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El Hasbani G, Nicolas J, Najjar V, Jawad ASM, Uthman I. Sarcoidosis as a cause of chronic back pain: a case report. Sarcoidosis Vasc Diffuse Lung Dis 2024; 41:e2024007. [PMID: 38567561 PMCID: PMC11008322 DOI: 10.36141/svdld.v41i1.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/31/2023] [Indexed: 04/04/2024]
Abstract
While sarcoidosis is typically a multisystem disease, it can, in some instances, exclusively affect the vertebrae, leading to back pain. Additionally, sarcoidosis may manifest with inflammation of the sacroiliac joints, not meeting the criteria for spondyloarthritis, yet contributing to back pain. In this report, we present a case involving a previously healthy 55-year-old woman who sought medical attention due to chronic back pain. She was subsequently diagnosed with spinal sarcoidosis, based on MRI, PET scan, and biopsy results. Furthermore, treatment with prednisolone monotherapy demonstrated substantial improvement in her symptoms.
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Affiliation(s)
- Georges El Hasbani
- Department of Medicine, Hartford Healthcare St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Jessica Nicolas
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vicky Najjar
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ali SM Jawad
- Department of Rheumatology, Royal London Hospital, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hasbani GE, Nassar JE, Uthman I, Jawad AS. The Impact of Nicotine Use on Osteoarthritis. Curr Rheumatol Rev 2024; 20:CRR-EPUB-139324. [PMID: 38523546 DOI: 10.2174/0115733971270925240318080227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Georges El Hasbani
- Department of Medicine, Hartford HealthCare St. Vincent's Medical Center, Bridgeport, CT, 06606, USA
| | - Joseph E Nassar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, Kibbi AG, Jawad A, Uthman I. Vacuolar Interface Dermatitis as a Histologic Reaction Pattern of Sjögren's Syndrome: A Case Report. Cureus 2023; 15:e46412. [PMID: 37927643 PMCID: PMC10621630 DOI: 10.7759/cureus.46412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Sjögren's syndrome (SS) has been widely known for its dry mouth and dry eyes presentation. Extraglandular disease manifestations may be protean and pose a challenge for clinicians, especially when the typical known manifestations are absent. Skin involvement of SS is variable, and cutaneous signs and symptoms may be the initial presentation of this syndrome. Vacuolar interface dermatitis has been linked to dermatomyositis and systemic lupus erythematosus, but rarely to SS. Herein, we present the case of an 87-year-old man who presented for widespread itchy erythematous scaly plaques that were refractory to topical corticosteroids as well as discontinuation of possible offending medications. A biopsy demonstrated vacuolar interface dermatitis in the setting of strongly positive anti-SSA. Hydroxychloroquine treatment was effective in resolving the plaques.
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Affiliation(s)
| | - Abdul-Ghani Kibbi
- Dermatology, American University of Beirut Medical Center, Beirut, LBN
| | - Ali Jawad
- Rheumatology, Royal London Hospital, London, GBR
| | - Imad Uthman
- Rheumatology, American University of Beirut Medical Center, Beirut, LBN
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Namas R, Elarabi M, Fayad F, Muhanna Ghanem AA, Al-Herz A, Hafiz W, Joshi A, Merashli M, Okais J, Uthman I, Essa KS, Omair MA. Expert Opinion Guidance on the Detection of Early Connective Tissue Diseases in Interstitial Lung Disease. Open Access Rheumatol 2023; 15:93-102. [PMID: 37273763 PMCID: PMC10237281 DOI: 10.2147/oarrr.s401709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/16/2023] [Indexed: 06/06/2023] Open
Abstract
There is a significant variation in symptoms and clinical presentation of connective tissue disorders (CTD) associated with interstitial lung disease (ILD) (CTD-ILD). This presents difficulties in the diagnosis and treatment of CTD-ILD. Early detection and treatment of CTD-ILD using a multidisciplinary approach have been shown to enhance patient outcomes. This exercise aims to explore clinical components to develop a screening tool for pulmonologists for early detection of CTD in ILD and to provide a framework for a multidisciplinary approach in managing CTD-ILD. This in turn will lead to early treatment of CTD-ILD in collaboration with rheumatologists. A panel of 12 leading rheumatologists from the Middle East and North Africa (MENA) region met virtually to select the most relevant clinical findings to aid in identifying CTD-ILD. Twelve panellists opted to investigate seven of the most common inflammatory autoimmune disorders. The panel discussed how to improve the early detection of CTD-ILD. Clinical characteristics were categorized, and a nine-item questionnaire was created. A biphasic algorithm was developed to guide early referral to a rheumatologist based on the presence of one of nine clinical features of CTD (Phase 1) or the presence of CTD-specific antibodies (Phase 2). A brief questionnaire has been developed to serve as a simple and practical screening tool for CTD-ILD detection. Additional research is needed to validate and evaluate the tool in longitudinal cohorts.
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Affiliation(s)
- Rajaie Namas
- Department of Internal Medicine, Division of Rheumatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Elarabi
- Department of Internal Medicine, Division of Rheumatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Fouad Fayad
- Rheumatology Department, Hotel-Dieu de France Hospital, Lebanon and Saint Joseph University of Beirut-Beirut (Lebanon), Beirut, Lebanon
| | | | - Adeeba Al-Herz
- Department of Rheumatology, Amiri Hospital, Kuwait City, Kuwait
| | - Waleed Hafiz
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abhay Joshi
- Department of Rheumatology, Burjeel Day Surgery, Abu Dhabi, United Arab Emirates
| | - Mira Merashli
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jad Okais
- Rheumatology Department, Hotel-Dieu de France Hospital, Lebanon and Saint Joseph University of Beirut-Beirut (Lebanon), Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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El Hasbani G, Uthman I. Lupus, antiphospholipid syndrome, and stroke: An attempt to crossmatch. Lupus 2023; 32:593-602. [PMID: 36940089 DOI: 10.1177/09612033231165151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Cerebrovascular accidents (CVAs) or strokes are part of the common thrombotic manifestations of Systemic Lupus Erythematosus (SLEs) and Antiphospholipid syndrome (APS). Such neurological thrombotic events tend to occur in patients with SLE at a higher frequency when Antiphospholipid antibodies (aPLs) are present, and tend to involve the large cerebral vessels. The mechanism of stroke in SLE can be driven by complement deposition and neuroinflammation involving the blood-brain barrier although the traditional cardiovascular risk factors remain major contributing factors. Primary prevention with antiplatelet therapy and disease activity controlling agent is the basis of the management. Anticoagulation via warfarin had been a tool for secondary prevention, especially in stroke recurrence, although the debate continues regarding the target international normalized ratio (INR). The presence of either of the three criteria antiphospholipid antibodies (aPLs) and certain non-criteria aPL can be an independent risk factor for stroke. The exact mechanism for the involvement of the large cerebral arteries, especially in lupus anticoagulant (LAC) positive cases, is still to be deciphered. The data on the role of non-criteria aPL remain very limited and heterogenous, but IgA antibodies against β2GPI and the D4/5 subunit as well as aPS/PT IgG might have a contribution. Anticoagulation with warfarin has been recommended although the optimal dosing or the utility of combination with antiplatelet agents is still unknown. Minimal data is available for direct oral anticoagulants (DOACs).
