Clinical significance of interleukin-36 alpha and gamma in systemic lupus erythematosus patients: Potential relation to disease activity and subclinical arthritis

Aim of the workTo assess serum of interleukin-36 alpha (IL-36α) and interleukin-36 gamma (IL-36γ) levels in systemic lupus erythematosus (SLE) patients and to explore their association with clinical and laboratory features of SLE and with ultrasound evidence of subclinical hand arthritis.Patients and methodsThe study included 84 SLE patients without overt arthritis and 84 matched controls. The serum levels of IL-36α and IL-36γ were measured and compared between patients and controls. The hands and wrists of all patients underwent musculoskeletal ultrasound evaluation for evidence of subclinical arthritis and tenosynovitis. The SLE disease activity score was assessed for all patients.ResultsThe mean of serum IL-36α (65.5 ± 38.9 pg/ml) and IL-36γ (468.9 ± 315.9 pg/ml) were significantly higher in SLE patients compared to controls (37.9 ± 17.2 pg/ml and 151.1 ± 73.4 pg/ml; p < 0.001 each). IL-36α and IL-36γ had the ability to discriminate between SLE patients and controls with an AUC of 0.69 and 0.83 respectively. Serum IL-36α was significantly correlated with SLEDAI score (p = 0.04), synovitis (p < 0.001),Us erosion score (p = 0.01) and PD signals score (p = 0.002). Serum IL-36γ was significantly correlated with serum creatinine level (p = 0.04). SLE patients with arthralgia had significantly higher IL-36α serum level than patients without (p = 0.04). SLE patients with proteinuria had significantly higher IL-36γ than those without (p = 0.04). The linear regression analysis model revealed that the US evidence of synovitis was the strongest factor associated with the serum level of IL-36α meanwhile proteinuria was the strongest factor associated with the serum level of IL-36γ.ConclusionIL-36αserum level was significantly associated with SLEDAI score, arthralgia and US evidence of subclinical arthritis. IL-36γ serum level was significantly associated with proteinuria.     

Impact of care pathway adherence on recovery following distal pancreatectomy within an enhanced recovery program

BackgroundIn bowel surgery, adherence to enhanced recovery program (ERP) has been associated with improved recovery. The objective of this study was to evaluate the impact of adherence to ERP elements on outcomes, and identify factors associated with successful recovery following distal pancreatectomy (DP).MethodsData for 376 patients who underwent DP managed within an ERP including 16 perioperative elements were reviewed. Primary endpoint was successful recovery, a composite outcome defined as length of hospital stay≤7 days, no severe complications nor readmissions.ResultsPatients had a mean (SD) overall adherence of 76 (14)%. Overall, 166 (44%) patients had a successful recovery. There was a positive association between overall adherence and successful recovery (OR 1.19, 95%CI 1.08–1.31 for every additional element, p = 0.001), while an inverse relationship was found with comprehensive complication index (8% reduction, 95%CI -15 to −2%, p = 0.011). Adherence to postoperative phase interventions had the greatest impact on recovery (OR 1.29, 95%CI 1.13–1.47 for every additional postoperative element; p < 0.001). At multivariable regression, early termination of IV fluids was the only ERP element associated with successful recovery (OR 2.80, 95%CI 1.73–4.54; p < 0.001).ConclusionIncreased adherence to ERP elements was associated with successful early recovery and reduction of postoperative complication severity.     

Serum level of galectin-9 in systemic lupus erythematosus patients with lupus nephritis: Relation to clinical characteristics and disease activity

Aim of the workTo assess galectin-9 (Gal-9) level in the serum of systemic lupus erythematosus (SLE) patients with and without renal involvement and clarify its relation with disease activity.Patients and methods50 SLE patients; 25 with lupus nephritis (LN) and 25 without as well as 25 controls were studied. Systemic Lupus International Collaborating Clinics (SLICC) renal activity score and SLE disease activity index 2000 (SLEDAI-2 K) were determined. Serum Gal-9 was measured in all participants.ResultsGal-9 level was significantly elevated in SLE patients with (16.7; 11.6–33.7 ng/ml) and without (15.9; 11.8–25 ng/ml) compared to controls (3.9; 2.8–5.4 ng/ml) (p < 0.001) but was comparable between the patients groups (p = 0.83). In LN patients, serum Gal-9 and SLICC renal activity score significantly correlated (r = 0.48, p = 0.016). Serum Gal-9 significantly correlated with SLEDAI-2 K in patients with (r = 0.71, p < 0.001) and without (r = 0.95, p < 0.001) LN, with anti-double stranded deoxyribonucleic acid (anti-ds-DNA) titers (with r = 0.57, p < 0.001 and without r = 0.79, p < 0.001) and inversely with C3 (with r = -0.44, p = 0.027 and without r = -0.63, p < 0.001) and C4 (with r = -0.47, p = 0.018 and without r = -0.43, p = 0.03). Gal-9 had an area under the curve (AUC) of 0.96 to distinguish SLE cases from control. However, AUC between LN group and non-nephritic SLE was 0.48. On regression, SLEDAI-2 K was the only significant factor associated with serum Gal-9 (p < 0.001).ConclusionIn SLE patients, significantly raised Gal-9 levels and relation with disease activity were detected indicating its clinical relevance as biomarker of disease activity and its potential value in the disease diagnosis. Its value in discriminating LN from non-nephritic SLE is limited.     

