Dr nashwa El shaarawy | Suez Canal University (original) (raw)

Papers by Dr nashwa El shaarawy

Research paper thumbnail of Patrón de autoanticuerpos contra antígenos nucleares extraíbles (ENA) en pacientes con artritis reumatoide: relevancia e implicaciones clínicas

Reumatología clínica, 2021

Research paper thumbnail of Cam versus pincer femoroacetabular impingement. Which type is associated with more hip structural damage? An exploratory cross-sectional study

Current Orthopaedic Practice, 2017

Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur an... more Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P < 0.0001), cartilage degradation (P ¼ 0.001), pseudocysts (P < 0.0001), hip effusion (P ¼ 0.013) and reactive synovitis (P < 0.0001). However, in pincer FAI, BME only correlated with pain severity (P ¼ 0.004) and duration (P ¼ 0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA.

Research paper thumbnail of Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

Reumatismo, 2015

Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to as... more Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%)...

Research paper thumbnail of Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints

Clinical Rheumatology, 2015

Research paper thumbnail of Antibodies to extractablenuclear antigens (ENA) in antinuclear antibody positive (ANA + ve) autoimmune liver diseases (ALD)

Journal of Hepatology, 1994

ABSTRACT Autoantibodies to the saline extracts of cells are being used as diagnostic and prognost... more ABSTRACT Autoantibodies to the saline extracts of cells are being used as diagnostic and prognostic markers in the investigation of patients with suspected systemic rheumatic disease. These are also called antibodies to the extractable nuclear antigens or anti ENA antibodies. We used saline extracts of human spleen cells and rabbit thymus extract to detect six subtypes of anti ENA antibodies, namely anti SSA (anti Sjogren&#39;s syndrome A), anti SSB (anti Sjogren&#39;s syndrome B), anti RNP (anti Ribonucleoprotein), anti Sm (anti Smith), anti Jo-1 (anti Jo-1) and anti Scl 70 (anti Systemic sclerosis 70) antibodies. Two hundred and thirty-seven patients&#39; sera were screened in the department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, over a period of 16 months. Fifty-seven were positive for auto antibodies, of which 26 had anti SSA antibodies, 12 anti SSA+ anti RNP+ anti Sm antibodies, 7 anti RNP+ anti Sm antibodies, 6 anti SSA+ anti SSB antibodies, 5 anti SSA+ anti RNP antibodies while one patient showed only anti RNP antibody. The detection of the anti ENA antibodies was specially helpful in diagnosing patients with systemic lupus erythematosis presenting with atypical features and with mixed connective tissue disease.

Research paper thumbnail of Rheumatoid factor and anti-citrullinated protein antibodies (ACPA) in psoriatic arthritis (PsA), and skin psoriasis: Relevance and clinical implications

The Egyptian Rheumatologist

Research paper thumbnail of The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications

OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal c... more OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ...

Research paper thumbnail of A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG)

International Journal of Cardiology

Research paper thumbnail of Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide—a report by the HSS International Study Group

Clinical Rheumatology

Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread ve... more Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image sel...

Research paper thumbnail of Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications

Research paper thumbnail of Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two years

Clinical Rheumatology

Objective To evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psori... more Objective To evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psoriasis patients, without clinical arthritis or enthesitis compared with healthy controls, with a 2-year follow-up to study the associated incidence of psoriatic arthritis (PsA). Methods A total of 109 consecutive psoriasis vulgaris patients without clinical signs of PsA and 90 healthy controls were included from two tertiary medical centers. Subjects underwent dermatological examination, PASI score evaluation for severity of psoriasis, musculoskeletal examination using 68/66 joints count for tenderness and swollen joints. Patients were assessed for CRP, musculoskeletal ultrasound (MSUS) in the form of grayscale ultrasound (GSUS), and power Doppler ultrasound (PDUS) for eight entheses and 34 joints to detect MSUS subclinical enthesitis and synovitis. All patients were followed-up for 2 years to detect evolving PsA. Results Subclinical enthesitis and synovitis were detected in 39.5% of psoriasis patients and 10% of controls (P < 0.001). CRP was significantly higher in psoriasis patients with MSUS manifestations (P < 0.01). PDUS and GSUS subclinical synovitis and/ or enthesitis were detected at least in one site in psoriatic patients more than in controls (P < 0.05). During a 2-year follow-up of patients, the annual PsA incidence was 4.3%. Psoriasis patients who developed PsA showed a higher prevalence of baseline enthesitis, higher PDUS and GSUS synovitis scores, and higher baseline CRP level than those who did not develop PsA. Conclusions MSUS subclinical synovitis and enthesitis are quite common in psoriasis patients. The incidence of PsA in Saudi's psoriasis patients was slightly higher than worldwide reports. Subclinical enthesitis, PDUS, and GSUS synovitis could predict PsA development.