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, 11238American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, Saliba AN, Uthman I, Taher AT. Hematological manifestations of antiphospholipid syndrome: Going beyond thrombosis. Blood Rev 2023; 58:101015. [PMID: 36175215 DOI: 10.1016/j.blre.2022.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
Thrombotic complications are a hallmark of antiphospholipid syndrome (APS). These vascular - arterial, venous, and/or small vessel - complications are well described and known to hematologists and healthcare providers caring for patients with this disease. In this review, we shed light on other hematological manifestations of the disease, including bleeding, thrombocytopenia, autoimmune hemolytic anemia, and thrombotic microangiopathy syndromes. While these manifestations are not bona fide clinical criteria for the diagnosis of APS, they frequently interact and contribute to the complexity of clinical management of APS.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, Hartford Healthcare, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Antoine N Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon..
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El Hasbani G, Jawad ASM, Uthman I. Erythema nodosum in Behçet's disease in remission: Think COVID-19? SAGE Open Med Case Rep 2023; 11:2050313X231154316. [PMID: 36776209 PMCID: PMC9908516 DOI: 10.1177/2050313x231154316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
The coronavirus disease has several manifestations related to the activation of the immune system. Because of such activation, autoimmune diseases, including vasculitis, have been reported to occur. Behçet's disease, a variable vessel vasculitis, has been discussed in the context of coronavirus disease. Rarely, the induction of Behçet's disease flare or exacerbation has been reported necessitating aggressive treatment. The presentation of Behçet's disease flares secondary to coronavirus disease is variable, including mucocutaneous lesions and eye or joint involvement. We highlight the case of a 35-year-old woman with pre-existing Behçet's disease in remission on colchicine presenting with new onset erythema nodosum-like lesions on her right shin being diagnosed with coronavirus disease infection a few days after. Despite treatment with systemic corticosteroid, the lesions did not resolve, necessitating the initiation of anti-interleukin-6 therapy.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, Hartford Healthcare, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | | | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Imad Uthman, Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, Beirut 1107 2020, Lebanon.
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El Hasbani G, Uthman I. ANCA-Associated Vasculitis following the First Dose of Pfizer-BioNTech COVID-19 Vaccine. Nephron Clin Pract 2023; 147:103-107. [PMID: 35850104 PMCID: PMC9747720 DOI: 10.1159/000525562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease (COVID-19) vaccine can alter the body's immunological balance leading to autoimmune disease in rare cases. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is one of the autoimmune diseases which have been rarely reported to appear post-COVID-19 vaccine. Herein, we report the case of a 47-year-old woman who developed acute renal failure few days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. Corticosteroids along with azathioprine were used for the management.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, USA,
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, El Saghir N, Moukaddam H, Farhat L, Shabb N, Uthman I. Sarcoidosis Mimicking a Malignant Metastatic Disease. Clin Med�Insights�Arthritis�Musculoskelet Disord 2023; 16:11795441221145937. [PMID: 37152614 PMCID: PMC10160796 DOI: 10.1177/11795441221145937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/30/2022] [Indexed: 01/09/2023]
Abstract
Sarcoidosis can have pulmonary and extrapulmonary clinical manifestations depending on the organ of involvement. Because multiple organs are involved by the disease, sarcoid can mimic metastatic diseases. Whenever clinical and radiological clues of metastasis are present, differentials other than cancer should not be missed. Herein, we present a case of a middle aged gentleman who presented to the oncology clinic for 1-month history of low back pain associated with a dry cough along with radiological findings of metastatic disease involving the lungs, liver, lymph nodes, axial spine, and adrenal gland. A biopsy of the liver lesion showed non-caseating granuloma. Elevated blood levels of angiotensin-converting enzyme confirmed the diagnosis of sarcoidosis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Nagi El Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lama Farhat
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nina Shabb
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, Jawad ASM, Uthman I. Rheumatology research output in the Arab World: despite the challenges. Reumatismo 2022; 74. [PMID: 36580063 DOI: 10.4081/reumatismo.2022.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022] Open
Abstract
Rheumatology is a field in which diagnostic, pathophysiological, and therapeutic advancements occur daily. These developments are the result of research in basic sciences, translational sciences, and clinical sciences. Physical and financial support, provided by individuals and institutions, is essential for all types of research. The political and economic instability in the Arab world has impacted the advancement of healthcare and the output of research. This review seeks to evaluate the quantity and quality of rheumatology-related research conducted in the Arab world. This review examined the number of rheumatological clinical publications produced by Arab countries between 2017 and 2021 and cited by PubMed/MEDLINE. Publications with authors from multiple nations were disqualified. Publications were then categorized by type, including randomized controlled trials (RCTs), cohort studies, cross-sectional studies, systematic reviews, narrative reviews, and case reports. Publications were also organized according to the regions of the Arab world: North and East Africa, the Middle East, and the Arabian Peninsula. The review also used data from the world bank to evaluate the gross domestic product (GDP) and total population of Arabian nations in order to calculate a ratio of publications to GDP and publications to population. Egypt had the highest number of publications among north and east African countries and Arab countries in general, with 261 publications, including the highest number of RCTs, which were 23. With 81 publications, Saudi Arabia had the highest number of publications on the Arabian peninsula. However, no individual country on the Arabian peninsula published an RCT. Lebanon had the most publications in the Middle East, but the majority were reviews and case reports. Tunisia had the highest ratio of publications to GDP. Notably, the number of publications increased during the coronavirus disease 2019 era in some countries. The Arab world is still able to produce clinical rheumatology publications despite its political instability and lack of resources. The influence of such publications on the daily practice of rheumatology is still debatable.
