Amany Mohammad Ebaid

Objective: To investigate the association between anti-ribonucleoprotein (anti-RNP) antibodies and endothelial dysfunction (ED) in patients with SLE and their ability to predict early ED manifestations, both coronary and peripherally. Methods: A cross-sectional study was conducted at a tertiary hospital involving 70 patients with SLE meeting American College of Rheumatology (ACR)/Systemic Lupus International Collaborating Clinics (SLICC) criteria. All study participants underwent a full clinical and laboratory evaluation, including testing for Cardiovascular Diseases serum anti-RNP antibodies. Conventional transthoracic 2-dimensional echocardiography, tissue Doppler imaging and a transthoracic dobutamine stress echocardiography to assess coronary microvasculature by measuring coronary flow velocity reserve (CFVR). Peripheral microvascular morphology was evaluated via nailfold dermoscopy. The primary outcome measures were the mean CFVR values and the presence of dermoscopic abnormalities (capillary drop-out, tortuosity and density) in relation to anti-RNP titres. Results: In 70 patients with SLE, those with high disease activity (n=45) exhibited significantly impaired cardiac function compared with low-activity patients (n=25), showing lower ejection fraction (EF) and CFVR, alongside higher Wall Motion Score Index (p<0.05). Anti-RNP levels correlated positively with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI, r=0.653, p<0.001), erythrocyte sedimentation rate, proteinuria and Raynaud’s phenomenon. Significant negative correlations existed between anti-RNP and stress EF (r=−0.33), CFVR (r=−0.30), C3 and C4 (p<0.05). Furthermore, elevated anti-RNP levels were significantly associated with clinical manifestations such as myositis and avascular necrosis, as well as dermoscopic microvascular changes, including microhaemorrhage and capillary dropouts (p<0.05). Conclusions: High anti-RNP titres are significantly associated with subclinical coronary microvascular impairment and peripheral capillary architectural changes in SLE. These results suggest that anti-RNP acts as a sentinel marker for early ED, providing potential for improved cardiovascular risk stratification independent of traditional risk factors.

Objectives: The objective of this study was to evaluate the relationship between interleukin-17 (IL-17) serum levels, musculoskeletal ultrasound (MSUS) observations, and clinical disease activity in patients with rheumatoid arthritis (RA) and hand osteoarthritis (OA). Methods: This case–control study involved 120 participants, with 40 individuals assigned to each of the three groups: RA, OA, and control. IL-17 serum levels were quantified in all participants. MSUS of the hand joints was performed on all RA and OA patients. Disease activity in patients with RA was assessed using the Clinical Disease Activity Score (CDAS). Both RA and OA patients completed a Visual Analog Scale (VAS) to evaluate pain intensity. Functional status was evaluated using the Health Assessment Questionnaire (HAQ) for RA patients, while the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index was utilized for OA patients. Results: Serum levels of IL-17 were significantly higher in both the RA and OA groups compared to the control group. Among RA patients, a positive correlation was identified between the CDAS and the VAS for pain. In OA patients, a significant correlation was observed between VAS scores and serum IL-17 levels. Additionally, serum IL-17 levels were associated with the presence of synovitis in both RA and OA groups; however, no significant association was found between IL-17 levels and bony changes such as erosions or osteophytes. In terms of functional evaluation, serum IL-17 levels correlated with HAQ in the RA group, but not with AUSCAN in the OA group. Conclusions: Elevated IL-17 serum levels are linked to inflammatory changes identified by MSUS but not to bony changes. These findings suggest that the rise in IL-17 levels in both OA and RA is primarily driven by underlying inflammatory processes, positioning IL-17 as a potential therapeutic target for both conditions.

To evaluate the retinal vascular changes related to early Rheumatoid Arthritis (RA) and to correlate these changes with disease activity. 108 eyes of 54 early RA patients and 66 eyes of 33 age and sex-matched healthy participants underwent Optical Coherence Tomography Angiography (OCTA) examination to evaluate superficial (SCP), deep retinal capillary plexus (DCP), and radial peripapillary capillaries (RPC), we collected Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) along with a full rheumatological examination and disease activity score by (DAS28). RPC values were significantly lower among RA patients in all subfields apart from the temporal one. There was a significant difference between RA patients and healthy controls in foveal and all perifoveal measurements, except the nasal perifoveal region. Also, the FAZ value was significantly higher in RA patients. We performed Spearman's correlation between OCTA and RA disease parameters and detected a negative correlation between the duration of disease-related symptoms and RPC and parafoveal measurements and between DAS-28 and foveal measurements. A significant positive correlation between anti-CCP titer and FAZ measurements was detected among RA patients. OCTA can detect early retinal microcirculation affection in RA patients in the form of a reduction in the vascular density in most of the subfields of the peripapillary area as well as the fovea, perifoveal, and parafoveal areas. The results of the current study can provide new insight into the applications of OCTA as a diagnostic tool in RA patients' assessment and follow-up.

