Introduction:Pulmonary arterial hypertension (PAH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Because the diagnosis of PAH often is made years after symptom onset, early diagnostic strategies are essential. Doppler echocardiography currently is considered the noninvasive screening test of choice for evaluating pulmonary hypertension.Aim:Screening for asymptomatic pulmonary hypertension in systemic lupus erythematosus patients using Doppler echocardiography, and correlating it with inflammatory parameters of the disease.Patients and methods:Doppler echocardiography was performed in 74 patients with systemic lupus erythematosus over one year (66 adult and 8 juvenile), adult SLE included 57 patients with adult-onset and 9 patients with childhood-onset. Pulmonary hypertension was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 30 mmHg. All patients were subjected to full history taking, rheumatological examination, laboratory studies and chest x-ray.Results:In seventy four SLE patients, the pulmonary hypertension was detected in 8 patients (10.8%), 7 adult-onset SLE patients (aged from 19 to 30 years) and 1 juvenile SLE (aged 12 years). The range of pulmonary artery systolic pressure was 34–61.2 mmHg (43.19 ± 9.28). No significant differences between patients with and those without pulmonary hypertension as regard clinical features. Significantly higher frequencies of rheumatoid factor and anti-cardiolipin antibodies were found in patients with pulmonary hypertension versus those without (P = 0.02, P = 0.008 respectively). Positive rheumatoid factor and ACL were significantly associated with occurrence of PAH in SLE (P = 0.007, P = 0.006 respectively). No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI), ESR, and anti-ds DNA.Conclusion:Patients with SLE have an increased risk of pulmonary arterial hypertension. Echocardiography should be used as a screening tool in patients at high risk for development of pulmonary hypertension. Positive anti-cardiolipin antibodies and rheumatoid factor were significant predictors of pulmonary hypertension in our study.

AimTo determine whether early clinical, laboratory and musculoskeletal ultrasound (MSUS) characteristics can be used as early detectors of juvenile idiopathic arthritis.Patients and methodsForty (40) patients with juvenile idiopathic arthritis (JIA) diagnosed according to the ILAR criteria [1] and 20 healthy control children. All patients were subjected to the following assessment at base line and at follow up after 6 months: Clinical evaluation, MSUS examination and laboratory evaluation.ResultsOf the 40 patients, 6 patients (15%) had systemic onset subtype, 8 (20%) oligoarticular extended, 9 (22.5%) oligoarticular persistent, 5 (12.5%) polyarticular rheumatoid factor (RF) +ve, 6 (15%) polyarticular RF −ve, 5 (12.5%) enthesitis related subtype and only one patient (2.5%) had psoriatic JIA. MSUS detected more synovitis than clinical examination (subclinical synovitis) both at base line and at follow up. MSUS is highly sensitive for early detection of joint involvement in JIA when compared to physical examination. Significant decrease in the mean cartilage thickness of the patients measured at follow up as compared to measures at base line.ConclusionMSUS is highly sensitive for early detection of joint involvement in JIA when compared to physical examination

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Background:Ankylosing spondylitis (AS) is a progressive inflammatory disease involving cartilaginous structures in the spine and peripheral joints.Objectives:To examine the role of musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) in assessing femoral cartilage thicknesses in patients with aS and healthy controls, and to study the correlation between femoral cartilage thicknesses measurements and disease parametersMethods:Twenty five patients with aS (17 males and 8 females), and twenty five age, sex and BMI matched healthy individuals were included. For all patients assessment of disease activity, spinal mobility, functional limitation and radiological changes were done. Thickness of the femoral articular cartilage was measured by MSUS using a 10-18 MHz linear probe, three mid-point measurements were taken from each knee at the lateral condyle, intercondylar area, and medial condyle. Thickness of the femorotibial articular cartilage was measured by MRI using 1.5 Tesla MR machine.Results:AS patients had thinner femoral cartilage thickness than the healthy controls at all MSUS measurement sites, with statistically significant differences at medial femoral condyle and intercondylar area in both right and left knees (p<0.05). According to MRI examination, aS patients had statistically significant (p<0.05) thinner cartilage thickness at all subdivisions of femoral and tibial condyles than the healthy controls. Femoral cartilage thickness measurements either assessed by MSUS or MRI was negatively correlated with age, age at onset of the disease, and measures of disease activity and radiological changes. Positive correlation between ultrasonographic total femoral cartilage thickness and MRI total femoral cartilage thickness was found (r=0.49, p=0.02).Conclusion:Patients with ankylosing spondylitis seem to have thinner femoral cartilage thickness than healthy controls. Correlations of knee cartilage thickness (assessed by MSUS and MRI) with demographic data and disease parameters reflect useful value of MSUS and MRI in determining early cartilage loss in aS patients.References[1] alDhaheri F, almteri T, Dwid N, Majdali a, Janoudi N and almoallim H(2017). Rituximab Can induce Remission in a Patient with ankylosing Spondylitis Who Failed anti-TNF-α agent. Am J Case Rep.; 18 :143-147.[2] amin S, LaValley MP, Guermazi a, Grigoryan M, Hunter DJ, Clancy M, et al (2005). The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum; 52: 3152-3159.[3] andriacchi TP and Favre J (2014). The nature of in vivo mechanical signals that influence cartilage health and progression to knee osteoarthritis.CurrRheumatol Rep.; 16(11) :463.[4] anwar F, a-Khayer a, Joseph G, Fraser MH, Jigajinni MV and allan DB (2011). Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis.Eur Spine J.; 20(3) :403-7.Disclosure of interests:None declared

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