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Hammam N, El-Husseiny PN, Al-Adle SS, Samy N, Elsaid NY, El-Essawi DF, Mohamed EF, Fawzy SM, El Bakry SA, Nassr M, Nasef SI, El-Saadany HM, Elwan S, Gamal NM, Moshrif A, Hammam O, El Shereef RR, Ismail F, Tharwat S, Mosa DM, Elazeem MIA, Abdelaleem EA, Gheita TA. Clinical implications of seropositive and seronegative autoantibody status in rheumatoid arthritis patients: A comparative multicentre observational study. Rheumatol Immunol Res 2024; 5:57-65. [PMID: 38571932 PMCID: PMC10985701 DOI: 10.1515/rir-2024-0007] [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] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 11/20/2023] [Indexed: 04/05/2024]
Abstract
Background and Objectives Rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) have been used to improve the diagnosis and prognosis of rheumatoid arthritis (RA). However, their association with RA disease phenotypes, individually and in combination, is not well studied. The aim of the study was to compare patients' and disease characteristics, activity and severity in double seronegative (DNRA), single seropositive RF, single seropositive anti-CCP and double seropositive (DPRA) patients. Methods Adults subjects with RA from Egyptian College of Rheumatology (ECR) database who had RF and anti-CCP results available were included. Demographic, clinical features, disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ) and laboratory data were collected and compared among different RA groups. Results 5268 RA patients with mean age of 44.9±11.6 years, and 4477 (85%) were females. 2900 (55%) had DPRA, 892 (16.9%) had single positive RF, 597 (11.3%) had single positive anti-CCP while 879 (16.7%) had DNRA. Patients with DPRA had significantly high percentage of metabolic syndrome (19.3%, P < 0.001), and functional impairment using HAQ (P = 0.01). Older age (RRR [relative risk ratio]: 1.03, 95%CI: 1.0, 1.0, P = 0.029), greater DAS28 (RRR: 1.51, 95%CI: 1.2, 1.9, P < 0.001), higher steroid use (RRR: 2.4, 95%CI: 1.36, 4.25, P = 0.002) were at higher risk of DPRA while longer disease duration (RRR: 1.08, 95%CI: 1.01, 1.16, P = 0.017) and fibromyalgia syndrome (RRR: 2.54, 95%CI: 1.10, 5.88, P = 0.028) were associated with higher odds of single positive RF status. Conclusion Dual antibody-positive status has higher disease activity and severity, and higher chance of development of metabolic syndrome; highlighting the implicated role of inflammation, atherogenesis and cardiovascular disease risk in RA.
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Affiliation(s)
- Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Suzan S. Al-Adle
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nora Y. Elsaid
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina F. El-Essawi
- Health Radiation Research Department, Internal Medicine Unit, Rheumatology Clinic, (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Eman F. Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Samar M. Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samah A. El Bakry
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Maha Nassr
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Samah I. Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Hanan M. El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Shereen Elwan
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Nada M. Gamal
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelhfeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Osman Hammam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, New Valley University, New Valley, Egypt
| | | | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Doaa Mosad Mosa
- Department of Rheumatology and Rehabilitation, Mansoura University Hospitals, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Enas A. Abdelaleem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Tamer A. Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - on behalf of The Egyptian College of Rheumatology (ECR) Rheumatoid Arthritis (ECR-RA) Study Group
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
- Health Radiation Research Department, Internal Medicine Unit, Rheumatology Clinic, (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, New Valley University, New Valley, Egypt
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
- Department of Rheumatology and Rehabilitation, Mansoura University Hospitals, Mansoura University Faculty of Medicine, Mansoura, Egypt
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Gheita TA, Raafat HA, El-Bakry SA, Elsaman A, El-Saadany HM, Hammam N, El-Gazzar II, Samy N, Elsaid NY, Al-Adle SS, Tharwat S, Ibrahim AM, Fawzy SM, Eesa NN, Shereef RE, Ismail F, Elazeem MIA, Abdelaleem EA, El-Bahnasawy A, Selim ZI, Gamal NM, Nassr M, Nasef SI, Moshrif AH, Elwan S, Abdel-Fattah YH, Amer MA, Mosad D, Mohamed EF, El-Essawi DF, Taha H, Salem MN, Fawzy RM, Ibrahim ME, Khalifa A, Abaza NM, Abdalla AM, El-Najjar AR, Azab NA, Fathi HM, El-Hadidi K, El-Hadidi T. Rheumatoid arthritis study of the Egyptian College of Rheumatology (ECR): nationwide presentation and worldwide stance. Rheumatol Int 2023; 43:667-676. [PMID: 36617362 PMCID: PMC9995404 DOI: 10.1007/s00296-022-05258-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023]
Abstract