Impact of psycho-educational therapy on disease activity,quality of life,psychological status,treatment satisfaction and adherence in systemic lupus erythematosus patients

Aim of the workTo evaluate the impact of group psychotherapy and patient education on disease activity, quality of life, psychological symptoms, perceived stress, satisfaction to treatment, and medication adherence in systemic lupus erythematosus (SLE) patients.Patients and methodsThis study recruited 80 SLE patients divided equally into intervention and control groups, the intervention group received 12 sessions of group psychotherapy and patient education. SLE disease activity index (SLEDAI) was assessed. The following questionnaires were conducted: Symptom Checklist-90-Revised (SCL-90-R), perceived stress scale (PSS), Short Form 36 (SF36), Treatment Satisfaction Questionnaire for Medications (TSQM), and Medication Adherence Rating Scale-5 (MARS-5).ResultsThe mean age of the patients was 32.3 ± 7.4 years and disease duration 7.5 ± 5.7 years. They were 77 females and 3 males. At baseline, the SLEDAI, global severity index of SCL-90-R, PSS, SF36, TSQM and MARS-5 were comparable between both groups. After 3 months of the psycho-educational program, the intervention group exhibited significant improvement of SCL-90-R: anxiety (p = 0.052), depression (p = 0.002), global severity index (p = 0.001), PSS (p < 0.001), SF36 [limitations due to emotional problem (p < 0.001), emotional well-being (p < 0.001), MCS (p = 0.029), PCS (p = 0.001)], TSQM [effectiveness (p < 0.001), convenience (p = 0.026), side effects (p = 0.001), global satisfaction (p = 0.005) scores] and MARS-5 (p < 0.001) with no significant difference in SLEDAI (p = 0.802).ConclusionIntegration of a psycho-educational program in the management of SLE patients was associated with improvement of depression, anxiety, perceived stress, quality of life, satisfaction with treatment, and medication adherence, with no impact on disease activity.     

Impact of antiphospholipid syndrome on disease characteristics and outcome in patients with systemic lupus erythematosus

Aim of the workTo assess the impact of antiphospholipid syndrome (APS) on systemic lupus erythematosus (SLE) clinical characteristics and disease outcome.Patients and methods216 SLE patients were classified according to the presence of APS into: SLE group (n = 109) and SLE-APS (n = 107). Evaluation of clinical, laboratory tests, immunological tests, SLE disease activity index 2000 (SLEDAI-2 K) and SLE damage index (SDI) were done.ResultsThe 216 patients mean age was 32.1 ± 8.4 years and the F:M was 8.4:1. There was a significantly higher frequency of abortion, neurological and cardiac manifestations (p < 0.001, p = 0.008, p = 0.016 respectively) in SLE-APS group. The SDI was significantly higher in SLE-APS patients (p < 0.001) with special attention to the presence of cerebrovascular accident (CVA) (p = 0.01), pulmonary hypertension (p = 0.04), cardiomyopathy (p = 0.034) and venous thrombosis (p < 0.0001). The frequency of thrombosis and active SLEDAI-2 K visits were significantly related to higher damage in SLE-APS (p < 0.001 and p < 0.001 respectively). Damage in SLE group was associated with hypocomplementemia (p = 0.015) and thrombosis (p = 0.049). Factors associated with damage in all SLE patients were male gender (p = 0.024), serositis (p = 0.02), neurological involvement (p < 0.001), thrombotic events (p < 0.001), cumulative doses of oral (p = 0.02) and pulse (p = 0.004) steroids and frequency of cyclophosphamide (CYC) use (p = 0.003). Predictors of damage included male gender, APS, neurological manifestations, use of steroids and CYC (p = 0.045, OR = 8.5; p < 0.0001, OR = 4.3; p = 0.001, OR = 6.3; p = 0.047, OR = 1.03; p = 0.005, OR = 2.96, respectively).ConclusionAPS adversely affect SLE disease course with prominent impact on end organ damage especially cerebral, cardiopulmonary and vascular events denoting the need for strict control of disease activity and early diagnosis.     