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Affiliation(s)
- G El Hasbani
- Department of Internal Medicine, Hartford HealthCare, St. Vincent's Medical Center, Bridgeport, CT.
| | - A S M Jawad
- Department of Rheumatology, The Royal London Hospital, London.
| | - I Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
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Abstract
PURPOSE This manuscript will summarize the role of pro-inflammatory cytokines and tackle newly discussed ones within the scope of OA pathogenesis as mentioned in the recent literature. This will allow for a better understanding of the mechanisms behind such a complicated disease. MATERIAL AND METHODS Relevant articles were obtained by searching key terms including "pro-inflammatory cytokines," "inflammation," "pathophysiology," "cartilage damage," and "OA" in PubMed and Google Scholar databases. The year ranges set for the selection of the articles was between 2015 -2021. Inclusion criteria was based on the relevance and contribution to the field of the study. RESULTS Osteoarthritis (OA) has a complex multifactorial pathophysiology which is attributed to molecular and biomechanical changes that disrupt the normal balance of synthesis and degradation of articular cartilage and subchondral bone. Pro-inflammatory cytokines, with their wide range of action and intricate signaling pathways, are the constant subject of new discoveries revolving around this inflammatory disease. The available literature indicates that some of these cytokines such as IL-33, IL-17, IL-6, and IL-22 have a direct relation to cartilage degradation, while others like IL-15, IL-1, IL-7, and IL-34 have an indirect one. CONCLUSIONS Inflammation has an essential role in the manifestation of osteoarthritis clinical events. Specifically, certain cytokines exhibit pro-inflammatory properties that are markedly activated during the course of the disease and notably alter the homeostasis of the joint environment. However, clinical trials and observational studies remain insufficient to navigate the varying nature of this disease in humans.
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Affiliation(s)
| | - Maha Trad
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Wafaa Bzeih
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, Uthman I, Jawad S, Jawad ASM. The psychological impact of Behçet's disease. Musculoskeletal Care 2022; 20:742-757. [PMID: 35384265 DOI: 10.1002/msc.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bechet's disease (BD), a chronic multiorgan involving disease, has a significant impact on quality of life in spite of effective treatment modalities. Disease manifestations such as arthritis, orogenital ulcerations, rashes, angiitis, and neurological involvement affect health-related quality of life (HRQoL) through its impact on depression, anxiety, and fatigue. OBJECTIVES We aimed explore the psychological impact of BD, taking into consideration the effect on the HRQoL, as well as the association with depression, anxiety, wellbeing, and fatigue. METHODS This is a narrative review of the literature that looks into the association of BD on the HRQoL including all studies that have assessed such as association. RESULTS/FINDINGS Depression and anxiety are prevalent among patients with BD, and contribute significantly to fatigue, a common symptom among BD patients. In addition, the psychological wellbeing is affected by the disease, however, more studies are needed to assess this relationship. CONCLUSION Depression and anxiety are strongly associated with BD, and contribute significantly to fatigue, a common symptom among BD patients. In addition, the psychological wellbeing is affected by the disease, however, more studies are needed to assess this relationship. Besides, the controlling factors of the psychological impact are still to be deciphered.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sudad Jawad
- The COPSE, Elysium Health Care, Weston-super-Mare, UK
| | - Ali S M Jawad
- The London Behçet's Centre of Excellence, Royal London Hospital, London, UK
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Ziadeh H, Chaaya M, Rachidi S, Asmar KE, Al-Hajje A, Hamieh L, Nahra V, Uthman I. Lebanese Hospital-Based Rheumatoid Arthritis Registry: Characteristics of Patients and Comparison with Other Populations. Mediterr J Rheumatol 2022; 33:218-223. [PMID: 36128213 PMCID: PMC9450197 DOI: 10.31138/mjr.33.2.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of the Lebanese hospital-based Rheumatoid Arthritis (RA) registry, initiated in 2011, is to evaluate the safety and efficacy of biologic agents among patients seeking care at the American University of Beirut Medical Center (AUBMC). We aimed to characterize the demographic and clinical profile of RA patients included in the Lebanese registry. We compared our results with those issued from Middle Eastern and non-Middle Eastern registries. Methods 195 Patients enrolled in the RA registry from 2011 to 2018 were considered in this study. Patients enrolled in the registry were eligible to be treated with biologics, but 56 patients remained biologics naïve. Patients were reassessed every six months. Results The highest proportion of patients were female (81%). The mean age was 55.53±15 years, and the disease duration was 11.38±7.7 years. RA was diagnosed at a mean age of 44.13±16 years. Almost one-third of RA patients were smokers (29.2%) and 15% consumed alcohol. Comorbidities included cardiac diseases (30.8%), hypertension (24.6%), hyperlipidemia (11.8%), diabetes mellitus (9.2%), and Hypothyroidism (6.2%). Three cases of cancer and seven cases of tuberculosis were reported. The mean of the Disease Activity Score (DAS28) was 3.75 ± 2.28 with no difference according to gender; the mean of the Health Assessment Questionnaire (HAQ) score showed a significant difference between females and males (1.02 ± 0.84 and 0.61 ± 0.7 respectively). Methotrexate was the most commonly used medication. There was non-significant difference in taking biologics according to gender. Conclusion Our findings are similar to other studies in terms of gender distribution. The higher mean age at diagnosis compared to other populations could indicate a delay in seeking appropriate care. The Lebanese RA registry provides valuable data on pharmacological interventions used and an opportunity to follow up to examine the effectiveness of different therapeutics and to monitor their side effects.
