Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters.

BACKGROUND AND OBJECTIVES: The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). PATIENTS AND METHODS: A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. RESULTS: The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. CONCLUSION: Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.

Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study.

OBJECTIVE: To evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy. METHODS: This is an observational cross-sectional study on patients with SLE and healthy controls. Five nerves in each patient were examined bilaterally with NMUS, and the cross-sectional area (CSA) of each nerve at certain sites was estimated. The mean CSA at each site, for each nerve, in each group was statistically analysed and compared between groups. RESULTS: 370 nerves were evaluated in 37 patients. By nerve conduction study (NCS), 36 patients had polyneuropathy (80.6% mixed type, 19.4% sensory). Significant mean CSA enlargement was present among the ulnar nerve at the Guyon's canal and mid-humerus (both p=0.001); tibial nerve at the distal leg and proximal to the tarsal tunnel (p=0.003 and p=0.001, respectively); and peroneal nerve at the popliteal fossa (p=0.042). The mean CSA showed high specificity compared with NCS. CONCLUSION: Our study shows that CSA could be a complementary tool to NCS for studying peripheral neuropathy in SLE. Furthermore, NMUS provides data on the different pathophysiological aspects of nerve involvement in SLE. Future studies using more than one sonographic parameter in combination with NCS and nerve histopathology are recommended to further investigate SLE-related neuropathy.Trial registration number NCT04527172.

Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters.

BACKGROUND AND OBJECTIVES: The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). PATIENTS AND METHODS: A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. RESULTS: The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. CONCLUSION: Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.

Evaluation of brain changes in systemic sclerosis (SSc) patients using two different techniques of MRI: Is it really worthy?

BACKGROUND: Systemic sclerosis (SSc) is a rare chronic multi-system autoimmune disease of unknown cause and a complex pathogenesis. The hallmark of the disease is microvascular vasculopathy which results in tissue ischemia with recurrent episodes of reperfusion. Diffusion-weighted (DW) Magnetic Resonance imaging (MRI) is an excellent tool for the detection of activity of any vascular or inflammatory lesions. OBJECTIVES: Detect brain changes in systemic sclerosis patients with asymptomatic CNS manifestations using fluid attenuation inversion recovery (FLAIR) weighted sequence and diffusion-weighted (DW) sequence MRI. METHODS: Fifteen systemic sclerosis female patients aged 27-60 years old with disease duration of 1-20 years with no CNS clinical manifestations were included. A controlled group of 14 clinically normal persons, age and sex matched. Both groups were subjected to brain MR examination at 1.5T; a FLAIR weighted sequence and a DW sequence. SPSS (version 20) was used for statistical analysis. RESULTS: 37 white matter hyperintense lesions (≤2 to ≥ 5mm in diameter) were detected in patient group using FLAIR weighted MRI while diffusion-weighted MRI failed to detect the same lesions. A non-significant relation (P=.259) between the presence of white matter hyperintense lesions and the severity of peripheral vascular affection of the disease was observed. CONCLUSIONS: Asymptomatic central nervous system vasculopathy is detected in systemic sclerosis using FLAIR MRI, while diffusion MRI failed to detect such lesions. These findings suggest a non-inflammatory form of central nervous system microvasculopathy in SSc patients.

Grading of Ultrasonography in Rheumatoid Arthritis of Wrist and Hand Joints.

RATIONALE AND OBJECTIVES: To evaluate the role of musculoskeletal ultrasound (MSUS) in the grading of rheumatoid arthritis (RA) wrist and hand joints and correlate it with clinical, laboratory, and radiological data. MATERIALS AND METHODS: A cross-sectional study recruited 50 patients in a tertiary care hospital. RA activity was assessed by DAS28. MSUS dorsal longitudinal scan was performed on the wrists, MCPs, and PIPS joints using high frequency (18 MHZ) linear transducer. 100 wrists in three different views, 500 MCPs, 500 PIPs were evaluated using the grayscale ultrasound and power Doppler ultrasound semiquantitative scale and scores ranging from 0-3. The results were correlated with clinical, laboratory and radiological data. All patients' wrist and hand joints X-rays were evaluated using the Larsen score. RESULTS: The mean age of the patients (49 females and one male) was 44.58 ± 10.07 years, and their mean disease duration was 16.26 ± 1.07 years. The mean DAS28 was 5.19 ± 0.95. 97.5% of joints had grade I Larsen score, 11.07% of the joints had erosions, 9.2% of the joints had effusions, 23.8% of the joints had synovial thickening, 11.9% of the joints showed PD signals and 3.5% of the joints were accompanied with tenosynovitis. Significant relations (p < 0.05) found among DAS28 and (PD signals, synovial thickening, tenosynovitis, effusion, and Larsen score). A nonsignificant relation (p > 0.05) among DAS28 and erosions detected by MSUS and X-ray. CONCLUSION: MSUS is powerful in the detection of early RA regarding synovitis, joint effusion, tenosynovitis, and bone erosions, which were correlated with clinical and laboratory parameters.