Research paper thumbnail of Atteinte axiale avec arthropathie des articulaires postérieures et ankylose osseuse dans un syndrome de camptodactylie, arthropathie, coxa vara et péricardite (CACP)

Revue du Rhumatisme, 2013

ABSTRACT L’arthropathie familiale associée à la camptodactylie congénitale a été précédemment rec... more ABSTRACT L’arthropathie familiale associée à la camptodactylie congénitale a été précédemment reconnue comme entité clinique bien définie dans la littérature. Le spectre clinique de cette maladie semble variable. Les caractéristiques cliniques typiques du syndrome camptodactylie congénitale, arthropathie, coxa vara et péricardite (syndrome CACP) semblent être plus fréquent chez les enfants provenant du Moyen-Orient et d’Afrique du Nord. La présentation ostéoarticulaire de cette forme familiale rare d’arthropathie est unique et hétérogène. Dans tous les articles précédents, une atteinte non inflammatoire type arthropathie incluant les articulations périphériques avec une coxa vara typique a été décrite, et dans certains cas des anomalies rachidiennes incluant la cyphose, la lordose ou la scoliose. Nous décrivons le premier cas d’atteinte axiale dans le cadre d’un syndrome CACP avec une arthropathie des articulaires postérieures et une ankylose rachidienne au niveau L5/S1.

Research paper thumbnail of Vasculopathie artérielle dans la sclérodermie systémique. Caractéristiques micro- et macrovasculaire de l’angioscanner des artères des membres supérieurs

Revue du Rhumatisme, 2015

ABSTRACT Décrire les résultats de l’angioscanner de la vasculopathie artérielle des gros vaisseau... more ABSTRACT Décrire les résultats de l’angioscanner de la vasculopathie artérielle des gros vaisseaux ainsi que des petits et moyens vaisseaux de l’ensemble de l’arbre vasculaire des membres supérieurs chez les patients porteurs d’une sclérodermie systémique (ScS) avec ou sans ulcération digitale.

Research paper thumbnail of Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

Joint Bone Spine, 2014

To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as... more To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. Twenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases. CTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P=0.001). Macrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.

Research paper thumbnail of Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients

The Egyptian Rheumatologist, 2014

Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic s... more Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis.

Research paper thumbnail of MTHFR functional genetic variation and methotrexate treatment response in rheumatoid arthritis: a meta-analysis

Pharmacogenomics, 2014

To date, functional MTHFR SNPs have been tested for their impact on low-dose methotrexate (MTX) r... more To date, functional MTHFR SNPs have been tested for their impact on low-dose methotrexate (MTX) response in small rheumatoid arthritis (RA) cohorts. We sought to test their effect in the single largest cohort studied to date, and undertook a meta-analysis utilizing stringent study inclusion criteria. RA patients treated with MTX monotherapy from the Yorkshire Early Arthritis Register (YEAR) were genotyped using RFLP assays, and tested for association with treatment efficacy. Studies for meta-analysis were screened by a set of stringent inclusion criteria. rs1801131 and rs1801133 were not associated with response to MTX in the YEAR cohort, nor did they affect the probability of achieving a low disease activity state. A meta-analysis of comparable studies found no association with these SNPs. MTHFR SNPs rs1801131 and rs1801133 are unlikely to have a clinically meaningful effect on the first 6 months of MTX treatment in early RA.

