Quality of life assessment in Egyptian rheumatoid arthritis patients: Relation to clinical features and disease activity

Aim of workTo assess the impact of rheumatoid arthritis (RA) on the health related quality of life (QoL) of patients, using the 36-item short form (SF-36) and to study the influence of different disease variables.Patients and methodsEighty-six RA patients were recruited from the Rheumatology and Rehabilitation outpatient of Assiut University Hospital. Forty-three, age and sex matched subjects were included as controls. The QoL was measured in all subjects using the SF-36 health survey. Disease activity was assessed in RA patients by the disease activity score (DAS28).ResultsAll domains of the SF36 were significantly lower in the patients (p < 0.0001). Patients with a lower educational level and those unemployed had significantly lower SF36 components. Those with a disease duration >5 years, positive rheumatoid factor and higher disease activity had a significantly lower SF36 physical component. Patients receiving hydroxychloroquine or prednisolone had significantly lower mental component. Significant negative correlation of the SF36 physical and mental components was found with both disease duration (p = 0.01 and p < 00001 respectively) and DAS28 (p < 0.0001 for both). Rheumatoid factor negatively correlated with the physical component (p < 0.0001). Regression analysis showed that disease duration was the most profound predictor of both SF36 components (p < 0.0001).ConclusionThe quality of life is impaired in Egyptian RA patients and disease duration was the most significant predictor. Routine assessment of the health-related QoL in those patients is recommended to detect and monitor the impact of the disease and medications used on different aspects of their quality of life.     

Correlation between synovial vascular endothelial growth factor,clinical, functional and radiological manifestations in knee osteoarthritis

Aim of the workTo correlate between synovial vascular endothelial growth factor (VEGF), clinical, functional and radiological findings in knee osteoarthritis (KOA) patients.Patients and methodsTwenty patients with primary KOA were clinically examined and the modified Ritchie articular index (RAI) recorded. The knees were examined and knee pain evaluated by the visual analog scale (VAS) and tenderness by the knee subscale of the RAI. The Western Ontario Mc Master scale (WOMAC) was recorded and the Kellgren–Lawrence grading used to assess radiographic severity. The synovial level of VEGF was assessed using ELISA.ResultsThe mean age was 56.15 ± 7.77 years and body mass index 28.1 ± 4.04. All patients had knee effusion; 40% were bilateral and 60% unilateral. The mean duration of knee pain was 3.01 ± 1.43 years; duration of morning stiffness was 15.75 ± 3.72 min. The mean WOMAC was 44.22 ± 11.46 and modified RAI 5.45 ± 2.94. The mean knee subscale of RAI was 2.9 ± 1.16 and VAS for knee pain 5.7 ± 2.92. The mean synovial VEGF level was 693.71 ± 314.63 pg/ml. There was a significant increase in the synovial VEGF compared to the reference value (p = 0.0001). There was a significant correlation between the synovial VEGF and patients’ age (p = 0.04), knee pain duration (p = 0.025), morning stiffness (p < 0.0001), modified RAI (p = 0.0001), knee subscale of RAI (p < 0.0001), VAS for knee pain (p < 0.0001) and WOMAC (p = 0.0001). There was a significant negative correlation between synovial VEGF and muscle strength grading (p = 0.0001) and a significant correlation with the radiological assessment (p = 0.0001).ConclusionSynovial VEGF significantly correlated with clinical manifestations, functional impact, as well as radiological changes of KOA.     

Assessment of mitral valve geometric deformity in patients with ischemic heart disease using three-dimensional echocardiography

Background

A full understanding of the geometry of the nonplanar saddle-shaped mitral annulus can provide valuable information regarding the pathophysiology of mitral regurgitation (MR).

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study

Background/objectives

Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL).

