Background This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management.

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Background Psoriasis is a chronic, inflammatory disease that mainly affects skin and nails. Approximately 13%-25% of Psoriasis patients develop Psoriatic arthritis (PsA). Psoriasis and PsA are strongly associated with numerous comorbid diseases and among them, cardiovascular diseases are of particular importance. Low levels of serum vitamin D are associated with increasing risk of metabolic diseases and cardiovascular diseases. Vitamin D deficiency is observed in numerous chronic systemic inflammatory diseases including psoriasis. Carotid intima-media thickness (CIMT) is a marker of arterial vascular disease used to predict a future vascular event. It can serve as a surrogate marker for subclinical atherosclerosis and cardiovascular diseases. Coronary artery calcification score (CACS) is a non-invasive and highly reliable method to measure coronary atherosclerosis through non-contrast cardiac CT. Objective To detect subclinical atherosclerosis and study its relation with serum levels of 25hydroxyvitamin D in psoriatic patients with and without arthritis. Patients and Methods This study was carried out on 25 Egyptian psoriatic patients and 25 healthy individuals matched as regarding age, sex and BMI as a control group. Patients were classified into 2 groups; Group I: 13 patients with PsA and Group II: 12 patients with psoriatic skin lesion without any arthritic manifestations. All patients were subjected to full medical history taking, thorough clinical examination. Basic laboratory investigations in addition to assessment of serum levels of 25-OH vitamin D were done to all patients and control. carotid duplex for measurement of CIMT in addition to measurement of CACS using coronary CT. Results Patients with PsA had lower values of vitamin D than psoriatic patients and controls despite being statistically insignificant (median; 5, 5.5 & 11). CIMT and CACS were statistically higher among PsA patients (CIMT mean; 0.57, 0.52 & 0.44) and (CACS median; 53, 1.5 & 0) respectively. Vitamin D was found to be negatively well correlated with PASI, ALT, AST, serum creatinine and CACS in psoriatic patients. A significant relation between higher PASI and low vitamin D levels in psoriatic patients. CIMT was significantly positively correlated with age, BMI, LEI, ALT, AST, SUA, cholesterol and CACS in psoriatic patients, while CACS was positively correlated with age, ALT, SUA and cholesterol. Conclusion Psoriatic patients especially those with PsA had lower values of vitamin D than controls despite being statistically insignificant. They also suffered from increased risk of CVDs and subclinical atherosclerosis due to increased burden of inflammation and lack of physical activity. Vitamin D was negatively correlated with CACS in psoriatic patients in addition to a strong positive correlation between CIMT and CACS among them.

Background: There is lack of evidence from randomized clinical trials that had assisted the efficacy of PRP in treating of rotator cuff diseases (RCD). Aim of the work: To study the effect of PRP injection on functional improvement on RCD, and to study the role of proinflammatory and angiogenesis-related cytokines as a pathogenic factor in RCD. Patients and methods:The study was conducted on 40 patients with RCD. All patients subjected to: clinical shoulder examination, clinical scoring including; (VAS and Los Angeles Shoulder score), cytokine assay of vascular endothelial growth factor (VEGF) and interleukin one beta (IL-1β), and diagnostic musculoskeletal ultrasound examination (MSU). All patients underwent two doses of ultrasound guided PRP injection with 4 weeks in-between. Reevaluation after 4 weeks from first injection was done using clinical scoring, cytokine assay and MSU. Third assessment was done 3 months from first injection using clinical scoring and MSU. Results: There was a statistically high significant decrease in pain, improvement of range of motion (ROM), power and functional state in all participants after 2 doses of PRP injection and rehabilitation program. In addition, there was a highly statistical significant decrease of cytokines serum levels after 4 weeks. There was a highly significant improvement regarding MSU grading. There was positive correlation between the serum levels of cytokines and VAS and negative correlation between the serum levels of cytokines and other clinical scores. There was positive correlation between the serum levels of VEGF and MSU grading. Conclusion:PRP therapy is an effective treatment for RCD and lead to functional improvement. There is a strong correlation between levels of cytokines (IL-1β and VEGF) and clinical scores before injection and 4 weeks following first injection. There is strong correlation between level of VEGF and ultrasound grading of RCD.

Background Despite the diagnostic contribution of anti-citrullinated protein( anti-CCP) antibody and rheumatoid factor (RF), approximately one-third of patients with rheumatoid arthritis (RA) remain seronegative .Anti-carbamylated protein (Anti-Carp) antibodies have been attracting increasing attention as a new diagnostic marker of RA. Objective evaluate levels of anti-carp antibodies in RA patients in order to detect its role as a diagnostic marker and its possible association with disease activity and severity. Methods This study included thirty adult patients with clinical evidence of rheumatoid arthritis and thirty healthy matched age and sex as controls. All underwent history taking, clinical examination, assessment of disease activity with modified Disease Activity28 (DAS28), Laboratory investigations including Complete blood count (CBC), erythrocytes sedimentation rate (ESR), C-Reactive Protein (CRP), Liver function tests, Kidney function tests, Serum uric acid, RF, anti CCP Ab, anti-Carp Ab and radiographic Assessment with Larsen score. Results Plasma levels of anti-Carp Ab were significantly higher in patients than control group (p > 0,001) with sensitivity of 73.33% and specificity of 100%.it showed significant positive correlation with CRP (r = 0.37 )(p < 0.05) as a marker of activity of RA and also there was significant positive correlation with RF and ACPA (r = 0.45)(r = 0.48) (p < 0.05) respectively as a diagnostic marker for RA. Plasma levels of anti-Carp Ab were higher in patients with more joints damage and erosions as assessed by Larsen radiological score as there was a highly significant correlation between Larsen score and serum Anti-Carp(r = 0.61)(p < 0.001).. Conclusion serum Anti–Carp antibody level was higher in RA patients which serve as a diagnostic marker for RA, also its significant correlation with CRP and Larsen score may serve as a marker for disease progression and severity.