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Affiliation(s)
- Houda Ziadeh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Doctoral School of Science and Technology, Lebanese University, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy Department, Lebanese University, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy-Clinical Pharmacy Department, Lebanese University, Beirut, Lebanon
| | - Lamiaa Hamieh
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Vicky Nahra
- Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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El Hasbani G, El Ouweini H, Dabdoub F, Hourani R, Jawad AS, Uthman I. Rheumatoid Cerebral Vasculitis in a Patient in Remission. Clin Med Insights Case Rep 2022; 15:11795476221083114. [PMID: 35283656 PMCID: PMC8915229 DOI: 10.1177/11795476221083114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Cerebral vasculitis is a very rare extra-articular complication of rheumatoid arthritis (RA) that is often challenging to diagnose. Elevated titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antinuclear antibodies (ANA) have been linked with severe complications. The absence of highly elevated titers of RF, anti-CCP, and ANA can complicate the diagnosis of RA-associated cerebral vasculitis. We report the case of a 59-year-old woman with long-standing arthritis maintained on rituximab and leflunomide who developed sudden headaches and altered level of consciousness. Laboratory work-up revealed normal lymphocyte count and mildly elevated total serum protein and anti-CCP with negative RF and ANA and no evidence for viral or bacterial infections. Cerebrospinal fluid analysis (CSF) showed slightly elevated anti-CCP with normal levels of CXCL-13 and interleukin 6 (IL-6). Brain magnetic resonance imaging (MRI) showed ill-defined lesion of high T2 signal. Using MR angiogram, MR perfusion, and MR spectroscopy, the diagnosis of rheumatoid cerebral vasculitis was confirmed. The patient was treated with intravenous methyl-prednisolone with fast complete improvement. We conclude that adequate immunosuppression in RA might not be able to prevent rare extra-articular manifestations such as rheumatoid cerebral vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala El Ouweini
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatema Dabdoub
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Jawad AS, El-Hasbani G, Uthman I. The effect of wet-cupping therapy (hijama) in modulating autoimmune activity of Hashimoto’s thyroiditis. Saudi Med J 2022; 43:321. [PMID: 35256502 PMCID: PMC9280538 DOI: 10.15537/smj.2022.43.3.20220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ali S Jawad
- Department of Rheumatology The Royal London Hospital London, United Kingdom
| | - Georges El-Hasbani
- Department of Rheumatology The Royal London Hospital London, United Kingdom
| | - Imad Uthman
- Department of Rheumatology The Royal London Hospital London, United Kingdom
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16
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Hasbani GE, Uthman I, Jawad AS. Musculoskeletal Manifestations of Sarcoidosis. Clin Med Insights Arthritis Musculoskelet Disord 2022; 15:11795441211072475. [PMID: 35185345 PMCID: PMC8854226 DOI: 10.1177/11795441211072475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 01/12/2023]
Abstract
Since its initial description in the late 19th century, sarcoidosis has been extensively studied. Although the general mechanism of immune activation is known, many details especially in the context of disease associations are still missing. One of such associations is the musculoskeletal complications that are widely variable in terms of presentation and response to treatment. Sarcoidosis can involve the joints leading to acute and, less commonly chronic, arthritis. While acute arthritis is mostly self-resolving in nature, chronic arthritis may lead to deformity and destruction of the joint. Sarcoidosis can also involve the muscles, leading to different pathologies primarily categorized according to the clinical presentation, despite the efforts to find a new classification based on imaging, histological, and clinical findings. The bones can be directly and indirectly affected. Different types of bone lesions have been described, although around half of these patients remain asymptomatic. Osteoporosis, increased risk of fractures, hypercalcemia, and hypercalciuria are examples of the indirect effect of sarcoidosis on the bones, possibly contributed to elevated levels of calcitriol. Nevertheless, sarcoidosis can be associated with small-vessel, medium-vessel, and large vessel vasculitis, although it is frequently difficult to differentiate between the co-existence of a pure vasculitis and sarcoidosis and sarcoid vasculitis.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sm Jawad
- Department of Rheumatology, The Royal London Hospital, London, UK
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17
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Radin M, El Hasbani G, Barinotti A, Roccatello D, Uthman I, Taher A, Sciascia S. Quality of life measures in Systemic Lupus Erythematosus: A systematic review. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient’s perspective.
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Affiliation(s)
| | - Nabil J Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- From the Division of Rheumatology, Department of Internal Medicine
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Abstract
Whether affecting children or adults, SARS-CoV-2 infection (COVID-19) can have multi-organ involvement mediated by an inflammatory cascade. Immunoglobulin A (IgA) is one of the key components of the inflammatory cascade that can lead to endothelial injury and inflammation. IgA vasculitis or Henoch-Schönlein purpura (HSP) has been rarely reported in the context of COVID-19. In this report, we highlight a case of HSP occurring 2 days after diagnosis of COVID-19 in a 16-year-old boy, who presented with palpable purpura of the lower extremities and buttocks, diffuse abdominal pain, hemoptysis, and hematochezia. He was treated with oral prednisolone with rapid clinical improvement.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali S M Jawad
- Department of Rheumatology, Royal London Hospital, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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20
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Consultant Rheumatologist, Department of Rheumatology, The Royal London Hospital, London, UK
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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21
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Hasbani GE, Taher AT, Sunji N, Sciascia S, Uthman I. Antiphospholipid antibodies and cerebrovascular thrombosis in the pediatric population: Few answers to many questions. Lupus 2021; 30:1365-1377. [PMID: 34082580 DOI: 10.1177/09612033211021488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most of the knowledge in pediatric antiphospholipid syndrome (APS) is derived from studies performed on the adult population. As in adults, antiphospholipid antibodies (aPL) can contribute to thrombosis, especially cerebrovascular thrombosis, in neonates and children. Since aPL have the potential to cross the placental barrier, and since the pediatric population is prone to infections, re-testing for their positivity is essential to specify their role in cerebrovascular thrombosis.In this review, we aimed at assessing the prevalence of aPL, criteria or non-criteria, in neonatal and childhood ischemic stroke and sinovenous thrombosis trying to find an association between aPL and cerebrovascular thrombosis in the neonatal and pediatric population. Also, we looked into the effect of aPL and anticoagulants/antiplatelets on the long term neurological outcomes of affected neonates or children. The questions regarding the prevalence of aPL among pediatric patients with cerebrovascular thrombosis, the relationship between the titers of aPL and incidence and recurrence of cerebrovascular events, the predictability of the long term neurological outcomes, and the most optimal anticoagulation plan are still to be answered. However, it is crucial for clinicians to screen neonates and children with cerebrovascular thrombosis for aPL and confirm their presence if positive.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Sunji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy.,Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, Turin, Italy.,Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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22
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El Hasbani G, Taher AT, Abi-Ghanem AS, Nassif S, Bizri AR, Uthman I. Polymyalgia rheumatica-like presentation in a case of diffuse large B-cell lymphoma: a diagnostic pitfall. J Int Med Res 2021; 49:3000605211018595. [PMID: 34044637 PMCID: PMC8168051 DOI: 10.1177/03000605211018595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) commonly presents with systemic manifestations including fever, weight loss, and night sweats. Uncommonly, patients with DLBCL can present with musculoskeletal manifestations mimicking polymyalgia rheumatica (PMR). Herein, the case of a 61-year-old woman who presented with pain in the bilateral shoulders, arms, hands, knees, pelvic girdle, and neck with bouts of fever, is presented. Laboratory workup for infectious and connective tissue diseases was non-revealing, except for elevated inflammatory markers. A positron emission tomography (PET)/computed tomography (CT) scan was suggestive of PMR, but also revealed enlarged lymph nodes initially thought to be reactive in nature. However, a lymph node biopsy showed findings consistent with DLBCL. This case highlights the importance of a thorough investigational workup when cases with features of PMR do not meet the proper criteria for this diagnosis to be made, in order not to miss a hematopoietic neoplasm with a PMR-like presentation.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alain S Abi-Ghanem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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23
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El Hasbani G, Jawad A, Uthman I. Axial and peripheral spondyloarthritis triggered by sars-cov-2 infection: a report of two cases. Reumatismo 2021; 73:59-63. [PMID: 33874649 DOI: 10.4081/reumatismo.2021.1374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can show musculoskeletal symptoms such as peripheral arthritis. In rare cases, peripheral arthritis can develop after the resolution of SARS-CoV-2. We present two cases of spondyloarthritis induced by SARS-CoV-2; one case with axial and peripheral spondyloarthritis and the other with peripheral spondyloarthritis. Both cases refer to Lebanese patients who were HLA-B27 positive. These two cases highlight the possible predisposition of HLA-B27 positive patients to the development of spondyloarthritis symptoms triggered by SARS-CoV-2.
