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A
Abaza, N. A., E. M. Abdel-Latif, and T. A. Gheita, "Clinical Significance of Neutrophil/lymphocyte Ratio in Patients With Granulomatosis With Polyangiitis.", Reumatologia Clinica, 2018.
Acar-Denizli, N., I. - F. Horváth, T. Mandl, R. Priori, A. Vissink, G. Hernandez-Molina, B. Armagan, S. PRAPROTNIK, A. Sebastian, E. Bartoloni, et al., "Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies.", Clinical and experimental rheumatology, vol. 38 Suppl 126, issue 4, pp. 85-94, 2020. Abstract

OBJECTIVES: To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjögren's syndrome (pSS) fulfilling the 2002 classification criteria.

METHODS: The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative.

RESULTS: The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score ≥1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group.

CONCLUSIONS: Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients.

Alfadl, E. A., F. Ismail, R. E. R. Shereef, E. Hassan, S. Tharwat, E. F. Mohamed, E. A. Abda, A. R. Radwan, R. M. Fawzy, A. H. Moshrif, et al., "Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural-urban gap and north-south gradient.", Rheumatology international, vol. 41, issue 2, pp. 345-353, 2021. Abstract

During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care.

Ayeldeen, G., O. Shaker, and T. Gheita, "Possible use of miRNAs-146a and -499 expression and their polymorphisms as diagnostic markers for rheumatoid arthritis.", Mol Cel Biochem, vol. 449, issue 1-2, pp. 145-156, 2018.
B
Bassyouni, I. H., S. Fawzy, and T. A. Gheita, "Clinical Association of a Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) in Patients with Systemic Lupus Erythematosus.", Immunol Invest, vol. 46, issue 1, pp. 38-47, 2017.
Brito-Zerón, P., N. Acar-Denizli, W. - F. Ng, I. F. Horváth, A. Rasmussen, R. Seror, X. Li, C. Baldini, J. - E. Gottenberg, D. Danda, et al., "Epidemiological profile and north-south gradient driving baseline systemic involvement of primary Sjögren's syndrome.", Rheumatology (Oxford, England), vol. 59, issue 9, pp. 2350-2359, 2020. Abstract

OBJECTIVE: To characterize the systemic phenotype of primary Sjögren's syndrome at diagnosis by analysing the EULAR-SS disease activity index (ESSDAI) scores.

METHODS: The Sjögren Big Data Consortium is an international, multicentre registry based on worldwide data-sharing cooperative merging of pre-existing databases from leading centres in clinical research in Sjögren's syndrome from the five continents.

RESULTS: The cohort included 10 007 patients (9352 female, mean 53 years) with recorded ESSDAI scores available. At diagnosis, the mean total ESSDAI score was 6.1; 81.8% of patients had systemic activity (ESSDAI score ≥1). Males had a higher mean ESSDAI (8.1 vs 6.0, P < 0.001) compared with females, as did patients diagnosed at <35 years (6.7 vs 5.6 in patients diagnosed at >65 years, P < 0.001). The highest global ESSDAI score was reported in Black/African Americans, followed by White, Asian and Hispanic patients (6.7, 6.5, 5.4 and 4.8, respectively; P < 0.001). The frequency of involvement of each systemic organ also differed between ethnic groups, with Black/African American patients showing the highest frequencies in the lymphadenopathy, articular, peripheral nervous system, CNS and biological domains, White patients in the glandular, cutaneous and muscular domains, Asian patients in the pulmonary, renal and haematological domains and Hispanic patients in the constitutional domain. Systemic activity measured by the ESSDAI, clinical ESSDAI (clinESSDAI) and disease activity states was higher in patients from southern countries (P < 0.001).

CONCLUSION: The systemic phenotype of primary Sjögren's syndrome is strongly influenced by personal determinants such as age, gender, ethnicity and place of residence, which are key geoepidemiological players in driving the expression of systemic disease at diagnosis.

