https://pubmed.ncbi.nlm.nih.gov/38795561/ by Yasser Emad
A 48-year-old male patient with long-standing ulcerative colitis since February 2001 which was di... more A 48-year-old male patient with long-standing ulcerative colitis since February 2001 which was diagnosed by endoscopy, developed acute digital ischemia affecting both hands with fixed colour changes in the left index finger which was followed shortly by digital ulceration. Magnetic resonance angiography (MRA) of both upper limbs showed evidence of vasculitis affecting digital arterioles on both sided and right subclavian occlusion. The patient received pulse methylprednisolone followed by cyclophosphamide pulse therapy, the latter continuing on a monthly basis for 6 months with appreciable improvement and remission of the vasculitic process; follow-up MRA showed reperfusion of the previously occluded subcalvian artery. To the authors' knowledge vasculitis complicating the course of ulcerative colitis is a rare association and is only sporadically reported in the literature. This rare entity should be diagnosed early and aggressively treated; MRA is a very promising diagnostic tool that is suitable for both diagnosis and follow-up of patients with this rare entity.
The aim was to explore possible correlations of antibodies to extractable nuclear antigens (ENA) ... more The aim was to explore possible correlations of antibodies to extractable nuclear antigens (ENA) with clinical manifestations and disease activity indices in systemic lupus erythematosus (SLE) patients. A total of 70 consecutive SLE patients (64 females) were included. Disease activity was assessed by SLE activity index (SLEDAI), and British Isles Lupus Assessment Group (BILAG). Anti-Ro/SSA correlated positively with, headache (r=0.24, p=0.04), blurring of vision (r=0.25, p=0.03) and SLEDAI (r=0.25, p=0.04) and negatively with C3 (r=-0.35, p=0.003). Anti-Ro/SSA correlated with anti La/SSB antibodies (r=0.69, p<0.001), but not with anti-DNA, anti-RNP and anti-Sm antibodies. Anti-La/SSB antibodies correlated with headache (r=0.26, p=0.03), SLEDAI (r=0.25, p=0.03) and negatively with C3 (r=-0.34, p=0.004). Anti-La/SSB did not correlate with anti-RNP or anti-Sm antibodies. Anti-Sm antibodies correlated with disease duration (r=0.34, p=0.003), 24 hours urinary proteins (r=0.31, p=0.008), SLEDAI (r=0.31, p=0.009), BILAG renal score (r=0.29, p=0.02) and negatively with age at onset (r=-0.27, p=0.02), WBCs (r=-0.29, p=0.014) and C4 (r=-0.25, p=0.049). In multivariate analyses, anti-Ro/SSA antibodies remained associated with headache, blurring of vision and C3 and anti-La/SSB antibodies remained associated with C3 and with headache. Anti-Sm antibodies were independently associated with disease duration and total SLEDAI scores, while anti-RNP antibodies remained significantly associated with BILAG mucocutaneous scores only. Antibodies to ENAs are associated with clinical aspects of SLE and may play a role in the assessment of disease activity. Insight into these ENAs may lead to new approaches to diagnostic testing, accurate evaluation of disease activity and lead to target approach for SLE.
