Is CDAI comparable to DAS 28 and SDAI regarding inter-observer agreement and correlation to MHAQ in Egyptian RA patients?

Choosing between the different disease activity indices used for rheumatoid arthritis RA evaluation in clinical practice and research is often difficult. The aim of the current study was to compare clinical disease activity index (CDAI) to simplified disease activity index (SDAI), and disease activity score 28 (DAS28) regarding inter-observer reliability and correlation to the modified health assessment questionnaire (MHAQ) in a cohort of Egyptian RA patients. This study included one hundred RA patients. Every patient had an independent clinical evaluation made by two rheumatologists (professor and candidate) to evaluate disease activity using DAS28 with its 4 types, CDAI and SDAI. We used Cohen's weighted kappa coefficient to measure the inter-observer agreement between the professor and candidate in different disease activity measures. Correlation between MHAQ and disease activity measures was made with Spearman's rho test. Inter-observer agreement in CDAI and DAS28 values was almost perfect. A strong positive correlation was found between professor and candidate regarding the tested activity indices (p<0.001), and a positive correlation was found between MHAQ and all Disease Activity Scores made by both professor and candidate (p<0.001). CDAI proved to be comparable to other disease activity scores regarding inter-observer agreement and relation to MHAQ.

Low body mass index in long standing rheumatoid arthritis: relation to RA disease activity and functional indices.

The aim of the work was to study the relationship between the body mass index (BMI) in longstanding rheumatoid arthritis (RA) and RA disease activity and functional indices. This study included 105 RA patients. For all patients, we recorded the presence of erosions on radiographs, the presence of subcutaneous nodules (SCN), the 28-tender joint count (TJC), 28-swollen joint count (SJC) scores, the visual analogue scale (VAS), physicians' global assessments (PhGA), the erythrocyte sedimentation rate (ESR), and the rheumatoid factor (RF). The disease activity index (DAS28) and BMI were calculated and current treatment was recorded. Patients were divided into two groups: group I: BMI 25. Group I included 32 (30.5%) patients, whereas group II included 73 (69.5%) patients. There were statistically significant differences between the two groups regarding each of the following: SJC (p=0.006), erosions (p=0.006), DAS28 (p=0.016) and PhGA (p=0.007). All were higher in group I (underweight and normal) than in group II (overweight and obese). No statistically significant differences emerged regarding age (p=0.11), smoking (p=0.69), disease duration (p=0.46), TJC (p=0.14), SCN (p=1.00), HAQ (p=0.26), VAS (p=0.16), ESR (p=0.25), RF (p=0.54) and steroid cumulative dose (p=0.08). Low BMI in longstanding RA patients may indicate more active and erosive disease and it may be considered as a poor prognostic factor.

Retrospective analysis of nephritis response and renal outcome in a cohort of 928 Egyptian lupus nephritis patients: a university hospital experience.

Aim We aim to describe the pattern of response to treatment in a cohort of Egyptian lupus nephritis (LN) patients and to define variable prognostic factors. Methods We retrospectively analyzed records of 928 systemic lupus erythematosus (SLE) patients (898 females, 30 males) with biopsy-confirmed LN seen between 2006 and 2012 at Cairo University hospitals. Results Our study involved 928 SLE patients with a mean age of 26.25 ± 6.487 years, mean LN duration at time of renal biopsy 6.48 ± 4.27 months, mean SLEDAI 28.22 ± 11.7, and mean follow-up duration of 44.14 ± 17.34 months. Induction treatment achieved remission in 683 patients. Remission was achieved in all 32 patients with class II LN, compared to 651/896 (72.7%) patients in classes III, IV, and V. Induction by intravenous (IV) cyclophosphamide achieved response in 435/575 (75.7%) patients, while induction by mycophenolate mofetil (MMF) resulted in response in 216/321 (67.3%) patients ( p = 0.0068). Nephritic flares were least observed when MMF was used for maintenance (30/239 (12.6%) patients), compared to 71/365 patients (19.5%) ( p = 0.0266) when azathioprine (AZA) was used, and 22/79 patients (27.8%) ( p = 0.002) with IV cyclophosphamide. Class IV LN, high chronicity index, presence of crescents, and interstitial fibrosis in biopsies were all associated with chronic kidney disease (CKD) development eventually ( p < 0.001, p = 0.005, p = 0.012, and p = 0.031, respectively). By the end of the study duration, 305 (32.7%) patients had CKD. Logistic regression detected that high baseline serum creatinine, failure to achieve remission, hypertension, and nephritic flare were the main risk factors for poor renal outcome ( p < 0.001, p < 0.001, p = 0.004, and p < 0.001, respectively). The 5 years' mortality was 69 (7.4%) patients with sepsis being the main cause of death. Conclusion IV cyclophosphamide superseded as induction treatment, while MMF was the best maintenance treatment. High serum creatinine, hypertension, and nephritic flare were the main risk factors for poor renal outcome.

Subclinical atherosclerosis in systemic lupus erythematosus patients and its relationship to disease activity and damage indices.

