Is CDAI comparable to DAS 28 and SDAI regarding inter-observer agreement and correlation to MHAQ in Egyptian RA patients?

Choosing between the different disease activity indices used for rheumatoid arthritis RA evaluation in clinical practice and research is often difficult. The aim of the current study was to compare clinical disease activity index (CDAI) to simplified disease activity index (SDAI), and disease activity score 28 (DAS28) regarding inter-observer reliability and correlation to the modified health assessment questionnaire (MHAQ) in a cohort of Egyptian RA patients. This study included one hundred RA patients. Every patient had an independent clinical evaluation made by two rheumatologists (professor and candidate) to evaluate disease activity using DAS28 with its 4 types, CDAI and SDAI. We used Cohen's weighted kappa coefficient to measure the inter-observer agreement between the professor and candidate in different disease activity measures. Correlation between MHAQ and disease activity measures was made with Spearman's rho test. Inter-observer agreement in CDAI and DAS28 values was almost perfect. A strong positive correlation was found between professor and candidate regarding the tested activity indices (p<0.001), and a positive correlation was found between MHAQ and all Disease Activity Scores made by both professor and candidate (p<0.001). CDAI proved to be comparable to other disease activity scores regarding inter-observer agreement and relation to MHAQ.

Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center.

Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can vary among different ethnic and racial groups. Objective The objective of this paper is to study the prevalence of various manifestations of SLE in a sample of the Egyptian population. Patients and methods Information in this study was derived from the medical records of SLE patients who sought medical advice at a private clinic in Cairo from January 1980 to June 2016. Results This study included 1109 SLE patients, of whom 114 (10.3%) were males and 995 were females (89.7%). Mean age of onset was 25.89 ± 10.81 years, while the median of disease duration from the onset of the disease till the last recorded visit was 26 months. The most common cumulative manifestations were arthritis (76.7%), malar rash (48.5%), leukopenia (45.7%), and photosensitivity (45.6%). A total of 33.1% of the patients had nephritis, and neuropsychiatric lupus was present in 6.4% of the patients. Secondary antiphospholipid syndrome was present in 11.5% of the patients. Antinuclear antibody and anti-double-stranded deoxyribonucleic acid were present in 1060/1094 (96.9%) and 842/1062 (79.3%) of the patients, respectively. Antiphospholipid antibodies were present in 266/636 (41.8%) of the patients, anti-Smith in 54/240 (22.5%), anti-SSA/Ro in 61/229 (20.4%), and anti-SSB/La in 32/277 (11.6%) of the patients. Male patients had a statistically higher prevalence of nephritis ( p = 0.01), whereas arthritis and alopecia were statistically higher in females ( p = 0.012 and p = 0.006, respectively). Patients with juvenile onset had a statistically higher prevalence of nephritis and seizures ( p < 0.001 and p = 0.012, respectively). Conclusions Arthritis and malar rash represented the most common clinical manifestations. Male and juvenile-onset patients had a predilection toward a more severe disease. These results are in agreement with many studies conducted in the Middle East and worldwide. On the other hand, major organ involvement was exceptionally low, which is contradictory to several reports from the Middle East and across the globe.