Egyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101When to Start Urate Lowering Therapy?35446910.21608/ejrci.2015.4469ENAdelAEProf. & Head of Rheumatology Division, Department of Internal Medicine, Ain Shams University; EgyptJournal Article20171207https://ejrci.journals.ekb.eg/article_4469_42180c3bfcd1628999c3dddcb4a0cfd0.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Psychosocial Aspects of Rheumatic Diseases78447010.21608/ejrci.2015.4470ENAbdelAzeimElhefnyProfessor of Internal Medicine, heumatology & Immunology, Ain Shams University; EgyptJournal Article20171207https://ejrci.journals.ekb.eg/article_4470_26f56d36ae9685816d80589fd5776290.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Urinary Podocalyxin and Lupus Nephritis Disease Activity1522447310.21608/ejrci.2015.4473ENAshrafMohamedDepartments of Internal Medicine, Mansoura UniversityMahmoudAwadDepartments of Internal Medicine, Mansoura UniversityAsmaaEneinDepartments of Internal Medicine, Mansoura UniversityMonaBalataRheumatology , Ain Shams UniversityAlaaAlsalawyPhysical Medicine & RheumatologyEmadElmasryClinical Pathology , Mansoura University; EgyptJournal Article20171207Background: Lupus nephritis (LN) is a common and serious complication in systemic lupus erythematosus (SLE) and<br />is associated with significant mortality and morbidity of SLE patients. The conventional laboratory markers used in clinical<br />practice such as serum complement levels and double-stranded DNA antibodies are unreliable indicators of LN as they lack<br />both sensitivity and specificity for prediction of active or relapsing LN. Studies have shown that podocyte injury occurs in the early stages of glomerular damage in LN, and that quantification of podocyturia could be used as a marker for active disease. Podocalyxin (PCX) is probably the most frequently used marker protein for podocyturia. Aim of the work: To investigate urinary podocalyxin (u-PCX) as a marker of lupus nephritis (LN) disease activity. Methods: 63 patients with clinical and biopsy proven LN were recruited and divided into two groups; 35(55.56%) patients with active LN & 28(44.44%) patients with inactive LN. Estimation of u-PCX/creatinine ratio, urine protein /creatinine ratio (PCR), erythrocyte sedimentation rate, C reactive protein, serum albumin, serum complement C3 and C4, anti-double stranded DNA antibody titers, serum creatinine, estimated glomerular filtration rate and renal biopsy were done. Results: Patients with active LN had significant higher levels of PCR (1159.38±724.37 Vs 332.29±145.10), u-PCX (109.18±28.21 Vs 67.93±8.24), and SLEDAI-2K renal score (6.83±2.16 Vs 2.0±1.17) (P<0.001). However, active LN group had significant lower serum albumin (2.87±0.51 Vs 3.61±0.22, P<0.001). In active LN; u-PCX correlated positively with PCR (r=0.516, p=0.002), SLEDAI-2k (renal) (r=0.568, p<0.001), ads DNA ab (r=0.362, p<0.032) and negatively with serum albumin (r= - 0.421, p=0.014).Moreover, SLEDAI-2k renal score was negatively correlated with serum albumin(r=-0.710, P<0.001). Conclusion: u-PCX could be served as a marker of LN disease activity. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 23-31]https://ejrci.journals.ekb.eg/article_4473_583473a89b4f569662891fe3df447e45.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Assessment of Neutrophil Lymphocyte Ratio in Systemic Sclerosis Patients in Tanta University Hospital: A Promising Marker in Predicting Disease Severity3341447510.21608/ejrci.2015.4475ENNohaEshebaDepartment of Internal Medicine, Tanta University; EgyptAbeerShahbaDepartment of Internal Medicine, Tanta University; EgyptJournal Article20171207Introduction: Systemic sclerosis (SSc) is a multisystem autoimmune disease, with complex pathogenesis resulting in<br />obliterative vasculopathy, tissue injury, fibrosis, remodeling and atrophy. The neutrophil lymphocyte ratio (NLR) was<br />developed to provide easily measurable and readily available parameter reflecting the intensity of stress and systemic<br />inflammation in critically ill patients following shock, multiple traumas, major surgery, or sepsis. Aim of the work: to<br />evaluate NLR levels in patients with SSc and explore their clinical significance and their association with different organ<br />manifestations. Results: There was a significant increase in NLR in SSc patients who had cardiovascular or cardiorespiratory affection. Also NLR showed a significant positive correlation with both CRP and ESR, while it showed a significant negative correlation with serum albumin. Conclusion: NLR may serve as a promising marker for cardiorespiratory involvement in SSc patients. