Psoriatic arthritis was described as a distinct rheumatic disease in the 1960s, and subsequently grouped among the spondyloarthropathies. Recently, other rheumatic manifestations of psoriasis, such as enthesopathy and osteoperiostitis, were recognized. This study attempts to examine the rheumatological and radiological manifestations of Psoriasis and their association with skin and nail disease. Eighty-one psoriatic outpatients were interviewed consecutively during 6 months. Questionnaires and indices were carried out to assess the extent and severity of skin and nail involvement, as well as the activity and severity of peripheral and axial rheumatic manifestations. Radiological examination of the hands, feet, spine and pelvis was also done for all patients. Fifty-nine psoriatic outpatients (73%) had rheumatic manifestations clinically and/or radiologically (Psoriatic arthropathy "PsA"). Clinical peripheral arthritis was found in 14 (23.7%) of the patients with PsA, being oligoarticular in 11, polyarticular in two, and exclusively of the distal interphalangeal (DIP) joints in one patient. Sacroiliitis and/or spondylitis were found in 38 (64.4%), enthesopathy in 36 (61%), dactylitis in two (3.3%), radiological DIP involvement in 24 (40.6%), and radiological osteoperiostitis in 49 (83%) of patients with PsA. Most PsA patients had more than one rheumatic manifestation, while four patients (6.7%) had isolated enthesopathy without any other rheumatic manifestations. Subungual hyperkeratosis of the nails was significantly correlated with PsA (p<0.05), as well as with clinical arthritis, enthesopathy, and DIP involvement (p<0.01), while other types of skin and nail lesions were correlated with selected rheumatic manifestations. The performance of existing criteria for PsA was poor, as individual sets favored either sensitivity or specificity. Psoriatic arthropathy (PsA), occurring in about three-quarters of hospital outpatients with psoriasis, is more common than previously thought. More sensitive and specific criteria for the diagnosis and classification of PsA need to be developed, taking into account the recently described clinical and radiological manifestations.

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Background/objective: HCV viremia has been known to provoke a plethora of autoimmune syndromes as well as nonspecific rheumatologic manifestations. HCV is the most frequent cause of mixed cryoglobulinemia, which is characterized by endothelial deposition of rheumatoid factor containing immune complexes and endorgan vasculitis. Rheumatoid factor positivity is found to be more prevalent among patients with HCV infection compared to the general population. The aim of the study was to ascertain the relationship of rheumatoid factor titer with cryoglobuliemia in hepatitis C virus positive patients and to assess its relation with different disease characteristics. Methods: A cross sectional study was carried out through one year. Fifty patients known to suffer from HCV were subjects of the study. Patients were interviewed and demographic, clinical and serologic data were recorded. All patients were tested for cryoglobulins by crude method and rheumatoid factor titer was determined in all patients. Child-Pugh classification was used for assessment of liver cell failure. Data were analyzed by the Statistical Package for the Social Sciences (SPSS, version 17). Data analysis is done by using Chi-Squared test (χ 2) test and Fisher's exact test as appropriate. Associations between interval, ordinal and dichotomous variables were tested by Pearson`s Product Moment Correlation Coefficients (r). Results: Cryoglobulinemia was detected in 36 (72%) patients out of the 50 HCV patients. Rheumatoid Factor (RF) was positive in 38% patients (76%). All HCV patients who were positive for cryoglobulin had a positive RF. Presence of RF found to be positively significantly correlated with the presence of cryogloulins in HCV patients. Conclusions: HCV infection is a major contributing factor of mixed cryoglobulinemia with elevation in RF titre. Positive anti-HCV antibodies together with highly positive RF titre in the presence of musculoskeletal, neurological and cutaneous manifestations strongly suggest the diagnosis of mixed cryoglobulinemia.

