Rheumatoid arthritis study of the Egyptian College of Rheumatology (ECR): nationwide presentation and worldwide stance

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.

A case of isolated aglossia

Introduction: Aglossia is a rare condition of failure of development of the lateral lingual swellings during embryogenesis and is usually associated with other deformities especially the fingers and limbs. Isolated aglossia is extremely rare. Observation: This is a case report of a 21-year-old patient with isolated aglossia whose floor of the mouth compensated for the tongue's absence in speech, eating and swallowing. Thus the patient did not express any disability and refused reconstructive treatment. Commentaries: Aglossia may be accompanied by many deformities or as part of a syndrome, so other symptoms must be excluded. The floor of the mouth usually adapts to the role of the tongue leading to fulfillment of most of the functions of the tongue. Conclusion: Aglossia is a rare condition, however the adaptation of the surrounding tissues compensated for the absence of the tongue makes the condition tolerable to the patient, this however does not undermine the fact that a multidisciplinary approach is key in managing such a condition.

Interferon gamma and interleukin 8 gene polymorphisms in patients with hepatitis C virus related oral lichen planus

OBJECTIVES

This study aimed to determine the association of rs2430561 and rs4073 polymorphisms in the Interferon gamma (IFN-ɤ) and Interleukin 8 (IL-8) genes, respectively, with hepatitis C virus-related oral lichen planus and disease severity.

DESIGN

This is a case-control study. 60 subjects were equally divided into patients with and without oral lichen planus. They were further subdivided into hepatitis C virus seropositive and seronegative patients. All patients were genotyped for IFN-γ rs2430561 thymine to adenine (T > A) and IL-8 rs4073 adenine to thymine (A > T) polymorphisms. All patients with oral lichen planus had their lesions measured and documented using the Escudier scoring system.

RESULTS

Disease activity was significantly higher in the "oral lichen planus/hepatitis C virus-positive" patients than in the "oral lichen planus/hepatitis C virus-negative" patients (P = 0.003). IFN-γ rs2430561 T > A and IL-8 rs4073 A > T genotypes and allele frequencies were not associated with the oral lichen planus group or the normal group. Stratification of the two groups into HCV and non-HCV-infected patients or into erosive and non-erosive types revealed no significant associations. The "A-allele-containing" genotypes of IL-8 rs4073 A > T were significantly more prevalent in the patients with oral lichen planus than in those without.

CONCLUSION

Hepatitis C virus infection is associated with the development of erosive oral lichen planus. The A-allele of IL-8 rs4073 A > T may have a role in the development and progression of oral lichen planus.

Diminished soluble levels of growth arrest specific protein 6 and tyrosine kinase receptor Axl in patients with rheumatoid arthritis

AIM

Growth arrest specific protein 6 (Gas-6) and its tyrosine kinase receptor Axl plays an important role in apoptosis, and regulation of innate immune response, therefore, we investigated their plasma concentrations in Rheumatoid arthritis (RA) patients and correlated them to clinical, laboratory and radiological parameters of the disease.

METHODS

Plasma from 77 RA patients and 50 normal healthy subjects were assayed for plasma Gas6 and Axl levels. Demographic, clinical and serological data were prospectively assessed. Rheumatoid arthritis disease activity was assessed using 28-joint Disease Activity Score (DAS-28) and functional capacity by modified health assessment questionnaire (mHAQ). Standardized x-rays for hands and feet were done to all participants.

RESULTS

The level of Gas6 and Axl were significantly decreased in the RA patients compared to those of the healthy control subjects. Levels of Gas6 correlated positively with Axl levels in both patients and healthy control. Gas6 levels were remarkably reduced in those patients with erosive RA than those without. Levels of Gas6 were found to be negatively correlated with the presence of erosive disease and positively correlated with DAS-28, ESR, Leucocytosis and IL6.

CONCLUSION

The plasma concentrations of Gas6 and Axl are altered in RA patients and thus may have a role in RA pathogenesis. Further mechanistic studies on the involvement of all TAM receptors tyrosine kinases pathway in RA are needed to help in understanding the pathogenesis and possibly aid in diagnosis and future treatments of RA especially for patients with erosive disease.

The association of Varicella zoster virus reactivation with Bell's palsy in children

OBJECTIVES

Bell's palsy is considered the most common cause of facial nerve paralysis in children. Although different theories have been postulated for its diagnosis, reactivation of the Varicella zoster virus (VZV) has been implicated as one of the causes of Bell's palsy. The aim of the study was to evaluate the association of Varicella-zoster virus infection with Bell's palsy and its outcome in children.

