Egyptian Rheumatology and Rehabilitation

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ISSN / EISSN : 1110-161X / 2090-3235
Total articles ≅ 279
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, Sevgi Ikbali Afşar, Selin Özen, Cihat Burak Sayın
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-8; doi:10.1186/s43166-021-00075-0

Background Hemodialysis (HD) patients suffer from musculoskeletal disorders. The most reported musculoskeletal problem is arthralgia. Hip arthralgia has been commonly reported in patients undergoing HD. Hip pain can lead to a decrease in levels of physical activity, limitation in joint range of motion, and consequently difficulties in performing activities of daily living (ADL) and impair the quality of life (QoL). The aim of the study is to reveal the prevalence of hip pain and related factors in HD patients. This cross-sectional study included 73 patients on prevalent HD whose ages ranged from 25 to 65 years and who were on HD for more than 6 months. Physical examination and radiological imaging were done to every patient. Visual analog scale, Barthel Index, and Short Form-36 were used to evaluate pain, ADL, and QoL, respectively. Results Hip arthralgia was detected in 32 patients. Around 43% of which were diagnosed hip osteoarthritis, 34% greater trochanteric pain syndrome, 15% femoroacetabular impingement, and 6% soft tissue calcifications. Diabetes mellitus and hemodialysis duration were found to be significantly different between the groups of hip pain and without hip pain. Diabetes mellitus was identified as an independent risk factor for hip pain in hemodialysis patients. ADL and QoL were significantly lower in patients with hip pain compared to those without (p < 0.01; p < 0.05, respectively). Conclusions The results of our research show that HD patients should be screened for the presence of hip pain and other musculoskeletal disorders and that this is an area which requires further consideration and medical research.
Mohammed A. Muzaffer, Abobakr A. Abdelgalil
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-7; doi:10.1186/s43166-021-00074-1

Background Juvenile idiopathic arthritis (JIA) is the most prevalent pediatric rheumatic disorder. Progress in modalities of therapy improves the disease outcome. We aimed to determine the efficacy and safety of tocilizumab (TCZ) in the management of systemic (sJIA) and polyarticular (pJIA) in children who are resistant to conventional as well as other biological therapies. In this retrospective study, we selected JIA patients according to the International League of Association for Rheumatology (ILAR) criteria and were treated with TCZ. Response to TCZ was assessed using Juvenile Arthritis Disease Activity Score-10 (JADAS-10) and also outcomes were assessed according to the American College of Rheumatology (ACR) remission criteria. Safety of the drug was assessed by documenting possibly related adverse effects (AE). Statistical analysis using SPSS version 25 with statistical significance is considered if p ≤ 0.05. We included 16 JIA patients aged ≤ 18 years but 2 of them were excluded as they developed severe reaction during the TCZ 1st dose, so finally, 14 patients were included. Results The median age of our patients was 12 years. Of these 14 patients, 9 (64.3%) had sJIA and 5 (35.7%) had pJIA. TCZ use led to significant improvement in the JADAS-10 from mean 22.4 (± 7.9) when it was initially assessed and then 3, 6, 12, and 24 months after TCZ initiation with means 5.7 (± 3.9), 4.4 (± 3.7), 3.5 (± 3.1), and 2.7 (± 2.2), (P = 0.001, 0.001, 0.005, 0.012), respectively. Five patients exhibited TCZ possibly expected side effects. Neutropenia and infusion-related reactions were the most frequent AE. Conclusions Tocilizumab seems to be generally effective and safe drug in the management of sJIA and pJIA especially in cases refractory to conventional as well as other biologic agents.
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-11; doi:10.1186/s43166-021-00073-2