Background: Recently there is growing interest for inner ear involvement in systemic autoimmune diseases. Several studies showed inflammatory cells in the inner ear, describing the presence of resident cochlear macrophages in animal models and the recruitment of inflammatory macrophages to the cochlea. (1) Method: 16 rheumatoid arthritis patients were enrolled in this study. Audiological assessment was done using pure tone audiometry (PTA). Vestibular assessment for lateral semicircular canal was done by video head impulse test (VHIT). Results: 50% of rheumatoid arthritis patients were discovered to be suffering of hearing loss of all types and degrees detected by pure tone audiometry, VHIT was normal in all patients. Conclusion: Hearing impairment is not uncommon finding in rheumatoid arthritis patients. It can have a negative impact on a patient's quality of life. So, audiological assessment and follow up are necessary for rheumatoid arthritis patients.

Background:Rheumatoid arthritis (RA) is characterized by persistent synovitis that leads to structural joint damage causing deformity and disability. Dickkopf-1(DKK-1) was shown to be a major regulator of joint remodeling, which is associated with subchondral bone erosion in RA. Dickkopf-1 is a secreted glycoprotein that also acts as a potent negative regulator of wingless signaling. Current therapies used to treat RA are not able to effectively repair damaged bone. There is a strong relationship between Wnt signaling pathway, RA and DKK-1 so; this relationship may be a therapeutic point of interestObjectives:To assess the correlation between Dickkopf-1 and RA disease activity, disability, severity and functional status.Methods:Fifty patients fulfilled the 2010 ACR -EULAR criteria for RA were included. Twenty five healthy age and sex matched individuals served as a control (for assessment of serum DKK-1 level). Excluded from the study, patients with Paget disease, Multiple myeloma, Breast cancer, Bone metastasis, Diabetes mellitus, Hyperthyroidism, patients on medication that influence bone metabolism as: heparin, anticonvulsant or thyroxin.All patients were subjected to full history and examination. Disease activity measures as disease activity score (DAS 28-ESR), Visual analogue scale (VAS) and Disease disability indices including ACR criteria of functional status in RA and Health assessment questionnaire disability index (HAQ-DI). Erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), Rheumatoid factor (RF), Anti citrullinated peptide antibody (ACPA) and Serum dickkopf-1 level. Simple erosion narrowing score (SENS) and Ultrasound DAS (US DAS) were done for all patients. Ultrasound DAS included 28 joints, Power Doppler ultrasound (PDUS) examination of 22 joints and gray scale ultrasound (GSUS) examination for Effusion/Hypertrophy (E/H) of 28 joints. Ultrasound erosion count (USEC) and Ultrasound erosion rate (USER) were assessed.Results:Dickkopf-1 level in RA patients ranged from 66 to 453 ng/ml while in the control group ranged from 15 to 87 ng/ml with statistically significant difference. RA patients were grouped in to: group 1 included 15 (30%) patients with normal DKK-1 level and group 2: included 35 (70%) patients with elevated DKK-1. The differences between both groups were highly significant regarding clinical and laboratory measures (duration of morning stiffness, DAS 28, VAS, ESR, CRP, RF and ACPA), and regarding HAQ-DI, SENS and US DAS. We found significant positive correlation between DKK-1 level and laboratory measures (ESR, CRP, RF, ACPA), radiographic parameters (SENS and erosion score), ultrasonographic parameters (US DAS, USEC and USER) and with HAQ-DI and functional status.Conclusion:Serum level of dickkopf-1 was elevated in RA patients and the results demonstrated the relationship between increased dickkopf-1 level and increased disease activity, decreased functional capacity and chronic structural damage suggesting its important role in the pathogenesis of RA.References:[1]Cardona-Rincón A D, Acevedo-Godoy M, Perdomo-Lara S, Chila L, et al. (2018).AB0001 Association of dickkopf1–1 polymorphisms with radiological damage and periodontal disease in patients with early rheumatoid arthritis. Annals of the Rheumatic Diseases; 77(2): 1206.[2]Huang Y, Liu L and Liu A. (2018).Dickkopf-1: Current knowledge and related diseases. Life sciences; 209: 249-54.Disclosure of Interests:None declared