METHODS

A total of 30 children with Bell's palsy were recruited and were assayed for evidence of VZV infection. The severity of facial nerve dysfunction and the recovery rate were evaluated according to House-Brackmann Facial Nerve Grading Scale (HB FGS). Paired whole blood samples from all patients were obtained at their initial visit and 3 weeks later, and serum samples were analyzed for VZV IgG and IgM antibodies using ELISA.

RESULTS

A significantly higher percentage of Bell's palsy patients were seropositive for VZV IgM antibodies than controls (36.6% of patients vs 10% of controls) while for VZV IgG antibodies the difference was statistically nonsignificant. HB FGS in Bell's palsy patients with serologic evidence of VZV recent infection or reactivation showed a statistiacally significant less cure rate than other patients.

CONCLUSIONS

VZV reactivation may be an important cause of acute peripheral facial paralysis in children. The appropriate diagnosis of VZV reactivation should be done to improve the outcome and the cure rate by the early use of antiviral treatment.

Statistical analysis of monotonic mechanical properties for unidirectional glass fiber (U)/random glass fiber (R)/epoxy hybrid and non-hybrid polymeric composites

The aim of this article is to study the variability in tensile, flexural, in-plane shear, and interlaminar shear properties of unidirectional glass fiber (U)/random glass fiber (R)/epoxy hybrid and non-hybrid composite laminates. Six kinds of laminated composites of average thickness 5.5 ± 0.2 mm and total fiber volume fraction ( VfT) = 37% were manufactured using hand lay-up technique and tested under tensile, bending, in-plane shear, and interlaminar shear loading conditions. The failure modes of all test specimens have been recorded and discussed. Two-parameter Weibull distribution function was used to statistically analyze the composite samples experimental results. Weibull graphics were plotted for each sample using experimental monotonic mechanical properties results. The Weibull distribution has also been employed to show both the failure probabilities as well as the scatter in the experimental results for the above mentioned composites. The obtained failure probability graphs for the manufactured composites under different static loading conditions are important tools for helping the designers to understand and choice the suitable material for the required design and development.

Experimental study on flexural fatigue behavior of glass fibers/epoxy hybrid composites with statistical analysis

Flexural fatigue behaviors were investigated experimentally for unidirectional glass fiber (U)/random glass fiber (R)/epoxy hybrid composite laminates. Three different hybrid composites, i.e. [0.5R/U/U]S, [U/0.5R/U]S and [U/U/0.5R]S were fabricated using hand lay-up technique with 37% total fiber volume fraction ( VfT), unidirectional glass fiber relative volume fraction ( VfU/ VfT) = 0.8 and of 5.5 ± 0.2 mm thickness. Flexural fatigue tests were performed at zero mean stress. A 20% reduction of the flexural stiffness was taken as a failure criterion. The effects of layer stacking sequences on both initial stress–no. of cycles to failure relationships and the relative surface temperature increase of the mentioned composites were investigated. The specimen failure modes have been recorded and discussed. The S–N curves and fatigue safe workability areas for the fabricated hybrid composites have been constructed as design curves. Two-parameter Weibull distribution function was used to obtain the scatter in the experimental results and to construct the reliability graphs for the fabricated hybrid composites.

Laryngeal involvement in juvenile idiopathic arthritis patients

Juvenile idiopathic arthritis (JIA) is an autoimmune diseases characterized by chronic arthritis and systemic manifestations. Autoimmune diseases can affect the upper airways including the larynx. The aim of this study was to investigate laryngeal involvement in JIA patients and its possible association with JIA disease parameters. Fifty consecutive JIA patients were screened for laryngeal abnormalities using flexible fiberoptic laryngoscope and laryngeal computerized tomography. Laryngeal abnormalities were detected in nine (18%) of our cases, with cricoarytenoiditis in six cases (12%) and a rheumatoid nodule in the pyriform fossa in only one case (2%). Diffuse congestion and edema of the posterior part of the larynx with normal vocal cord mobility was detected in two cases (4%). In our study, laryngeal abnormalities were significantly higher in patients with polyarticular seropositive disease subtype and also were significantly higher in patients with longer disease duration, higher disease activity scores, and those with erosive disease. JIA may affect the larynx. Laryngeal involvement in JIA patients is more in polyarticular seropositive cases. JIA patients have to be subjected to thorough otolaryngologic examination for early diagnosis and prompt management.