Background Knee osteoarthritis (KOA) is a common joint disorder in elderly individuals, causing pain, loss of physical functioning, disability, and reduction of life quality. Home exercise programs (HEP) serve as a crucial complement to outpatient rehabilitation therapy, as they save the cost of supervised physical therapy sessions, while also offering a high level of treatment. The aim of this study was to evaluate the effectiveness of the 6-month HEP on pain, quality of life, and self-efficacy in patients with primary KOA and to identify the adherence level to exercises and associations with patients’ characteristics and clinical outcomes. Results After 6 months of HEP, there were statistically significant differences between groups for self-efficacy (p ≤ 0.001, from 58.29 to 71.5) (p = 0.23, from 55.98 to 57.72), quality of life (p ≤0.001, from 60.1 to 72.2) (p = 0.074, from 60.35 to 60.92), and pain severity (P ≤0.001, from 58.29 to 41.4) (P = 0.88, from 61.2 to 60.9) in favor of exercise group. Conclusions Home-based exercise program improves pain score, self-efficacy, and quality of life in patients with knee osteoarthritis. Adherence level to the exercise program may have a positive impact on patient improvement.
, Azza Taha, Dalia E. Desouky, Shorouk F. Abd-Elmakoud, Elsayed M. Rageh, Abdulmajeed M. Algethami, Mohamed Algethami, Peter M. Ten Klooster, Johannes J. Rasker
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-9; doi:10.1186/s43166-021-00072-3

Background Health-related quality of life (HRQOL) as a patient reported outcome plays important roles in the life of patients with RA (rheumatoid arthritis) and SLE (Systemic lupus erythematosus) as well as their families. Evaluating the impact of sustained remission on HRQOL is important and could be of potential help in daily practice. Thus, we aimed to assess and compare prospectively the impact of sustained remission on HRQOL in Saudi RA and SLE female cohorts. Results Sixty-two female patients with active RA and 34 female patients with active SLE fulfilled the inclusion-, entry- and follow-up criteria. At baseline, the SLE patients had significantly better SF-36 scores than the RA patients. In both groups, significant correlations were found between disease activity and physical (PCS) and mental (MCS) components summary of the SF-36 (all p’s ≤ 0.001). In sustained remission, both SLE and RA patients showed significant improvements of the SF-36 scores (p < 0.001) compared to baseline. RA patients in sustained remission had a significantly better general health, bodily pain and physical functioning, and total PCS scores (p < 0.001) than those with SLE. Conclusions Both SLE and RA patients in sustained remission showed strongly improved HRQOL. In sustained remission, RA patients had comparable or better HRQOL than SLE patients.
Howaida Abdelhameed Elshinnawy, Ahmed Mohamed Bakr Bakr Mohamed, Dina Abou Bakr Farrag, Moustafa Abd Elnassier AbdElgawad
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-7; doi:10.1186/s43166-021-00071-4

Background Chronic kidney disease increases the risk of fractures and altered bone and mineral metabolism. Exercise training could be a non-pharmacological therapeutic intervention. The aim of this work is to evaluate the effect of intradialytic exercise training on bone markers in hemodialysis (HD) patients. Results Forty adult patients on regular HD participated in the study. Twenty of which completed 3 months supervised intradialytic cycling exercise program and 20 served as controls. At baseline, there was no difference between both groups regarding age, sex, physical performance, and laboratory studies performed. After 3 months, the exercise group showed significant improvement in short performance battery test (SPBT) total score (P<0.001) associated with significant decrease in serum parathormone (PTH) (P=0.01) and increase in serum alkaline phosphatase (ALP) and bone specific alkaline phosphatase (BALP) (P<0.05 and P<0.001 respectively). Controls did not show similar change in SPBT or laboratory studies. There was no significant change in serum calcium or phosphorus in both groups. A significant positive correlation was observed between SPBT scores post-exercise and both BALP and ALP levels (r=0.432, P=0.01 and r=0.645, P<0.01 respectively). Also, an inverse relation was observed between SPBT and PTH (r=−0.503, P=0.01). Conclusion Intradialytic cycling exercise program resulted in significant increase in physical performance associated with decrease in serum PTH and increase in BALP and ALP in HD patients. This indicates the positive influence of exercise not only on physical performance in dialysis patients but also on bone metabolism.
Mervat I. Abd Elazeem, Aya B. S. Ahmed, Rabab A. Mohamed, Enas A. Abdelaleem
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-7; doi:10.1186/s43166-021-00070-5

