Rheumatologists' practice during the Coronavirus disease 2019 (COVID-19) pandemic: a survey in Egypt.

The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.

Role of serum leptin levels and leptin receptor gene polymorphisms in systemic lupus erythematosus.

BACKGROUND: Serum leptin and leptin receptor gene polymorphisms may play a role in the etiopathogenesis of SLE. OBJECTIVE: This study was undertaken to explore the relationship between serum leptin levels and leptin receptor (LEPR) gene polymorphisms with susceptibility to SLE in Egyptian population and to study their relationships with clinical, laboratory, radiographic findings, and disease activity of SLE (SLEDAI). MATERIALS AND METHODS: A total of 50 unrelated female patients, who met the SLICC classification criteria for SLE and fifty healthy blood donors, matched for age, sex, and BMI with SLE patients, serving as a control group, were included in this study. All participants had completed preliminary questionnaires and clinical, laboratory, and radiographic examinations. Serum leptin levels were measured by ELISA assays. LEPR genotyping was done by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. We compared serum leptin levels and LEPR gene polymorphisms in SLE patients and controls, and we tested their relationships with clinical, laboratory, and radiographic findings and SLEDAI in SLE patients. RESULTS: The present study showed significant differences of serum leptin levels between SLE patients and controls (p < 0.001). Moreover, higher frequencies of variant genotype (AA) and (A) allele were found in SLE patients compared to controls (p = 0.008 and 0.001, respectively). No associations were observed between the serum leptin, various LEPR genotypes, and gene alleles and the development of clinical, laboratory, and radiological manifestations. Furthermore, no associations were observed between the various LEPR genotypes or gene alleles and leptin levels (p = 0.633 and 0.337 respectively) in SLE patients. Additionally, no correlations were observed between leptin levels, various genotypes, and alleles with SLEDAI (p = 0.244, 0.741, and 0.838 respectively) in SLE patients. CONCLUSION: Serum leptin and LEPR gene polymorphism increase risk of SLE in Egyptian population; however, they are not associated with the development of clinical, lab, and radiological findings. Disease activity is neither correlated with serum leptin level nor associated with LEPR gene polymorphism. Serum levels of leptin are not associated with LEPR gene polymorphism. Key Points • Serum leptin and LEPR gene polymorphism increase risk of SLE in Egyptian patients. • Serum leptin is not associated with SLE disease activity.

Osteoarthritis of knee joint in metabolic syndrome.

Pathogenesis of osteoarthritis may have a systemic metabolic component. This study was undertaken to assess the prevalence of primary knee osteoarthritis (OA) in a sample of Egyptian patients with metabolic syndrome (MetS) and to examine the relationship of metabolic syndrome and its components with clinical, functional, and radiographic findings of knee OA. A total of 60 patients (55 females, 5 males) diagnosed as having MetS according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria and 30 obese subjects without MetS (24 females, 6 males), serving as a control group, were included in this study. All participants had completed preliminary questionnaires, clinical and laboratory examinations, and an evaluation for radiographic knee OA. Scores from the Western Ontario and Mc-Master University (WOMAC) were used for the pain, stiffness, and disability assessments of OA patients. X-rays were classified according to the Kellgren-Lawrence (KL) radiographic rating scale. We tested the relationship of metabolic syndrome and its components with the WOMAC score and radiographic findings of knee OA after adjusting for BMI. The prevalence of OA was 83.3% in MetS group compared with 63.3% in control group (P = 0.034). MetS patients with OA had higher WOMAC score and radiographic grading than controls with OA (P = 0.034, 0.019). MetS patients with OA had more waist circumference (WC) (P = 0.022), and higher frequency of hypertension (HTN) and diabetes mellitus (DM) (P = 0.009, 0.002 respectively) than MetS patients without OA. There were significant associations of MetS, WC, HTN, DM, high TG, and low HDL with OA (P = 0.041, 0.007, < 0.001, < 0.001, 0.016, 0.012 respectively) by linear regression analysis. There were also significant associations of MetS with WOMAC score and X-ray grading (P = 0.003, 0.019 respectively) by linear regression analysis. Knee OA is prevalent in patients with MetS and associated with worse pain and functional impairment score and advanced radiographic changes. Abdominal obesity, hypertension, and diabetes are the most common components of MetS in patients with knee OA.