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Background: Knee osteoarthritis (OA) is a painful condition with peripheral and central pain transmission. Fibromyalgia (FM) is the role model of central sensitization of pain perception. Aim: To assess the frequency of FM in knee OA patients and evaluate the impact of FM on mental health and the quality of life in knee OA patients. Patients and Methods: A total of 121 female patients were recruited and divided into 3 groups: group I of 59 patients with knee OA only, group II of 32 patients with knee OA and FM, and group III of 30 FM patients. Patients underwent history taking, examination, investigations, and radiological evaluation of both knees. The assessment of visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Pain Anxiety Symptom Scale Short Form 20 (PASS20), Beck Depression Inventory (BDI-II), and PCASEE questionnaire were done for all patients. Lequesne index of knee OA and radiological Kellgren and Lawrence score severity were done for all OA patients. Fibromyalgia Impact Questionnaire (FIQ) was assessed for all FM patients. Results: FM was diagnosed in 35.5% of knee OA patients. Group II patients had higher VAS, PASS-20, PSQI, and lower quality of life than either groups I and III, elevated Lequesne index score than group I, significant correlation between VAS and BMI (p=0.002), Lequesne index score (p<0.001), PASS20 (p=0.006), BDI-II score (p=0.002), and FIQ (P<0.001), and a negative correlation was found between VAS and physical (p<0.001), anxiety (p=0.046), and social (p=0.026) QoL parameters. Univariable regression analysis showed a higher age, VAS, PSQI, PASS20, and FIQ were associated with lower QoL in group II. A higher PASS20 was the only predictor of lower QoL in multivariable analysis. Conclusion: Fibromyalgia coexists frequently in knee OA patients and has implications on their mental health, functional activity, and quality of life.

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Objectives This study aims to assess the urinary soluble alpha chain of the interleukin-2 receptor (sCD25) concentrations in patients with juvenile systemic lupus erythematosus (JSLE) and to evaluate its validity to be a possible marker of disease activity in patients with lupus nephritis (LN). Patients and methods We assessed sCD25 concentrations in urine samples obtained from 53 JSLE patients (15 males, 38 females; median age 11 years; range, 7 to 17 years) and 30 age- and sex-matched apparently healthy controls (10 males, 20 females; median age 10 years; range, 6 to 16 years). Concentrations were normalized according to urinary creatinine excretion. JSLE patients were subjected to clinical examination and assessment of overall disease activity by Systemic Lupus Erythematous Disease Activity Index (SLEDAI), while evaluation of LN activity was preformed using Systemic Lupus International Collaborating Clinics (SLICC) renal activity score. Results The JSLE patients had significantly higher normalized urinary sCD25 concentrations compared to the healthy controls (p=0.001). Patients with active LN had significantly higher normalized urinary sCD25 levels than active JSLE patients without LN (p=0.002) and JSLE patients with inactive disease (p<0.001). A significant positive correlation was found between normalized urinary sCD25 concentrations with different activity parameters such as proteinuria (p=0.004), SLEDAI (p<0.001), renal SLEDAI (p<0.001), and SLICC renal activity score (p<0.001). A significant negative correlation was found between urinary sCD25 and complement 3 (p<0.001). Conclusion Urinary concentrations of sCD25 were significantly elevated in JSLE patients, particularly in those with active LN. The remarkable association between urinary sCD25 concentrations and different renal disease activity parameters implies that urinary sCD25 can be a beneficial marker to monitor active nephritis in JSLE patients.

Aim: Highlighting some health consequences of hypovitaminosis D on adult Egyptian population. Methods: Fifty-five apparently healthy volunteers aged from 20 to 40 years were involved in the study. By history and physical examination 40 of them had mild clinical manifestation of negligible medical importance that affect the quality of their life without interfering with their daily activity. All volunteers were subjected to vitamin D and calcium dietary intake history, sun exposure assessment, body mass index (BMI), serum vitamin D and calcium profile, bone mineral density measured by Dual-energy X-ray absorptiometry (DXA), psychometric evaluation by the Beck Depression Inventory (BDI) score and physical activity evaluation by the International Physical Activity Questionnaire (IPAQ). Results: About 73% of our subjects had hypovitaminosis D (61.8% insufficient and 10.9% deficient). The prevalence was more in the female gender (OR 4.5; p≤ 0.05), older subjects (31-40) age group (OR 4.4; p≤ 0.05), with poor sun exposure (OR 7.8; p≤ 0.05), and low vitamin D and calcium dietary intake (OR 4.6; p≤0.05). Vitamin D deficient group showed the higher prevalence of obesity (45.5%). Osteopenia was detected in seven subjects (14.3%) who had low vitamin D levels. Vitamin D status had a negative correlation (r=-0.653; p=<0.001) with the Beck score, and a positive correlation (r=0.430; p=0.001) with the IPAQ score. Conclusion: Hypovitaminosis D is a frequent condition in the healthy Egyptians that implicates their physical, functional, mental, and emotional health.

Objective: to evaluate the potential clinicopathological involvement of macrophage migration inhibitory factor (MIF) in systemic lupus erythematosus (SLE), and its relationship with lupus nephritis (LN) through measuring serum and urinary MIF levels. Methods: A crosssectional case-control study was carried out on 30 SLE female patients and 30 healthy age-matched females as a control group. SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2k) and renal activity was evaluated with the renal-SLEDAI (rSLEDAI-2k). SLE damage was evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index. Serum MIF (sMIF), urinary MIF (uMIF) levels were assayed and uMIF/creatinine ratio was estimated in all studied subjects. Results: SLE patients had significantly higher levels of sMIF, uMIF and uMIF/ creatinine ratio than the control group (p <0.001 for each).They were also significantly higher in SLE patients with lupus nephritis compared with those without lupus nephritis (p <0.001 for each) and in patients with active nephritis compared with inactive cases (p= 0.007, 0.001, 0.018, respectively). There were significant increase in sMIF, uMIF levels and uMIF/creatinine ratio in association with disease activity assessed by SLEDAI (p =0.005, 0.026, 0.049, respectively). Through regression analysis revealed that sMIF, uMIF, uMIF/creatinine ratio were found to be independent predictors for lupus nephritis development. Conclusion:This study showed that MIF is related to renal disease activity in SLE. Further prospective studies are required to verify whether MIF has a prognostic value in predicting clinical outcomes in SLE patients with different therapeutic regimens.

Purpose: To study the ability of pattern reversal visual evoked potentials (VEPs) to detect subclinical visual pathway pathologic assessment in Behcet disease (BD) and correlate VEP results in BD with disease activity and response to corticosteroid treatment. Methods: This study included 18 patients (36 eyes) with BD without recent ocular manifestations and 20 healthy controls (40 eyes). Clinical history was taken, and clinical examinations were done. Visual evoked potential recordings were performed by an electromyographic evoked machine for patients and controls. Corticosteroids were given to patients with extraocular activity, and VEP was repeated after clinical and laboratory improvement of the manifestations. Results: p100 latency of VEP was prolonged in 8 patients (11 eyes) (44.4% of cases). Mean p100 latency showed statistically significant prolongations in BD group compared with the control group (106.7 ± 8.1 ms vs. 99.6 ± 1.9 ms) with P value < 0.001. There was a positive correlation between p100 latency and the disease activity score (r = 0.8673), whereas there was no correlation between p100 latency and the disease duration (r = 0.00072). Patients treated with corticosteroids showed statistically significant reduction in mean p100 latency after treatment (P < 0.001). Conclusions: Visual evoked potential may be a valuable tool for detecting subclinical neurologic affection in BD.