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 <6. No detected significant correlation between any of (patients’ age, BMI, disease duration, tenderness score, and WOMAC score) with serum Adrenomedullin levels among studied OA cases (p values >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.
Samar Abd Alhamed Tabra, Mohammad Ibrahim Zaghloul, Doaa Shawky Alashkar
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-10; doi:10.1186/s43166-021-00068-z

Background Stroke patients often present with upper limb spasticity which impairs the functional status of patients. Recently, extracorporeal shock wave therapy (ESWT) is reported to be a safe, non-invasive, alternative treatment for spasticity. Many articles have been published on the effect of ESWT on lower limb spasticity, but only few of them had focused on upper limb spasticity, so the aim of this study is to evaluate the clinical and electrophysiological effect of ESWT on wrist and hand spasticity of chronic stroke patients and its impact on functional performance. In this monocentric study, forty chronic stroke patients with upper limb spasticity were recruited and randomly allocated into two groups. Both groups continued to receive conventional stroke rehabilitative program, while group I received three sessions of radial extracorporeal shock wave therapy (rESWT) 1 week apart. Results There was a significant decrease in wrist and hand spasticity after treatment and at follow-up in group I compared to group II (Modified Ashworth Scale after rESWT 1.45 ± 0.16, 2.90 ± 0.18 and follow-up 1.55 ± 0.13, 3.00 ± .0.15 in groups I and II, respectively). Also, there was a significant improvement of wrist control and hand function after treatment and at follow-up in group I compared to group II (p < 0.001). The improvement of pinch grip was noticed at follow-up with a significant difference relative to baseline in group I (p < 0.05). Hmax/Mmax ratio was significantly decreased at follow-up in group I compared to group II (p < 0.001). Conclusion ESWT is a valuable adjuvant treatment for spasticity of the hand and wrist in stroke patients which is reflected as improvement of functional activity. Trial registration, NCT04312581. Registered on 18 March 2020.
Marwa A. Saad, Reham A. Aboelwafa, Eman H. Elsayed
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-10; doi:10.1186/s43166-021-00069-y

Background Osteoporosis is a major health problem of elders. Dual X-ray absorptiometry (DEXA) is the commonly used modality for diagnosis osteoporosis; serum markers have been suggested for predicting osteoporosis and discriminate osteoporotic from healthy subjects. We aimed to analyze the status of some bone turnover biochemical markers namely PINP, B-ALP, estrogen, and progesterone in the elderly osteoporotic and osteopenic women as probable markers for the discrimination between patients and healthy individual in diagnosing osteoporosis, and also, to detect the impact of osteoporosis on quality of life of patients using assessment of the quality of life for osteoporosis (ECOS-16). Post-menopausal 108 females were involved in the current study, divided into two groups (osteoporotic group (60 with BMD˂-2.5), osteopenic group (48 with BMD between − 1 and − 2.5)), and 60 healthy elderly females as control group were involved in the study. Serum levels of procollagen type I N-terminal propeptide (PINP), bone alkaline phosphatase (B-ALP), estrogen, and progesterone were measured by ELISA technique. Results PINP and B-ALP significantly differ between studied groups. Also, PINP and B-ALP levels had high sensitivity and specificity to discriminate osteoporotic patients from healthy individuals. PINP and B-ALP significantly correlated with bone mineral density (BMD) and with ECOS-16. Estrogen differs significantly between osteoporotic and osteopenic groups and significantly correlated with bone mineral density of femur (BMD-F) and bone mineral density of spine (BMD-S) in the osteopenic group. Progesterone differed significantly between patients and controls and significantly correlated with BMD-F in the osteoporotic group. Conclusion We can consider PINP and B-ALP as biomarkers for early detection then monitoring of osteoporosis. Measuring these serum markers can replace the assessment of BMD if not available. Also, it could replace the gap between BMD subsequently spaced assessment or could be of value in cases with severe spondylosis, DISH syndrome, old spondylarthritis, and/or previous spinal surgery. Sex hormones could not differentiate the normal from the osteoporotic/osteopenic patients, so they cannot be used as diagnostic or prognostic markers. Validation of this assumption needs large and longitudinal studies.
, Rasha Ahmed Gaber, Hala Mostafa Elsabagh, Elsayed Mohamed Rageh
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-6; doi:10.1186/s43166-021-00067-0