E
Eesa, N. N., H. Abdel Nabi, R. E. Owaidy, I. Khalifa, A. R. Radwan, A. M. NourEl-Din, M. A. Amer, R. R. El Shereef, E. Hassan, F. Ismail, et al., "Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation.", Lupus, vol. 30, issue 13, pp. 2135-2143, 2021. Abstract

OBJECTIVES: This study aims to present the manifestations of juvenile systemic lupus erythematosus (JSLE) across Egypt, to focus on age at onset and gender-driven influence on disease characteristics, and to compare findings to other countries.

METHODS: The study included 404 Egyptian children with systemic lupus erythematosus (SLE) presenting to one of the specialized rheumatology centers corresponding to 13 major governorates. Juvenile cases age was ≤ 16°years at the time of recruitment. The SLE Disease Activity Index (SLEDAI) and damage index (DI) were assessed.

RESULTS: The mean age was 13.2 ± 2.4°years; 355 females and 49 males (7.2:1), and the disease duration was 2.3 ± 1.6 years, while age at disease onset was 11.1 ± 2.5°years. Their SLEDAI was 13.5 ± 12.3, and DI, 0.36 ± 0.78. The overall estimated prevalence of childhood-SLE patients in the recruited cohort in Egypt was 1/100,000 population (0.24/100000 males and 1.8/100000 females). 7.4% developed pre-pubertal SLE (≤ 7 years); 73.3%, peri-pubertal; and 19.3% during early adolescence. The differences according to age group were equal for gender and clinical manifestations except skin lesions present in 59.3% of pre-pubertal onset, 74.6% of peri-pubertal, and 84.2% of adolescents ( = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents ( = 0.03). Laboratory investigations, SLEDAI, and DI were similar among age categories. Lupus nephritis was more common in Egypt compared to JSLE from other countries.

CONCLUSION: Our large multicenter study identified that female gender influenced disease characteristics with more frequent skin involvement. Skin lesions were significantly higher in adolescents, while renal involvement in peri-pubertal children.

El-Gazzar, I. I., H. M. Fathy, T. A. Gheita, and S. A. Kenawy, "Tumor necrosis factor-α -308 A/G gene polymorphism in children with juvenile idiopathic arthritis: relation to disease activity, damage, and functional status.", Clin Rheumatol, vol. 36, issue 8, pp. 1757-1763, 2017.
Eldefrawy, A., T. Gheita, H. Raslan, and M. El-Ansary-etal, "Serum and synovial cartilage oligomeric matrix protein levels in early and established rheumatoid arthritis", Z Rheumatol, vol. 75, issue 9, pp. 917-923, 2016.
Elessawi, D. F., H. Gabr, M. M. M. Badawy, and T. A. Gheita, "Therapeutic potential of mesenchymal stem cells for scleroderma induced in mouse model.", Tissue & cell, vol. 73, pp. 101671, 2021. Abstract

OBJECTIVE: To examine the potential therapeutic effect of mesenchymal stem cells (MSCs) for experimental scleroderma.

MATERIALS AND METHODS: Fifty-four mice six-week-old (30-35 g) were studied. Hypochlorous acid (HOCl) induced scleroderma was considered. Mice were divided into 3 groups: (I) Control: Six mice did not receive any treatment and were sacrificed at the end of the experiment; (II) HOCl mice (induced scleroderma as a positive control): (III) MSCs-treated HOCl mice: Thirty six HOCl-induced mice were injected with MSCs (7.5 × 105) intravenous every week for 3 weeks. Skin pieces were taken from the backs of mice and lung tissue pieces. a smooth muscle actin (α-SMA) and transforming growth factor-β (TGF-β1) were analysed or fixed in 10 % formalin for skin and lung tissue histopathological analysis. Plasma nitric oxide (NO) was also assayed.

RESULTS: There was a significant rise in the NO level and of the cutaneous and lung tissue α-SMA and TGF-β1 in untreated scleroderma-induced mice. The values significantly normalized after MSC therapy over the 7 weeks duration of the study. The altered histopathology of the skin and lung tissues in the scleroderma-induced mice showed a remarkable tendency to normalization of the skin and lung parenchyma and vasculature.

CONCLUSION: There was a significant rise in the level of NO and skin and lung tissue α-SMA and TGF-β1 in untreated scleroderma-induced mice and values were significantly normalized after MSC therapy over the 7 weeks duration of the study. Altered histopathology of the skin and lung appeared nearly normal after MSC therapy.