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 43-47]https://ejrci.journals.ekb.eg/article_4475_9c018133c119b92e4f714fe4360513b0.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Interleukin-22 and Tumor Necrosis Factor Receptor Associated Factor 1 (TRAF1) in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus: Correlation with Disease Activity4347447610.21608/ejrci.2015.4476ENEmanRashwanDepartments of Immunology and Allergy , Medical Research Institute, Alexandria;MaiMoaazDepartments of Immunology and Allergy , Medical Research Institute, Alexandria;NevineMohannadInternal Medicine , Rheumatology Unit, Alexandria University Hospitals, Alexandria;MohamedRahmanClinical Pathology , Mostafa Kamel Army Hospital, Alexandria; EgyptEmanZaghloulDepartments of Immunology and Allergy , Medical Research Institute, Alexandria;Journal Article20171207In autoimmune diseases including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), cytokines<br />play a central role in initiating and maintaining diverse immune and inflammatory responses. Interleukin 22 (IL-22), a<br />member of IL-10 cytokine family, has been believed to be an important player in regulating inflammatory responses<br />associated with many autoimmune diseases. The aim of this study was to detect the role of IL-22 and Tumor necrosis<br />factor receptor associated factor 1 (TRAF1) in patients with RA and SLE and their correlation with disease activity. The<br />current study was conducted on 70 RA, 64 SLE patients and 45control subjects from Egyptian population, using ELISA to<br />assess IL-22 in culture supernatants of cultured lymphocytes and TaqMan genotyping assay for TRAF1 (rs10818488). A<br />significant increase in IL-22 levels in both RA and SLE patients than control group (pbefore and after lymphocyte stimulation. Also, a significant differences in A allele frequency with RA patients was found<br />(P=0.030) indicating that TRAF1 could be considered as a susceptibility gene to RA in the Egyptian population. The A<br />allele of TRAF1 was significantly increased RA patients with positive rheumatoid factor (RF) (p=<0.001) and/or anti-<br />CCP antibodies (p=0.034), this could not be demonstrated in SLE patients or controls(P=0.750). Also, IL-22 level<br />correlated positively with disease activity in RA and SLE patients which may rise a possible role in the pathogenesis of<br />both conditions. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 49-58]https://ejrci.journals.ekb.eg/article_4476_ac4954688e2227d97dc3f48665f8404f.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Study of Peptidyl Arginine Deiminases 4 (PAD 4) Antibodies in Rheumatoid Arthritis Patients4958447710.21608/ejrci.2015.4477ENDarwishEl-HallousDepartments of Internal Medicine, Alexandria UniversityNevineMohannadAlexandria University HospitalsMaherKamelMedical Biochemistry , Alexandria University; Alexandria; EgyptEl-SayedRadwanDamanhour Teaching Hospital, Alexandria University; Alexandria; EgyptJournal Article20171207Rheumatoid arthritis (RA) is one of the most commonly occurring form of inflammatory polyarthritis. If untreated,<br />20%–30% of RA patients become debilitated within the first three years following initial diagnosis. The clinical examination<br />often fail to identify patients with early RA partly due to heterogeneity of disease presentation and course. To meet the need<br />for improved diagnostic and prognostic tests, various serum biomarkers are being assessed, including a wide range of<br />autoantibodies. Autoantibodies against peptidyl arginine deiminase type 4 (PAD-4) have recently been described as a specific<br />biomarker in subjects with clinically apparent RA. In this study, we tested the presence of anti-PAD4 antibodies in 40<br />Egyptian subjects with RA and their first