To assess gender differences in Ankylosing Spondylitis (AS) patients regarding the clinical presentation, disease activity and functional status. Methods and findings: Forty AS patients; 21 males and 19 females, regularly following at the Rheumatology outpatient's clinic, Saudi German Hospital, Riyadh, KSA were included. Functional status and the disease activity were evaluated using Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath AS Disease Activity Index (BASDAI) respectively. Mean age was 34.3 ± 8.5 years with a comparable sex ratio (M:F 1.11:1). Morning stiffness was markedly lower in females (72.4 ± 52.4 vs 112.9 ± 44.4 minutes) (p=0.01).Bilateral sacroiliitis was significantly more in males (n=18; 85.7% vs n=13; 68.4%) (p=0.02).The Schöber's test was more limited and the finger-to-floor distance more increased in males (4.5 ± 0.8 cm and 40.7 ± 9.2 cm vs 4.9 ± 0.7 cm and 27.9 ± 9.7 cm; p=0.046 and p<0.001 respectively). Human leukocytic antigen-B27) was positive in 85.7% of males while rheumatoid factor was positive in only 3 females. BASFI showed significantly higher value in females (6.7 ± 1.1 vs 5.8 ± 1.4) (p=0.04), while BASDAI showed only a tendency to be higher in females. Using Magnetic resonance imaging of the sacroiliac joint, sacroiliitis was detected in all cases with signs of activity in 9 males and 7 females, erosions in 8 males and 5 females, effusion in 1 female and total ankylosis in 1 male. Conclusion: The clinical presentation and genetic background were more remarkable in the AS males; however the disease activity and functional impairment were increased in females. Radiological findings were comparable.Understanding the gender differences in AS may discern how this may impact future research, diagnosis and treatment.
To determine the frequency of Rheumatic and Musculoskeletal Diseases (RMDs) in patients with renal failure on regular hemodialysis. Methods and findings: The present study included forty-nine patients (28 males and 21 females) with renal failure on regular hemodialysis. Full history taking and clinical examination were documented for all patients. Blood samples were collected for laboratory investigations before the midweek session. Dual Energy X-ray Absorptiometry (DXA) was performed to all patients to assess bone mineral density (BMD). Kt/V was used as a marker of dialysis adequacy. Mean age for all patients was 54.41 ± 15.9 years, and the dialysis duration was 3 ± 2.3 years. The detected RMDs included (in order of descending frequency): fibromyalgia syndrome (51%), myalgias (37%), arthralgia (37%), flexor tenosynovitis (29%), cramps (29%), ectopic calcifications (25%), flexion deformity of the elbow (16%), carpal tunnel syndrome (14%), destructive spondyloarthritis (8%) and Vasculitis (4.1%). Positive anti-CCP was detected in 1 female and rheumatoid factor in 4 females and 1 male. The BMD was reduced with the DXA t-score at lumbosacral spine, hip and forearm-1.5 ± 1.8,-1.7 ± 1.6,-1.9 ± 1.9 respectively. Overall, there was a tendency to a higher frequency of musculoskeletal findings in males. Other co-morbidities included: diabetes mellitus (45%), hypertension (96%), cardiovascular (33%), cerebrovascular stroke (6%), hyperuricemia (37%), hepatitis C (16%) and amyloidosis (8%). Conclusion: Rheumatic and musculoskeletal diseases are frequent and overlooked among hemodialysis patients especially males and usually associated with chronic pain.
Background:
Juvenile idiopathic arthritis (JIA) could be disabling if left untreated. Methotrexate (MTX) is well
known as a corner stone in management, however, its adverse effects may limit treatment.
Objective:
The objective of this study was to evaluate the frequency of hepatotoxicity based on liver chemistry in JIA
children receiving MTX.
Methods:
An observational case-control study of children with JIA who attend the Pediatric Rheumatology Unit, Cairo
University Pediatric Hospital, Egypt, from January 2018 to December 2018 was carried out. Data were retrieved for 80
children; 50 (62.5%) were prescribed MTX. Their demographic, clinical characteristics, mean dose, duration of MTX
therapy and other medications were described. Hepatotoxicity was defined as at least one value above the normal
laboratory range of either ALT or AST during the study period.
Results:
Fourteen patients developed hepatotoxicity, giving an incidence of 28%. Children receiving methotrexate had
higher alanine aminotransferase (ALT) interquartile range (IQR) (26 [21–359] vs. 23[20–32]; p =0.003), higher aspartate
aminotransferase (AST) interquartile range (IQR) (31 [22–267] vs. 28[2–35]; p <0.001), and lower alkaline phosphatase
(ALP) mean (±SD) (98±35.5 vs. 256 ± 39.5; p <0.001). However, there were no significant differences in age, sex,
weight, type of JIA, and duration of MTX treatment (p< 0.05).
Conclusion:
Hepatotoxicity due to MTX, based on liver chemistry is common among children with JIA.
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