Research paper thumbnail of Giant Intraosseous Synovial Cyst with Intraarticular Communication with the Ankle Joint in Longstanding Rheumatoid Arthritis

The Journal of Rheumatology, 2012

... and Radiology Department, Dr. Erfan and Bagedo General Hospital; NASHWA EL-SHAARAWY, MD, Rheu... more ... and Radiology Department, Dr. Erfan and Bagedo General Hospital; NASHWA EL-SHAARAWY, MD, Rheumatology and Rehabilitation Department, Suez Canal University, Ismailia, Egypt;AHMED KAMAL, MD ... 4. Kirino Y, Ihata A, Shizukuishi K, Hama M, Takase K, Suda A, et al. ...

Research paper thumbnail of Lichen Planus in Association with Adult-onset Still's Disease Successfully Treated with Mycophenolate Mofetil

The Journal of Rheumatology, 2012

A 55-year-old woman presented with acute onset of spiking fever, symmetric polyarthritis with int... more A 55-year-old woman presented with acute onset of spiking fever, symmetric polyarthritis with intense myalgia, and sore throat. Onset was associated with diffusely itchy purple papules involving the trunk, anterior chest wall, and upper and lower limbs. Initial laboratory investigation showed elevated erythrocyte sedimentation rate (90 mm/h), elevated C-reactive protein (17.8 mg/dl), negative rheumatoid factor (RF), negative anti-citrullinated protein antibody, and negative antinuclear antibody (ANA). Complete blood count showed leukocytosis with white blood cell count 14.7 × 10 3 /µl, anemia with hemoglobin 9.6 g/dl, thrombocytosis with platelet count 802 × 10 3 /µl, and 2-fold increase in serum ferritin levels (350 ng/ml, normal values up to 150 ng/ml). Other laboratory investigations showed elevated liver enzymes [aspartate transaminase 69 IU/l, alanine transaminase 125 IU/l, and elevated creatine phosphokinase (CPK) levels 320 IU/l, normal 40-120 IU/l] with negative virology screening for viral hepatitis. Skin biopsy showed focal thinning of the epidermis with focal destruction of basal layers and focal dermal mononuclear infiltrate, features consistent with the diagnosis of lichen planus (LP; ). No history of medications known to induce LP was given by the patient.

Research paper thumbnail of Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

The Journal of Rheumatology, 2012

This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of kne... more This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic arthritis.

Research paper thumbnail of Correlations of Urinary Biomarkers, TNF-Like Weak Inducer of Apoptosis (TWEAK), Osteoprotegerin (OPG), Monocyte Chemoattractant Protein-1 (MCP-1), and IL-8 with Lupus Nephritis

Journal of Clinical Immunology, 2011

This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of... more This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) levels, with renal involvement in a cohort of systemic lupus erythematosus (SLE) patients to examine their diagnostic performance. In 73 SLE patients, and in 23 healthy volunteers, urinary levels of TWEAK, OPG, MCP-1, and IL-8 levels were measured. Disease activity was assessed by total SLE disease activity index, and renal activity by renal activity index (rSLEDAI), and both were correlated with urinary biomarkers. Sensitivity, specificity, and predictive values of individual biomarkers to predict lupus nephritis were also calculated. Significantly higher levels of urinary biomarkers were observed in SLE patients with lupus nephritis (LN) compared with those without LN (TWEAK, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; MCP-1, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; OPG, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; IL-8, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.032). Other significantly higher levels were observed in SLE patients with LN compared with control subjects (TWEAK, MCP-1, OPG, and IL-8 p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Positive correlations were observed between rSLEDAI and TWEAK (r = 0.612 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), MCP-1 (r = 0.635 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and OPG (r = 0.505 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Urinary levels of TWEAK, OPG, and MCP-1 positively correlate with renal involvement as assessed by rSLEDAI with reasonable sensitivity, specificity, and predictive values to detect lupus nephritis while IL-8 was not significantly associated with global or rSLEDAI.