Comparison of sexual function in men with spondyloarthritis and rheumatoid arthritis

Aim of the workTo evaluate sexual function in Tunisian men with spondyloarthritis (SpA) and rheumatoid arthritis (RA) compared to healthy controls. The association between erectile dysfunction (ED) and specific parameters of SpA and RA was also studied.Patients and methodsThe study included 37 SpA, 13 RA patients and 50 healthy age matched controls. Sexual function of patients and controls was evaluated by the International Index of Erectile Function-5. ED was considered if the score was <21. Pain during intercourse and sexual desire were also assessed.ResultsThe mean age of the SpA and RA patients and control were comparable (42.5 ± 11.4 years, 49.6 ± 12.8 years and 48.8 ± 13.9 years). The prevalence of ED in rheumatic disease patients (SpA and RA) was 80% versus 70% in controls. A significant difference was found in the severity of the ED between patients and control (p = 0.04) and between SpA and RA patients (p = 0.012). There was also a higher prevalence of pain during intercourse (p < 0.0001), lower intensity of sexual desire (p = 0.005) and more dissatisfaction in relation with the partner (p < 0.0001) in the RD patients. ED in SpA and RA patients was significantly associated with higher age (p = 0.001), marital status (p = 0.007), higher age of disease’s onset (p = 0.027), pain during intercourse (p = 0.05) and lower sexual desire (p < 0.0001). On regression analysis, only sexual desire was significantly associated with ED (p = 0.03).ConclusionThis work suggests that patients with SpA or RA have a more severe ED in comparison with healthy control. However, specific disease parameters were not linked to ED.     

Utero-placental and cerebrovascular indices in pregnant women with systemic lupus erythematosus: Relation to disease activity and pregnancy outcome

Aim of the workTo assess maternal and fetal vascular indices in SLE patients during pregnancy, and the impact of disease activity on these vascular indices.Patients and methods30 pregnant SLE patients and 30 age -matched healthy females with uncomplicated pregnancies were assessed during the third trimester using ultrasonography (US) and Doppler study to detect fetal biometry, the uterine, umbilical (UA) and fetal middle cerebral (MCA) arterial resistance (RI) and pulsatility (PI) indices, as well as cerebro-placental ratio (CPR). Disease activity was determined using the SLE Disease Activity Index (SLEDAI).ResultsThe mean uterine artery PI, RI and the UA-PI in SLE group were significantly higher than controls (p value < 0.001), but no significant difference as regards UA-RI (p = 0.68) between both groups. There was unilateral uterine artery notch in 20% and bilateral in 6.7% while it was absent in 73.3%. The MCA-PI was significantly lower in SLE group (p = 0.003), Where the MCA-RI showed higher values than control (p < 0.001). The CPR showed a lower significant values for SLE group compared to controls (p < 0.001), while the PR interval was significantly higher in SLE group (p = 0.006). Fetal biometry showed no significant difference between two groups apart from higher abdominal circumference (AC) values in controls (p = 0.01). There was no significant correlation between abnormal vascular indices or biometric parameters and SLEDAI score (p > 0.05).ConclusionPregnancies in SLE are associated with abnormal maternal and fetal vascular indices. Doppler US can identify at-risk pregnancies and optimize the time of delivery; confirming a good pregnancy outcome.     

Sexual dysfunction and physical performance in female systemic lupus erythematosus patients