Elgengehy, F. T., S. M. Gamal, N. Sobhy, I. Siam, A. M. Soliman, G. W. Elhady, and T. A. Gheita, "Vasculitis damage index in Behçet's disease.", Advances in rheumatology (London, England), vol. 61, issue 1, pp. 33, 2021. Abstract

BACKGROUND: Vasculitis damage index (VDI) is a validated damage index for systemic vasculitis, and as Behçet's disease is considered one of systemic vascular disease we aimed to study the relationship of the vasculitis damage index to clinical manifestations and comorbidity in patients with Behçet's disease (BD) to determine if VDI could be used to assess damage in patients with BD.

METHODS: A total of 109 patients with BD were recruited from the Rheumatology Department (outpatient and inpatient clinic), Cairo University Hospitals. All patients were subjected to full history taking, clinical examination, and routine laboratory investigations. Disease activity was assessed by the BD current activity form, and the VDI was calculated in all patients. The relationship of the VDI to the disease clinical manifestations was studied. Mann-Whitney and Kruskal Wallis tests were used to estimate differences in quantitative variables. Spearman correlation test was used to test for correlation between quantitative variables.

RESULTS: In the current study, the VDI ranged from 1 to 10, with a mean of 3.5 ± 1.8. It was significantly associated with total thrombosis (P = 0.022); total neurological manifestations (P = 0.000), especially stroke and cranial nerve affection; uveitis (P = 0.005); avascular necrosis (AVN) (P = 0.015); osteoporosis (P = 0.01); impaired vision (P < 0.0001); cataract (P < 0.0001); and diabetes (P = 0.012). Generally, immunosuppressive treatment was significantly associated with VDI (P = 0.039), especially cyclophosphamide (P < 0.0001), biological agent (P = 0.008), chlorambucil (P = 0.003), and anticoagulant (P = 0.02). VDI was also significantly correlated with age (P = 0.033), disease duration (P = 0.029), and duration of eye involvement (P = 0.003).

CONCLUSION: VDI is significantly associated with most disease parameters of BD, except for parameters such as mucocutaneous manifestations and uncomplicated venous thrombosis; however, further studies may be needed to establish BD-specific damage index.

F
Fathi, H. M., I. E. I. Gazzar, M. A. I. Elazeem, E. AboulKheir, N. M. Gamal, F. Ismail, R. E. R. Shereef, S. Tharwat, S. Elwan, N. Samy, et al., "Rheumatologists' knowledge and perception of COVID-19 and related vaccines: the vaXurvey2 online survey.", Rheumatology international, 2022. Abstract

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.

Fotouh, A. A., M. O. N. A. HAMDY, F. Ali, E. F. Mohamed, A. Allam, W. A. Hassan, A. Elsaman, A. El-Najjar, M. A. Amer, D. Mosad, et al., "The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic.", Open access rheumatology : research and reviews, vol. 14, pp. 43-56, 2022. Abstract

Imaging has long been taking its place in the diagnosis, monitor, and prognosis of rheumatic diseases. It plays a vital role in the appraisal of treatment. Key progress in the clinical practice of rheumatology is the innovation of advanced imaging modalities; such as musculoskeletal ultrasound (MSUS), computerized tomography (CT) and magnetic resonance imaging (MRI). These modalities introduced a promising noninvasive method for visualizing bone and soft tissues to enable an improved diagnosis. The use of MSUS in rheumatology is considered a landmark in the evolution of the specialty and its ease of use and many applications in rheumatic diseases make it a forerunner instrument in the practice. The use of MSUS among rheumatologists must parallel the development rate of the excellence revealed in the specialty. Moreover, innovative interventional imaging in rheumatology (III-R) is gaining fame and key roles in the near future for a comprehensive management of rheumatic diseases with precision. This review article throws light on the emergence of these robust innovations that may reshape the guidelines and practice in rheumatology, in particular, efforts to enhance best practice during the coronavirus disease 2019 (COVID-19) pandemic are endorsed.