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Affiliation(s)
- G El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
| | - A Jawad
- Rheumatology department, Royal London Hospital, London.
| | - I Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
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24
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Abstract
Introduction: As soon as the association of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL) with thrombosis and miscarriages was described in the 1980s, the definition of the antiphospholipid syndrome (APS) became a need. Early descriptions of the disease by members of the Graham Hughes team included broad categories and unexplained laboratory inclusions. Over time, new clinical and experimental data refined the criteria, especially the obstetric manifestations, as well as the laboratory criteria.Areas covered: The authors performed a review of the literature using the PubMed database, and the following keywords were used: 'antiphospholipid antibody', 'antiphospholipid syndrome', and 'criteria of antiphospholipid'. The history of antiphospholipid criteria, clinical and experimental advancements, and other expert opinions were included in this paper.Expert opinion: It has been 14 years since an international congress on antiphospholipid antibodies has generated new classification based on the recent extensive research performed in the field. Currently, there is a need to update the international APS classification taking into consideration the inclusion of new clinical criteria such as aPL-related nephropathy as well as new standardized antibody specificities (e.g., anti-phosphatidylserine/prothrombin antibodies) with the adoption of a standardized scoring system that can stratify APS patients.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases and SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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25
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Ziade N, Arayssi T, Elzorkany B, Daher A, Karam GA, Jbara MA, Aiko A, Alam E, Emadi SA, Mashaleh MA, Badsha H, Kibbi LE, Halabi H, Harifi G, Khan B, Masri AF, Menassa J, Merashli M, Merheb G, Messaykeh J, Mroue' K, Saad S, Salloum N, Uthman I, Masri B. Development of an Educational Video for Self-Assessment of Patients with RA: Steps, Challenges, and Responses. Mediterr J Rheumatol 2021; 32:66-73. [PMID: 34386703 PMCID: PMC8314883 DOI: 10.31138/mjr.32.1.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives: The primary objective was to develop an educational video to teach patients with rheumatoid arthritis (RA) self-assessment of their disease activity. Secondary objectives were to validate the video, identify the challenges in producing it, and the responses to these challenges. Methods: Rheumatologists from 7 Middle Eastern Arab countries (MEAC) discussed unmet needs in the education of patients with RA. They reviewed pre-existing educational audiovisual material and drafted the script for a new video in Arabic. The video was produced in collaboration with a technical team, then validated by patients using a standardized interview. At each step of production, challenges were identified. Results: Twenty-three rheumatologists from MEAC identified unmet needs in patients’ education. A video was produced, explaining the concepts of treat-to-target and showing a patient performing self-assessment using DAS-28. Sixty-two patients were interviewed for validation and found the video to be useful and easy to understand, albeit not replacing the physician’s visit. Most common challenges encountered included acceptance of patient empowerment, agreement on DAS-28 as composite measure, production of a comprehensible written Arabic text, and addressing the population cultural mix. Conclusion: Despite challenges, the video was well accepted among patients and can be used for clinical and research purposes. It is particularly useful in pandemic periods where social distancing is recommended.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Humeira Badsha
- Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | | | | | - Ghita Harifi
- Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Bhavna Khan
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | | | | | | | | | | | | | - Sahar Saad
- Assiut University, Egypt & King Hamad University Hospital, Bahrain
| | | | - Imad Uthman
- American University of Beirut, Beirut, Lebanon
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26
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El Hasbani G, Chahine R, Uthman I, Taher AT. Intravenous immunoglobulin, neonatal alloimmune thrombocytopenia, and Sjogren's syndrome: A case report. Eur J Obstet Gynecol Reprod Biol 2021; 258:476-477. [PMID: 33549366 DOI: 10.1016/j.ejogrb.2021.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rabih Chahine
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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27
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El Hasbani G, Viola M, Sciascia S, Taher AT, Uthman I. Antiphospholipid Antibodies in Inflammatory and Autoimmune Rheumatic and Musculoskeletal Diseases Beyond Lupus: A Systematic Review of the Available Evidence. Rheumatol Ther 2021; 8:81-94. [PMID: 33420626 PMCID: PMC7991011 DOI: 10.1007/s40744-020-00273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background The diagnosis of antiphospholipid syndrome (APS) requires the presence of thrombosis and/or recurrent miscarriages along with one or more anti-phospholipid antibodies (aPL). The role of aPL has been largely investigated in systemic lupus erythematosus (SLE) with minimal data on other autoimmune rheumatic diseases. In this review, we aim to assess the prevalence of aPL in patients with inflammatory and autoimmune rheumatic and musculoskeletal diseases (RMDs) other than SLE, and their association with thrombosis. Results A total of 20 studies, including 3242 patients, measured aPL in different inflammatory and autoimmune RMDs. The overall median percentage of aPL-positive patients was 14.05% (from 0 to 57.5%). For systemic sclerosis (SSc) patients, the median positivity was 14.05% for aPL, with IgG aCL being detected in up to 35.48% of all SSc aPL-positive patients. Only six studies (30%) performed an antibody confirmation test after 12 weeks, with the median prevalence being 10.88% (from 0 to 29.79%). Only six studies also assessed the number of double or triple aPL-positive patients. A total of eight (40%) studies including 1071 patients investigated the association between aPL and thrombotic events, namely five for SSc, one for SS, one for ANCA associated vasculitides (AAV), and one for RA. A median of 18.75% (7.69–71.43%) of aPL-positive patients experienced an arterial event in comparison to a median of 13.66% (7.69–31.25%) who underwent venous thrombotic event. Taking into consideration only the studies that performed a confirmation test, a median value of 34.36% (12.9–71.43%) of aPL-positive patients underwent an arterial event and a median value of 16.32% (9.68–25%) of aPL-positive patients underwent a venous event. Conclusions Anti-phospholipid antibodies can be detected in up to a third of patients with inflammatory and autoimmune RMDs, especially in SSc. However, there was a large heterogeneity among the retrieved studies. Available data supporting a general screening for aPL in all inflammatory and autoimmune RMDs are still insufficient. Screening for aPL in selected scenarios (e.g., pregnancy planning) could be considered.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mario Viola
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases and SCDU Nephrology and Dialysis, University of Turin, Turin, Italy
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases and SCDU Nephrology and Dialysis, University of Turin, Turin, Italy
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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28
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Hasbani GE, Jawad A, Uthman I. Cupping (Hijama) in Rheumatic Diseases: The Evidence. Mediterr J Rheumatol 2021; 32:316-323. [PMID: 35128323 PMCID: PMC8802202 DOI: 10.31138/mjr.32.4.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Although practiced initially for the alleviation of pain, cupping therapy (Hijama in Arabic) has been used for a variety of medical conditions, including autoimmune and autoinflammatory diseases, with variable outcomes. In recent years, scientific research on the effectiveness of cupping in the treatment of various diseases has accelerated. Relevant literature to identify the types of cupping along with its association with certain rheumatic conditions was screened through a search of the online databases (MEDLINE, PubMed, and Google Scholar) for an indefinite period. Many reports have drawn serious rheumatic side effects which led medical providers to raise the voice against its practice. Moreover, the rare induction of rheumatic conditions has been partly referred to the immunomodulatory effect that cupping exerts in the body. Cupping therapy still needs more evidence to be labelled as therapeutic procedure for rheumatic conditions. Many studies agree that cupping works best when used in combination to pharmacotherapy. Other studies find no clinically significant beneficial role.
