Systemic lupus erythematosus children in Egypt: Homeland spectrum amid the global situation.

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 (p = 0.029), and renal involvement in 73.8% of peripubertal, 62.1% of pre-pubertal and 58.9% of adolescents (p = 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.

Asymptomatic atherosclerosis in egyptian rheumatoid arthritis patients and its relation to disease activity.

Aim. To detect the frequency of subclinical atherosclerosis in rheumatoid arthritis patients without clinically evident atherosclerosis and to correlate its presence with the disease activity. Patients and Methods. Our study includes 112 RA patients (group 1) and 40 healthy controls (group 11). All patients and controls were subjected to full history taking, clinical examination, and laboratory investigations. Carotid intima media wall thickness (IMT) and carotid plaques were measured in both groups by B-mode ultrasonography; also color duplex Doppler ultrasound of the brachial artery was done to detect endothelial function. Results. There is atherosclerosis in 31.3% of asymptomatic RA patients compared with only 5% in controls (P = 0.003(**)). A significant difference was detected in patients with and without atherosclerosis regarding duration of the disease (P = 0.0001(***)) and patient's age (P = 0.01(*)). There is highly statistical significant correlation between atherosclerosis and disease activity index. Conclusion. The frequency of subclinical atherosclerosis was high in long-term active RA patients.

Early detection of spondyloarthropathy in patients with psoriasis by using the ultrasonography and magnetic resonance image.

OBJECTIVE: To assess the validity of ultrasound (US) in the early detection of arthritis and enthesitis, with assessment of the validity of magnetic resonance imaging (MRI) in the early detection of sacroiliitis and spondylitis in patients with psoriasis and to compare the findings of clinical examination and conventional radiography. MATERIAL AND METHODS: The study included 50 patients with psoriasis and 20 healthy controls. All patients and controls underwent US and power Doppler analyses for the joints of both hands and feet and the entheseal sites. MRI of the lumbosacral spine and sacroiliac joints was performed. RESULTS: Abnormal US findings of arthritis were present in 18% patients, whereas only 6% patients had X-ray abnormalities, the enthesopathy represent 74%, at a higher percentage than clinical and radiological assessment (46, 26% respectively). MRI and radiological study demonstrated evidence of inflammation in the spine in 44% and 16% patients, respectively, and evidence of sacroiliitis in 10% and 6% patients, respectively. CONCLUSION: Use of newer imaging modalities allows early diagnosis and early initiation of therapy.