Aim of the work: To assess the role of serum anti-annexin V antibodies in Behҫet's disease (BD) p... more Aim of the work: To assess the role of serum anti-annexin V antibodies in Behҫet's disease (BD) patients in relation to disease manifestations and activity. Aim of the work: Patients and methods Aim of the work: 65 BD patients and 30 matching controls were included. Disease activity was estimated by the Behçet Disease Current Activity Form (BDCAF). Serum IgG anti-annexin V antibodies titre was measured using the enzyme-linked immunosorbent assay. Aim of the work: Results Aim of the work: The patients' age was 36.1 ± 8.5 years and disease duration 7.2 ± 5.2 years; 56 males and 9 females. The serum anti-annexin V antibodies level was significantly increased in the BD patients (50.9 ± 12.9 AU/ml) compared to the control (7.3 ± 3.1 AU/ml) (p < 0.0001). Serum anti-annexin V antibodies were significantly increased in BD patients with ocular involvement, skin lesions and neuro-Behcet's compared to those without (p = 0.02, p = 0.004 and p = 0.002 respectively). Levels were comparable between those with uveitis, vitrous cells, retinal vasculitis, conjunctivitis and hypopyon and those without (p = 0.12, p = 0.22, p = 0.9, p = 0.67, p = 0.79 and p = 0.46 respectively). While those with xerophthalmia had a significantly higher level of anti-annexin V antibodies (60.6 ± 5.7 AU/ml) compared to those without (50.2 ± 13.1 AU/ml) (p = 0.02). The anti-annexin V antibodies significantly correlated with the BDCAF (r = 0.41, p = 0.001) and age (r = 0.43, p < 0.0001) but not with the disease duration (r = 0.22, p = 0.08), steroid dose (r = À0.21, p = 0.09) or laboratory investigations. On regression analysis, only the age would predict the anti-annexin V antibodies level (p = 0.02) while the BDCAF would not (p = 0.33). Aim of the work: Conclusion Aim of the work: There is a role of apoptosis in the pathogenesis of BD with special relation to the ocular, cutaneous and neurological manifestations and a possible link to the disease activity.
Aim: The aim of this study is to evaluate pulmonary manifestations of ankylosing spondylitis on h... more Aim: The aim of this study is to evaluate pulmonary manifestations of ankylosing spondylitis on high-resolution computed tomography (CT) scan and to correlate these findings with clinical assessment, plain chest X-ray and pulmonary function tests. Methods: The study comprised 32 patients (26 males [81.3%], 6 females [18.8%]) who met the modified New York criteria for diagnosis of idiopathic ankylosing spondylitis; in addition 10 normal subjects not complaining of any respiratory symptoms and matched for age and sex served as a control group. All patients were subjected to full history-taking, full clinical examination, chest X-ray, high-resolution computed tomography (HRCT) chest and pulmonary function tests. Results: The abnormalities on HRCT included evidence of apical lung fibrosis in two patients (6.3%), interstitial lung disease in six (18.8%), minor interstitial abnormalities in eight (25%), bronchiectasis in four (12.5%), lung nodules in three (6.3%) and pleural thickening in five patients (6.3%). Nine patients (28.1%) showed negative findings by chest X-ray which revealed positive findings on HRCT. Five patients (15.6%) showed positive findings on both HRCT and plain chest X-ray, and 18 patients (56.3%) showed no findings on both HRCT and chest X-ray. Four patients (12.5%) showed normal pulmonary function tests, 25 (78.13%) showed restrictive pattern, 17 (53.13%) had obstructive pattern and 26 patients (81.3%) had diffusion defects. Conclsuion: The identification of non-apical minor basal interstitial lung disease in our study which was previously reported in other studies, raises a possible association to ankylosing spondylitis. High-resolution CT scan is more sensitive than chest X-rays in detection of such minor interstitial lung disease (ILD), and other parenchymal lung changes.
To present a case of bilateral extensive steroid-associated osteonecrosis (SAON) of femur, tibia ... more To present a case of bilateral extensive steroid-associated osteonecrosis (SAON) of femur, tibia and patella that was successfully managed with combined antiresorptive and anabolic bone agents. Case presentation: A 38-year-old female patient encountered an aggressive coronavirus disease 2019 (COVID-19) infection and was given systemic steroids for six months. The patient then began to experience bilateral lower limb pain. Tenderness over the knee joint margins was found, as well as tenderness of the lower end of the femur, upper tibia, and patella on both sides. The initial plain x-ray of the lower limb bones revealed subtle areas of sclerosis at the proximal metaphysis of tibial bones. The patient did not improve despite stopping steroids and repeated courses of simple analgesics, and the pain became progressive and more intense, to the point where the patient was unable to bear any weight and became wheel chair bound. Magnetic resonance imaging (MRI) was done revealing extensive osteonecrotic lesions involving the distal metaphysis of the femur with posterior extension into the medial and lateral condyles abutting the articular surfaces. Two anti-osteoporotic drugs were used; alendronate, used weekly to inhibit osteoclastic activity and limit the progression of the osteonecrotic lesions and teriparatide, an anabolic agent that increases osteoblasts, resulting in new trabecular and cortical bone growth. Clinical improvement, pain and ambulation, occurred after one month of initiation of treatment and follow up MRI study after 10 months showed marked radiological improvement. Conclusion: Combined antiresorptive and anabolic bone agents remarkably reversed SAON.