Aim of the workTo investigate the sexual dysfunction in systemic lupus erythematosus (SLE) patients and its relation to physical fitness and other disease parameters.Patients and methodsThe study included 47 SLE females and 47 matched healthy controls. SLE disease activity index (SLEDAI) and systemic lupus international collaborative clinics damage index (SLICC DI) were assessed. Physical performance of the patients was assessed by the grip ability test (GAT), gait velocity test, Jebsen hand function test, fatigue severity scale (FSS) and the modified health assessment questionnaire (mHAQ). Sexual dysfunction of the patients was assessed by the sexual function index (FSFI). Depressive disorders of the patients were assessed by Beck depression inventory.ResultsThe mean age of the patients was 28.7 ± 7.2 years and disease duration 4.4 ± 2.9 years. GAT was significantly lower (43.65 vs 70.00; p = 0.001), and FSS higher (6.5 vs 1; p = 0.001) in patients compared to control. The total FSFI was significantly lower (23.41 vs 29.60; p = 0.001) and all domains scores were significantly lower except the pain domain (p = 0.001). Beck depression inventory score was higher in patients (13.29 vs 12.74; p = 0.365). SLE females with prescribed corticosteroids and azathioprine had significantly lower FSFI as compared to those without while FSFI score was higher in those receiving hydroxychloroquine. The FSFI significantly correlated with C4 level (r = 0.328, p = 0.024 and inversely with, SLEDAI (r = ?0.07, p = 0.001), FSS (r = ?0.54, p = 0.001), mHAQ (?0.37, p = 0.01) and with Beck depression inventory (r = ?0.57, p = 0.001).ConclusionMarried female patients with SLE revealed a higher degree of sexual dysfunction of all domains except pain.     

Pregnancy outcome in a cohort of Egyptian women with rheumatoid arthritis

BackgroundFemale patients with rheumatoid arthritis (RA) can have successful pregnancies. However, those who experience a higher disease activity during pregnancy and require continued treatment have a potential risk of maternal and neonatal complications.Aim of the workTo assess pregnancy outcome (adverse maternal and neonatal outcomes) in an Egyptian cohort of female RA patients.Patients and methodsThiscross-sectional study involved 200 female RA patients and 100 healthy age-matched controls. All were subjected to detailed gynecological history including: number of pregnancies, miscarriage, mode of delivery, maternal complication (gestational diabetes and preeclampsia), fetal complication (prematurity, low birth weight ‘LBW’ and congenital anomalies) and medicationsused during pregnancy. The disease activity score (DAS28) was assessed pre-conception and in each trimester.ResultsPatients had significantly lower number of pregnancies (p = 0.002) and deliveries (p = 0.001) and higher incidence of miscarriages (p = 0.022) compared to controls. Delivery by Cesarean section (CS) was higher inpatients (p = 0.001) with an increased risk of preeclampsia (p = 0.042). Both the antenatal and natal DAS28 significantly correlatedwith abortions, deliveries by CS and LBW (p = 0.005, p = 0.004 and p < 0.001, respectively). Pre-conceptional methotrexate use significantly correlated with the number of abortions (p = 0.02). Corticosteroid use during pregnancy was related to LBW of newborns (p = 0.03).ConclusionPregnant RA patients have higher frequency of abortion, delivery by CS, preeclampsia and LBW of newborns; especially those having higher disease activity and/ortreated with potentially harmful medications. It is crucial to educate female RA patients about these risks and they should be considered as high-risk pregnancy and followed accordingly.     

Patient reported exposure to smoking and alcohol abuse are associated with pain and other complications in patients with chronic pancreatitis

Background/objectivesSmoking and alcohol abuse are established risk factors for chronic pancreatitis (CP). Few studies have examined how exposure to smoking and alcohol abuse act as risk factors for complications in CP. Our aim was to examine associations between patient reported exposure to smoking and alcohol abuse and complications in CP in a large cohort of patients from the Scandinavian and Baltic countries.MethodsWe retrieved data on demographics, CP related complications and patients’ histories of exposure to smoking and alcohol abuse from the Scandinavian Baltic Pancreatic Club database. Associations were investigated by univariate and multivariate logistic regression analyses. Results are presented as odds ratios (OR) with 95% confidence intervals.ResultsA complete history of smoking and alcohol exposure was available for 932 patients. In multivariate regression analyses, the presence of pain and exocrine pancreatic insufficiency were both significantly associated with history of smoking (OR 1.94 (1.40–2.68), p < 0.001 and OR 1.89 (1.36–2.62), p < 0.001, respectively) and alcohol abuse (OR 1.66 (1.21–2.26), p = 0.001 and 1.55 (1.14–2.11), p = 0.005, respectively). Smoking was associated with calcifications (OR 2.89 (2.09–3.96), p < 0.001), moderate to severe ductal changes (OR 1.42 (1.05–1.92), p = 0.02), and underweight (OR 4.73 (2.23–10.02), p < 0.001). History of alcohol abuse was associated with pseudocysts (OR 1.38 (1.00–1.90) p = 0.05) and diabetes mellitus (OR 1.44 (1.03–2.01), p = 0.03). There were significantly increased odds-ratios for several complications with increasing exposure to smoking and alcohol abuse.ConclusionSmoking and alcohol abuse are both independently associated with development of complications in patients with CP. There seems to be a dose-dependent relationship between smoking and alcohol abuse and complications in CP.     

