The burden of entheseal involvement in systemic lupus erythematosus: a comparative ultrasonograghic study.

BACKGROUND: Imaging is crucial for identifying and diagnosis of the musculoskeletal (MSK) symptoms, which are one of the most typical manifestations of systemic lupus erythematosus (SLE). For the joints, tendons, and entheseal sites, ultrasonography has shown to be sensitive and accurate for the diagnosis of both inflammation and structural damage. AIM: The goal of the current investigation is to determine the prevalence and the distribution of entheseal abnormalities in SLE patients, using musculoskeletal ultrasonography (MSUS) and to assess the relationship between entheseal sonographic changes and the SLE disease activity. PATIENTS AND METHODS: One hundred sixty-eight subjects were studied (56 SLE patients, 56 psoriatic arthritis (PSA) patients, and 56 normal cases). To compare the frequency and the distribution of entheseal involvement, high-resolution MSUS was conducted to assess the entheseal sites of all patients in accordance with the Madrid Sonographic Enthesitis Index (MASEI). RESULTS: Clinical enthesitis was detected in 39.3% of the SLE patients using the Leeds Enthesitis Index compared to 71% detected via US examination, indicating a high proportion of subclinical enthesitis in our SLE patients. The most frequently affected enthesis was the distal insertion of the patellar tendon at the tibial tuberosity which was detected in 41% of SLE patients. Enthesitis was significantly more frequent in PSA patients (100%) compared to SLE patients (71.4%) (p < 0.05) and more significantly frequent in SLE patients compared to the healthy controls (19.6%). There was a significant correlation between MASI and SLEDAI scores (r = 0.250*, p = 0.048) and the total protein in 24 h (r = 0.289*, p = 0.031). In addition, there was an inverse significant correlation between MASEI and serum albumin (r = - 0.324*, p = 0.015). CONCLUSION: In SLE patients, enthesitis is frequently clinical and ultrasound-verified. The most impacted enthesis is at the insertion of the quadriceps tendon. Enthesitis presence and the rise in the MASI score can serve as indicators of the severity of the SLE disease. Key Points • The most impacted entheseal site lies at the insertion of the quadriceps tendon. • The presence and the rise in MASEI score can serve as indicators of the severity of the SLE disease.

Significance of platelets to lymphocytes and platelets to haemoglobin ratios in patients with systemic sclerosis.

BACKGROUND: Systemic sclerosis (SSc) is a progressive autoimmune connective tissue disease. Platelets to lymphocytes (PLR) and platelets to haemoglobin ratios (PHR) are emerging biomarkers used in the assessment of activity and severity of various autoimmune diseases. This study was designed to clarify the association of PLR and PHR with SSc disease activity and its different manifestations. METHOD: A cross-sectional study involved sixty SSc patients. Demographic, clinical data and investigations were done. RESULTS: PLR and PHR were correlated positively with ESR (r=0.351, p=0.003*), (r=0.620, p=0.000**), CRP (r=0.417, p=0.001*), (r=0.305, p=0.018**) and SSc activity index (r=0.292, p=0.024*), (r=0.359, p=0.005*). PLR and PHR were highly significantly related to digital ulcerations, musckeloskeletal, and pulmonary manifestations. Also, they had a significant relation to ground glass abnormalities on HRCT, mild restriction in pulmonary function tests and anti-scleroderma-70 antibodies. The cutoff value for PLR was 107.8 with high sensitivity 97.9% and specifity 92.3%, area under the curve (AUC=0.723, P 0.015) on receiver operating characteristic curve (ROC). PHR AUC (0.799, P .001), cut value was 23.5 at 95.7% sensitivity and 84.6% specifity. CONCLUSION: PLR and PHR were significantly related to digital ulcerations, musculoskeletal, and pulmonary manifestations and can be considered as predictive biomarkers for the assessment of SSc disease activity and severity.

Validity and reliability of the Arabic version of the Self-Efficacy for Managing Chronic Disease scale in rheumatoid arthritis patients.