Research paper thumbnail of Patrón de autoanticuerpos contra antígenos nucleares extraíbles (ENA) en pacientes con artritis reumatoide: relevancia e implicaciones clínicas

Reumatología clínica, 2021

Research paper thumbnail of Cam versus pincer femoroacetabular impingement. Which type is associated with more hip structural damage? An exploratory cross-sectional study

Current Orthopaedic Practice, 2017

Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur an... more Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P < 0.0001), cartilage degradation (P ¼ 0.001), pseudocysts (P < 0.0001), hip effusion (P ¼ 0.013) and reactive synovitis (P < 0.0001). However, in pincer FAI, BME only correlated with pain severity (P ¼ 0.004) and duration (P ¼ 0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA.

Research paper thumbnail of Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

Reumatismo, 2015

Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to as... more Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%)...

Research paper thumbnail of Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints

Clinical Rheumatology, 2015

Research paper thumbnail of Antibodies to extractablenuclear antigens (ENA) in antinuclear antibody positive (ANA + ve) autoimmune liver diseases (ALD)

Journal of Hepatology, 1994

ABSTRACT Autoantibodies to the saline extracts of cells are being used as diagnostic and prognost... more ABSTRACT Autoantibodies to the saline extracts of cells are being used as diagnostic and prognostic markers in the investigation of patients with suspected systemic rheumatic disease. These are also called antibodies to the extractable nuclear antigens or anti ENA antibodies. We used saline extracts of human spleen cells and rabbit thymus extract to detect six subtypes of anti ENA antibodies, namely anti SSA (anti Sjogren&#39;s syndrome A), anti SSB (anti Sjogren&#39;s syndrome B), anti RNP (anti Ribonucleoprotein), anti Sm (anti Smith), anti Jo-1 (anti Jo-1) and anti Scl 70 (anti Systemic sclerosis 70) antibodies. Two hundred and thirty-seven patients&#39; sera were screened in the department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, over a period of 16 months. Fifty-seven were positive for auto antibodies, of which 26 had anti SSA antibodies, 12 anti SSA+ anti RNP+ anti Sm antibodies, 7 anti RNP+ anti Sm antibodies, 6 anti SSA+ anti SSB antibodies, 5 anti SSA+ anti RNP antibodies while one patient showed only anti RNP antibody. The detection of the anti ENA antibodies was specially helpful in diagnosing patients with systemic lupus erythematosis presenting with atypical features and with mixed connective tissue disease.

Research paper thumbnail of Rheumatoid factor and anti-citrullinated protein antibodies (ACPA) in psoriatic arthritis (PsA), and skin psoriasis: Relevance and clinical implications

The Egyptian Rheumatologist

Research paper thumbnail of The Clinical Utility of Faecal Calprotectin in Patients with Differentiated and Undifferentiated Spondyloarthritis: Relevance and Clinical Implications

OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal c... more OBJECTIVES There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA. MATERIAL AND METHODS A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed. RESULTS The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ...

Research paper thumbnail of A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG)

International Journal of Cardiology

Research paper thumbnail of Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide—a report by the HSS International Study Group

Clinical Rheumatology

Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread ve... more Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image sel...

Research paper thumbnail of Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications

Research paper thumbnail of Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two years

Clinical Rheumatology

Objective To evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psori... more Objective To evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psoriasis patients, without clinical arthritis or enthesitis compared with healthy controls, with a 2-year follow-up to study the associated incidence of psoriatic arthritis (PsA). Methods A total of 109 consecutive psoriasis vulgaris patients without clinical signs of PsA and 90 healthy controls were included from two tertiary medical centers. Subjects underwent dermatological examination, PASI score evaluation for severity of psoriasis, musculoskeletal examination using 68/66 joints count for tenderness and swollen joints. Patients were assessed for CRP, musculoskeletal ultrasound (MSUS) in the form of grayscale ultrasound (GSUS), and power Doppler ultrasound (PDUS) for eight entheses and 34 joints to detect MSUS subclinical enthesitis and synovitis. All patients were followed-up for 2 years to detect evolving PsA. Results Subclinical enthesitis and synovitis were detected in 39.5% of psoriasis patients and 10% of controls (P < 0.001). CRP was significantly higher in psoriasis patients with MSUS manifestations (P < 0.01). PDUS and GSUS subclinical synovitis and/ or enthesitis were detected at least in one site in psoriatic patients more than in controls (P < 0.05). During a 2-year follow-up of patients, the annual PsA incidence was 4.3%. Psoriasis patients who developed PsA showed a higher prevalence of baseline enthesitis, higher PDUS and GSUS synovitis scores, and higher baseline CRP level than those who did not develop PsA. Conclusions MSUS subclinical synovitis and enthesitis are quite common in psoriasis patients. The incidence of PsA in Saudi's psoriasis patients was slightly higher than worldwide reports. Subclinical enthesitis, PDUS, and GSUS synovitis could predict PsA development.