Left ventricular function and left atrial volumes in rheumatoid arthritis patients: Subclinical cardiac involvement and relation to seropositivity

BackgroundLeft ventricular (LV) dyfunction with preserved ejection fraction has been associated with increased mortality. Left atrium (LA) modulates LV filling and plays a role in maintaining cardiac function. Cardiovascular disease is a leading cause of death in rheumatoid arthritis (RA).Aim of the workTo study the left atrium modulating the left ventricular filling and to investigate its relation with disease activity to detect subclinical early cardiac affection in RA patients.Patients and methods45 RA patients and 30 control were studied. The disease activity score (DAS28) was calculated. Conventional and tissue Doppler imaging (TDI) and strain (S) and strain rate (SR) analysis by two-dimensional speckle tracking of LA were conducted.ResultsThe 45 female patients mean age was 38.8 ± 8.7 years, disease duration was 7.3 ± 6.2 years and mean DAS28 was 4.1 ± 0.9. Regarding the LA emptying fractions, only the 2 LA passive emptying fraction (PEF) and total emptying fraction (TEF) were significantly lower in patients compared to control (p = 0.01 and p = 0.025 respectively). The LA expansion index (EI) was significantly reduced in patients compared to control (p = 0.009). Regarding TDI-derived mitral annular velocities, lateral e’ and s as well as SRe (l/s) were significantly slower in patients compared to control (p = 0.001, p = 0.02 and p < 0.0001 respectively). Rheumatoid factor (RF) was significantly inversely related to TDI laterale, TDI laterals, and strain rate e, LA-PEF, LA-EI and LA-TEF.ConclusionRA patients had alteration in LV longitudinal myocardial function and more LA stiffness. Cardiac affection is more in seropositive patients.     

Synchronous resection of colorectal cancer primary and liver metastases: an outcomes analysis

BackgroundConcurrent resection of the primary cancer and synchronous colorectal cancer liver metastases (CRCLM) was evaluated for differences in outcomes following stratification of both the liver and colorectal resection.MethodsConsecutive cases of synchronous resection of both the CRC primary and CRCLM were reviewed retrospectively at a single, high-volume institution over a 17-year period (2000–2017).Results273 patients underwent simultaneous resection of CRCLM. The distribution of the primary lesion was similar between the colon (52.4%) and rectum (47.6%), while 46.9% of patients had bilobar liver disease. Major liver/major colorectal resection (n = 24) were significantly more likely to experience colorectal specific morbidity (OR 3.98, 95% CI 1.56–10.15, p = 0.004), liver specific morbidity (OR 7.4, 95% CI 2.22–24.71, p = 0.001), total morbidity (OR 2.91, 95% CI 1.18–7.18, p = 0.020) and 90-day mortality (OR 5.50, 95% CI 1.27–23.81, p = 0.023). Failure to receive adjuvant chemotherapy secondary to postoperative morbidity was associated with significantly worsened survival (HR for death 5.91, 95% CI 1.59–22.01, p = 0.008).ConclusionsPostoperative morbidity precluding the administration of adjuvant chemotherapy is associated with an increase in mortality. Combining a major liver with major colorectal resection is associated with a significant increase in major morbidity and 90-day mortality, and should be avoided.     

Methylation of receptor activator of nuclear factor kappa ligand (RANKL) gene in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by synovitis, cartilage damage and bone resorption. Methylation of deoxyribonucleic acid plays a crucial role in repressing gene expression. Receptor activator of nuclear factor-kappa ligand (RANKL) controls bone homeostasis.Aim of the workTo assess the serum level of RANKL and its gene promoter methylation in RA patients and to determine its association with clinical characteristics and disease activity.Patients and methodsThe study included 40 RA patients and 40 control. The disease activity score (DAS28) was assessed. Frequency of RANKL gene promoter methylation was determined by quantitative methylation specific PCR (QMSP) and serum RANKL level by enzyme linked immunosorbant assay (ELISA).ResultsPatients mean age was 46.8 ± 10.6 years, 36 females and 4 males (F:M 9:1) with median disease duration 4.5 years. Positive rheumatoid factor, anti-cyclic citrullinated peptide and C-reactive protein were present in 65 %, 75 % and 55 % of cases. Methylation percentage of RANKL gene promoter was significantly lower in patients (3.4 %) than in controls (3.7 %)(p = 0.035) while serum level was significantly increased in patients (9.1 ng/ml,5.3–11.8 ng/ml) than in controls (5.7 ng/ml, 4.5–8 ng/ml)(p = 0.003). RANKL methylation frequency was inversely associated with serum level (rs = -0.21,p = 0.06). There was no significant correlation of RANKL serum level and methylation with DAS28 (r = 0.03,p = 0.87 and r = 0.06,p = 0.73 respectively). RANKL serum level (>9.5 ng/ml) and methylation percentage (≤9%) significantly discriminate RA cases from control (sensitivity 47.5 %, specificity 91.9 %; p = 0.001 and sensitivity 100 %, specificity 40 %; p = 0.03 respectively).ConclusionRA patients expressed elevated serum RANKL with low methylation.     

