•It is the first study that addresses IL-8-251 T/A polymorphism association with SLE.•Risk of SLE in AA genotype was increased when compared with TT genotype carriers.•Patients with active SLE had a ...higher frequency of IL-8-251 AA genotype.•SLE patients with the AA genotype presented high levels of IL-8.•IL-8 interacts with key members of SLE signaling pathway.
Systemic lupus erythematosus (SLE) susceptibility was found to be correlated with genetic polymorphisms. Therefore, the current study aimed to investigate the association of the IL-8-251 T/A polymorphism with the risk of SLE.
A total of 135 SLE patients and 75 controls were enrolled in our study. The IL-8-251 T/A polymorphism was analysed by PCR-RFLP. Also, the serum concentration of IL-8 was measured using ELISA. Finally, investigate possible IL-8 pathways in SLE pathogenesis by using the STRING database.
Our results revealed that the risk of having SLE in AA genotype carriers was significantly increased (OR = 1.92, 95 % CI = 1.23–3.10, p = 0.006) when compared with TT genotype carriers. Patients with SLE had a significantly higher frequency of the A allele (OR = 1.37, 95 % CI = 1.09–1.7; P = 0.01) than controls. Serum IL-8 levels were significantly increased in SLE patients (77.81 ± 21.27; p < 0.001) when compared to healthy controls (48.85 ± 7.89). Also, it was found that the serum IL-8 level had significant positive correlations with proteinuria, ESR, ANA, urea and SELADI, and significant negative correlations with RBCs count, C3 and hemoglobin. According to ROC curve analysis, serum IL-8 levels are a good biomarker for the detection of SLE disease, with 87.5 % sensitivity and 85 % specificity. STRING analysis revealed that IL-8 interacts with key SLE signaling pathway members such as TNF-α, IL-1β, IL-6, and IL-10.
There was a correlation between the IL-8-251 T/A polymorphism and the risk of SLE. Our findings also suggest that the IL8-251 A allele may be an important risk factor for the development of SLE.
Objectives
The present work was conducted to estimate the prevalence of adult Behçet’s disease (BD) in adult Egyptian and to study the clinical pattern and influence of age at-onset and sex on ...disease phenotype. Also, we investigated the spectrum of presentation and frequencies along the north-to-south gradient of the country.
Patients and method
The population-based, multicenter, cross-sectional study included 1526 adult BD patients from 26 specialized Egyptian rheumatology centers. Demographic, clinical, and therapeutic data are assessed for all patients.
Results
The mean age of patients was 35.7 ± 9.84 years, disease duration 6.58 ± 5.25 years, and age at onset 29.37 ± 8.6 years; 91 were juvenile-onset (JoBD). There were 1102 males and 424 females (M:F 2.6:1). Regarding co-morbidities, 19.92% were diabetic, and 26.05% were hypertensive. The mean body mass index was 27.57 ± 5.24 (43.1% overweight; 25.9% obese). The mean BD current activity form was 4.48 ± 4.28. Regarding the medications use, systemic steroid and colchicine were the most common drugs used (947 (90.2%) and 611 (82.7%), respectively). The overall estimated prevalence of BD in Egypt was 3.6/100,000 population being highest in the two main cities: Alexandria (15.27) and Cairo (8.72). Pathergy test was positive in 43.4%. 90.2% were receiving systemic steroids and 8.3%, biologics. Disease characteristics were comparable between JoBD and adult-onset BD cases. Central nervous system (CNS), deep venous thrombosis (DVT), and gastrointestinal (GIT) involvement were significantly higher in males (
p
= 0.01,
p
= 0.001, and
p
= 0.001 respectively) while joint affection (
p
= 0.001) and disease activity (
p
= 0.011) were increased in females.
Conclusions
This study provides current prevalence of BD in Egypt; 3.6/100,000 with no remarkable north-to-south gradient. The sex influences the disease phenotype with the CNS, DVT, and GIT involvement are higher in males, while the joint affection and disease activity were increased in females.
Key Points
•
The prevalence and phenotype of Behçet’s disease across Egypt is presented in a multicenter nationwide study.
•
The potential influence of the age at onset and sex on disease phenotype is highlightened.
•
A review of the literature worldwide is presented allowing comparisons with studies from other nations.
