Value of hematological indices versus VEGF as biomarkers of activity in Behçet's disease.

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.

Neurosonological and cognitive screening for evaluation of systemic sclerosis patients.

OBJECTIVE: Assessment of cerebrovascular hemodynamics, third ventricle diameter (as a proxy of brain atrophy) by transcranial sonography (TCS), and screening of cognitive performance by the Symbol Digit Modalities Test (SDMT) in systemic sclerosis (SSc) patients. METHODS: A total of 38 SSc patients recruited from the outpatient clinic of the Rheumatology Department, Kasr Alainy Hospital, Cairo University, and 51, age- and sex-matched, healthy controls were included in the study. TCS was used to assess the mean flow velocity (MFV), pulsatility index (PI) of the anterior, middle, and posterior cerebral arteries bilaterally, and to measure the third ventricle diameter as a proxy of brain atrophy. Cognitive impairment was screened using the SDMT. p values < 0.05 were considered statistically significant. RESULTS: There was no significant difference between SSc patients and controls regarding either PI or MFV of the anterior, middle, and posterior cerebral arteries; also, there was no difference regarding the third ventricle diameter; however, limited SSc patients showed a significant increase in the PI of PCA and MFV of ACA as compared with diffuse SSc patients (p = 0.005, 0.004). There was a significant difference between SSc patients and controls regarding the SDMT (p = 0.016). CONCLUSION: There is an evidence of increased cerebral vascular tone and resistance in limited SSc patients compared with diffuse SSc subgroup, without evidence of cerebral atrophy, suggesting early cerebrovascular affection even in asymptomatic limited SSc patients. There was also an evidence of cognitive impairment in SSc patients.

MicroRNA-146a expression and microRNA-146a rs2910164 polymorphism in Behcet's disease patients.

Behcet's disease is a chronic, multisystem, inflammatory disease of unknown etiology. Oral ulcers, genital ulcers, cutaneous lesions, and ocular and articular involvement are the prominent features of the disease. The aim of the study was to assess expression of microRNA-146a and its gene polymorphism in Egyptian Behcet's disease (BD) patients and to evaluate their possible relation with clinical manifestations and activity. This is a case-control study, included 47 BD Egyptian patients, recruited from the Rheumatology outpatient clinic, Kasr Alainy Hospital, Cairo University Hospitals, and 50 healthy controls. BD activity was assessed using the BD Current Activity Score. Quantitative expressions of serum microRNA-146a and microRNA-146a rs2910164 SNP genotyping were performed by real-time polymerase chain reaction (RT-PCR). P values < 0.05 were considered statistically significant. Serum microRNA-146a expression was significantly higher in BD patients than in controls (7. 27 ± 4.11, 1.13 ± .37) (P < 0.001). There was a significant association between microRNA-146a expression and eye activity (P = 0.033) and vascular activity (P = 0.041). miRNA-146a rs2910164 genotyping revealed that the frequency of CC genotype was higher in controls (12 vs 8.5%) and the frequency of GG genotype of rs2910164 was higher in the BD patients (59.6 vs 24%) (P = 0.138). MicroRNA-146a expression in Egyptian BD patients is significantly higher than that in controls; there is significant association between microRNA-146a expression and eye and vascular activity of BD. The frequency of CC genotype of rs2910164 was decreased; frequency of GG genotype of rs2910164 was increased in BD patients as compared to controls, suggesting that GG genotype of rs2910164 confers susceptibility to BD while CC genotype has a protective role against BD development.

Rheumatoid arthritis: A single-center Egyptian experience.

OBJECTIVE: Demonstration of rheumatoid arthritis (RA) characteristics in a large cohort of Egyptian patients. METHODS: Retrospective analysis of data of 3219 RA patients attending the Rheumatology outpatient clinic, Kasr Alainy Hospital, Cairo University; from January 1995 till December 2015. RESULTS: Mean age at disease onset was 36.1 ±13.4 years; 2774 (84%) were females and mean disease duration was 12.9 ±7.9 years. Regarding number of joint affected at disease onset; polyarticular pattern was found in 77.1%, pattern of joint involvement; combined small and large joints involvement was in 83.2%, subcutaneous nodules in 14.2%, interstitial lung disease in 0.3%, secondary Sjogren's syndrome in 10.5%, hand bony erosions at diagnosis in 20.6%. Rheumatoid factor was positive in 52%. There was annual increase in the newly diagnosed cases (P = 0.017) reflecting increase in patients' awareness and improvement of medical service, also annual increase in: mean age of onset (P < 0.001) reflecting changes in health measures, also in cases with monoarticular or oligoarticular patterns at disease onset (P = 0.02, 0.01 respectively) reflecting earlier diagnosis of patients and in patients with small joint involvement (P = 0.001) with a significant decline in: polyarticular pattern (P = 0.001), combined small and large joint affection (P < 0.001), and number of cases with hand bony erosions (P = 0.01) denoting earlier diagnosis, tight disease control. CONCLUSION: We found a female predominance, younger age at disease onset, lower frequency of extra articular manifestations, more frequent polyarticular pattern at disease onset and less erosive disease, denoting changing referral patterns, earlier diagnosis, improved disease control in Egyptian RA patients over 2 decades. ABBREVIATIONS: SNs: Subcutaneous nodules; 2ry SS: 2ry Sjogren's syndrome; ILD: Interstitial lung disease; ACPA: Anti-cyclic citrullinated peptide antibodies; DMARDs: Disease modifying anti-rheumatic drugs.