Evaluation of serum calprotectin level as a biomarker of disease activity in rheumatoid arthritis and osteoarthritis patients

Aim of the workTo measure the levels of serum calprotectin (CLP) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients and to assess its association with disease activity, severity and functional status.Patients and methodsA total of 30 RA and30 OA patients and 30 controlswere included. Rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), Disease activity score (DAS28), health assessment questionnaire (HAQ) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. Western Ontario and McMaster Osteoarthritis index (WOMAC) and Kellgren-Lawrence (KL) grading scale were assessed in OA patients and serum CLP levels were measured.ResultsThe mean age of RA and OA patients was 48.6 ± 8.6 and 50.8 ± 9.3 years respectively andthe majority of studied groups were females. CLP was significantly higher in RA patients in comparison to OA patients and healthy control (2.70 ± 2.08 vs. 1.18 ± 0.35 vs 1.11 ± 0.24 μg/ml); p < 0.0001). Serum CLP correlated with swollen joint count (SJC) (r = 0.7, p < 0.0001), tender joint count (TJC) (r = 0.73, p < 0.0001), patient global assessment (PGA) (r = 0.51, p = 0.004), Physician global assessment (PhGA) (r = 0.58, p = 0.001), HAQ (r = 0.6,p < 0.0001), erythrocyte sedimentation rate (ESR) (r = 0.5, p = 0.005), DAS28 (r = 0.69, p < 0.0001), RARBIS (r = 0.66, p < 0.0001). At a cut-off value of 2.5 µg/ml CLP can significantly differentiate active RA patients from those in remission (AUC 0.896; p < 0.0001) at a sensitivity of 83.3%, specificity of 88.9%, and accuracy of 86.7%.CLP was significant predictor for RA activity.ConclusionThe serum CLP levels were significantly high in RA patients compared to OA patients and controls and these high levels were associated with disease activity, severity, and functional status.     

Renal arterial resistive index as a noninvasive biomarker of disease activity in lupus nephritis patients

Aim of the workTo evaluate the renal resistive index (RI) in lupus nephritis (LN) patients and to study its association with clinical features, laboratory investigations and LN pathological classes in systemic lupus erythematosus (SLE) patients.Patients and methodsThe study included 45 SLE patients and 25 matched controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into LN (renal SLEDAI ≥ 4) and no-renal activity (NRA) (renal SLEDAI = 0). Ultrasound Doppler renal examination was done to measure RI. Renal biopsies were performed in 30 LN patients.ResultsThe mean age of patients was 29.8 ± 10.1 years and disease duration 4.3 ± 3.9 years. They were 40 females and 5 males (F:M 8:1). Their SLEDAI was 10.9 ± 8.2 and renal SLEDAI was 5.2 ± 5.1. They were 30 with LN and 15 NRA SLE patients. Renal RI was significantly higher in LN patients compared to NRA SLE patients and controls (0.61 ± 0.04 vs. 0.55 ± 0.01 vs. 0.55 ± 0.02; p < 0.0001). RI significantly correlated with anti-double stranded deoxyribonucleic acid (anti-dsDNA) positivity (r = 0.33, p = 0.03), 24-hour proteins in urine (r = 0.38, p = 0.01) and negatively with creatinine clearance (r = -0.33, p = 0.03). Renal RI significantly correlated with pathological classes of renal biopsy (r = 0.65, p < 0.0001). At renal RI cut-off value 0.57 renal RI can detect renal activity with sensitivity of 83.3%, specificity of 82.5%, p < 0.0001. Renal RI ≥ 0.57 had higher activity index score compared to those with normal RI (5.7 ± 0.6 vs. 9 ± 3.3, p = 0.04). Conclusion: Renal RI was significantly increased in LN compared to NRA patients and was associated with laboratory parameters and pathological classes.     