Researchers around the world are working at record speed to find the best ways to treat and prevent coronavirus disease 2019 (COVID‐19). This study aimed to evaluate the efficacy of ivermectin for ...the treatment of hospitalized mild to moderate COVID‐19 infected patients. This was a randomized open‐label controlled study that included 164 patients with COVID‐19. Patients were randomized into two groups where Group 1 (Ivermectin group) included patients who received ivermectin 12 mg once daily for 3 days with standard care and Group 2 (control group) included patients who received standard protocol of treatment alone for 14 days. The main outcomes were mortality, the length of hospital stay, and the need for mechanical ventilation. All patients were followed up for 1 month. Overall, 82 individuals were randomized to receive ivermectin plus standard of care and 82 to receive standard of care alone. Patients in the ivermectin group had a shorter length of hospital stay (8.82 ± 4.94 days) than the control group (10.97 ± 5.28 days), but this was not statistically significant (p = 0.085). Three patients (3.7%) in each group required mechanical ventilation (p = 1.00). The death rate was three patients in the ivermectin group (3.7%) versus four patients (4.9%) in the control group without any significant difference between the two groups (p = 1.00). Although there was no statistically significant difference in any endpoints by ivermectin doses (12 mg/day for 3 days); there was an observed trend to reducing hospital stay in the ivermectin‐treated group.
Objective
To investigate the characteristics, evolution, and visual outcome of non-infectious uveitis.
Methodology
Records of 201 patients with non-infectious uveitis (136 (67.7%) males and 84 ...(41.8%) juvenile-onset (≤ 16 years)) were retrospectively reviewed. Data were analyzed through Kruskal–Wallis and Mann–Whitney, chi-square (
χ
2
) tests, and logistic regression.
Results
The median disease and follow-up durations were 36 (interquartile range (IQR) 24–70) and 24 (IQR 10–36) months, respectively. Fifty-eight (28.9%) patients had persistently idiopathic uveitis, and 143 (71.1%) were associated with rheumatic diseases, of whom uveitis heralded, coincided with, and succeeded the rheumatic manifestation(s) in 62/143 (43.4%), 37/143 (25.9%), and 44/143 (30.7%) patients, respectively. Established rheumatic diseases were Behçet’s disease (103/201 (51.2%)), juvenile idiopathic arthritis (13/201 (6.5%)), sarcoidosis (8/201 (4%)), seronegative spondyloarthropathy (7/201 (3.5%)), and Vogt-Koyanagi-Harada (7/201 (3.5%)), and other diagnoses were present in 5/201 (2.5%) patients. Patients with idiopathic uveitis were characterized by a juvenile-onset (
p
< 0.001), lower male predominance (
p
= 0.01), prevalent granulomatous (
p
< 0.001), and anterior (
p
= 0.001) uveitis. The median visual acuity at last visit was 0.3 (IQR 0.05–0.6). Visual loss was present in 45/201 (22.3%) patients (36/201 (17.9%) unilateral and 9/201 (4.4%) bilateral). Apart from a longer disease duration (
p
= 0.002), lower educational level (
p
= 0.03), and prevalent panuveitis (
p
< 0.001), visual loss was not associated with any other studied ocular or extra-ocular characteristics.
Conclusion
Behçet’s disease (51.2%) and idiopathic uveitis (28.9%) were the most prevalent causes of non-infectious uveitis in our study. Visual loss (22.3%) was associated with a longer disease duration, lower education level, and prevalent panuveitis.
Key Points
• Most common causes of uveitis referred to rheumatologists were Behçet’s disease and idiopathic uveitis.
• Several rheumatic diseases initially presented only with uveitis, more commonly in adult and male patients.
• Panuveitis was more frequent among patients with an established rheumatic disease, whereas granulomatous uveitis was uncommon.
• Longer disease duration and presence of panuveitis were independently associated with visual loss.
Objectives
The frequency of different vasculitides and their characteristics vary among different regions. The identification of geographic disparities of disease phenotypes helps the development of ...international criteria, allowing the classification of patients of different ethnicities. This study aimed to describe the frequency, characteristics, course, response to treatment, and outcome of the different adulthood vasculitides in Egypt.
Methods
This was a multicenter study in which the medical records of adult Egyptian patients diagnosed with vasculitis between 2002 and 2018 were retrospectively reviewed.
Results
The most frequent vasculitides in Egypt were Behçet’s disease (76%), hepatitis C virus vasculitis (13.9%), and granulomatosis with polyangiitis (3.9%). Most patients (73.8%) had a major event at the time of diagnosis. Generalized granulomatosis with polyangiitis was more common than the localized type (90% versus 10%, respectively). The aortic arch and its branches were the most common affected sites of Takayasu arteritis. Of vasculitides, Behçet’s disease and giant cell arteritis were associated with the greatest rates of relapse (62.7% and 33.3%, respectively). Delayed diagnosis and permanent organ damage were reported in 69.9% and 68.9% of patients, respectively. A low mortality rate was noted (1.3%).
Conclusions
The most common types of adulthood vasculitides in Egypt are Behçet’s disease, hepatitis C virus vasculitis, and granulomatosis with polyangiitis. Major organ involvement is frequent. Delayed diagnosis and permanent organ damage are common.
