Background Rheumatoid arthritis (RA) patients have a risk of fractures due to secondary osteoporosis. This study aimed to evaluate the probability of fractures in the next 10 years in Egyptian RA patients by the Fracture Risk Assessment Tool (FRAX). Results The study was a case–control study. It included a hundred RA patients as well as 51 apparently healthy volunteers. Bone mineral density (BMD) means of lumbar vertebra, femoral neck, and total femur were significantly lower in the RA patient group. Additionally, FRAX of the major osteoporotic and hip fractures means were significantly higher in the RA group than in the control group. It was also found that age, body mass index (BMI), Health Assessment Questionnaire Disability Index (HAQ-DI), and BMD of the femoral neck were significant predictors of FRAX of major osteoporotic and hip fractures (P ≤ 0.05). The cumulative dose of steroids was a significant predictor for FRAX of major osteoporotic fractures; however, the 28 joints disease activity score calculated with erythrocyte sedimentation rate (ESR) (DAS28-ESR) was a significant predictor for FRAX of hip fractures. Conclusions RA patients have a high fracture risk probability. Regular annual screening for BMD and FRAX of major osteoporotic and hip fractures is necessary for those patients.

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Background Patients with rheumatic diseases significantly suffer during and after infection with coronavirus disease (COVID-19). Post-COVID-19 syndrome (PCS) refers to signs and symptoms occurring during or following a COVID-19 infection that continue beyond 12 weeks. The study aimed to assess PCS symptoms in rheumatic disease patients compared to a control group not suffering from a rheumatic disease or any other chronic illness. Results The prevalence of PCS symptoms was significantly higher in rheumatic disease patients compared to the control group: fatigue (69.1% vs. 41.25%), myalgia (73.5% vs. 37.5%), attention deficits (57.4% vs. 40%), and muscle weakness (33.8% vs. 13.8%). Objectively, the study group had significantly higher scores for the Fatigue Severity Scale (FSS) (35.46 ± 13.146 vs. 25.1 ± 7.587), Short-form McGill Pain Questionnaire (SF-MPQ-2) (21.66 ± 10.3 vs. 11.6 ± 3.433), and higher grades of functional disability in the Post-COVID-19 Functional Status scale (PCFS). Rheumatic disease patients had significantly higher frequencies of anxiety and depression, as assessed by the Hospital Anxiety and Depression Scale (HADS), and cognitive impairment, as assessed by the Mini-Mental State Examination (MMSE), than the controls (P = 0.023, P = 0.003, P = 0.0001, respectively). Moreover, SLE patients had the most symptoms and the highest FSS, SF-MPQ-2, PCFS, and HADS scores, as well as the lowest MMSE scores (P = 0.0001 for all except cough (P = 0.043), weakness (P = 0.015), paresthesia (P = 0.027), and anosmia (P = 0.039)). Lower disease duration, hospitalization during acute COVID-19, steroid use, smoking, and biologics non-use were significantly associated with higher PCS symptoms. Smoking was a significant risk factor (P = 0.048), and biologics use was protective (P = 0.03). Rheumatic disease patients who received two doses of the COVID-19 vaccinations had better scores on the FSS, HADS for anxiety and depression, and MMSE than those who received a single dose (P = 0.005, P = 0.001, P = 0.009, P = 0.01). Conclusion Rheumatic disease patients have a higher prevalence and risk of PCS, so strict follow-up, avoiding smoking, controlling disease activity, and COVID-19 vaccinations are essential for decreasing the morbidity of PCS.

Background Idiopathic inflammatory myopathies (IIM) are a disease complex that encompasses several distinctly acquired muscle illnesses. Anti-synthetase syndrome is a subset of IIM that is characterized by the presence of antibodies against aminoacyl-tRNA synthetases (ARS). This syndrome has a characteristic phenotype of IIM. Anti-synthetase syndrome was rarely associated with peripheral nerve involvement and endocarditis. Case presentation We report a 46-year-old female patient with a history of mitral and aortic valve replacement for seven years and on warfarin, presented with symmetrical muscular weakness, generalized edema, progressive dyspnea, dysphagia, fever, fatigue, myalgia, and polyarthralgia. The motor power grading was 2 in proximal muscles of upper limbs and 3 in the distal muscles involving hands and wrists, and it was 0 in proximal muscles in lower limbs and 2 in distal muscles involving ankle and toes movements. Also, her oxygen saturation decreased remarkably. Echocardiography revealed that the patient had severe stenosis (70%) of the prosthetic aortic valve. Electrophysiological studies showed axonal polyneuropathy with average F wave latencies. She was diagnosed with anti-synthetase syndrome for elevated muscle enzymes, interstitial lung disease (ILD), mechanic’s hands, fever, polyarthralgia, and positive anti-Jo-1 antibody. There was a significant improvement with plasmapheresis, mycophenolate mofetil (MMF), and high-dose prednisolone. Conclusions To the best of our knowledge, this is a case of anti-synthetase syndrome accompanied by neuropathic involvement and cardiac valve prosthetic stenosis. These were reported as an unusual presentation of the anti-synthetase syndrome. The significant improvement with plasmapheresis gives us a treatment choice for similar critical cases.

Background Resilience is the process of adjusting successfully in the face of adversity, trauma, threats, or severe stress, such as serious health problems. It is one of the factors that affect recovery from psychiatric disorders. It was suggested that fibromyalgia patients have low resilience. This study aimed to assess the impact of resilience on disease severity and psychiatric comorbidities in patients with fibromyalgia. Results We found that patients with fibromyalgia had a significantly lower resilience and higher prevalence of psychiatric comorbidities than the control group (P < 0.05). Also, fibromyalgia patients with high disease severity had a significantly lower resilience and a higher percentage of psychiatric problems than those with a better disease state (P = 0.0001). Also, there was a significant negative correlation of resilience with disease severity (as assessed by the FIQ score), visual analog scale (VAS) of anxiety, and VAS of depression (P = 0.0001). Conclusion Resilience significantly impacts the severity and psychiatric comorbidities in patients with fibromyalgia. So, enhancing and improving resilience must be considered in the management protocols of fibromyalgia patients.