Mohammed Hassan Abu-Zaid

Background and objectives: Systemic sclerosis (SSc) is a heterogeneous and debilitating multi-system autoimmune disease characterized by widespread microvascular vasculopathy and progressive multi-organ fibrosis. While localized cohorts have been described, there is a critical need for a standardized, national-scale multicenter validation to fully capture the epidemiological and phenotypic characteristics of SSc in Egypt. This study aimed to delineate the nationwide clinical, serological, and functional landscape of systemic sclerosis across Egypt utilizing the standardized EUSTAR registry framework across major geographic referral centers. Methods: A multi-center, retrospective registry-based review was conducted on 354 Egyptian SSc patients enrolled within the international EUSTAR database. Longitudinal and cross-sectional data were extracted across standardized registry parameters, including detailed demographics, clinical subsets (LeRoy criteria), comprehensive organ system involvement (evaluated via high-resolution computed tomography [HRCT], echocardiography, and nailfold capillaroscopy [NFC]), autoantibody profiles, and patient-reported quality-of-life indices (HAQ-DI and L-PF questionnaires). Results: The cohort demonstrated a prominent female predominance (89.3%) with a mean overall age of disease onset of 37.6 + 13.5 years. Limited cutaneous SSc was the most frequent phenotype (53.1%), though an exceptionally high rate of diffuse cutaneous SSc was documented (42.2%). Marked microvascular severity was evidenced by a high prevalence of active digital ulcers (56.7%), a history of digital gangrene (10.8%), and a dominant “active” capillaroscopic microangiopathy pattern (47.8%). Visceral organ involvement was highly pervasive: gastrointestinal reflux and dysphagia affected 78.7% and 75.4% of patients, respectively, while Gastric Antral Vascular Ectasia (GAVE) was remarkably frequent at 20.9%. Objective interstitial lung disease (ILD) was confirmed on HRCT in 46.8% of evaluated patients ( n = 47/101), with ground-glass opacification documented in 70.4%, and an echocardiographic high probability of pulmonary hypertension (PH) was documented in 11.8% ( n = 40/342 valid cases). Serological evaluation revealed a highly robust seropositive footprint with elevated rates of anti-Scl70 (51.0%) and anti-centromere (55.6%) autoantibodies. Symptomatic inflammatory arthritis was reflected by a moderate mean disease activity index (DAS28-ESR: 4.4 + 1.3). Conclusion: The national Egyptian SSc phenotype is characterized by an significant microvascular burden, an elevated diffuse cutaneous subset rate, and widespread gastrointestinal and active inflammatory pulmonary involvement. The cohort exhibits a unique serological signature featuring highly robust autoantibody positivity and significant systemic inflammation, highlighting the urgent need for targeted national screening algorithms and specialized therapeutic access.

Background: Rheumatoid arthritis (RA) is associated with increased risk of fractures due to decreased bone mass. Sclerostin is a glycoprotein that suppresses bone formation. It is expressed in osteocytes and some chondrocytes and works by suppressing osteoblast activity. This study aimed to assess the relation between serum sclerostin and rheumatoid disease activity, bone mineral density (BMD) and subsequently fracture risk. Patients and methods: This case-control study included 50 premenopausal RA female (aged 18–50 years), and 50 healthy controls (aged, sex matched). Serum sclerostin level was assessed for all participants. Disease activity score (DAS28), BMD and fracture risk assessment tool (FRAX) were assessed for RA patients. Results: RA patients showed higher levels of serum sclerostin compared to healthy controls, with mean (6.63 ± 4.60 vs. 4.62 ± 2.09 ng/mL, p = 0.047). Serum sclerostin was not correlated with DAS28. There was a negative correlation between serum sclerostin and radius T-score ( r = − 0.298, p = 0.036), and Z-score ( r = -0.278, p = 0.049). No correlations were found between serum sclerostin and femoral neck BMD, lumbar spine (T- and Z-scores), or major osteoporotic or hip fracture scores. DAS28 was negatively correlated with radius T-score ( r = − 0.295, p = 0.038) and radius Z-score ( r = − 0.340, p = 0.016). FRAX scores (major osteoporotic fracture and hip fracture) were positively correlated with age ( r = 0.646 and 0.397, respectively; both p < 0.01) disease duration ( r = 0.480 and 0.426 respectively; both p < 0.01), in addition to the duration of steroid therapy, particularly the duration of the minimum dose ( r = 0.357 and 0.460, p = 0.011 and 0.001 for major osteoporotic and hip fracture, respectively), and with the duration of the maximum dose for hip fracture ( r = 0.300, p = 0.034). Conclusion: Serum sclerostin level is elevated in women with RA compared to healthy controls and is related to reduced peripheral BMD. Progressive disease factors such as longer disease duration, older age and higher disease activity, may contribute to worsening bone health and increased risk of hip and major osteoporotic fractures. Additionally, prolonged corticosteroid therapy may further exacerbate fracture risk. Overall, these findings highlight that BMD declines with advancing RA duration and activity, underscoring the importance of monitoring both disease progression and treatment exposures to mitigate fracture risk. Tight control of disease activity in RA patients is essential, as it may help preserve BMD and reduce the risk of OP. The use of steroids should be carefully limited to the lowest effective dose and shortest possible duration, particularly in patients at high risk of bone loss.