Assessment of health-related quality of life,anxiety and depression in patients with early rheumatoid arthritis

Aim of the workTo assess the effect of clinical manifestations, disease activity and medications on health-related quality of life (HRQoL) among patients with early rheumatoid arthritis (RA).Patients and methodsTwenty-six early RA patients (mean age 43.31 ± 10.51 years, disease duration: 16.5 ± 5.2 months) diagnosed according to the 2010 RA classification criteria were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department, Sohag University, and 22 age and sex matched healthy persons participated in a case control study. Demographic data were taken from all participants in the study. The 36-item short-form health survey (SF-36) and Hamilton Anxiety Rating Scale (HAM-A) were assessed as measures of HRQoL and psychiatric comorbidity for both patients and controls. Disease activity in RA was assessed using the disease activity score (DAS28). Scoring algorithms were applied to produce the physical and mental component scores (PCS and MCS).ResultsThere was statistically significant difference in the total SF36 score, anxiety and depression scores of HAM-A scale between patients and controls. The PCS showed the highest significant difference (p < 0.0001), followed by SF36 (p = 0.01) and MCS (p = 0.024). There were no significant differences according to the age, gender, occupation or level of education of the patients. Anxiety and depression scores significantly correlated with the bodily pain and DAS28 scores and inversely with the PCS and MCS. The DAS28 strongly negatively correlated with the PCS and MCS.ConclusionRheumatoid arthritis has a major impact on many areas of an individual’s life and tends to have a profound impact on the health-related quality of life.     

Quality of life in fibromyalgia,osteoarthritis and rheumatoid arthritis patients: Comparison of different scales

Aim of the work

To compare fibromyalgia syndrome (FMS), osteoarthritis (OA) and rheumatoid arthritis (RA) patients in terms of their measured quality of life (QoL).

Illness perceptions and quality of life in families with child with atopic dermatitis

ObjectiveTo assess the Quality of Life (QoL) of children with Atopic Dermatitis (AD) and their families and the impact of the mothers’ illness perceptions on the family QoL.Materials and methodsSeventy-five children with AD (54 infants and 21 children) and their mothers participated in the study. The following questionnaires were administrated: 1. Brief Illness Perception Questionnaire (Brief IPQ); 2. Infant's Dermatitis Quality of Life Index (IDQOL); 3. Children's Dermatology Life Quality Index (CDLQI); 4. Dermatitis Family Impact Questionnaire (DFIQ) and 5. The Severity Scoring of Atopic Dermatitis (SCORAD).ResultsAtopic dermatitis had a moderate impact on the QoL of the infants (6.67 ± 5.30), children (7.86 ± 7.19) and their families (9.42 ± 7.03). The DFIQ was associated with certain dimensions of the Brief IPQ, specifically, with Illness Identity (greater symptom burden) (r = 0.615, p = 0.000), beliefs about the Consequences of the illness (r = 0.542, p = 0.000), the Concerns (r = 0.421, p = 0.000) and the Emotional Representations (r = 0.510, p = 0.000). Correlation was demonstrated between IDQOL and DFIQ (r = 0.662, p = 0.000) and between CDLQI and DFIQ (r = 0.832, p = 0.000), and a weaker correlation between SCORAD and DFIQ (r = 0.255, p = 0.035). The chronicity of the AD showed negative association with DFIQ (p < 0.001).ConclusionsThe QoL of families with a child with AD is associated with the mother's illness perceptions about AD, the children's QoL and with both the severity and the chronicity of the disease. Therefore, clinicians should pay attention not only to the clinical characteristics of the children, but also to the parents’ beliefs and emotions, to improve the family QoL.     

Interstitial lung disease in Egyptian patients with rheumatoid arthritis: Frequency,pattern and correlation with clinical manifestations and anti-citrullinated peptide antibodies level

Introduction

Interstitial lung disease (ILD) represents 13% of the overall mortality in rheumatoid arthritis (RA) patients.

Comparing D-dimer status in children with familial Mediterranean fever during and in between acute attacks

Aim of the work

To compare the D-dimer status in children with familial Mediterranean fever (FMF) during, and in between acute attacks.