Aim: To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence.Methods: A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3 months. The Visual Analog Scale for Pain (VAS‐p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren‐Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed.Results: One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS‐p) (p = 0.016) and improved function as measured by WOMAC (p = 0.018). Factors primarily associated with patient non‐adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow‐up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%).Conclusion: Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

Objectives To measure the expression level of the vacuolar protein sorting 13 (VPS13) gene and stimulator of interferon genes (STING) in patients with SLE with and without reported neuropsychiatric symptoms to establish their possible role in the pathogenesis of neuropsychiatric SLE (NPSLE). Methods This study included 100 subjects: 50 patients diagnosed with SLE and 50 age-matched and sex-matched healthy participants as the control group. The patients with SLE were further subdivided into NPSLE and non-NPSLE groups. All the subjects underwent rheumatological, neurological and psychological evaluation, MRI, VPS13C gene and STING expression assessment via quantitative real-time PCR. Results Seventy-eight per cent of the SLE group were classified as non-NPSLE, and 22% were classified as NPSLE. Positive MRI results were found in 55% of the patients with NPSLE and 7.7% of the patients without NPSLE. VPS13C expression levels were decreased in the patients with SLE compared with the control (pConclusion The VPS13C expression levels were decreased in patients with NPSLE compared with patients without NPSLE, while STING expression levels showed higher levels in NPSLE. Both were associated with the MRI findings. To distinguish patients with NPSLE from those without it, the VPS13C assessment performed better.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that results in severe pain and stiffness in the joints. The causes and pathophysiology of AS are still largely unknown. The lncRNA H19 plays key roles in the pathogenesis of AS by mediating inflammatory progression by acting in the axis of IL-17A/IL-23. The aims of this study were determining the role of lncRNA H19 in AS and assessing its clinical correlation. A case–control study was conducted and qRT-PCR was utilized to measure H19 expression. Comparing AS cases to healthy controls, it was found that H19 expression was significantly upregulated. For AS prediction, H19 demonstrated a 81.1% sensitivity, 100% specificity, and 90.6% diagnostic accuracy at a lncRNA H19 expression value of 1.41. lncRNA H19 had a significantly positive correlation with AS activity, MRI results, and inflammatory markers. lncRNA H19 seemed to be an independent predictor of AS (adjusted OR of 211 (95% CI: 4.7–939; p = 0.025)). After 3 months of clinical follow-up, seventeen patients (32.1%) showed minimal clinical improvement and fifteen patients (28.3%) showed major improvement. AS activity scores were significantly decreased in patients with high H19 expression. A significantly elevated lncRNA H19 expression was observed in AS cases compared with that in healthy controls. These results suggest that upregulation of lncRNA H19 expression may be involved in the pathogenesis of AS. The expression of the lncRNA H19 is related to the duration and activity of the disease. LncRNA H19 expression seems to be an independent predictor of AS.

BACKGROUND: Rheumatoid arthritis (RA) causes disabilities that affect people in working age and can impair their working activity and quality of life (QoL). OBJECTIVES: To assess work activity limitation and QoL among RA patients and to explore the associated risk factors. METHODS: A cross-sectional study on 344 RA patients was conducted at the outpatient clinic using a number of standardized questionnaires including the Health Assessment Questionnaire Disability Index, Workplace Activity Limitation Scale, and RA QoL. Clinical examinations were also performed including the measurement of pain intensity, assessment of disease activity, and the Rheumatoid Arthritis Severity Scale. RESULTS: Most of the employed participants (87%) experienced high work activity limitations. Increasing work limitations were significantly associated with a decrease in QoL domains scores. The most significant risk factors affecting work limitation by logistic regression were high disease activity, the severity of the disease, married females, and a high health assessment disability index among RA patients. CONCLUSIONS: RA patients experience limitations that affect their productivity at work and their QoL. Paying more attention to early management to prevent the upcoming unfavorable health and economic consequences for RA patients is significantly important.