Objective: 1. To develop a scoring system for the GCA Disease Activity 2. To validate the composite of the GCA Disease Activity Score (GCA-DAS). 3. To assess the GCA-DAS feasibility and effectiveness in the routine clinical setting for monitoring and assessment of treatment outcomes of GCA. Methods: The developed GCA-DAS includes acute temporal headache, visual deficit, physician global assessment of disease activity, patient global assessment of well-being, and ESR, rated on 0–10 scale. These variables have been identified as the main GCA outcome measures and criteria for improvement. Validation analyses were conducted on 124 patients and included assessment of construct validity, discriminant validity, and responsiveness to change. Results: The GCA-DAS was found to hold face and content validity, good construct validity, satisfactory internal consistency, appropriate dimensional structure, fair discriminative validity and strong responsiveness to clinically important change over time. The devised GCA-DAS was feasible and easily recorded in standard practice. This has been supported by the parallel significant improvement in the patients’ functional ability ( p < 0.001) and patient satisfaction (86.3%). Conclusion: The GCA-DAS was found to be a valid instrument for assessment of GCA disease activity and is potentially applicable in standard clinical care, observational studies, and clinical trials.

Objective: This study aimed to provide a comprehensive profile of the national pattern of systemic sclerosis (SSc) in Egypt.,Methods,This retrospective study included 354 SSc patients retrieved from the Egyptian cohort of the EUSTAR database. Data collected included demographics, modified Rodnan Skin Score (mRSS), SSc subsets, internal organ involvement, auto-antibody profile, acute phase reactants, and organ function tests (PFTs, ECHO, HRCT, and Nailfold Capillaroscopy [NFC]), Health Assessment Questionnaire (HAQ), and Living with Pulmonary Fibrosis Questionnaire (L-PF). Categorical variables were described as frequency and percentages, whereas continuous variables were described as mean and standard deviation or median and interquartile if skewed, together with the range of values encountered.,Results,The Egyptian cohort was overwhelmingly female (89.2%) with a mean age of onset of 32.6 years (± 13.5 SD). More than half presented with limited cutaneous SSc (53.1%). Mean skin disease severity was moderate (mRSS = 13.8 ± 10.6). Microvascular damage was severe, evidenced by a high prevalence of the active NFC pattern (47.8%) and frequent digital ulcers (56.7%).,Internal organ involvement was common: dysphagia (75.4%) and reflux (78.7%) were the most frequent GI symptoms. Interstitial Lung Disease (ILD) was diagnosed in 46.8% of assessed patients, predominantly showing a Ground-Glass Opacification (70.4%) pattern. Pulmonary Arterial Hypertension (PAH) was observed in 11.8% of tested individuals. Autoantibody profiles were notable for high positivity of both anti-Scl70 (51.0%) and anti-centromere (55.6%) among those tested. Inflammatory and muscular markers were often elevated (mean CRP = 6.7 mg/dL; mean CK = 164.3 U/L). Joint disease was significant, with a mean DAS28-ESR of 4.4 (+1.3).,Conclusion,This SSc cohort is characterized by a strong female predominance, a high rate of limited SSc, and significant systemic inflammation. The phenotype is dominated by severe microvascular manifestations and high rates of GI and pulmonary involvement. Analysis of autoantibodies may imply a specific serological profile.

Objective To present updated evidence-based recommendations with a range of therapeutic options for children in Africa with oligoarticular juvenile idiopathic arthritis (JIA), adopting the treat to-target approach. Methods This study was conducted by the Paediatric Society of the African League Against Rheumatism (PAFLAR) to reach a consensus for recommendations regarding diagnosis and management of oligoarticular JIA suitable for application among different African countries. The Delphi technique was used to reach a consensus of 15 key questions identified by the steering committee. According to the PICO (patient/population, intervention, comparison, outcome) approach, a voting process among 22 African and international clinicians and experts in the field of pediatric rheumatology was performed after intensive systematic review of literature. Results A consensus was reached for 15 recommendations for diagnosis, monitoring, management of the disease, and its complications, intervention, and when to discontinue treatment of oligoarticular JIA patients with high level of agreement (ranging between 85 and 95%) who agreed or strongly agreed, and the response rate was 100%. Conclusion These recommendations focus on the early diagnosis and multidisciplinary management of oligoarticular JIA and its complications with high levels of consensus and agreement, improving practice consistency among healthcare providers. Key Points • A panel of experts created a consensus about the early diagnosis of oligoarticular JIA • Consensus-based recommendations to the management of oligoarticular JIA • These guidelines emphasized on the oligoarticular JIA-specific characteristics, severity factors, and treatment alternatives