Background One of the most important and dangerous complications of rheumatoid arthritis (RA) is bone loss, which manifested by erosions and juxta-articular or systemic bone loss. Anti-carbamylated protein (anti-CarP) antibodies which are also called anti-homocitrulline antibodies have recently been found in RA. Increase anti-CarP antibody titres may lead to severe disease and increase the progression of bone loss. Osteoprotegrin and receptor activator for nuclear factor kappa B and its ligand (RANKL) are the main players in the pathogenesis of osteoporosis. Thus, we aimed to investigate and detect the presence and prevalence of anti-CarP in rheumatoid arthritis and their association with disease severity and osteoporosis, as well as with OPG/RANKL in 80 Egyptian RA patients to highlight this relationship which could be useful in managing RA patients with osteoporosis. Results Serum anti-CarP levels were significantly increased in the RA group compared with the control group (P< 0.001). We found a negative association between anti-CarP and anti-CCP and disease activity (r=−0.878, −0.534, respectively, Pr=0.646, 0.287, 0.243, 0.892, 0.671, 0.869 [respectively], Pr=−0.553, P Conclusion Anti-CarP antibodies are associated with disease severity and disability in RA patients. They could play an important and significant role in the pathogenesis of osteoporosis in these patients.
Eman A. Baraka, Mona G. Balata, Shereen H. Ahmed, Afaf F. Khamis, Enas A. Elattar
Egyptian Rheumatology and Rehabilitation, Volume 48, pp 1-9; doi:10.1186/s43166-021-00065-2

Background This study aimed to measure the serum and synovial interleukin (IL)-37 levels in rheumatoid arthritis (RA) patients compared to patients with primary knee osteoarthritis (PKOA) and healthy controls and to detect its relation to RA disease activity. Results This cross-sectional study included 50 RA patients with a mean age of 40.24 ± 8.62 years, 50 patients with PKOA with a mean age of 56.69 ± 4.21, and 40 healthy controls with a mean age of 41.75 ± 7.38 years. The mean serum IL-37 level in the RA patients (382.6 ± 73.97 pg/ml) was statistically significantly (P < 0.001) the highest among the studied groups; however, it showed a non-significant difference between the PKOA patients (70.38 ± 27.49 pg/ml) and the healthy controls (69.97 ± 25.12 pg/ml) (P > 0.94). Both serum and synovial IL-37 levels were significantly positively correlated with disease activity scores (r = 0.92, P< 0.001 and r = 0.85, P < 0.001), tender joint counts (r = 0.83, P < 0.001 and r = 0.82, P < 0.001 ), swollen joint counts (r = 0.72, P < 0.001 and r = 0.60, P < 0.001), visual analog scale (r = 0.82, P < 0.001 and r = 0.82, P < 0.001), erythrocyte sedimentation rate (r = 0.75, P < 0.001 and r = 0.65, P < 0.001), and C-reactive protein (r = 0.93, P < 0.001 and r = 0.79, P < 0.001), respectively. Conclusion Serum and synovial IL-37 were significantly elevated in the RA patients, and they were closely correlated. Being less invasive, the serum IL-37 could be a marker of disease activity and could reflect the effective disease control by drugs. Having an anti-inflammatory effect could not suggest IL-37 as the key player to control inflammation alone, but its combination with other anti-proinflammatory cytokines could be investigated.
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