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The aim of this study was to describe the array and disease characteristics of spondyloarthritis (SpA) across Egypt. This work included 1401 SpA patients recruited from 15 specialized Egyptian rheumatology centers representing 20 major cities. The demographic and clinical features, as well as the therapeutic data, were recorded. The mean age of the patients was 37.6 ± 11.4 years, disease duration 8.01 ± 6.7 years, and age at onset 29.9 ± 11 years; 148 (10.6%) were juvenile-onset. There were 813 males and 588 females (M: F 1.4:1). 5.7% were diabetic, 6.1% hypertensive, and 19.3% were smokers. The mean BASDAI was 3.98 ± 1.78, and the BASFI was 4.02 ± 1.77. The human leukocytic antigen (HLA-B27) was positive in 19.8%. Biologic therapy was received by 55.5%, followed by methotrexate (36%) ,steroids (10.8%), and sulfasalazine in 10.7%. In males, the age at onset was significantly lower (p = 0.02), while radiographic axSpA, neuropsychiatric and pulmonary manifestations, HLA-B27 positivity, and receiving biologic therapy were significantly higher (p = 0.02, p < 0.0001, p = 0.03, p < 0.0001, and p < 0.0001). In females, cutaneous manifestations and arthritis were significantly more frequent (p < 0.0001 and p < 0.0001). Those with positive HLA-B27 had a significantly higher frequency of AS (73%) (p = 0.003), male gender (66.2%) (p < 0.0001), longer disease duration (p = 0.001), and were receiving a higher frequency of biologic therapy (89%, p < 0.0001). Radiographic axial SpA was most reported from Assuit (15.9%), nr-axSpA from Cairo (24.5%), peripheral arthritis only from Giza (30.7%), and unclassified from Kafr ElSheikh (33.9%) (p = 0.002). The spectrum of SpA in Egypt is inconsistent across the country. Gender, disease subtype, and HLA-B27 seem to play a key role in the phenotypic presentation.

The study aimed to explore the experience of coronavirus disease-2019 (COVID-19) infection and vaccine adverse events (AEs) among rheumatologists. A validated questionnaire was distributed as a Google form to rheumatologists across the country via social networking sites from late December 2021 till early January 2022. The questionnaire included questions regarding participants' socio-demographic details, COVID-19 infection and vaccination details with special emphasis on AEs. Out of 246 responses, 228 were valid. 200 (81.3%) responders had received the vaccine. The mean age of the 228 participants was 37.9 ± 8.5 years, 196 were females and 32 males (F:M 6.1:1) from 18 governorates across the country. Comorbidities were present in 54 subjects (27%). There was a history of highly suspicious or confirmed COVID-19 infection in 66.7% that were all managed at home. The COVID-19 vaccine was received by 200 and a booster dose of 18.5%. Obesity and musculoskeletal involvement co-morbidities were present only in those with AEs (9.1% and 5.5% respectively). AEs were present in 82%; 66.7% had injection-site tenderness, 50% fatigue, 35.5% fever, 15% chills, 42.5% myalgia, 14.5% arthralgia, 8% low back pain, headache 31%, dizziness 10%, sleepliness 16% and 15% developed post-vaccine. There were no differences according to the geolocation regarding the occurrence of COVID-19 infection (p = 0.19) or AEs post-vaccine (p = 0.58). The adverse events were mostly mild to moderate and tolerable which makes this work in agreement with other studies that support the broad safety of the vaccine in favor of the global benefit from mass vaccination.

Primary Sjögren's Syndrome (pSS) is a systemic autoimmune disease that predominantly impacts the exocrine glands. It is characterized by a diverse clinical manifestation and the existence of various autoantibodies. There is a lack of studies assessing the primary pSS phenome driven by anti-Sjögren syndrome autoantibodies in Africa, particularly in Egypt. This study aims to evaluate the clinical implications of antinuclear antibodies (ANA) and anti-Ro/anti-La autoantibodies in an Egyptian national cohort of pSS patients. We conducted a cross-sectional analysis of pSS patients, comparing clinical manifestations and disease severity based on serological profiles. A total of 301 pSS patients (mean age: 45.6±10.2 years; F:M ratio 7.4:1) were included. Patients with positive ANA (59.5%) had a higher prevalence of anti-Ro (p=0.001) and anti-La (p=0.0001) antibodies, along with lower rates of dry eyes (p=0.04) and enlarged parotid glands (p=0.001). Corticosteroid and azathioprine use was more frequent in ANA-positive patients (p=0.017, p=0.003). Double-positive anti-Ro/anti-La patients exhibited higher rates of dry mouth (p=0.045), articular manifestations (p<0.0001), fibromyalgia (p=0.001), RF positivity (p<0.001), and C4 consumption (p<0.001). Patients with pSS exhibit distinct clinical and laboratory profiles based on their autoantibody status, emphasizing the importance of immunological assessment for disease management.