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
| | - Ali Jawad
- Department of Rheumatology, Royal London Hospital, Bancroft Road, London, United Kingdom
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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29
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Nahra V, Hasbani GE, Chaaya M, Uthman I. The Use of Infliximab (Remicade®) for the Treatment of Rheumatic Diseases at a Tertiary Center in Lebanon: A 17-Year Retrospective Chart Review. Mediterr J Rheumatol 2020; 31:400-405. [PMID: 33521572 PMCID: PMC7841097 DOI: 10.31138/mjr.31.4.400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives: Infliximab (Remicade®) was the first tumour necrosis factor-α (TNF) inhibitor to receive its initial marketing approval from the US Food and Drug Administration (FDA) for the treatment of Crohn’s disease. Following that, infliximab became approved for several immune-mediated inflammatory diseases. No evidence exists in the Middle East and North Africa region on the experience with infliximab use over an extended period in terms of efficacy and safety. Methods: The Rheumatology division at the American University of Beirut Medical Centre (AUBMC), one of the largest tertiary centres in the Middle East and North Africa region, has been using infliximab infusions for the treatment of certain rheumatic diseases for around two decades. By reviewing retrospectively medical charts at AUBMC, we investigate indications, safety and efficacy, rate of withdrawals, rate of switching to another biologic, and financial coverage of the drug to present data for practitioners and patients in the region considering infliximab for treatment of immune-mediated inflammatory diseases. Results: A total of 198 patients were identified in the past 17 years to have taken infliximab. The largest proportion of treated patients had RA. Fourteen percent of the total cohort experienced serious adverse events, with 96.4% of those events being mild hypersensitivity reactions. Five patients withdrew the medication because of infectious complications, 4 of which were cases of tuberculosis reactivation. Despite that, around half of the patients were switched to another biologic agent such anti-TNF-α, anti-CD20, and anti-IL-6 due to partial response, and less than half were receiving add-on disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, 70% of patients who used infliximab only or were switched achieved complete remission at their last hospital information. Around 98% of infliximab users were financially covered. Conclusion: According to our experience, infliximab has made remission and prevention of long-term disability realistic goals of therapy in the Middle East region.
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Affiliation(s)
- Vicky Nahra
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Medical Center, Beirut, Lebanon
| | - Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Medical Center, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Medical Center, Beirut, Lebanon
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30
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El Hasbani G, Taher AT, Jawad A, Uthman I. COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association? Clin Med Insights Arthritis Musculoskelet Disord 2020; 13:1179544120978667. [PMID: 33328777 PMCID: PMC7720319 DOI: 10.1177/1179544120978667] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hasbani GE, Ghazzal Z, Dakik H, Hamie L, Uthman I. Acute Coronary Syndrome in a Male with Elevated Anti-Cyclic Citrullinated Peptide and no Evidence of Longstanding Rheumatoid Arthritis. Mediterr J Rheumatol 2020; 31:362-365. [PMID: 33163872 PMCID: PMC7641022 DOI: 10.31138/mjr.31.3.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023] Open
Abstract
A 55-year-old male, previously known to be healthy, presented to the emergency department with a 30-minute history of chest pain radiating to the upper extremities. Vital signs were within normal limits. Four days prior to this presentation, the patient presented for acute onset of polyarthritis and morning stiffness. Significantly elevated titres of anti-cyclic citrullinated peptides (anti-CCP) were found. In the emergency department, electrocardiography showed ST segment elevations in leads V1 to V5 and aVL. Cardiac enzymes were elevated. The patient underwent cardiac catheterization. A coronary angiography revealed an ectatic proximal left anterior descending (LAD) coronary artery with critical (90–99%) stenosis at the mid segment. A drug-eluting stent was successfully inserted in the LAD without any residual stenosis. Although it is known that anti-CCP positivity is a key element in the pathogenesis of atherosclerosis in RA patients, this case report adds to the existing body of literature which demonstrates that anti-CCP positivity is an independent risk factor for development of cardiovascular events.
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Affiliation(s)
| | - Ziyad Ghazzal
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Habib Dakik
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Lamiaa Hamie
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut, Lebanon
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Abstract
The history of colchicine dates to ancient Egyptians when it was used for alleviation of swelling and pain. Although its popularity varied throughout the years, colchicine has been a mainstay for the treatment of several diseases, mainly rheumatic and cardiac ones. The mechanism of action of the drug involves several intracellular and extracellular targets, although interaction with tubulin is the most described. Based on several clinical trials and meta-analyses, colchicine is safely recommended as a monotherapy or as an add-on for the treatment and prevention of recurrent pericarditis, post-pericardiotomy syndrome, gout, pseudogout, familial Mediterranean fever (FMF), and Behçet's disease (BD). Notably, drug safety has been noted during pregnancy and lactation. Besides its major indications, colchicine has shown efficacy and safety in the treatment of various conditions. Because the indications for using colchicine in the prevention of certain conditions such as acute coronary syndrome, stroke, and hepatic cirrhosis and treatment of others such as pneumonia and psoriasis are still debatable, further research works are needed.
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London E1 4DG, United Kingdom
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El Hasbani G, Uthman I, Jawad AS. Is adhesive capsulitis of the shoulder a form of complex regional pain syndrome type I? Saudi Med J 2020; 41:1144-1145. [PMID: 33026058 PMCID: PMC7841508 DOI: 10.15537/smj.2020.10.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[No Abstract Available].
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. E-mail.
