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.
Background:
Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of the ambiguity of measurement choice.
Aim:
To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a disease-specific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity.
Methods:
A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated QoL.
Results:
Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively.
Conclusion:
QoL was impaired in AS patients with the highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.
Background: Albumin and derived neutrophil to lymphocyte ratio (dNLR) are known biomarkers that can reflect systemic inflammation and it has been hypothesized that combination of both markers in one score (albumin-dNLR score) can be useful in monitoring rheumatoid arthritis (RA) patients. The current study intended to measure albumin-dNLR score in patients with RA in the order to find whether these new biomarkers could reflect the activity of the disease and the articular activity detected by ultrasonography. We measured serum albumin and dNLR in blood samples obtained from 100 RA patients and from 100 apparently healthy controls (HC). Albumin-dNLR score was calculated according to the presence of hypoalbuminemia (≤ 3.76 gm/dl) and/or raised dNLR (>1.37). Results: RA patients had a significantly elevated dNLR (p< 0.001) and albumin-dNLR score (p< 0.001) compared to their levels in HC, while serum albumin was significantly decreased (p< 0.001) in RA patients than its level in HC. In RA patients, albumin-dNLR score correlated significantly with DAS28 (p< 0.001), erythrocyte sedimentation rate (ESR) (p< 0.001), C-reactive protein (p< 0.001), grey scale (p< 0.001), power Doppler (p< 0.001) and total ultrasound score (p< 0.001). Also, tender joint count, ESR and albumin-dNLR score were significant predictors of DAS28 in multivariate regression analysis. Conclusions: Our study settled that albumin-dNLR score is increased in RA patients than in healthy subjects. The score correlated well with DAS28, acute phase reactants, and ultrasonographic synovitis scores implying that it could be an easy valuable biomarker to monitor RA disease activity.
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