To present a case with extra-articular calcication o the lateral collateral ligament (LCL) pres... more To present a case with extra-articular calcication o the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis. Case presentation: A 53-year-old Saudi male patient presented with acute onset o right-sided knee pain, localized swelling and tenderness along the lateral aspect ater sport related activity. He reported a similar attack at the same knee joint a ew years earlier. Plain X-ray and magnetic resonance imaging (MRI) ater the initial attack showed calcication along the LCL. On examination, the patient had mild knee eusion, painul knee extension, and localized swelling along the LCL. A recent MRI and complementary computerized tomography (CT) showed a ragmented calcic shadow along the LCL. The latter was associated with sot tissue hyperintensity, which indicated extensive local infammatory reaction. Ater ruling out internal derangement and inection, it was concluded that the patient had an acute episode o peri-arthritis caused by calcication along the LCL o the aected knee joint. Intramuscular (IM) betemetazone sodium dipropionate/phosphate was used to treat the periarthritis and as such deposits may cause a potent neutrophilic chemotactic response and intense infammation, colchicine was added or its anti-infammatory properties and other known mechanisms that are eective in treating crystal-induced arthritis. On the second day ollowing treatment, a signicant improvement was seen. A case-based review was presented. Conclusion: Despite the rare incidence o symptomatic LCL calcication, ragmentation o the calcic deposits may lead to acute intense infammatory exacerbation and peri-arthritis. Successul and optimum management may involve IM steroid with oral colchicine.
Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur an... more Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P < 0.0001), cartilage degradation (P ¼ 0.001), pseudocysts (P < 0.0001), hip effusion (P ¼ 0.013) and reactive synovitis (P < 0.0001). However, in pincer FAI, BME only correlated with pain severity (P ¼ 0.004) and duration (P ¼ 0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA.
We describe a case of bone marrow edema (BME) shifting within one ankle joint in a 35-yearold-mal... more We describe a case of bone marrow edema (BME) shifting within one ankle joint in a 35-yearold-male patient. He presented with increasing pain and no history of trauma. Clinically no local swelling was found and laboratory findings and plain x-ray studies were normal. He did not improve on non-steroidal anti-inflammatory drugs for 2 weeks. A Gadolinium enhanced magnetic resonance imaging showed no evidence of synovitis, but BME was observed in the talus and transient regional osteoporosis was diagnosed. The patient was treated conservatively by protective partial weight bearing of the affected joint and he showed partial improvement after 6 months of daily treatment with Calcitonin Salmon nasal spray. A magnetic resonance imaging after 6 months showed that the BME had shifted anteriorly with complete resolution at the initial site. Transient regional osteoporosis is a rare self-limiting syndrome characterized by sudden onset of joint pain, functional limitations and spontaneous recovery, without preceding trauma. The condition may present as one episode affecting only one joint or recurrent episode that may affect multiple joints. BME between different compartments of the same joint can occur and has been reported only in a few case reports in the knee joint. The case is discussed and the literature is reviewed.