Research paper thumbnail of Atteinte axiale avec arthropathie des articulaires postérieures et ankylose osseuse dans un syndrome de camptodactylie, arthropathie, coxa vara et péricardite (CACP)

Revue du Rhumatisme, 2013

ABSTRACT L’arthropathie familiale associée à la camptodactylie congénitale a été précédemment rec... more ABSTRACT L’arthropathie familiale associée à la camptodactylie congénitale a été précédemment reconnue comme entité clinique bien définie dans la littérature. Le spectre clinique de cette maladie semble variable. Les caractéristiques cliniques typiques du syndrome camptodactylie congénitale, arthropathie, coxa vara et péricardite (syndrome CACP) semblent être plus fréquent chez les enfants provenant du Moyen-Orient et d’Afrique du Nord. La présentation ostéoarticulaire de cette forme familiale rare d’arthropathie est unique et hétérogène. Dans tous les articles précédents, une atteinte non inflammatoire type arthropathie incluant les articulations périphériques avec une coxa vara typique a été décrite, et dans certains cas des anomalies rachidiennes incluant la cyphose, la lordose ou la scoliose. Nous décrivons le premier cas d’atteinte axiale dans le cadre d’un syndrome CACP avec une arthropathie des articulaires postérieures et une ankylose rachidienne au niveau L5/S1.

Research paper thumbnail of Vasculopathie artérielle dans la sclérodermie systémique. Caractéristiques micro- et macrovasculaire de l’angioscanner des artères des membres supérieurs

Revue du Rhumatisme, 2015

ABSTRACT Décrire les résultats de l’angioscanner de la vasculopathie artérielle des gros vaisseau... more ABSTRACT Décrire les résultats de l’angioscanner de la vasculopathie artérielle des gros vaisseaux ainsi que des petits et moyens vaisseaux de l’ensemble de l’arbre vasculaire des membres supérieurs chez les patients porteurs d’une sclérodermie systémique (ScS) avec ou sans ulcération digitale.

Research paper thumbnail of Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

Joint Bone Spine, 2014

To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as... more To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. Twenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases. CTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P=0.001). Macrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.

Research paper thumbnail of Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients

The Egyptian Rheumatologist, 2014

Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic s... more Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis.

Research paper thumbnail of MTHFR functional genetic variation and methotrexate treatment response in rheumatoid arthritis: a meta-analysis

Pharmacogenomics, 2014

To date, functional MTHFR SNPs have been tested for their impact on low-dose methotrexate (MTX) r... more To date, functional MTHFR SNPs have been tested for their impact on low-dose methotrexate (MTX) response in small rheumatoid arthritis (RA) cohorts. We sought to test their effect in the single largest cohort studied to date, and undertook a meta-analysis utilizing stringent study inclusion criteria. RA patients treated with MTX monotherapy from the Yorkshire Early Arthritis Register (YEAR) were genotyped using RFLP assays, and tested for association with treatment efficacy. Studies for meta-analysis were screened by a set of stringent inclusion criteria. rs1801131 and rs1801133 were not associated with response to MTX in the YEAR cohort, nor did they affect the probability of achieving a low disease activity state. A meta-analysis of comparable studies found no association with these SNPs. MTHFR SNPs rs1801131 and rs1801133 are unlikely to have a clinically meaningful effect on the first 6 months of MTX treatment in early RA.