The role of musculoskeletal ultrasound in assessment of disease activity in rheumatoid arthritis patients with fibromyalgia

IntroductionFibromyalgia (FM) is frequently present in rheumatoid arthritis (RA) patients and this can lead to an overestimation of disease activity and consequently overtreatment. Musculoskeletal ultrasound (MSUS) can aid in evaluating synovitis for assessment of disease activity with more precision.Aim of the workTo verify the potential role of MSUS in the assessment of disease activity in RA patients with and without FM.Patients and methodsThis study was conducted on 100 active RA patients. Disease activity score (DAS28) and clinical disease activity index (CDAI) were assessed. MSUS was assessed using the 12 joint simplified score.ResultsThe 100 patients were 88 females and 12 male (F:M 7.3:1) with a mean age of 44.82 ± 11.4 years and disease duration of 6.88 ± 5.77 years. 67 RA patients had associated secondary FM and 33 did not. DAS-28 and CDAI were significantly higher in those with FM (4.99 ± 0.82 and 30.49 ± 10.59) compared to those without (4.22 ± 0.96 and 18 ± 10.68)(p < 0.001). Regarding ultrasonographic finding, no significant difference was found between those with and without FMS. DAS28 and CDAI significantly correlated (p = 0.006, p = 0.002 respectively) with grey scale ultrasound (GS-US12) in patients without FMS while DAS28 only significantly correlated with GS-US12 in those with FMS (r = 0.28, p = 0.022).ConclusionSecondary FM is common in RA patients and associated with a higher disease activity making it a potential influencer on the treatment strategy. MSUS can complement physical examination in the assessment of disease activity but had a limited role to delineate RA patients with FM from those without.     

Galectin-3 and interleukin-7 as potential serologic markers in rheumatoid arthritis patients

Aim of the workTo assess the level of serum galectin-3 and interleukin-7 (Il-7) in rheumatoid arthritis (RA) patients and to study their association with disease activity as well as other disease parameters.Patients and methodsSerum samples from 66 RA patients and 20 matched controls were tested for galectin-3 and IL-7 using enzyme-linked immunosorbent assay (ELISA). Disease activity was assessed using disease activity score (DAS28).ResultsThe mean age of the patients was 46.6 ± 12.02 years, mean disease duration was 7.5 ± 7.6 years and they were 61 females and 5 males. The mean DAS28 of the patients was 4.72 ± 1.77. Serum galectin-3 and IL-7 were higher in RA patients (7.7 ± 5.7 ng/ml and 9.03 ± 5.97 pg/ml) than the control (1.5 ± 0.8 ng/ml and 1.6 ± 1.1 pg/ml) (p < 0.001). Serum galectin-3 and IL-7 significantly correlated with age (r = 0.27, p = 0.03 and r = 25, p = 0.04), DAS28 (r = 0.64, p < 0.001 and r = 39, p = 0.001), as well as to each other (r = 0.48, p < 0.001). Serum galectin-3 significantly correlated with ESR (r = 0.29, p = 0.018) and significantly higher in those with fever (p = 0.017). At a cutoff of 2.94 ng/ml, serum galectin-3 showed 84.8% sensitivity and 100% specificity (p < 0.001) and at 2.71 pg/ml, serum IL7 showed a sensitivity of 92.4% and a specificity of 95% (p < 0.001) to diagnose RA.ConclusionSerum galectin-3 and IL-7 were higher in patients than in controls and were increased with high disease activity making them promising biomarkers for RA. Both of them showed high diagnostic power for RA. This may provide further understanding of RA pathogenesis and suggest new therapeutic interventions.     

Potential value of collagen triple helix repeat containing-1 (CTHRC1) in systemic lupus erythematosus (SLE) patients with arthritis detected clinically or by musculoskeletal ultrasound