degree relatives in order to determine whether these autoantibodies play a role in<br />early disease evolution. In addition, we aimed to describe the Anti-PAD4 relation to anti-CCP autoantibodies, and potential<br />associations with a more severe RA phenotype. The study was carried out on total of 100 subjects divided into; 40 RA<br />patients, 40 of first degree relatives (sister or brother) of RA patients and 20 matched controls. Results: The results<br />indicated that the serum level of Anti-PAD 4 is increased in Egyptian RA patients and their relatives and has a positive<br />association with disease activity. Also its level together with Anti-CCP provides a good diagnostic tool of RA. Conclusion:<br />The serum level of Anti-PAD4 may provide diagnostic information of RA and may be considered as an early marker of the<br />disease among the first degree relatives of RA patients. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 59-66]https://ejrci.journals.ekb.eg/article_4477_efc46f73cb3e673087153780721e8fd6.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Assessment of Cytotoxicity and Genotoxicity in Patients with Rheumatoid Arthritis and its Relation to Disease Activity and Medications5966447810.21608/ejrci.2015.4478ENSallyTayelDepartments of Internal Medicine, Faculty of Medicine,ManalTayelDepartments of Internal Medicine , Faculty of MedicineHananMahrousHuman Genetics , Medical Research Institute; Alexandria University; EgyptEimanSolimanDepartments of Internal Medicine , Faculty of MedicineJournal Article20171207Objectives: To assess the chromosomal aberrations (CAs) as a measure of cytotoxicity and micronuclei (MNi) and<br />nucleoplasmic bridges (NPB) as a measure of genotoxicity in patients with rheumatoid arthritis (RA) and its relation to the<br />disease activity. The work also aimed to assess the possible cytotoxicity and genotoxicity induced by some Disease<br />Modifying Anti-Rheumatic Drugs (DMARDs) used for treatment of RA patients. Patients and Methods: The study included<br />20 female RA patients treated with DMARDs (MTX and SSZ), 10 RA patients not receiving DMARDs (used NDAIDs), and<br />10 control. Peripheral blood samples were taken to assess the cytotoxicity by chromosomal analysis (karyotyping) using solid Giemsa stain and GTG- banding according to the International System for Human Chromosome Nomenclature. Genotoxicity and DNA damage was assessed by the miconucleus (MN) test using cytochalasin-B. Results: The DMARDs RA patients had a mean age of 42.2±11.76 yr and a mean disease duration of 7.95±6.43 yr. The MTX dose was 50 mg/wk and the SSZ dose was 500 mg/ 8 hours, and the mean duration of use was 7.1±6.27 yr. The 20 RA patients of the DMARDs group received folic acid dose of 0.5 mg/day for the same period as DMARDs. The mean age of the non- MTX RA (NSAIDs) group was 43.1±13.5 yr, the mean disease duration was 4.3±1.9 yr. The results showed a high significant increase (p<0.001) of chromosomal breaks, satellite association, chromosome endoreduplication, aneuploidy, and other CAs in RA patients compared to control. This significant difference was not correlated with disease activity. Cytotoxicity of MTX was illustrated by the significant increase in the number of satellite association, and cells with aneuploidy when compared to the NSAIDs group. The frequency of micronuclei (MNi), nucleoplasmic bridges (NPB), and necrotic and/or apoptotic cells were significantly higher in RA patients when compared to control (p<0.05) but not correlated to disease activity. RA patients receiving DMARDs showed a significant increase in the number of binucleated cells with one MN when compared to the NSAIDs group. Conclusion: CAs, MNi, and NPB were increased RA patients so suggesting that cytotoxicity and genotoxicity are manifestations of RA disease itself. These CAs, MNi, and NPB were not correlated to the degree of disease activity, and seemed to be randomly distributed except in the case of X- chromosome anomalies. MTX is still cyto-and genotoxic to RA patients despite the associated use of folic acid. This toxicity might be due to the high dose and its long time of use in the present study. