Consensus Evidence-Based Clinical Practice Recommendations for the Diagnosis and Treat-To-Target Management of Osteoporosis in Chronic Kidney Disease Stages G4-G5D and Post-transplantation: An Initiative of Egyptian Academy of Bone Health.

Objective: The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Methods: Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. Results: The surveys were sent to an expert panel (n = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. Conclusion: A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management.

Health-Related Quality of Life in Patients with Ankylosing Spondylitis: Relationship with Disease-Related Variables.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of ambiguity of measurement choice. AIM: To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a diseasespecific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity. METHODS: A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated Qol. RESULTS: Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively. CONCLUSION: QoL was impaired in AS patients with highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.

Serum Level of Interleukin-37 and Expression of Its mRNA in Ankylosing Spondylitis Patients: Possible Role in Osteoporosis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton.Interleukin-37 (IL-37) is a member of IL-1 family cytokines, that downregulate expression of pro-inflammatory cytokines in chronic inflammatory diseases. The aim of the work is to investigate role of IL-37 in AS disease activity and osteoporosis. Twenty-five patients with AS and 25 controls were enrolled into this study. They were subjected to full clinical examination including assessment of disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Serum IL-37 levels and IL-37 mRNA relative concentration were measured by enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcriptase- polymerase chain reaction (RT-PCR) respectively. Bone mineral density (BMD) was determined using dual energy X-ray absorptiometry (DEXA). Spine radiographs were scored using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Mean serum IL-37 level was significantly higher in AS patients compared with the controls (P < 0.001) and significantly elevated in AS patients with osteoporosis (P < 0.05). IL-37 mRNA gene expression showed a significant increase expression in active AS patient (25 folds) as well as in inactive patient (12 folds) as compared to controls . In conclusion, serum IL-37 and its mRNA expression is increased in AS patients with special consideration in patient with Osteoporosis and correlates with disease activity and BMD which indicate that IL-37 may provide a novel research target for pathogenesis and therapy of AS. .

Role of T helper 17 cells in the pathogenesis of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that occurs in genetically prone individuals. Autoimmunity could not be simply explained by Th1/Th2 cell paradigm. T helper 17(Th17) cells producing the cytokine interleukin-17 (IL-17) may explain the promotion and progression of autoimmune phenomena. This study aimed to investigate the role of Th17cells, IL-17 and interleukin-23 (IL-23) in the pathogenesis of SLE and their correlation with disease activity. The frequencies of circulating Th17 cells in 15 patients with active SLE, 15 patients with inactive disease and 15 healthy control subjects were measured using Flowcytometry after stimulation with phorbol myristate acetate (PMA) and ionomycin for 4 hours. Serum levels of IL-17 and IL-23 were measured using the enzyme linked immunosorbent assay (ELISA). Significantly higher mean frequencies of circulating Th17 cells were found in active SLE patients (1.54 +/- 0.38%, P < 0.001) and inactive SLE patients (1.23 +/- 0.25%, P = 0.009) compared to the control group (0.88 +/- 0.41%). The frequencies of circulating Th17 cells positively correlated with the SLEDAI score (r = 0.812, P < 0.001). The serum levels of IL-17 and IL-23 were significantly higher in active SLE (P < 0.001) and inactive SLE patients (P < 0.001) than the control group while, serum levels of both cytokines correlated positively with SLEDAI score (r = 0.661, P < 0.01 and r = 0.701, P < 0.01 respectively). There was significant positive correlation between the frequency of circulating Th17 cells and plasma levels of IL-17 and IL-23 (r = 0.789, P < 0.001) and (r = 0.792, P < 0.001) respectively. Results of this study provides evidence of a role of Th17 cells in the pathogenesis of SLE, and offer scientific rationale for the utility of Th17 cells, IL-17 and IL-23 as biological markers for SLE disease activity. This would raise the possibility of anti-IL-17 and anti-IL-23 as innovative therapeutic options in controlling disease activity of SLE.