Right ventricular diastolic function abormalities in patients with systemic sclerosis

Systemic sclerosis is a generalized disorder of connective tissue characterized clinically by thickening and fibrosis of the skin and by distinctive forms of involvement of internal organs, among which is the heart. Manifestations of scleroderma heart disease are quite variable, and often not seen until late in the course of the disease. This work aimed to assess the prevalence of right ventricular diastolic abnormalities in patients with systemic sclerosis and to investigate the relation to the clinical manifestations of the disease. Our study group included thirty four patients with systemic sclerosis [32 females and 2 males, their age ranged from 19 to 67yrs with a mean of 40.3 +/- 11.5yrs and a mean disease duration of 8.9 +/- 7.4yrs.] and thirty healthy subject who served as controls. All the study groups were subjected to full clinical evaluation and echo-Doppler study. Parameters of diastolic function included, E/A ratio and time velocity integrals of A wave and diastolic filling [TVI of A/TVI of DF]. Patients were diagnosed as having diastolic dysfunction when one or more of the two criteria were abnormal. Right ventricular diastolic abnormalities were found in 23 patients [67.65%] while left ventricular diastolic abnormalities were found in 11 patients [32.35%]. Seven patients had an ejection fraction below 60%, all had right ventricular diastolic dysfunction. There was a highly statistically significant difference between patients and control as regard tricuspid E/A [1.1 +/- 0.3 vs 1.3 +/- 0.2, p=0.0001] and tricuspid TVI of A/TVI of DF [0.4 +/- 0.1 vs 0.3 +/- 0, p=0.0001]. A significant correlation was found between right ventricular diastolic abnormalities and age of patients [the mean age of patients with abnormal diastolic function was 44.6 +/- 12 vs 35.4 +/- 8.8 for patients with normal diastolic function, p=0.017]. Right and left ventricular diastolic function abnormalities are common in patients with systemic sclerosis. Echocardiography should be recommended for all patients with systemic sclerosis even in asymptomatic patients especially in elderely

Ocular manifestations in patients with systemic lupus erythematosus: prevalence and relation to disease activity

This study aimed to investigate spectrum of ocular manifestations in systemic lupus erythematosus [SLE] patients and to clarify their relation to disease activity. Seventy female patients fulfilling the American College of Rheumatology [ACR] criteria for the diagnosis of SLE were enrolled in this study. Full medical history was taken with comprehensive clinical examination performed in all patients. Rheumatological laboratory investigations were done. Disease activity was assessed using Systemic Lupus Activity Measure [SLAM] index. Full ophthalmic examination was done including assessment of the lacrimal function and fundus examination. Fundus photography and fluorescein angiography were done for patients with evident or suspected posterior segment manifestations. From the results obtained, it was concluded that ocular manifestations are common with SLE. Although most ocular affection in SLE is relatively benign, sight-threatening complications are not rare. Visual compromise is usually related to retinal or optic nerve involvement and both are strongly correlated with the systemic disease activity. Therefore, early recognition of SLE ophthalmic manifestations and timely institution of systemic therapy may minimize visual morbidity. In a similar vein, documented SLE eye affection may guide the rheumatologist to either disease reactivation or systemic drug-related complications

study of iron status in rheumatoid arthritis patients and its correlation with disease activity

This study was conducted on 40 subjects, 30 patients with rheumatoid arthritis [R.A. Group] with disease duration 1-16 years and normal healthy persons [control group]. All subjects had full clinical examination including articular index score and laboratory investigations. 15 of the R. A. patients [50%] were shown to have anemia. In 5 patients [33.3%], it was iron deficiency anemia, while in 10 patients [66.7%], it was anemia of chronic disorders. Statistical comparison revealed significant increase in the ESR [p < 0.005] in the group of nonanemic R. A. patients as compared to the control group. Correlation studies of the 10 R. A. patients with anemia of chronic disorders [with normal or raised serum ferritin level] showed that a nonsignificant correlation was found between disease duration and each of Hb, serum iron and serum ferritin. A significant inverse correlation was found between Hb level and each of the parameters of disease activity [morning stiffness, articular index and ESR] i.e. The more the disease activity the more the degree of anemia, while nonsignificant correlation was found with serum iron and serum ferritin. It was concluded that in R.A. patients, anemia is a common feature being present in 50% of the patients. The degree of anemia corresponded with R. A. activity. Serum ferritin is a good indicator of iron stores and hence is valuable in the differentiation between these 2 types of anemia. Thus, serum ferritin can be used as an indicator of iron responsive anemia in patients with rheumatoid arthritis