AIM OF THE WORK: To detect the incidence of premature atherosclerosis in systemic lupus erythematosus (SLE) patients and to study its association with disease activity and damage indices. PATIENTS AND METHODS: This study involved 50 adult female SLE patients with mean age 26.24 ± 8.63 years and mean disease duration 3.44 ± 4.01 years. The control group comprised 25 healthy adult females. All patients were subjected to a detailed clinical examination and laboratory investigations, and full case history was recorded. Assessment of disease activity was performed according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and disease damage was assessed using the Systemic Lupus International Collaborating Clinics (SLICC) score. B mode ultrasound was used to measure the intima-media wall thickness (IMT) and detect the presence of carotid plaques. RESULTS: In 15 patients (30 %), positive ultrasonographic findings represented by a significant increase in IMT (> 0.9 mm) could be shown; plaques were found in 3 of these patients (6 %). A significant difference was found between SLE patients and controls in terms of IMT (P < 0.0001). On subgrouping the SLE patients according to their IMT, there was a significant difference between those with thickened and normal IMT in terms of SLEDAI (P < 0.0001) and SLICC (p = 0.035) scores. CONCLUSION: Subclinical atherosclerosis is frequent in SLE patients. Increased disease activity and damage are associated with the occurrence of premature atherosclerosis.

Resistin in inflammatory and degenerative rheumatologic diseases. Relationship between resistin and rheumatoid arthritis disease progression.

AIMS OF THE STUDY: To assess and compare resistin levels in the serum and synovial fluid of patients with rheumatoid arthritis (RA; an inflammatory rheumatologic disease) and osteoarthritis (OA; a degenerative rheumatologic disease) and to study the relationship between resistin levels and prognostic factors of RA disease progression. PATIENTS AND METHODS: This study included a total of 50 patients: 25 with RA and 25 with OA. Full case history was documented for all patients and all underwent a thorough clinical examination and laboratory testing. Body mass index (BMI) values were also calculated. Radiographs were made of OA patients' knees and RA patients' hands. Disease Activity Score 28 (DAS28) was calculated for RA patients. Serum and synovial fluid samples were obtained from the effused knees of all patients and tested for resistin level. RESULTS: Serum resistin levels were higher in RA patients than in those with OA (p < 0.01). Synovial fluid resistin levels were also higher in RA than OA patients (p < 0.001). While serum resistin levels correlated with Larsen score and total leukocyte count (TLC), synovial fluid resistin levels correlated with rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels in addition to Larsen score and TLC. CONCLUSION: Resistin levels were found to be higher in the serum and synovial fluid of RA patients than in those with OA. This may suggest a role for resistin in inflammatory rheumatologic diseases. The observed statistically significant correlation between synovial fluid resistin levels and RF, ACPA and Larsen score may suggest that high synovial fluid resistin levels can be considered a poor prognostic factor for RA progression. However, further studies employing a larger cohort of patients are needed to confirm the relevance of resistin as a prognostic marker in RA patients.

Mechanical performance and thermal stability of hardened Portland cement-recycled sludge pastes containing MnFe2O4 nanoparticles.

This study focused on investigating the possibility of using different ratios (5, 10, 15 mass%) of recycled alum sludge (RAS) as partial replacement of ordinary Portland cement (OPC), to contribute to solving the problems encountered by cement production as well as stockpiling of large quantities of water-treated sludge waste. MnFe2O4 spinel nanoparticles (NMFs) were used to elaborate the mechanical characteristics and durability of different OPC-RAS blends. The outcomes of compressive strength, bulk density, water absorption, and stability against firing tests fastened the suitability of utilization of RAS waste for replacing OPC (maximum limit 10%). The inclusion of different doses of NMFs nanoparticles (0.5, 1 and 2 mass %) within OPC-RAS pastes, motivates the configuration of hardened nanocomposites with improved physico-mechanical characteristics and stability against firing. Composite made from 90% OPC-10% RAS-0.5% NMFs presented the best characteristics and consider the optimal choice for general construction applications. Thermogravimetric analysis (TGA/DTG), X-ray diffraction analysis (XRD), and scanning electron microscope (SEM) techniques. affirmed the positive impact of NMFs particles, as they demonstrated the formation of enormous phases as ilvaite (CFSH), calcium silicate hydrates (CSHs), MnCSH, Nchwaningite [Mn2 SiO3(OH)2 H2O], [(Mn, Ca) Mn4O9⋅3H2O], calcium aluminosilicate hydrates (CASH), Glaucochroite [(Ca, Mn)2SiO4, and calcium ferrite hydrate (CFH). These hydrates boosted the robustness and degradation resistance of the hardened nanocomposites upon firing.

Cytogenetic study of a severe case of Pallister-Killian syndrome using fluorescence in situ hybridization.

Usually, the supernumerary isochromosome 12p characterizing Pallister-Killian syndrome patients was detected in cultured skin fibroblasts but not in cultured blood lymphocytes. The proband of this study was a one-day-old female, who presented with major clinical characteristics of the Pallister-Killian syndrome, and had severe malformations in the form of anal atresia, cleft palate, and severe laryngomalacia. Chromosome preparations from cultured blood lymphocytes and skin fibroblasts, as well as buccal smears, from this patient were analyzed by fluorescence in situ hybridization (FISH) using a chromosome 12-specific alpha satellite probe. The proportions of cells showing positive signals for i(12p) in these samples were found to be 20, 62.5, and 70%, respectively. Repeated FISH studies of buccal smears from this patient showed considerable decreases in the proportions of i(12p) containing cells to 40% at one year of age and to 32% at the age of one year and five months. The decline in the percentage of i(12p)-containing cells in buccal smears with aging supports the concept of in vivo loss of the marker during repeated cell division.