Background: Liposynovitis prepatellaris (Hoffa's syndrome) is a rare condition in children and ra... more Background: Liposynovitis prepatellaris (Hoffa's syndrome) is a rare condition in children and rarely discussed in the literature. Hoffa's syndrome can lead to an obscure anterior knee pain resulting from impingement and inflammation of the infrapatellar fat pad. Aim of the work: The aim of this case report is to increase awareness among rheumatologists about this condition among children to avoid erroneous diagnosis of juvenile idiopathic arthritis (JIA) and unnecessary treatment with disease-modifying antirheumatic drugs (DMARDs). Case report: In this report we presented a 12 year-old child with this condition who presented with chronic pain and intermittent swelling involving his right knee. The patient was wrongly diagnosed as a case of JIA and wrongly treated with DMARDs for three years duration. The report will shed light on the characteristic MRI features of this condition and the value to order MRI in such atypical presentation. Conclusion: Hoffa's syndrome can present with chronic arthropathy in children that can mimic mono-articular JIA presentation and eventually unnecessary treatment with DMARDs. MRI is generally very helpful from the diagnostic point of view, it clearly depicts Hoffa's infrapatellar fat pad entrapment and its findings may suggest Hoffa's syndrome.
Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to as... more Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%), sciatic nerve injury in 1 (1.4%), leukemia with BME in 1 (1.4%), coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%), and a benign bone cyst in 1 (1.4%). MRI studies showed hip effusion in a total of 51 patients (70.8%), joint space narrowing in 9 (12.5%), and BME in 15(20.8%). MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.
A 23-year-old single female patient developed constitutional manifestations in the form of fever,... more A 23-year-old single female patient developed constitutional manifestations in the form of fever, weight loss, anorexia, malaise, fatigue, and generalized aches in January 1995, 2 weeks after an attack of German measles. This was followed by painful, reddish, macular skin lesions over both legs which healed by dark pigmentation (leucocytoclastic vasculitis), mononeuritis multiplex, and Raynaud's phenomena of both hands and feet. Angiography of lower limbs was done to visualize the arterial tree of both lower limbs and revealed typical beading of distal arterial branches, a diagnosis compatible with polyarteritis nodosa (PAN). At that time, the patient received prednisone (45 mg/day) and azatioprin (100 mg/day) and responded well to treatment. In a second presentation in June 2005, the patient developed sudden attack of loss of vision in her left eye. Ophthalmological examination of the patient revealed evidence of left central retinal artery occlusion, ischemic optic neuropathy. The patient received methyl prednisolone, 1 g IV infusion, daily infusion for three consecutive days followed by oral prednisolone, 30 mg/ day. The patient received pulse cyclophosphamide IV infusion (0.6 g/m 2) on the fourth day. One week after receiving therapy, the patient progressed from having light perception to counting of fingers from a distance of 1 m.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic s... more Background: Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis. Aim of the work: The aim of the current case reports is to describe the clinical and the magnetic resonance imaging features of acute gouty olecranon bursitis as initial presentation of acute gouty attack. Case report: In this report we describe the clinical and MRI features of three cases presenting with acute gouty olecranon bursitis, in spite of normal serum uric acid and stable renal function. For all cases diagnostic aspiration was carried out to exclude septic bursitis as initial first step of management. The bursal fluid was also examined under Polarized microscopy and monosodium urate crystals were identified in the aspirated fluid with typical negative birefringence typical for urate crystals. The literature on MRI features of olecranon bursitis as atypical presentation of gout is reviewed. Conclusion: Olcernaon gouty bursitis can be the initial presentation of acute gouty attack and should be considered in the differential diagnosis in acute presentation after exclusion of sepsis. The importance of bursal fluid analysis in such atypical presentation to look for monosodium urate crystals and excluding bacterial infection is quite important clinical task in such atypical presentation.