Objective The specific carbohydrate diet (SCD) has demonstrated a beneficial effect in pediatric inflammatory bowel disease. This study aimed to determine the potential effect of a minimum 4-week SCD intervention on children with juvenile idiopathic arthritis (JIA). Methods This prospective, single-arm, interventional pilot study encompassed 40 patients with JIA exhibiting mild to moderate disease activity as per juvenile arthritis disease activity score-27(JADAS27), with ≤ 2 active joints, and an erythrocyte sedimentation rate (ESR) of < 30 mm/h at inclusion. Participants were required to have maintained stable medical treatment without any modifications for a minimum of 12 weeks prior to enrollment, with no anticipated alterations in medication during the study duration. Patients adhered to the SCD for at least 4- week duration under the guidance of a pediatric dietitian. Of the 40 JIA patients incorporated into the study, only 27 patients aged 9–16 years with disease duration of 1-11years completed a minimum 4 weeks adherence to the SCD. Evaluation of morning stiffness duration, pain visual analogue scale (VAS), JADAS27 and physical functional evaluation using child health assessment questionnaire (CHAQ) were determined. Laboratory assessments, including ESR and C-reactive protein (CRP) were analyzed. Furthermore, Faecal Short-Chain Fatty Acids (SCFAs) including butyrate, propionate, acetate, and valerate, were measured. All evaluations were conducted at baseline and subsequent to a minimum of four weeks of adherence to the SCD. Results Regarding the evaluation of SCFAs, butyrate levels demonstrated a significant increase ( p  < 0.001) following the SCD intervention. Propionate and acetate, while also elevated ( p  = 0.004 and 0.01 respectively), displayed a less substantial increase in comparison to butyrate. Valerate likewise showed a significant increase ( p  = 0.048). These elevations in SCFAs coincided with a significant improvement in morning stiffness duration ( p  = 0.016), pain VAS, JADAS27, and CHAQ ( p  < 0.001 for all), which was further corroborated by a significant decrease in laboratory markers of inflammation, including ESR ( p  = 0.009) and CRP ( p  = 0.006). Conclusion Specific carbohydrate diet, as a prospective adjunctive therapeutic option, could potentially improve clinical outcomes in JIA patients. While the positive preliminary findings, it is essential to conduct more rigorous and controlled studies to validate these results.

Objective The objective of this study is to present the clinical characteristics of immunoglobulin G4-related diseases (IgG4-RD) patients and describe associated overlap with autoimmune rheumatic diseases (ARDs). Patients and methods This cross-sectional study included 81 patients with IgG4-RD who were recruited from 13 specialized rheumatology departments and centers across the country in collaboration with the Egyptian College of Rheumatology (ECR). Patients underwent a thorough history-taking and clinical examination. We reviewed patients’ medical records and recorded the medications they used. The presence of comorbidities or cumulative manifestations was determined. Laboratory investigations, imaging, and biopsy histopathology were assessed. Results The mean (SD) age was 41.4 (14.6) years with 60 females and 21 males (F/M 2.9:1). The diagnosis was definite in 50 (61.7%), probable in 19 (23.5%), and possible in 12 (14.8%). The most common cumulative clinical features are IgG4-related respiratory disease in 19 (23.5%), autoimmune pancreatitis (AIP) in 18 (22.2%), and Riedel’s thyroiditis in 17 (21.0%). Approximately 80% were administered corticosteroids, whereas 40% received azathioprine as adjunct therapy. Approximately 16% developed a relapse with this combination and transitioned to an alternative steroid-sparing treatment. Twelve individuals (14.7%) required rituximab. Fifty percent of patients receiving rituximab (six patients) exhibited complete improvement, while the remaining had partial improvement. Ten (12.3%) patients had associated ARDs: five (6.2%) with systemic lupus erythematosus (SLE), four (4.9%) with rheumatoid arthritis (RA), and one with vasculitis. Of the four patients with associated RA, three were rheumatoid factor (RF) negative. IgG4 was in all cases, RF was positive in 18.5%, and antinuclear antibody was in 14.7%. Conclusion IgG4-RDs exhibit a wide range of presentations, closely associated with ARDs. Awareness among clinicians about this condition will increase their consideration and rate of prompt diagnosis, which is essential to prevent damage to critical organs. Key Points • IgG4-RDs have a myriad spectrum of presentation with a close link to rheumatic diseases . • Awareness among clinicians about this condition will increase their consideration and rate of prompt diagnosis . • The lack of reliable biomarkers for this condition has been an important hurdle for diagnosis .