Background: Psoriatic arthritis (PsA) patients may have elevated serum uric acid levels, and hyperuricemia may impact the degree of inflammation and clinical disease severity. Objectives: comparison between PsA patients with and without hyperuricemia and assessment of the effect of hyperuricemia on clinical presentation, disease activity, disease severity, and associated comorbidities in PsA patients. Methods: 76 PsA patients with hyperuricemia and 74 PsA patients with normal uric acid as control were included. Demographic, clinical, comorbidities, and laboratory data were collected. Hyperuricemia threshold ≥ 60 mg/L. Results: There were no significant differences between patients with and without hyperuricemia regarding gender, PsA articular subtype, PASI score, and treatment received, while patients with hyperuricemia were older (40.47 ± 8.53 vs 34.59 ± 7.29, p = 0.0001), had more comorbidity, higher body mass index (BMI) (28.49 ± 2.07 vs 26.91 ± 1.63kg/m2, p = 0.0001), DAPSA score (16.75 ± 7.04 vs 9.32 ± 6.35, p = 0.0001), ESR (34.78 ± 7.12 vs 28.55 ± 8.97, p = 0.0001), CRP (11.42 ± 3.23 vs 8.68 ± 4.04, p = 0.0001), serum cholesterol (220.42 ± 46.83 vs 169.82 ± 37.82, p = 0.0001), and triglycerides (136.47 ± 36.4 vs 104.89 ± 22.15, p = 0.0001), and longer duration of Psoriasis and PsA. The serum uric acid levels were significantly positively correlated with age, duration of Psoriasis, duration of PsA, BMI, CRP, ESR, DAPSA, and PASI score. Multivariate analysis showed that male sex, BMI, and increased disease activity were independent predictors of hyperuricemia in PsA patients. Conclusion: Psoriatic arthritis patients with hyperuricemia have higher age, BMI, disease activity, and more associated comorbidities. In PsA patients, hyperuricemia was associated with male sex, BMI, and increased disease activity, but not associated with PASI score. Key Points• Psoriasis, PsA, and hyperurice s is a bi-centric case–control retrospective of cardiovascular disease.• Male gender, BMI, and increased disease activity were independent predictors of hyperuricemia in PsA patients. • Psoriatic arthritis patients with hyperuricemia have been more associated with comorbidities.

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disease of childhood. The Existing guidelines for polyarticular JIA are typically based on data from non-African populations and may not fully address the unique challenges faced in African settings. We aimed to produce updated African guidelines for the diagnosis and treatment of children and adolescents with polyarticular juvenile idiopathic arthritis (poly-JIA). Methods: This study was conducted with the aim of reaching a consensus among African experts on the diagnosis and treatment of poly-JIA using the Delphi technique. The first scientific committee identified a total of 15 key clinical questions according to the PICO (Patient/Population, Intervention, Comparison, Outcome) approach. A systematic review of the evidence-based literature was conducted for this work. The core steering group identified researchers and clinicians with expertise in pediatric rheumatology. A Delphi process was used to reach consensus. Results: An online questionnaire was sent to the expert panel that participated in the survey (100% response rate). A total of 15 recommendation points were identified, divided into two parts: five recommendations for diagnosis and ten recommendations for management. The percentage of those who agreed with the recommendations (fourth and fifth place) ranged from 80 to 100%. All 15 clinical recommendation statements that the scientific committee had identified had been agreed upon in wording (i.e., 75% of respondents agreed or strongly agreed). Conclusions: We successfully developed guidelines for children with polyarticular JIA, taking into consideration the African specific nature of limited resources and low income, also on the same time incorporating newly released data and using a treat to target approach.

The objective of this study is to develop evidence-based recommendations for the diagnosis and management of enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA) in the African context. The recommendations for ERA and JPsA were combined into a single document. The steering committee and task force identified 15 key questions and formulated 35 research questions. A comprehensive literature review, utilizing Medline and a manual search for African local data, was conducted to gather evidence. Following this synthesis, the task force developed draft recommendations and engaged in a Delphi process with an expert panel, including 17 African and three international experts, to reach a consensus and ensure alignment with global standards. The final recommendations were assigned a level of evidence and subsequently approved by the task force members, the expert panel, and the PAFLAR Board. Fifteen recommendations on the diagnosis and management of ERA and JPsA were developed, covering the role of the pediatric rheumatologist in multiple aspects of disease management, including diagnosis, monitoring of disease and extra-articular manifestations, determining treatment strategies, and guiding interventions. The level of evidence supporting these recommendations was variable, leading to the identification of a research agenda to address African particularities and answer pending questions. The final recommendations achieved a high level of agreement, with consensus ranging from 90 to 100%. These recommendations represent an important achievement for pediatric rheumatology in Africa, being the first of their kind, tailored specifically to the region. Developed through a rigorous methodology and collaboration between international and African experts, they aim to standardize care and address the unique challenges faced in African setting.