Background and aim: Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary... more Background and aim: Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD). The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. Methods: The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. Results: Deep venous thrombosis was observed in 31 (73.8%) patients, arterial thrombosis in 13 (31%), peripheral arterial aneurysms in 12 (28.5%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8 (19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13 (31), true unstable PAAs in 11 (26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7 (16.7%), unstable PAPs in 17 (40.5%), perianeurysmal leaking in 26 (61.9%) and bronchial indentation in 19(45.2%). In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). The severity of hemoptysis affects the likelihood of death over time (p=0.0057), whereas combined immunomodulator therapy reduces the risk of death over time (P= 0.0680). Conclusion: Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictors of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt
Magnetic resonance imaging (MRI) has advanced our understanding of many types of arthritis, with ... more Magnetic resonance imaging (MRI) has advanced our understanding of many types of arthritis, with respect to both inflammatory processes and articular damage. The role of MRI in differentiating between different forms of arthritis is still debatable and under discussion. The current available data suggest that MRI can separate subsets of early synovitis patients on the basis of two principal imaging patterns: one in which the inflammatory changes are located primarily in the synovium; and another in which the periarticular entheses are inflamed in association with intense edema of the adjacent bone. These two patterns are proposed to broadly classify patients with early synovitis into an ''RA'' phenotype where synovitis is the primary process, and a ''spondyloarthropathy'' (SpA) phenotype where enthesitis is the primary process and synovitis occurs on a secondary basis. Enthesitis is a common feature on MRI in SpA, which can help to determine the evolving pattern of patients with undifferentiated arthritis of the knee joint, and may have important clinical implications for classification purposes.
This study aimed to determine the frequency of rheumatoid factor (RF) and cyclic citrullinated pe... more This study aimed to determine the frequency of rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies in a cohort of patients with palindromic rheumatism (PR) and to find determinants for progression to rheumatoid arthritis (RA). All new cases of PR (n=90) were included prospectively and followed up for 1 year, and a comparison group of RA cases (n=70) was also included. At study entry in all patients in both groups, RF and anti-CCP antibodies were tested, and the findings were compared and correlated. In the PR group at presentation, RF was positive in 30 patients (33.3 %) and, in the RA group, in 45 patients (64.3 %). Anti-CCP antibodies were positive in 35 patients (38.9 %) with PR and in 58 patients (82.9 %) with RA. In the PR group, positive correlations were observed between RF and C-reactive protein (CRP) (p=0.036), while anti-CCP positively correlated with disease duration (p=0.015) and CRP (p<0.001). At 1-year follow-up, 25 cases (27.5 %) had progressed to RA, 3 (3.3 %) cases had developed s y s t e m i c l u p u s , 4 3 c a s e s h a d r e s p o n d e d t o hydroxychloroquine with complete remission, five cases had developed other rheumatic diseases, and 14 cases had progressed to undifferentiated arthritis. After regression analysis, the involvement of hand joints and positive anti-CCP were the only predictors that determined progression into RA within a year (p<0.001 and p=0.02, respectively). Early hand joint involvement and positive anti-CCP at disease onset are good predictors for progression to RA in this domain. Keywords Anti-cyclic citrullinated peptide antibodies (anti-CCP). Palindromic rheumatism (PR). Rheumatoid arthritis (RA). Rheumatoid factor (RF). Undifferentiated arthritis (UA)
In this report, we described two male patients with Hughes-Stovin syndrome. The first patient was... more In this report, we described two male patients with Hughes-Stovin syndrome. The first patient was a 26-year-old male who initially presented with deep vein thrombosis (DVT) in the right lower limb followed shortly by hemoptysis. Pulmonary CT angiography revealed bilateral pulmonary artery aneurysms secondary to underlying pulmonary vasculitis. While the second case was a 16-year-old male patient who initially presented with generalized fits due to sagittal sinus thrombosis and later followed by DVT in the left lower limb. Pulmonary CT angiography showed small pulmonary artery aneurysms with thrombosis of peripheral pulmonary artery branches. Both patients were treated successfully with steroids and immunosuppressive therapy and showed clinical improvement.
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https://pubmed.ncbi.nlm.nih.gov/38795561/ by Yasser Emad