BACKGROUND AND OBJECTIVES: Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that causing disability and affection of patient's quality of life (QoL). Self-efficacy investigation helps us to detect the requirements of chronically affected patients and evaluation of self-care management programs. The aim of our study was to test validity and reliability of Self-Efficacy for Managing Chronic Disease (SEMCD-Arabic) in RA patients. METHOD: This study included 248 RA patients, carried out at Rheumatology and Rehabilitation Department. The SEMCD-Arabic Validity was assessed by correlating the SEMCD-Arabic scale with the validated Arabic version of the modified Health Assessment Questionnaire HAQ (MHAQ), the Arabic version of the Multidimensional Assessment of Fatigue (MAF) scale, and the Arabic version of Short Form 36 version 2 for quality of life (SF QoL). Internal consistency, test-retest reliability was assessed. RESULTS: Convergent validity was confirmed by a positive correlation between (physical, mental) component of SF QoL and SEMCD-Arabic (r = 0.918, r = 0.925) respectively, and negative correlation between MAF and SEMCD-Arabic (r = - 0.657) and MHAQ with SEMCD-Arabic (r = - 0.595). Discriminant validity confirmed by a significant negative correlation between visual analogue scale (VAS) for pain, disease activity scale (DAS28), Morning stiffness, patient health, physician health, age, duration, and SEMCD-Arabic (r = - 0.1-0.7) (P < 0.001). Test-retest reliability was estimated which revealed a high interclass correlation coefficient (ICC = 0.87-0.997) indicating excellent agreement and internal consistency is acceptable as the Cronbach's alpha value (0.660 to 0.78). CONCLUSION: The SEMCD-Arabic questionnaire can be used as a valid and reliable measure for assessment of patient's self-efficacy in RA. Key Points • The SEMCD-Arabic questionnaire has a statistically significant validity in correlation with different clinical manifestations MHAQ, SF QoL, and MAF. • The Arabic SEMCD is highly reliable with a Cronbach's alpha of 0.660 to 0.78.

Cultural adaptation and validation of the Systemic Sclerosis Quality of Life questionnaire into Arabic language.

BACKGROUND AND OBJECTIVES: Systemic sclerosis (SSc) is a chronic connective tissue disease affecting all quality of life (QoL) parameters. In addition to clinical assessment, QoL measures should be included in patient assessment. There is no Arabic tool specific for assessing QoL in Arabic SSc patients; therefore, this work was designed to translate the SScQoL questionnaire, culturally adapt and check its reliability and validity. METHOD: Based on the principle of translation and cross-cultural adaptation in other language, the SScQoL questionnaire was translated into Arabic. Correlation of SScQoL scores for 50 patients with Short Form Health Survey (SF-36) scores has been tested for convergent validity and discriminate validity evaluated by stratifying clinical parameters of patients and disease subtypes. The intraclass correlation coffee (ICC) was used to assess reliability by interviewing patients twice 14 days apart. RESULTS: Correlations were present between SScQoL scores and physical and mental component scores of SF-36 questionnaire. We found strong negative correlation between the physical component of SF-36 and QoL function, QoL emotion, QoL total scores (r = - 0.654**, r = - 0.512**, r = - 0.540**) and moderate negative correlation present between SF-36 mental component and QoL function, QoL emotion, QoL social, and QoL total (r = - 0.314*, r = - 0.486**, r = - 0.357*, r = - 0.433*). Also, significant association (P < 0.05*) between scores of total QoL and visceral involvements (GIT involvement, pericardial effusion, and LVDD) was evident. The Arabic edition of SScQoL has a Cronbach's alpha of 0.78. CONCLUSION: The translated Arabic version is a valid and reliable tool to assess Egyptian SSc patients' QoL. Key Points • The SScQoL questionnaire items have a convergent validity with physical and mental component scores of SF-36, and discriminant validity with visceral involvement. • The Arabic edition of SScQoL is reliable with a Cronbach's alpha of 0.78.