Clinical and immunological pattern and outcome of Egyptian systemic lupus erythematosus patients: a single center experience

Objective

The objective of this study was to describe the clinical and immunological pattern and disease outcome in Egyptian systemic lupus erythematosus patients.

Patients and methods

The medical records of 770 systemic lupus erythematosus patients who were followed from 2002–2015 at Kasr Alainy Hospital, Cairo University, were retrospectively reviewed.

Results

There were 707 (91.8%) females. The mean age at disease onset was 22.1 ± 8.6 and the disease duration was 6.1 ± 4.5 years. The main clinical manifestations were mucocutaneous (90.8% with oral ulcers affecting 52.5%), arthritis (80.3%), nephritis (67.8%), hematologic involvement (64.9%), serositis (55.2%) and neuropsychiatric manifestations (44.3%). The frequencies of antinuclear antibodies were 94.3%, anti-dsDNA 74.8%, anti-Smith 11%, anticardiolipin antibodies 29.5% and lupus anticoagulant 19.8%. Infections, predominantly bacterial, affected 337 (43.8%) patients. Thirty-three (4.3%) patients died. The main causes of death were sepsis and disease activity. The five- and 10-year survival rates for the total cohort were 97.4% and 96.3%, respectively, and were 96% and 92%, respectively for those with nephritis ( p = 0.008). Autoimmune hemolytic anemia, thrombocytopenia, elevated serum creatinine, a higher damage index, infections, a higher glucocorticoid dose and cyclophosphamide use ≥ six months were associated with an increased risk of mortality with odds ratios of 3.69, p < 0.01; 4.12, p < 0.001; 1.54, p < 0.001; 1.43, p < 0.001; 5.08, p < 0.001; 5.04, p < 0.001 and 2.25, p = 0.03, respectively.

Conclusion

Compared to other cohorts, a relatively lower mean age at systemic lupus erythematosus onset and higher frequencies of oral ulcers, serositis and nephritis were found.

Renal outcomes among Egyptian lupus nephritis patients: a retrospective analysis of 135 cases from a single centre

OBJECTIVES

The objective of this paper is to describe renal outcomes in a group of Egyptian patients with lupus nephritis and to identify variable prognostic factors.

PATIENTS AND METHODS

The records of 135 patients (129 females, six males) with biopsy-proven lupus nephritis seen between 1999 and 2011 at Kasr Al-Aini Hospital, Cairo University, were reviewed and included in a retrospective analysis. Biopsies were classified according to the WHO classification. Renal outcomes were defined according to the Renal Subcommittee of Renal Insufficiency of the American College of Rheumatology.

RESULTS

The mean follow-up period was 55.64 ± 25.68 (range 4-156) months. Thirty-nine patients (29.9%) developed an adverse final outcome. This composite outcome, defined as persistent elevation of serum creatinine ≥ 1.2 mg/dl, chronic renal insufficiency, end-stage renal disease or death, was seen in 12 (8.9%), seven (5.2%), three (2.2%) and 17 (12.6%) patients, respectively. The overall patient survival was 93.5% and 87.5% at five and 10 years, respectively. Factors associated with an adverse outcome included male gender (p = 0.037), hypertension at nephritis onset (p = 0.001), serum creatinine ≥1.2 mg/dl (p < 0.001), urinary casts (p = 0.006), anticardiolipin antibodies (p = 0.03), class IV nephritis (p < 0.001), hyaline thrombosis (0.003), glomerular sclerosis (p = 0.002), tubular atrophy(p < 0.001), interstitial fibrosis (p < 0.001) and a higher chronicity index (p = 0.006). Time-dependent factors associated with an adverse outcome included failure to achieve remission within the first year, uncontrolled hypertension, persistently low C3 and development of flares (p = 0.003, < 0.001, = 0.004, = 0.003, respectively).

CONCLUSION

The association of several adverse prognostic factors with the development of poor renal outcome has been confirmed in this study.

Effects of Temperature on the Fluoride Release and Recharging Ability of Glass Ionomers

The use of a higher temperature during topical fluoride applications may increase the fluoride recharging and re-release ability of glass ionomers, and a low oral environment temperature should be avoided during topical fluoride application.

Hypermobility among Egyptian children: prevalence and features

OBJECTIVE

To determine the prevalence, clinical manifestations, and possible associated features of hypermobility among Egyptian children in a prospective study.

METHODS

Nine hundred ninety-seven healthy children from 4 different educational areas for primary and presecondary schools were screened for the presence of hypermobility. A hypermobility score was used to denote the degree of laxity. Sites and possible clinical associations of hypermobility were determined.

RESULTS

The presence of hypermobility was 16. 1% among Egyptian children. Hypermobility was more frequent among girls (18%). than boys (14.4%), although the difference was not statistically significant. Age was inversely correlated with the frequency of hypermobility (r = 4).967, p < 0.001) and degree of joint laxity (r = -0.789, p < 0.01). Hypermobility was most prevalent in fingers (96.9%) and least prevalent in knee joints (3.1%). Hypermobility was statistically more frequent in nondominant than dominant fingers (p < 0.002). Arthralgia, high palate, flat feet, Raynaud's phenomenon, and easy bruising were more common among the hypermobility group.

CONCLUSION

Our results suggest that hypermobility is not uncommon among Egyptian children. Increased awareness of the condition is needed among pediatricians and other concerned physicians.