Aim of the workIs to measure collagen triple helix repeat containing 1 (CTHRC1) in systemic lupus erythematosus (SLE) patients and assessing its value as a marker of arthritis.Patients and methodsThis study included 44 female SLE patients and 44 matched healthy controls. All patients underwent hand and wrist Ultrasound (US) examination. Patients were divided into those with arthritis either clinically or sub-clinically by Ultrasound (A) and second one without arthritis. Serum level of CTHRC1 was measured using Enzyme linked immunosorbent assay. Disease activity was assessed using SLEDAI-2 K and joint activity using swollen to tender ratio (STR).ResultsSerum CTHRC1 level was significantly higher in patients compared to controls (52.3 ± 25.7 ng/ml and 14.5 ± 3.9 ng/ml respectively, p < 0.001). It was significantly higher in renal patients with nephritis and active arthritis by STR compared to those without (p = 0.04 and p = 0.003 respectively). Arthritis was detected in 68% of patients and they showed significantly higher CTHRC1 levels compared to those without (p = 0.037). Serum CTHRC1 showed positive significant correlation with STR (P = 0.007), CRP (p < 0.001), SLEDAI-2 K (p = 0.01) but not US findings. The STR showed significant association with CTHRC1 on regression analysis (p = 0.034). There was a fair ability for CTHRC1 to predict clinical and sub-clinical arthritis among SLE patients with sensitivity 56.7, specificity 85.7 at cut off value >55 ng/ml and area under curve 0.67.ConclusionSerum CTHRC1 level was significantly higher in SLE patients with nephritis and arthritis. It was significantly related to arthritis activity, inflammatory markers and disease activity. However, it showed fair performance for detecting arthritis.     

Clinical utility of urinary soluble CD163 in evaluation of lupus nephritis patients

Aim of the workTo assess urinary soluble CD163 (sCD136) in systemic lupus erythematosus (SLE) patients compared to healthy controls. In addition to determine its association with different SLE clinical features, laboratory investigations and pathological indices focusing on those suggest renal disease activity.Patients and methodsThe study included 58 SLE patients and 30 controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into active lupus nephritis (ALN) (renal SLEDAI ≥ 4) and no-renal activity (NRA) SLE patients (renal SLEDAI = 0). Urinary sCD163 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). Urine values were normalized to urinary creatinine excretion. Renal biopsies were performed in 21 ALN patients.ResultsThey were 54 females and 4 males with a mean age 31.8 ± 9.1 years and disease duration 6.2 ± 4.8 years. They were 31 with ALN and 27 NRA SLE patients. Urinary sCD163 level was significantly higher in SLE patients (1.85 ± 0.3) than controls (0.5 ± 0.36, p < 0.001). In ALN, it was significantly higher (2.91 ± 2.52) compared to NRA SLE patients (0.64 ± 0.38) and controls (p < 0.001 in both). The optimum cut-off value above which normalized urinary sCD136 can predict renal activity was > 0.82 with sensitivity of 90.3%, specificity of 88.89%, p < 0.001. Urinary sCD163 significantly correlated with renal (r = 0.75, p < 0.001) but not with extra-renal SLEDAI. It correlated with activity index of renal biopsy (r = 0.46, p = 0.038).ConclusionUrinary sCD163 is a potential biomarker for LN activity. Its level is associated with clinical features, laboratory investigations and pathological indices that indicate renal disease activity.     

Clinical significance of interferon lambda-3 (IFNλ3)/interleukin 28B (IL28B) in systemic lupus erythematosus patients

BackgroundInappropriate and excessive activation of type I interferon (IFN) system is a key feature of systemic lupus erythematosus (SLE), and its targeting has led to important achievements in the development of novel drugs for SLE.Aim of the workTo evaluate the serum levels of interferon lambda IFNλ3 (IL28B) in Egyptian patients with SLE and investigate its potential relation with different clinical and laboratory parameters.Patients and methodsThe study included 40 SLE patients and 40 controls. The SLE disease activity index (SLEDAI) was assessed. The measurement of serum levels of IFNλ3 was performed in all participants using enzyme linked immunosorbent assay (ELISA).ResultsThe mean age of the patients was 26.8 ± 7.8 years with disease duration 5.1 ± 4.5 years and they were 35 females and 5 males. The serum levels of IFNλ3 were significantly higher in SLE patients (9.7 ± 12.47 pg/mL) compared to the control (5.13 ± 1.63 pg/mL)(p = 0.02). Significant correlations were observed between serum IFNλ3 and serositis (r = 0.35,p = 0.03), C3 consumption (r ?0.33, p = 0.04) and SLEDAI (r 0.34, p = 0.03). On multivariate regression analysis, serositis and SLEDAI (but not C3) were significant independent predictors of IFNλ3 levels (β = 0.08, p = 0.037 and β = 0.06, p = 0.014 respectively).ConclusionThe results support a possible role of IFNλ3/IL28B in the immunopathogenesis of SLE. The significant association of serum IFNλ3 with disease activity highlights the utility of IFNλ3 as a novel biomarker for monitoring disease activity and predicting severity in SLE. Further studies on IFNλ3 in SLE could be promising in the development of personalized therapy for lupus patients.