The impact of fatigue on health related quality of life in adolescents with benign joint hypermobility syndrome

Benign Joint Hypermobility Syndrome (BJHS) is a major source of morbidity in children and adolescents. Due to fatigue and pain, activities of daily living may be limited.Aim of the workTo investigate the relationship between fatigue and health related quality of life in adolescents with BJHS.Patients and methodsThirty adolescents with BJHS and 30 controls were enrolled in the study. All participants were subjected to clinical and laboratory assessment to exclude other causes of fatigue. All were requested to complete self assessment Pediatric Quality of Life (PedsQL) and multidimensional fatigue scale questionnaires. Pain was assessed by Visual Analogue Scale (VAS).ResultsCompared to healthy adolescents, patients with BJHS had a significant lower total score for PedsQL scale (52.56 ± 8.40 and 87.63 ± 4.68 for patients and controls respectively, p < 0.001) and a significant lower total score for multidimensional fatigue scale (66.09 ± 13.05 and 91.32 ± 3.97 for patients and controls respectively, p < 0.001). General and cognitive fatigue that accompanied BJHS, were the only significant predictors of lower health related quality of life in patients’ group. Among patients with BJHS; general fatigue was a significant predictor for emotional and social function impairment, while cognitive fatigue was a significant predictor for school function reduction. Total multidimensional fatigue scale score, general and cognitive fatigue were predictors of physical function impairment in patients and controls. VAS was highly correlated to PedsQL (r = ?0.88, p = <0.001) and multidimensional fatigue (r = ?0.99, p = <0.001) scales.ConclusionThis study highlights the importance of fatigue as a significant predictor of poor health related quality of life in adolescents with BJHS.     

Correlation of physical aptitude; functional capacity,corporal balance and quality of life (QoL) among elderly women submitted to a post-menopausal physical activities program

The objective of this study was to evaluate the effect of physical activity from the “Menopause in Form” program on physical aptitude, functional capacity, corporal balance and QoL among elderly women. In addition, correlations among these variables were examined. The present work was a longitudinal study that was quasi-experimental and correlational. A total of 323 elderly women (age: 69.0 ± 5.53 years) participated in this study. Subjects were non-institutionalized, post-menopausal individuals residing at the Elderly Care Center in Belém Municipality (Pará, Brazil) and practiced one activity (i.e., dancing or walking) over a 10-month period. The assessment protocols used were the following: the Fullerton functional fitness test battery (physical aptitude); the activities of daily living (ADL) indices (functional capacity); the Tinetti-scale (corporal balance); and the WHOQOL-OLD questionnaire (QoL). The adopted significance level was p < 0.05. Results from the Wilcoxon test demonstrated significant differences for the post-test assessment of functional capacity (Δ% = 5.63%; p = 0.0001) and general QoL (Δ% = 9.19%; p = 0.001). These results suggest that the physical activities employed during the “Menopause in Form” program resulted in significant improvements in the functional capacity and QoL of post-menopausal elderly women.     

Determinants of atherosclerosis in an Egyptian cohort of systemic sclerosis: Relation to disease activity and severity

BackgroundSystemic sclerosis (SSc) is a rare multi-system autoimmune disease characterized by vascular abnormalities with an increased prevalence of macrovascular disease.Aim of the workTo evaluate macro-vascular disease (atherosclerosis) in SSc patients and determine its relation to the disease activity and severity.Patients and methodsTwenty-five SSc patients and 20 matched controls were included. The modified Rodnan skin score (mRss) and disease severity by Medsger’s severity score were assessed. Carotid intima-media thickness (IMT) and flow mediated vasodilatation (FMD) of the brachial artery were measured. Traditional vascular risk factors were assessed by thorough history taking and laboratory investigations.ResultsThe age of the patients ranged from 15 to 60 years and they were 22 females and 3 males. 15 had limited and 10 diffuse cutaneous SSc. All SSc patients had an increased IMT (1.24 ± 0.29 mm) which was normal in the control subjects (0.77 ± 0.09 mm) (p < 0.0001). SSc patients had significantly lower HDL, thickened IMT and lower FMD than controls (p = 0.005, p < 0.0001 and p < 0.0001 respectively). The younger age of disease onset was significantly associated with more FMD impairment (r = −0.4, p = 0.04) and Medsger’s severity score (r = 0.5, p = 0.009). The mRss and Medsger’s severity score significantly correlated with the IMT (r = 0.84, p = 0.01 and r = 0.56, p = 0.003 respectively). A significant negative correlation was found between FMD and IMT (r = −0.77, p < 0.0001). Medsger’s severity score significantly correlated with FMD (r = −0.44, p = 0.02).ConclusionSSc is associated with an increased risk of atherosclerosis when compared to age and sex-matched controls. Determinants of this include; younger age of disease onset and more sever disease and low levels of HDL.     