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El Hasbani G, Al Rayess H, Abi-Ghanem A, Uthman I. The use of fluorodeoxyglucose positron emission tomography for the diagnosis of pediatric Takayasu arteritis. Acta Reumatol Port 2020; 45:293-294. [PMID: 33420770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | | | - Imad Uthman
- American University of Beirut Medical Center
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35
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El Hasbani G, Jawad A, Uthman I. Painless swelling of proximal interphalangeal joints in an adolescent child with preserved function and normal acute phase reactants. Arch Rheumatol 2020; 36:144-145. [PMID: 34046583 PMCID: PMC8140870 DOI: 10.46497/archrheumatol.2021.8091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/30/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, London, United Kingdom
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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36
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Nour-Eldine W, Noureldine HA, Haydar BA, Eldine MN, Noureldine MHA, Uthman I. A glimpse into the history of description of the antiphospholipid syndrome. Lupus 2020; 29:1493-1502. [PMID: 32741306 DOI: 10.1177/0961203320947152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior to 1983, several landmark reports prepared the stage for a detailed description of the Antiphospholipid (Hughes) syndrome (APS). Formerly depicted as lupus-like, APS exhibits a wide spectrum of symptoms that overlap with Sjogren's, Hashimoto, and other autoimmune diseases. In this review, we take a glimpse into the history of description of APS, discussing the events that led to its recognition as one of the most common autoimmune diseases and the enormous impact of that recognition in the rheumatology field.
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Affiliation(s)
- Wared Nour-Eldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hussein A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - Mariam Nour Eldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Mohammad Hassan A Noureldine
- Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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37
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El Hasbani G, Masri BK, Rebeiz AG, Uthman I. Recurrent Pericarditis as an Initial Presentation of Rheumatoid Arthritis. Am J Med 2020; 133:e50-e51. [PMID: 31421065 DOI: 10.1016/j.amjmed.2019.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Basel K Masri
- Department of Internal Medicine, Jordan Hospital and Medical Center, Amman, Jordan
| | - Abdallah G Rebeiz
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
Chronic inflammation has profound tumor-promoting effects. Inflammatory cells are the key players in immunosurveillance against tumors, and immunosuppression is known to increase the risk of tumors. Autoimmune diseases, which manifest as loss of self-tolerance and chronic immune dysregulation, provide a perfect environment for tumor development. Aside from managing the direct inflammatory consequences of autoimmune pathogenesis, cancer risk profiles should be considered as a part of a patient's treatment. In this review, we describe the various associations of malignancies with autoimmune diseases, specifically systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and Sjögren's syndrome, as well as discuss the mechanisms contributing to the pathogenesis of both disorders.
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Affiliation(s)
- H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - W Nour-Eldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - M H Hodroj
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M H A Noureldine
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - A Taher
- Division of Hematology and Medical Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hamed N, Rida MA, Uthman I, El Taha L, Assad M, Mikhael E, Bazi T. The Fibromyalgia Bladder Index in 100 consecutive women with fibromyalgia. Int Urogynecol J 2020; 31:1883-1889. [PMID: 31919557 DOI: 10.1007/s00192-019-04199-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Fibromyalgia Bladder Index (FBI) is a validated instrument to quantify bothersome bladder symptoms specifically in women with fibromyalgia syndrome (FMS). The FBI includes two sub-scales: one addressing urinary urgency and bladder pain (UP), the other addressing urinary frequency and nocturia (FN). The objectives of this study are to evaluate the FBI in a cohort of patients with FMS, to correlate it with certain characteristics in this cohort, and to compare it with controls. METHODS We performed a case-control study of 100 women with FMS and 155 controls. Demographic data, comorbidities, and other characteristics were registered. Comparison between FBI scores of participants with and without FMS, as well as correlation of FBI scores with the characteristics of FMS patients, were undertaken using independent two-sample t test for continuous outcomes and Pearson's Chi-squared test for categorical outcomes. RESULTS The mean UP subscale score of the FBI was significantly higher in the FMS group (10.29 ± 5.61) compared with the controls (1.65 ± 2.65; (p = 0.001). The mean FN subscale score was significantly higher in the FMS group (9.93 ± 5.37) compared with the controls (2.95 ± 3.27; p = 0.001). FMS patients diagnosed >3 years ago had a higher UP subscale score and a higher FN subscale score compared with FMS patients diagnosed <3 years ago (p = 0.020 and p = 0.024 respectively). Menopause and parity significantly increased the FBI scores. Smoking and a history of depression did not significantly affect any of the FBI subscale scores in the FMS group. CONCLUSION Women with FMS suffer from bothersome bladder symptoms that can be readily identified and quantified.
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Affiliation(s)
- Nouran Hamed
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 110-72020, Lebanon
| | - Mohamad Ali Rida
- Department of Internal Medicine, Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina El Taha
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 110-72020, Lebanon
| | - Mariam Assad
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Mikhael
- Department of Obstetrics and Gynecology, Hôpital Simone Veil, 14 rue de Saint Prix, Eaubonne, France
| | - Tony Bazi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 110-72020, Lebanon.
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Abstract
Antiphospholipid syndrome is a systemic autoimmune disease associated with obstetric complications along with vascular events affecting multiple organ systems in patients having positive titers of antiphospholipid antibodies. Eight to 20% of infertility cases have an unknown cause, part of which could be due to antiphospholipid syndrome. Although still debatable, many studies have addressed the relation between reproductive failure and antiphospholipid antibodies through the relation between antiphospholipid antibodies and unexplained infertility as well as the effect of antiphospholipid antibodies on the outcome of in vitro fertilization–embryo transfer. Few studies and cases have associated the presence of antiphospholipid antibodies with male infertility, describing morphofunctional penile abnormalities and testicular infarction. There are not enough data to support the routine practice of testing antiphospholipid antibodies in patients with infertility.
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Affiliation(s)
- G El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - I Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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41
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El Hasbani G, Jawad A, Uthman I. Familial Mediterranean fever as a rare cause of recurrent monoarthritis. Clin Exp Rheumatol 2019; 37 Suppl 121:167. [PMID: 31603072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, the Royal London Hospital, UK
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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El Hasbani G, Jawad A, Uthman I. Update on the management of colchicine resistant Familial Mediterranean Fever (FMF). Orphanet J Rare Dis 2019; 14:224. [PMID: 31615541 PMCID: PMC6794843 DOI: 10.1186/s13023-019-1201-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/13/2019] [Indexed: 01/03/2023] Open
Abstract
Background Familial Mediterranean Fever (FMF), an autoinflammatory disease, is characterized by self-limited inflammatory attacks of fever and polyserositis along with high acute phase response. Although colchicine remains the mainstay in treatment, intolerance and resistance in a certain portion of patients have been posing a problem for physicians. Main body Like many autoimmune and autoinflammatory diseases, many colchicine-resistant or intolerant FMF cases have been successfully treated with biologics. In addition, many studies have tested the efficacy of biologics in treating FMF manifestations. Conclusion Since carriers of FMF show significantly elevated levels of serum TNF alpha, IL-1, and IL-6, FMF patients who failed colchicine were successfully treated with anti IL-1, anti IL-6, or TNF inhibitors drugs. It is best to use colchicine in combination with biologics.
