Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura

Frequency and Predictors of Opioid Use in Rheumatoid Arthritis and Seronegative Spondyloarthropathy Patients

BACKGROUND

Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients.

METHODS

This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05.

FINDINGS

About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval.

CONCLUSION

Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Serum Interleukin 23 in Psoriatic Arthritis Patients: Relation to disease activity, physical function and health related quality of life

Objective To assess interleukin 23 (IL-23) levels in the sera of psoriatic arthritis (PsA) patients and to determine the relationship of IL-23 with different disease activity indices, physical function and quality of life (QoL).

Methods Fifty PsA patients and 46 matched healthy controls were included in this study. Data including a detailed history, a thorough clinical examination, skin severity based on the Psoriasis Area and Severity Index (PASI), the Disease Activity index for Psoriatic Arthritis (DAPSA) and the Composite Psoriatic Disease Activity Index (CPDAI) were obtained for all patients. Physical function was assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI) and health-related QoL was assessed using the Short Form Health Survey (SF-36), Psoriatic Arthritis Quality of Life (PsAQoL) and the Dermatology Life Quality Index (DLQI) were also assessed. Serum IL-23 levels were measured in the studied groups.

Results The study included 23(46%) females and 27 (54%) males with a mean age of 42.78±12.33 years. The mean serum IL-23 level was significantly higher in PsA patients (50.89±13.86 pg/ml) than in controls (43.88±6.34 pg/ml) (p=0.006). There were significant correlations between serum IL-23 levels and different grades of DAPSA activity (p=0.007) and PASI (p=0.015). No significant correlations could be detected between serum IL-23 levels and (HAQ-DI, DLQI, SF-36 or PsAQoL). CPDAI and DAPSA were significantly correlated with DLQI, SF-36 and PsAQoL.

Conclusion IL-23 is a useful biomarker for identifying joint activity or skin severity but not QoL or physical function.

Rheumatology in Egypt: back to the future

Medical knowledge in ancient Egypt had a remarkable reputation since rulers of other empires used to request the pharaoh to send them their best physician to treat their beloved ones. Many rheumatologic conditions as giant-cell arteritis, reactive arthritis and other forms of spondyloarthritis have been identified in ancient Egyptian materials. Rheumatologists in Egypt are enormously expanding and mastering the tools that aid them in enhancing the management of rheumatic diseases. More Egyptian rheumatologists are actively participating in the annual European League Against Rheumatism (EULAR) and American College of Rheumatology conferences and those attached to well known state of the art centers are increasing. EULAR certified Egyptian MSUS trainers are effectively performing regionally. This review throws light on the rheumatology practice in Egypt, its progress from ancient times passing through Egyptian medical healthcare services, education systems for rheumatologists, rheumatology associations, an overview on the spectrum of rheumatic diseases through publications in the field till future perspectives. Rheumatology in Egypt is an actively growing and dynamic specialty of medicine with considerable contributions to the world's literature. These days, persistent efforts are mandatory to raise the standard of clinical and basic research, to optimize clinical practice with regard to new biologics, to develop tailored and targeted therapies for the rheumatic diseases, and to meet the medical demands of the exponentially increasing Egyptian population. Opportunities and challenges discussed high-lighten future perspectives needed to boost the rheumatology practice in Egypt.