Background
Behçet’s disease (BD), commonly seen in the
Silk road
countries, is a variable vessel vasculitis with no specific investigation that reflects disease activity. The Behçet’s Disease Current ...Activity Form (BDCAF) is the most famous and acceptable clinical activity score.
Purpose
To develop a cross-cultural adaptation of the BDCAF to the Arabic language (Ar-BDCAF)—Egyptian dialect—across the country and to consider preliminary evaluation of its reliability in assessment of BD activity.
Patients and methods
The score was translated to Arabic language and revised by 3 rheumatology consultants. Reliability of Ar-BDCAF was tested among 88 BD patients from 9 Egyptian main city centers. Patients were questioned by two specialists at 30 min interval to evaluate inter-observer rating and twice by the same physician within 24 h to assess the intra-observer rating.
Results
Patients were 64 males and 24 females (2.7:1) with a mean age of 35 ± 10.3 years. The average time required by the consultant to fill in the form was 5.1 ± 2.2 min (1.5–15 min). The mean Ar-BDCAF scores were 9.81 ± 6.22 (0–25) and 9.53 ± 6.13 (0–28) with an intra-observer concordance (
p
= 0.28) and was 9.95 ± 6.47 (0–29) for the inter-observer rating (
p
= 0.89 and
p
= 0.66, respectively).
Conclusion
The Ar-BDCAF is a measurable, easy to calculate, and reliable index for assessing disease activity in Egyptian BD. The Ar-BDCAF score can be used in daily clinical practice to assess BD activity and its use can be extended to other Arab countries for possible regional validation and adaptations.
Key Points
• The Arabic version of the BDCAF can be extended to other Arab countries for development of a Pan-Arab score.
• This is the first study to provide a reliable and valid Arabic version of the BDCAF-Egyptian dialect for measuring current disease activity in BD patients.
Eye lesions, occur in nearly half of patients with Behçet's Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the ...development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD.
Patients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors.
A total of 1094 BD patients 71.5% were men, mean ± SD age 36.1 ± 10 years were included. 549 (50.2%) individuals had VTBD. Extreme Gradient Boosting was the best-performing ML model (AUROC 0.85, 95% CI 0.81, 0.90) compared with logistic regression (AUROC 0.64, 95%CI 0.58, 0.71). Higher disease activity, thrombocytosis, ever smoking, and daily steroid dose were the top factors associated with VTBD.
Using information obtained in the clinical settings, the Extreme Gradient Boosting identified patients at higher risk of VTBD better than the conventional statistical method. Further longitudinal studies to evaluate the clinical utility of the proposed prediction model are needed.
Background
Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms.
Objectives
This study is designed to evaluate the audiovestibular ...manifestations in patients with different autoimmune diseases especially asymptomatic cases.
Subjects and Methods
This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz).
Results
patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases).
Conclusion
Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
To study the frequency of cranial and peripheral neuropathies in systemic lupus erythematosus (SLE), their clinical characteristics, electrophysiological pattern and relation to disease activity.
The ...study included 30 SLE patients and 20 matched healthy controls. Electrophysiological assessment included routine nerve conduction studies for assessment of peripheral nerves and visual evoked potential, blink reflex, and brain stem auditory evoked potential for assessment of the second, fifth, seventh, and eighth cranial nerves, respectively. Safety of Estrogens in Lupus Erythematosus National Assessment–SLE Disease Activity Index (SELENA–SLEDAI) was assessed.
The mean age of the patients was 35.8 ± 8.6 years, 27 females and 3 males (9:1) with median disease duration 4.5(1.2–8) years and SELENA-SLEDAI of 12.09 ± 4.94. The mean complement-3 (C3) level was 81.2 ± 26.9 mg/dl and C4 was 11.5 ± 4.4 mg/dl. Peripheral neuropathy was detected electrophysiologically in 66.7% and clinically in 53.3% of the patients and was sensory more than motor. Sensory neuropathy was found in 9(30%), sensorimotor in 11(36.7%), demyelinating in 9(30%), axonal in 6(20%) and both axonal and demyelinating in 5(16.7%) patients. 13.3% had subclinical neuropathy. Sensorimotor and sensory neuropathies were detected in 36.7% and 30% of patients, respectively. Cranial neuropathy was not detected in any patient or control clinically or electrophysiologically. Peripheral neuropathy significantly correlated with SELENA-SLEDAI (r = 0.55, p = 0.002) and negatively with C3 and C4 (r = −0.65, p = 0.012 and r = −0.63, p = 0.015 respectively).
Peripheral neuropathy is a well-recognized but underestimated manifestation of neuropsychiatric SLE with predominance of sensorimotor variant. Peripheral neuropathy is associated with disease activity and complement consumption.
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