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BACKGROUNDInfection in systemic lupus erythematosus (SLE) is common and is one of the leading causes of morbidity and mortality.OBJECTIVETo study the risk and occurrence of infection in Egyptian SLE patients and to determine its characteristics.METHODSA total of 200 SLE patients were followed up for 1 year at monthly intervals, undergoing clinical and laboratory evaluation. Disease activity was assessed by SLE disease activity measurement (SLAM) score. Infections were diagnosed on basis of clinical findings, medical opinion, positive blood and urine cultures, Gram stain results, and specific serological assays as measurement of CMV and EBV antibodies.RESULTSA total of 55% of patients developed infection, 45% had one infection, and the rest had multiple infection episodes. Total number of infections was 233 infections/year, 47.2% were major and 52.8% were minor infections. Urinary tract was the most commonly involved site with bacterial infection being the commonest isolated organism (46.4%), and E. coli the commonest isolated bacteria (14.2%). There were 51 episodes caused by systemic viral infection (CMV in 25, EBV in 22, HCV in 3, and 1 in HBV).CONCLUSIONThere is a high rate of infection among SLE patients. Disease activity, leukopenia, high CRP level, positive anti-dsDNA, consumed C3, and cyclophosphamide therapy are independent risk factors for infection in SLE.

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BackgroundRheumatoid arthritis(RA) is a disabling autoimmune systemic inflammatory disease. It manifests as peripheral symmetric inflammatory polyarthritis and produces a wide range of extra-articular manifestations. Interstitial lung disease (ILD), a diffuse progressive disease of the lung parenchyma, is the most serious manifestation of RA lung affection, it remains as a significant source of morbidity and mortality.ObjectivesTo evaluate the frequency and pattern of pulmonary affection in a cohort of Egyptian rheumatoid arthritis (RA) patients and the relation to disease activity and severity.MethodsSeventy RA patients who fulfilled 2010 (ACR/EULAR) classification criteria underwent full clinical assessment, plain X ray chest, chest high-resolution computed tomography (HRCT) with assessment of the extent and severity of pulmonary affection by Warrick score. Pulmonary function tests (PFTs) including diffusion lung capacity for carbon monoxide (DLCO) were done. Transthoracic echocardiography to screen for pulmonary hypertension (PH). Assessment of disease activity by DAS28 score and of radiographic joint damage by modified Larsen score.ResultsThe mean age of the patients was 44±10.8 years;females(87.1%) and males (12.9%), mean disease duration 7.3±6 years. PFTs were abnormal in (45.7%) with restrictive pattern in (24.3%) of patients followed by small airway affection in (10%), mixed pattern in (8.6%), the least is the obstructive pattern in (2.8%) of patients. DLCO was abnormal in (72.86%) with mild affection in (48.57%), moderate in (15.7%) and severe affection in (8.6%)of patients. HRCT abnormalities were found in 30 patients (42.85%). Interstitial abnormalities were detected in (35.7%). Septal or reticular lines, ground glass appearance, pleural irregularities and bronchiectasis were the most common findings. Most common HRCT pattern was nonspecific interstitial pneumonia (NSIP) in 12.8% (9/70), usual interstitial pneumonia (UIP) in 7% (5/70), organising pneumonia (OP) in 1.4% (1/70) and indeterminate subtype in 14% (10/70). HRCT total score (Warrick score) was correlated with age, disease activity (DAS ESR 28), ESR, modified Larsen score, FVC, FEV1 and DLCO. Age, dyspnea and DLCO impairment were significant predictors for development of HRCT chest abnormalities. Pulmonary hypertension(sPAP >30 mmHg) was detected in (14%) of patients.ConclusionsPulmonary abnormalities are common in Egyptian RA patients. HRCT and PFTs including DLCO can be used effectively for early diagnosis and monitoring of pulmonary affection in RA patients. DLCO can detect pulmonary abnormalities early in clinically asymptomatic patients. Age, disease activity and severity, PFTs and ESR are correlated with the pulmonary affection in RA. Age, dyspnea and DLCO impairment are significant predictors of pulmonary affection in RA patients. Echocardiography can be used as a screening tool for detection of pulmonary hypertension.Disclosure of InterestNone declared

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