To depict the spectrum of rheumatoid arthritis (RA) in Egypt in relation to other universal studies to provide broad-based characteristics to this particular population. This work included 10,364 adult RA patients from 26 specialized Egyptian rheumatology centers representing 22 major cities all over the country. The demographic and clinical features as well as therapeutic data were assessed. The mean age of the patients was 44.8 ± 11.7 years, disease duration 6.4 ± 6 years, and age at onset 38.4 ± 11.6 years; 209 (2%) were juvenile-onset. They were 8750 females and 1614 males (F:M 5.4:1). 8% were diabetic and 11.5% hypertensive. Their disease activity score (DAS28) was 4.4 ± 1.4 and health assessment questionnaire (HAQ) 0.95 ± 0.64. The rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were positive in 73.7% and 66.7% respectively. Methotrexate was the most used treatment (78%) followed by hydroxychloroquine (73.7%) and steroids (71.3%). Biologic therapy was received by 11.6% with a significantly higher frequency by males vs females (15.7% vs 10.9%, p = 0.001). The least age at onset, F:M, RF and anti-CCP positivity were present in Upper Egypt (p < 0.0001), while the highest DAS28 was reported in Canal cities and Sinai (p < 0.0001). The HAQ was significantly increased in Upper Egypt with the least disability in Canal cities and Sinai (p = 0.001). Biologic therapy intake was higher in Lower Egypt followed by the Capital (p < 0.0001). The spectrum of RA phenotype in Egypt is variable across the country with an increasing shift in the F:M ratio. The age at onset was lower than in other countries.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hala A Raafat
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samah A El-Bakry
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hanan M El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Iman I El-Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Samy
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nora Y Elsaid
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan S Al-Adle
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Amira M Ibrahim
- Rheumatology Department, Faculty of Medicine, Kafr El-Skeikh University, Kafr El-Shaikh, Egypt
| | - Samar M Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rawhya El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mervat I Abd Elazeem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Enas A Abdelaleem
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Amany El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Zahraa I Selim
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Nada M Gamal
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Maha Nassr
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Samah I Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Shereen Elwan
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Yousra H Abdel-Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa Mosad
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Dina F El-Essawi
- Internal Medicine Department, Rheumatology Unit (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
| | - Hanan Taha
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed N Salem
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rasha M Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalyoubia, Egypt
| | - Maha E Ibrahim
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Asmaa Khalifa
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Amany R El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Noha A Azab
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Khaled El-Hadidi
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tahsin El-Hadidi
- Rheumatology Department, Military Academy, Agouza Rheumatology Center, Giza, Egypt
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Fathi HM, Gazzar IIE, Elazeem MIA, AboulKheir E, Gamal NM, Ismail F, Shereef RRE, Tharwat S, Elwan S, Samy N, Baki NA, Elsaid NY, El-Bahnasawy AS, Moshrif A, Fattah YA, Amer MA, Ibrahim ME, Khalil NM, El-Dessouki S, Abaza N, El-Shanawany AT, Mohamed EF, El-Ghobashy N, Ayoub N, Hammam O, Fawzy S, Sayed S, Gheita TA, Hammam N. Rheumatologists’ knowledge and perception of COVID-19 and related vaccines: the vaXurvey2 online survey. Rheumatol Int 2022; 42:989-998. [PMID: 35429291 PMCID: PMC9012992 DOI: 10.1007/s00296-022-05130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022]
Abstract
The study aimed to explore the experience of coronavirus disease-2019 (COVID-19) infection and vaccine adverse events (AEs) among rheumatologists. A validated questionnaire was distributed as a Google form to rheumatologists across the country via social networking sites from late December 2021 till early January 2022. The questionnaire included questions regarding participants' socio-demographic details, COVID-19 infection and vaccination details with special emphasis on AEs. Out of 246 responses, 228 were valid. 200 (81.3%) responders had received the vaccine. The mean age of the 228 participants was 37.9 ± 8.5 years, 196 were females and 32 males (F:M 6.1:1) from 18 governorates across the country. Comorbidities were present in 54 subjects (27%). There was a history of highly suspicious or confirmed COVID-19 infection in 66.7% that were all managed at home. The COVID-19 vaccine was received by 200 and a booster dose of 18.5%. Obesity and musculoskeletal involvement co-morbidities were present only in those with AEs (9.1% and 5.5% respectively). AEs were present in 82%; 66.7% had injection-site tenderness, 50% fatigue, 35.5% fever, 15% chills, 42.5% myalgia, 14.5% arthralgia, 8% low back pain, headache 31%, dizziness 10%, sleepliness 16% and 15% developed post-vaccine. There were no differences according to the geolocation regarding the occurrence of COVID-19 infection (p = 0.19) or AEs post-vaccine (p = 0.58). The adverse events were mostly mild to moderate and tolerable which makes this work in agreement with other studies that support the broad safety of the vaccine in favor of the global benefit from mass vaccination.