To depict the spectrum of rheumatoid arthritis (RA) in Egypt in relation to other universal studies to provide broad-based characteristics to this particular population. This work included 10,364 adult RA patients from 26 specialized Egyptian rheumatology centers representing 22 major cities all over the country. The demographic and clinical features as well as therapeutic data were assessed. The mean age of the patients was 44.8 ± 11.7 years, disease duration 6.4 ± 6 years, and age at onset 38.4 ± 11.6 years; 209 (2%) were juvenile-onset. They were 8750 females and 1614 males (F:M 5.4:1). 8% were diabetic and 11.5% hypertensive. Their disease activity score (DAS28) was 4.4 ± 1.4 and health assessment questionnaire (HAQ) 0.95 ± 0.64. The rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were positive in 73.7% and 66.7% respectively. Methotrexate was the most used treatment (78%) followed by hydroxychloroquine (73.7%) and steroids (71.3%). Biologic therapy was received by 11.6% with a significantly higher frequency by males vs females (15.7% vs 10.9%, p = 0.001). The least age at onset, F:M, RF and anti-CCP positivity were present in Upper Egypt (p < 0.0001), while the highest DAS28 was reported in Canal cities and Sinai (p < 0.0001). The HAQ was significantly increased in Upper Egypt with the least disability in Canal cities and Sinai (p = 0.001). Biologic therapy intake was higher in Lower Egypt followed by the Capital (p < 0.0001). The spectrum of RA phenotype in Egypt is variable across the country with an increasing shift in the F:M ratio. The age at onset was lower than in other countries.

Background: Primary Sjogren's Syndrome (pSS) is a systemic autoimmune disease that predominantly impacts the exocrine glands. It is characterized by a diverse clinical manifestation and the existence of various autoantibodies. There is a lack of studies assessing the primary pSS phenome driven by anti-Sjogren syndrome autoantibodies in Africa, particularly in Egypt. Objective: This study aims to evaluate the clinical implications of antinuclear antibodies (ANA) and anti-Ro/anti- La autoantibodies in an Egyptian national cohort of pSS patients. Methods: We conducted a cross-sectional analysis of pSS patients, comparing clinical manifestations and disease severity based on serological profiles. Results: A total of 301 pSS patients (mean age: 45.6 [+ or -] 10.2 years; F:M ratio 7.4:1) were included. Patients with positive ANA (59.5%) had a higher prevalence of anti-Ro (p=0.001) and anti-La (p=0.0001) antibodies, along with lower rates of dry eyes (p=0.04) and enlarged parotid glands (p=0.001). Corticosteroid and azathioprine use was more frequent in ANA-positive patients (p=0.017, p=0.003). Double-positive anti-Ro/anti-La patients exhibited higher rates of dry mouth (p=0.045), articular manifestations (p<0.0001), fibromyalgia (p=0.001), RF positivity (p<0.001), and C4 consumption (p<0.001). Conclusion: Patients with pSS exhibit distinct clinical and laboratory profiles based on their autoantibody status, emphasizing the importance of immunological assessment for disease management. Keywords: primary Sjogren's syndrome, antinuclear antibody, anti-Ro, anti-La, Egypt

Rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) have been used to improve the diagnosis and prognosis of rheumatoid arthritis (RA). However, their association with RA disease phenotypes, individually and in combination, is not well studied. The aim of the study was to compare patients' and disease characteristics, activity and severity in double seronegative (DNRA), single seropositive RF, single seropositive anti-CCP and double seropositive (DPRA) patients. Adults subjects with RA from Egyptian College of Rheumatology (ECR) database who had RF and anti-CCP results available were included. Demographic, clinical features, disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ) and laboratory data were collected and compared among different RA groups. 5268 RA patients with mean age of 44.9±11.6 years, and 4477 (85%) were females. 2900 (55%) had DPRA, 892 (16.9%) had single positive RF, 597 (11.3%) had single positive anti-CCP while 879 (16.7%) had DNRA. Patients with DPRA had significantly high percentage of metabolic syndrome (19.3%, < 0.001), and functional impairment using HAQ ( = 0.01). Older age (RRR [relative risk ratio]: 1.03, 95%CI: 1.0, 1.0, = 0.029), greater DAS28 (RRR: 1.51, 95%CI: 1.2, 1.9, < 0.001), higher steroid use (RRR: 2.4, 95%CI: 1.36, 4.25, = 0.002) were at higher risk of DPRA while longer disease duration (RRR: 1.08, 95%CI: 1.01, 1.16, = 0.017) and fibromyalgia syndrome (RRR: 2.54, 95%CI: 1.10, 5.88, = 0.028) were associated with higher odds of single positive RF status. Dual antibody-positive status has higher disease activity and severity, and higher chance of development of metabolic syndrome; highlighting the implicated role of inflammation, atherogenesis and cardiovascular disease risk in RA.