G
Gaber, W., GS Azkalany, T. A. Gheita, and et al, "Clinical significance of serum interleukin-6 and −174 G/C promoter polymorphism in Rheumatoid arthritis patients.", The Egyptian Rheumatologist,, vol. 35, issue 2, pp. 107-113, 2013.
Gheita, T. A., S. M. El-Rabbat, and N. K. Mahmoud, "Fibromyalgia and Rheumatic Diseases. ", Fibrom Open Access, vol. 2, issue 1, pp. 1-5, 2017.
Gheita, T. A., B. R. Sakr, R. E. Rabea, and S. M. Abdel Hamid, "Value of hematological indices versus VEGF as biomarkers of activity in Behçet's disease.", Clinical rheumatology, vol. 38, issue 8, pp. 2201-2210, 2019. Abstract

OBJECTIVE: The aim of this study is to investigate the value of several hematological indices, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red blood cell distribution width (RDW), and mean platelet volume (MPV), versus vascular endothelial growth factor (VEGF) as biomarkers of activity in Behçet's disease (BD).

METHODS: This study included 96 adult BD patients recruited from the Rheumatology Outpatient Clinic, Kasr Al-Ainy Hospital, Cairo University, and 60 healthy subjects as controls. Assessment of BD activity was done using the Behçet's Disease Current Activity Form (BDCAF). The CBC was measured by COULTER LH 750 assay analyzer with special consideration to the NLR, PLR, MPV, and RDW. Serum VEGF level was measured by enzyme-linked immunosorbent assay (ELISA) technique.

RESULTS: The NLR, RDW, and PLR were significantly higher in BD patients when compared with healthy controls (p = 0.011, < 0.001, < 0.001, respectively), while there was no statistical difference in MPV or VEGF between patients and controls (p = 0.82, 0.46). NLR and PLR were significantly higher in BD patients with vascular activity (p = 0.03, 0.01). RDW was significantly higher, while MPV was significantly lower in patients with vascular manifestations (p = 0.04, 0.004). NLR and PLR were the most valuable predictors of vascular activity (p = 0.033, 0.018). PLR was more powerful as a predictor of vascular activity, but it had a lower specificity than NLR.

CONCLUSION: The NLR, PLR, and RDW are significantly higher in BD patients, suggesting their value as promising inflammatory biomarkers in BD. NLR and PLR are the most valuable predictors of vascular activity, while RDW and MPV were not valuable predictors of BD activity, rather implicated in the ongoing vascular inflammatory process in BD. The VEGF was neither a surrogate biomarker of BD activity nor reflecting the ongoing inflammatory process in BD.

Gheita, T. A., S. Sayed, GS Azkalany, and et al, "Subclinical sacroiliitis in brucellosis: Clinical presentation and MRI findings. ", Z Rheumatol., vol. 74, issue 3, pp. 240-245, 2014.
Gheita, T. A., S. Sayed, and H. A. Gheita, "Vitamin D status in rheumatoid arthritis patients: relation to clinical manifestations, disease activity, quality of life and fibromyalgia syndrome. ", Intl J Rheum Dis, issue doi: 10.1111/1756-185X.12426. [Epub ahead of print], 2014.
Gheita, T. A., and S. A. Kenawy, "Measurement of malondialdehyde, glutathione and glutathione peroxidase in systemic lupus erythematosus patients.", Systemic Lupus Erythematosus Methods and Protocols - Methods in Molecular Biology, NewYork, Springer - Humana Press, 2014.
Gheita, T. A., S. Sayed, W. Hammam, and G. A. Hegazy, "Subclinical hypovitaminosis D and osteoporosis in breast cancer patients", Middle East J of Internal Medicine, vol. 8, issue 2, pp. 12-17, 2015.
Gheita, T. A., I. I. El-Gazzar, R. I. El-Shazly, and et al, "Elevated Serum Resistin in Juvenile IdiopathicArthritis: Relation to Categories and Disease Activity.", J Clin Immunol. , vol. 33, issue 1, pp. 297-301, 2013.
Gheita, T. A., H. M. Abdel-Samad, M. A. Mahdy, and A. B. Kamel, "Pattern of Primary Vasculitis with Peripheral Ischemic Manifestations: REPORT of a Case Series and Role of Vascular Surgery.", Curr Rheumatol Rev, vol. 10, issue 2, pp. 26-30, 2015.
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