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London, E1 4DG, UK
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
INTRODUCTION Systemic lupus erythematosus affects 4.8-78.5 people per 100,000 worldwide, 90% of whom are females. Geography and ethnicity have been shown to significantly affect the prevalence and natural history of the disease. Lupus nephritis affects around half of patients with systemic lupus erythematosus. Data about systemic lupus erythematosus and lupus nephritis in the Middle East are still scarce. In this study, we aimed to describe the characteristics of systemic lupus erythematosus and lupus nephritis at a tertiary care center in Lebanon. METHODS This is a retrospective chart review of all biopsy-proven lupus nephritis patients admitted to the American University of Beirut medical center between January 2000 and December 2018. Patients above 12 years of age who had any International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of lupus nephritis on their renal biopsy were included in the study. RESULTS The study included 55 patients with lupus nephritis. Upon presentation of systemic lupus erythematosus, the most common clinical feature was arthritis, seen in 83% of patients, followed by anemia (82%) and malar rash (48%). In total 93% had positive ANA, 89% had positive anti-dsDNA and 98% of patients had proteinuria. The most common ISN/RPS class of lupus nephritis in our series was IV (49%). At the time of the biopsy 15% of patients underwent dialysis. At 6 months, 11/27 had complete remission, 6/27 had partial remission and 10/27 had no remission. At 1 year, 8/23 had complete remission, 4/23 had partial remission and 11/23 had no remission. During the study period, 15 out of 35 patients available for analysis had chronic kidney disease (CKD) and six out of 34 patients developed end-stage kidney disease requiring renal replacement therapy. In comparison to other series in the region, our series had more males affected, higher creatinine at the time of biopsy and greater degree of proteinuria. CONCLUSION Our study provided insight on the demographics, characteristics, and outcomes of lupus nephritis in Lebanon. Interestingly, male gender was present in a quarter of patients. This warrants further investigation and confirmation. We are hoping to expand this experience into a national prospective registry to further characterize this entity in our region.
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Affiliation(s)
- S H Koubar
- Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - J Kort
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Kawtharani
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - M Makki
- Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
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Bedaiwi M, Al-Homood IA, El-Garf A, Uthman I, Sunna N, Nassier R, Mohamed H, Al Saleh J. Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East. Rheumatol Int 2019; 39:1321-1329. [PMID: 31134289 DOI: 10.1007/s00296-019-04319-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/17/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic, inflammatory arthropathy occurring in up to 30% of patients with psoriasis, and is characterized by multiple manifestations including peripheral arthritis, enthesitis, dactylitis, spondylitis, and psoriatic skin and nail disease. This complex and heterogeneous disease is poorly understood and its diagnosis and treatment are suboptimal, particularly in Africa and the Middle East, where very few studies into the impact of PsA have been carried out. This article aims to highlight the disease burden of PsA in the region as well as to identify unmet clinical needs. A non-systematic review was carried out in the PubMed database and the most relevant publications were selected. Expert rheumatologists practicing in Africa and the Middle East provide an insight into the challenges of treating PsA in daily practice, along with recommendations for improvements.
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Affiliation(s)
- Mohamed Bedaiwi
- Division of Rheumatology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Ibrahim A Al-Homood
- Department of Medical Specialties, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman El-Garf
- Rheumatology Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Imad Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Jamal Al Saleh
- Rheumatology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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45
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Dargham SR, Zahirovic S, Hammoudeh M, Al Emadi S, Masri BK, Halabi H, Badsha H, Uthman I, Mahfoud ZR, Ashour H, El Haq WG, Bayoumy K, Kapiri M, Saxena R, Plenge RM, Kazkaz L, Arayssi T. Correction: Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients. PLoS One 2019; 14:e0214258. [PMID: 30883600 PMCID: PMC6422291 DOI: 10.1371/journal.pone.0214258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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46
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Ziade NR, Karam GA, Uthman I, Salloum N, Zoghbi M. Adherence to therapy in chronic inflammatory rheumatic diseases: the older the better. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
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48
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Dargham SR, Zahirovic S, Hammoudeh M, Al Emadi S, Masri BK, Halabi H, Badsha H, Uthman I, Mahfoud ZR, Ashour H, Gad El Haq W, Bayoumy K, Kapiri M, Saxena R, Plenge RM, Kazkaz L, Arayssi T. Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients. PLoS One 2018; 13:e0208240. [PMID: 30566451 PMCID: PMC6300286 DOI: 10.1371/journal.pone.0208240] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES There is limited information on the epidemiology and treatment patterns of rheumatoid arthritis (RA) across the Arab region. We aim in this study to describe the demographic characteristics, clinical profile, and treatment patterns of patients of Arab ancestry with RA. METHODS This is a cross sectional study of 895 patients with established rheumatoid arthritis enrolled from five sites (Jordan, Lebanon, Qatar, Kingdom of Saudi Arabia (KSA), and United Arab Emirates). Demographic characteristics, clinical profile, and treatment patterns are compared between the five countries. RESULTS The majority of our patients are women, have an average disease duration of 10 years, are married and non-smokers, with completed secondary education. We report a high (>80%) ever-use of methotrexate (MTX) and steroids among our RA population, while the ever-use of disease modifying anti-rheumatic drugs (DMARDs) and TNF-inhibitors average around 67% and 33%, respectively. There are variations in RA treatment use between the five country sites. Highest utilization of steroids is identified in Jordan and KSA (p-value < 0.001), while the highest ever-use of TNF-inhibitors is reported in KSA (p-value < 0.001). CONCLUSION Disparities in usage of RA treatments among Arab patients are noted across the five countries. National gross domestic product (GDP), as well as some other unique features in each country likely affect these. Developing treatment guidelines specific to this region could contribute in delivering standardized therapies to RA patients.
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Affiliation(s)
| | | | | | | | | | - Hussein Halabi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Humeira Badsha
- Dr. Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Imad Uthman
- American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Richa Saxena
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Broad Institute, Cambridge, Massachusetts, United States of America
| | - Robert M. Plenge
- Broad Institute, Cambridge, Massachusetts, United States of America
- Merck Research Laboratories, Boston, Massachusetts, United States of America
| | | | - Thurayya Arayssi
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- * E-mail:
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Ahmed S, Morsi M, Uthman I. Prognostic factors affecting the survival of hepatocellular carcinoma patients undergoing different surgical techniques. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Elemam R, Uthman I, Yahya A, Mohamed N, Shaltout A. Efficacy of multimodality treatment in survival patterns among patients with endometrial carcinoma stage III. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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