, MMP-3 and MMP-13 could diagnose KOA at a sensitivity of 98 %, 100 % and 100 % respectively with 100 % specificity for all. Conclusion: The expression of MMP-1, MMP-3 and MMP-13 could be a valuable non-invasive marker for early diagnosis of primary KOA with no relation to radiological finding

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