Research paper thumbnail of Giant Intraosseous Synovial Cyst with Intraarticular Communication with the Ankle Joint in Longstanding Rheumatoid Arthritis

The Journal of Rheumatology, 2012

... and Radiology Department, Dr. Erfan and Bagedo General Hospital; NASHWA EL-SHAARAWY, MD, Rheu... more ... and Radiology Department, Dr. Erfan and Bagedo General Hospital; NASHWA EL-SHAARAWY, MD, Rheumatology and Rehabilitation Department, Suez Canal University, Ismailia, Egypt;AHMED KAMAL, MD ... 4. Kirino Y, Ihata A, Shizukuishi K, Hama M, Takase K, Suda A, et al. ...

Research paper thumbnail of Lichen Planus in Association with Adult-onset Still's Disease Successfully Treated with Mycophenolate Mofetil

The Journal of Rheumatology, 2012

A 55-year-old woman presented with acute onset of spiking fever, symmetric polyarthritis with int... more A 55-year-old woman presented with acute onset of spiking fever, symmetric polyarthritis with intense myalgia, and sore throat. Onset was associated with diffusely itchy purple papules involving the trunk, anterior chest wall, and upper and lower limbs. Initial laboratory investigation showed elevated erythrocyte sedimentation rate (90 mm/h), elevated C-reactive protein (17.8 mg/dl), negative rheumatoid factor (RF), negative anti-citrullinated protein antibody, and negative antinuclear antibody (ANA). Complete blood count showed leukocytosis with white blood cell count 14.7 × 10 3 /µl, anemia with hemoglobin 9.6 g/dl, thrombocytosis with platelet count 802 × 10 3 /µl, and 2-fold increase in serum ferritin levels (350 ng/ml, normal values up to 150 ng/ml). Other laboratory investigations showed elevated liver enzymes [aspartate transaminase 69 IU/l, alanine transaminase 125 IU/l, and elevated creatine phosphokinase (CPK) levels 320 IU/l, normal 40-120 IU/l] with negative virology screening for viral hepatitis. Skin biopsy showed focal thinning of the epidermis with focal destruction of basal layers and focal dermal mononuclear infiltrate, features consistent with the diagnosis of lichen planus (LP; ). No history of medications known to induce LP was given by the patient.

Research paper thumbnail of Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

The Journal of Rheumatology, 2012

This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of kne... more This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic arthritis.

Research paper thumbnail of Correlations of Urinary Biomarkers, TNF-Like Weak Inducer of Apoptosis (TWEAK), Osteoprotegerin (OPG), Monocyte Chemoattractant Protein-1 (MCP-1), and IL-8 with Lupus Nephritis

Journal of Clinical Immunology, 2011

This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of... more This case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) levels, with renal involvement in a cohort of systemic lupus erythematosus (SLE) patients to examine their diagnostic performance. In 73 SLE patients, and in 23 healthy volunteers, urinary levels of TWEAK, OPG, MCP-1, and IL-8 levels were measured. Disease activity was assessed by total SLE disease activity index, and renal activity by renal activity index (rSLEDAI), and both were correlated with urinary biomarkers. Sensitivity, specificity, and predictive values of individual biomarkers to predict lupus nephritis were also calculated. Significantly higher levels of urinary biomarkers were observed in SLE patients with lupus nephritis (LN) compared with those without LN (TWEAK, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; MCP-1, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; OPG, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; IL-8, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.032). Other significantly higher levels were observed in SLE patients with LN compared with control subjects (TWEAK, MCP-1, OPG, and IL-8 p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Positive correlations were observed between rSLEDAI and TWEAK (r = 0.612 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), MCP-1 (r = 0.635 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and OPG (r = 0.505 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Urinary levels of TWEAK, OPG, and MCP-1 positively correlate with renal involvement as assessed by rSLEDAI with reasonable sensitivity, specificity, and predictive values to detect lupus nephritis while IL-8 was not significantly associated with global or rSLEDAI.