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4
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Gamal NM, Badawy ER, Talaat EA, Ibrahim HM, Abd Elsamea MH. Clinical utility of urinary soluble CD163 in evaluation of lupus nephritis patients. The Egyptian Rheumatologist 2022; 44:151-157. [DOI: 10.1016/j.ejr.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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5
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Salem GI, Gamal NM, Talaat EA, El-Hammady DH, Hammam N, Gheita TA. Clinical Impact of the ABO Blood Type in Patients with Rheumatic Diseases: Is there a Link to the ABO and Rhesus? Mediterr J Rheumatol 2021; 32:237-242. [PMID: 34964027 PMCID: PMC8693303 DOI: 10.31138/mjr.32.3.237] [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: 12/02/2020] [Revised: 05/22/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Several studies have shown associations of ABO and Rh blood groups with various diseases; however, the relationship of ABO and Rh blood groups with rheumatic diseases are scarce. The aim of the present study was to examine whether there is an association between ABO and Rh blood groups and the types of rheumatic diseases. Method In this multi-centre cross-sectional study, sociodemographic data, type of rheumatic disease, and type ABO and Rh blood groups were examined for patients with different rheumatic diseases. Results A total of 304 patients; 207 (68.1%) were diagnosed with rheumatoid arthritis, and 40 (13.2%) had systemic lupus erythematosus. The patients were assessed for blood types; 37.8% patients had A type, 27.6% had B type, 19.1% had O type, and 15.4% had AB type. The Rh (+) blood group was more prevalent (89.1%) than Rh (-). Blood group A was more prevalent in patients with rheumatic disease, followed by B, O, and AB respectively, although there was no significant difference in the distribution of ABO groups among rheumatic diseases. Female gender, smoking, and anti-cyclic citrullinated peptide are significantly different between the blood groups within rheumatic diseases. Conclusion The A and Rh (+) blood groups were more commonly observed in patients with rheumatic diseases. There was lack of association between types of rheumatic diseases and ABO blood groups. The study provides knowledge for the interaction between ABO blood groups and several risk factors related to rheumatic diseases and may serve a guide for future clinical studies.
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Affiliation(s)
- Gehan I Salem
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nada M Gamal
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa A Talaat
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dina H El-Hammady
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nevin Hammam
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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6
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Gheita TA, Salem MN, Eesa NN, Khalil NM, Gamal NM, Noor RA, Moshrif AH, Shereef RE, Ismail F, Noshy N, Fawzy RM, Elshebini E, Khalifa I, Saadany HE, Tharwat S, El-Najjar A, Fattah YA, Sallam R, El-Bahnasawy AS, Gharbia O, Hassan E, ElShanawany A, Mohamed EF, Senara S, Ismail M, Nasef SI, Abdalla AM, Elessawi D, Fawzy SM, Alfadl EA, Khalifa A, Abaza NM. Rheumatologists' practice during the Coronavirus disease 2019 (COVID-19) pandemic: a survey in Egypt. Rheumatol Int 2020; 40:1599-1611. [PMID: 32710198 PMCID: PMC7380140 DOI: 10.1007/s00296-020-04655-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/11/2020] [Indexed: 12/18/2022]
Abstract
The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.
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Affiliation(s)
- Tamer A. Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed N. Salem
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nahla N. Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M. Khalil
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nada M. Gamal
- Rheumatology Department, Faculty of Medicine, Assuit University, Asyut, Egypt
| | - Rasha Abdel Noor
- Rheumatology Unit, Internal Medicine Department, Tanta University, Gharbia, Tanta, Egypt
| | | | - Rawhya El Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Nermeen Noshy
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Rasha M. Fawzy
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Benha, Egypt
| | - Emad Elshebini
- Rheumatology Unit, Internal Medicine Department, Menoufiya University, Menoufiya, Egypt
| | - Iman Khalifa
- Pediatric Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hanan El Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Tanta, Egypt
| | - Samar Tharwat
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Amany El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Zagazig, Egypt
| | - Yousra Abdel Fattah
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rehab Sallam
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Amany S. El-Bahnasawy
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Ola Gharbia
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
| | - Eman Hassan
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira ElShanawany
- Rheumatology Department, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | - Eman F. Mohamed
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Soha Senara
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mervat Ismail
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Samah I. Nasef
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Ahmed M. Abdalla
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dina Elessawi
- Rheumatology Unit Internal Medicine Department, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Samar M. Fawzy
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esam Abu Alfadl
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
- Qena/Luxor Hospitals, Qena, Egypt
| | - Asmaa Khalifa
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Nouran M. Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - The ECR COVID19-Study Group
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Assuit University, Asyut, Egypt
- Rheumatology Unit, Internal Medicine Department, Tanta University, Gharbia, Tanta, Egypt
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Asyut, Egypt
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Benha University, Kalubia, Benha, Egypt
- Rheumatology Unit, Internal Medicine Department, Menoufiya University, Menoufiya, Egypt
- Pediatric Rheumatology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Tanta, Egypt
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
- Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Zagazig, Egypt
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt
- Rheumatology Unit Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Rheumatology Department, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
- Rheumatology Unit, Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
- Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rheumatology Unit Internal Medicine Department, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
- Qena/Luxor Hospitals, Qena, Egypt
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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