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 67-80]https://ejrci.journals.ekb.eg/article_4478_76961a74f592b4a5ccee76a002335dc9.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis6880447910.21608/ejrci.2015.4479ENAbd El-AzeimAlhefnyDepartments of Internal Medicine, Rheumatology Division, Ain Shams University; EgyptMaryamAbd El-RahmanDepartments of Internal Medicine, Rheumatology Division, Ain Shams University; EgyptSamehAbd El-MotelebDepartments of Internal Medicine, Rheumatology Division, Ain Shams University; EgyptHossamSakrDepartments of Internal Medicine, Radiodiagnosis2, Ain Shams University; EgyptRashaHassanDepartments of Internal Medicine, Rheumatology Division,Ain Shams University; EgyptJournal Article20171207Objectives: The aim of this study was to measure the frequency of medication adherence in rheumatoid arthritis (RA)<br />patients and to assess factors affecting it, deal with some factors to improve adherence and reevaluate after six months.<br />Methods: A prospective cohort interventional study of 100 patients with RA under treatment fulfilled the American College<br />of Rheumatology / European League against Rheumatism (ACR/EULAR) criteria. All patients subjected to full history<br />taking including socio-demographic data, medication and clinical examination, Assessment of disease activity by DAS28,<br />functional ability by Health Assessment Questionnaire (HAQ) score, pain by Visual Analogue Scale (VAS) scale, adherence<br />to treatment by Compliance Questionnaire of Rheumatology (CQR) and Power Doppler U/S for both metacarophalangeal<br />and wrist joints were done at baseline and after 6 months at the end of the study. Analysis of factors of non-adherence was done at baseline before intervention. Results: The baseline adherence rate (CQR80) was 37%. The cost of medication (62%), non-availability of medication in pharmacy (59%), lack of belief in the benefit of treatment (38%) forgetting the medication (37%) ,poor provider-patient relationship (25%), inadequate follow up (23%) and polypharmacy (20%) were the most common causes of non adherence in non adherent patients (p 0.05). Adherent patients to drug treatment were younger, living inside Cairo, with higher level of education and nonsmoker. Non-adherent patients had longer morning stiffness duration (p=0.013), more tender joints, higher DAS28 and HAQ scores, higher ESR and CRP titer (p<0.001) and higher frequency of active synovitis in Doppler ultrasound. They also had significantly more frequency of having medications on their expense (p<0.001). After 6 months of follow up and trying to correct the causes of non-adherence, the adherence rate increased to 69% and this associated with improvement in disease activity, functional state and ultrasongraphic findings. Conclusion: Adherence rate to drug treatment in RA patients at baseline was low (37%). It was associated with higher disease activity, functional disability. Patient education, financial support, good physician-patient relationship and simplification of the prescription were found to improve the patient adherence to treatment and to control disease activity after follow up. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 81-92]https://ejrci.journals.ekb.eg/article_4479_cf62810fe7b861a0a92f7cccb35ebc1d.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Year in Review 2015-2016 Rheumatoid Arthritis 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis (December 2015)8192448110.21608/ejrci.2015.4481ENJournal Article20171207https://ejrci.journals.ekb.eg/article_4481_4ea5d8dbd67986d05232fe68ea0c6a02.pdfEgyptian Society of Rheumatology & Clinical ImmunologyEgyptian Journal of Rheumatology and Clinical Immunology2090-75754120160101Lupus mimickers…!9394448210.21608/ejrci.2015.4482ENHowaidaMansourDepartment of Internal Medicine – Rheumatology Division, Ain Shams University; EgyptNahlaHussinDepartment of Internal Medicine – Rheumatology Division, Ain Shams University; EgyptRahmaElziatyDepartment of Internal Medicine – Rheumatology Division, Ain Shams University; EgyptWardaAbdelfattahDepartment of Internal Medicine – Rheumatology Division, Ain Shams University; EgyptJournal Article20171207https://ejrci.journals.ekb.eg/article_4482_5aae52e0923b8887e2563c7abc9e40e6.pdf