Evaluation of plasma basic fibroblast growth factor (bFGF) in primary knee osteoarthritis patients

Aim of the work

The aim of this study was to investigate plasma basic fibroblast growth factor (bFGF) levels in patients with primary knee osteoarthritis (KOA) and to correlate it with physical performance, functional status and radiological severity.

Liver fatty acid binding protein: A potential urinary and tissue biomarker for lupus nephritis

Aim of the work

To assess urinary liver fatty acid binding protein (uL-FABP) levels and tissue expression (tL-FABP) in renal biopsies of active and inactive lupus nephritis (LN) patients and examine their relationship with disease characteristics.

Clinical significance of fibromyalgia syndrome in different rheumatic diseases: Relation to disease activity and quality of life

Objective

To describe the frequencies of fibromyalgia syndrome (FMS) in various rheumatic diseases; rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and Behçets disease (BD) patients and to study the relation to clinical manifestations and quality of life (QoL).

Bilateral adrenalectomy in Cushing's disease: Altered long-term quality of life compared to other treatment options

Objective

Bilateral adrenalectomy (BADX) has become an important treatment of Cushing's disease (CD), especially when other treatment options have failed. The aim of this study was to evaluate the long-term quality of life (QoL) of patients having undergone BADX for CD, in comparison to other therapeutic options.

Esophageal motor function in Familial Mediterranean Fever: A prospective evaluation of motility in 31 patients

BackgroundThe aims of this study were to evaluate esophageal motor function in patients with Familial Mediterranean Fever (FMF) who had upper gastrointestinal symptoms and to compare esophageal motor function between FMF patients who developed amyloidosis and patients without amyloidosis.Methods31 FMF patients with dyspeptic symptoms and 31 healthy age-matched individuals were included in the study. Endoscopic examination and esophageal motility testing were performed.ResultsEsophageal motor abnormalities were detected in 25.8% (8/31) of these patients [incomplete Lower esophageal sphincter (LES) relaxation: n = 4, esophageal hypomotility: n = 2, and hypotensive LES: n = 2]. Median LES relaxation (%) (min–max) was significantly lower in patients with FMF compared to control group 94% (54–100) vs. 98% (80–100), p = 0.019 respectively). However, mean LES pressure (mmHg) (19.5 ± 8.9 vs. 19.7 ± 5.6, p = 0.813), duration of LES relaxation (s) (7.9 ± 1.7 vs. 8.7 ± 1.7, p = 0.068), contraction amplitude of esophageal body (mmHg) (60.4 ± 23.3 vs. 58.2 ± 19.7, p = 0.691) and median (min–max) peak velocity (s) [3.1(? 1.43–50.3) vs. 3.1 (0.9–8.7), p = 0.435] were similar in patients with FMF compared to control group. There were no significant differences with regard to LES pressure, LES relaxation, LES relaxation duration, contraction amplitude (mmHg) and peak velocity (sc) among patients with FMF and amyloidosis, amyloidosis negative FMF patients and healthy controls.ConclusionsAbnormal esophageal manometric findings can be observed at least in a subgroup of patients with FMF regardless of amyloid status. Investigation of esophageal motor function in patients with FMF who exhibit unexplained upper gastrointestinal symptoms between attacks may be a helpful tool in order to delineate esophageal motor dysfunction.     

Clinical experience with exenatide in a routine secondary care diabetes clinic

Exenatide use in type 2 diabetes is limited in routine clinical practice. We examined a cross-section of 90 patients. Mean weight and HBA_1c were 114.9 ± 20.6 kg, 10.3 ± 2.1% at initiation; 108.0 ± 15.3 kg (p < 0.0001), 9.0 ± 2.1% (p < 0.001) at 3 months; 109.2 ± 18.2 kg (p < 0.0001), 9.5 ± 2.3% (p = 0.08) at 6 months. Exenatide appears effective in reducing HBA_1c and weight.     

Exercise-induced quantitative microvolt T-wave alternans in hypertrophic cardiomyopathy

Background/Purpose

Patients with hypertrophic cardiomyopathy (HCM) have elevated risk for sudden cardiac death (SCD). Our study aimed to quantitatively characterize microvolt T-wave alternans (TWA), a potential arrhythmia risk stratification tool, in this HCM patient population.