Background: Lupus nephritis (LN) is a major issue that adds a burden on patients with systemic lupus erythematosus (SLE). Immunoglobulin-binding protein 1 (IGBP1) is identified as a phosphoprotein that has been recently reported to be linked to the B-cell receptor complex and regulates differentiation, proliferation, apoptosis, and tolerance of B cells. Its diagnostic and/or prognostic role in LN has been highlighted only recently. Objectives: This study aims to evaluate the relation between serum IGBP1 and SLE disease activity and/or renal activity and to investigate the validity of IGBP1 as a biomarker for LN. Methods: 96 participants were enrolled and divided into three groups: nephritis, nonnephritis, and control groups. The patients with SLE were diagnosed according to the Systemic Lupus International Collaborating Clinics classification (SLICC) criteria. The serum IGBP1 level was assayed using an enzyme-linked immunosorbent assay (ELISA). Assessments were conducted using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k) and renal biopsy for LN patients. Results: The nephritis and nonnephritis groups had higher IGBP1 levels than the controls; the nephritis group had the highest serum IGBP1 levels ( p < .001). Significant correlations were found between IGBP1 levels and proteinuria (r = 0.568, p = .001) and renal SLEDAI (r = 0.475, p = .006) in the nephritis group; on the other hand, the correlation of serum IGBP1 levels with SLEDAI-2K was non-significant for both groups (nephritis and nonnephritis groups). The IGBP1 levels were significantly different among histopathologic classes ( p < .001), with class V showing the highest level. Moreover, it showed a significant positive correlation with the pathologic activity index. Compared with renal SLEDAI for identifying active renal affection in patients with SLE, the serum IGBP1 level with a cut-off value of 547.45 ng/mL is a valid biomarker for detecting active nephritis with 93.8% sensitivity and 96.9% specificity. Conclusion: The serum IGBP1 levels were high in patients with LN and were positively correlated with the pathologic activity index. The serum IGBP1 level of 547.45 ng/mL is a valid biomarker for detecting active nephritis. Thus, we recommend that clinicians monitor the serum IGBP1 level of patients with SLE to detect LN.

This study was established to assess the effects of IRF5 rs10488631 and CD28 rs1980422 single-nucleotide polymorphisms (SNPs) and HLA-DRB1 shared epitope (SE) allele on the prognosis and disease activity of rheumatoid arthritis (RA) patients. A total of 150 RA patients and 150 healthy controls were genotyped for the selected SNPs by real-time PCR. HLA-DRB1 SE was determined using LAB Type SSO Class II DRB1 typing. Our results suggest that HLA-DRB1, CD28, and IRF5 significantly discriminated (p < 0.001) RA patients and healthy controls (OR of single HLA-DRB1 SE allele = 2.431, CI = 1.467–4.027, OR of two SE alleles = 11.152, CI = 2.479–50.159), (OR of CD28 risk allele C = 2.794, 95% CI = 1.973–3.956) and (OR of IRF5 risk allele C = 4.925, CI = 3.26–7.439). Rheumatoid factor (RF) seropositivity was associated with HLA-DRB1 SE (p < 0.001) and IRF5 risk allele (p < 0.001). ACPA was significantly associated only with IRF5 risk allele (p < 0.001). A better response to methotrexate therapy was found in HLA-DRB1 SE non-carriers, and CD28 TT patients. This study demonstrated associations of HLA-DRB1 SE, CD28, and IRF5 with the risk of RA. HLA-DRB1 SE and CD28 rs1980422 can be used as predictors of methotrexate therapy response.

Background: Bell’s palsy (BP) is a common idiopathic cranial mononeuropathy. The electrophysiological tests are one of supportive tools for localizing the site of facial nerve lesion, and to determine the severity and prognosis of the injury. The aim of this study was to evaluate the role of electrophysiology in the prediction of outcome of patients with Bell’s palsy. This study was carried out on 30 adult patients with Bell’s palsy. All study subjects were assessed clinically by Sunnybrook facial nerve grading score (SBS) and electrophysiologically by electroneurography (ENoG), blink reflex (BR), and electromyography (EMG); first evaluation was within 7th to10th day from onset, the second evaluation was done at 20th day, and the follow-up visit was after 1 month to assess the clinical grading system (SBS).Results: At 1 month, 20 patients (66.7%) had good recovery, while 10 patients (33.3%) had poor recovery according to the Sunnybrook scale. Multiple logistic regression analysis showed that the most significant predictive indicator of BP recovery was ENoG value and R1 latency of BR test. The receiver operating characteristic (ROC) curves showed ENoG degeneration index of 74.6%, considered as a critical cutoff value of non-recovery, with the sensitivity 95% and specificity 90%, and the highest specificity was with blink reflex parameters (R1, R2 latency) 100%.Conclusion: BR and ENoG were the best predictors of non-recovery of facial function, while EMG findings did not add any prognostic significance. The combination of both tests BR and ENoG, along with clinical findings can be considered a good indication in the acute phase of BP for the possibility to develop palsy residua.