Marwa Hammad

Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behçet’s disease: which and when to use?

Behçet’s disease (BD) is an uncommon autoimmune/autoinflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were investigated in many diseases as a marker of inflammation. In this study, we investigated NLR and PLR in patients with BD as a marker of disease activity and its association with different clinical manifestations. The study included 23 BD patients; their mean age was (32.5 ± 6.76) and M:F ratio was 16:7. Complete blood picture was done for all patients. NLR and PLR were compared in both active and inactive BD patients and its relation with different clinical manifestations was assessed. NLR was higher in active BD patients than in inactive BD patients (P < 0.01). Although both NLR and PLR were correlated with Behçet’s Disease Current Activity Form (BDCAF), the correlation of NLR with BDCAF was much stronger than that of PLR. NLR was associated with some mucocutaneous lesions. Both NLR and PLR were associated with articular and GIT manifestations, but also NLR showed more significant results. In our studied patients, both NLR and PLR were not informative about any ongoing ocular activity (P > 0.05). Both ratios were not affected by the presence of neurologic deficits nor previous vascular events (P > 0.05). NLR was superior to PLR as an indicator of disease activity. NLR was closely related to skin manifestations while PLR was not. In our study, both were not considered reliable in representing ocular activity.

Comparison between different disease activity scores in rheumatoid arthritis: an Egyptian multicenter study

The aim of our work was to assess the performance of different Disease Activity Score (DAS) other than DAS-ESR in daily clinical practice in our Egyptian outpatient clinics and also to evaluate the accuracy of European League Against Rheumatism Classification (EULAR) proposed cutoffs for these scores to stratify Egyptian patients into different categories of disease activity. This study is a cross-sectional Egyptian multicenter study. It included 130 rheumatoid arthritis (RA) patients who visited our Rheumatology and Rehabilitation outpatient and inpatient clinics; 80 patients from Cairo University Hospitals and 50 patients from Zagazig University Hospitals. The patients fulfilled the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism Classification criteria for rheumatoid arthritis. Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were calculated. A significant positive correlation was found between all three scores and morning stiffness, ESR, Modified Health Assessment Questionnaire (MHAQ), and DAS-ESR. Also, there was a significant negative correlation between DAS-CRP and hemoglobin and a significant positive correlation with CRP. Also, there was a highly significant moderate agreement between DAS-ESR and DAS-CRP using Fleischmann et al. thresholds and also between DAS-ESR and SDAI. While a highly significant fair agreement was found between DAS-ESR and DAS-CRP using DAS-ESR thresholds and between DAS-ESR and CDAI. We conclude that DAS-CRP, SDAI, and CDAI are very useful in representing disease activity in RA patients in our outpatient clinics being well correlated with many markers of disease activity. We recommend huge multicenter studies in Egypt and in different populations to define new cutoff values to optimize their use in clinical setting.

Possible risk factors associated with greater damage in systemic lupus erythematosus patients: an Egyptian multicenter study

Objectives Systemic lupus erythematosus (SLE) is a prototypic multisystem autoimmune disorder. The total damage in a patient with SLE may result from SLE itself or from any other pathologic process. The aim of this study was to assess risk factors of greater damage in a sample of Egyptian SLE patients. Methods This Egyptian multicenter retrospective study included 100 SLE patients: 64 patients from Cairo University Hospitals and 36 patients from Zagazig University Hospitals. The Systemic Lupus International Collaborative Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (ACR-DI) was used to document the damage in each patient. Results The total SLICC/ACR-DI score ranged from 0 to 8. A higher DI score was found in hypertensive patients, compared to normotensive patients; and among those with positive anti-phospholipid antibodies, compared to those with negative anti-phospholipid antibodies. This difference was statistically significant (p < 0.01). Also, a higher DI score was found in cyclophosphamide users, compared to non-users; and in those with proteinuria and seizures, compared to those without; and the difference was statistically significant (p < 0.05). There was a significant positive correlation between the DI and patient age (p < 0.05). Conclusions Damage in SLE cannot be prevented completely, as SLE disease is considered an aggressive disease treated by aggressive medications, but rheumatologists should try to minimize damage as much as possible to maintain the patients’ health, functioning and general wellbeing.

AB0967 Ultrasonographic Features of Neuropathic (Charcot) Arthropathy of Ankle Joint

Background neuropathic osteoarthropathy (Charcot arthropathy) is a progressive condition that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. It occurs most commonly in the lower extremity, at the foot and ankle. Although magnetic resonance imaging (MRI) is the modality of choice to examine patients with suspected neuropathic osteoarthropathy, for its ability to depict bone and soft tissues changes, ultrasonography (US) may be able to identify pathological changes in cases of Charcot arthropathy. Up to the best of our knowledge this the first study of ultrasonographic feature of neuropathic ankle joint. Objectives Our aim was to characterize the ultrasonographic features of patients with neuropathic (Charcot) arthropathy of ankle joint. Methods In this retrospective study, all 26 patients between January 2013 and December 2015 with neuropathic (Charcot) arthropathy of ankle joint proved by X ray and/or MRI were enrolled. We collected and analyzed 26 patients, on whom high-resolution (5–15 MHz) muculoskeletal US of ankle and small joints of the affected feet had been carried out. Results Ages of our patients ranged from 38 to 67years (57.3± 6.4). Most of our patients (25 patients) 96.2% had diabetes mellitus and all of our patients had peripheral neuropathy. According to the modified Eichenholtz classification system; 3 patients (11.5%) were in grade 0, 11 patients (42.3%) were in grade 1, 10 patients (38.5%) were in grade 2, and 2 patients (7.7%) were in grade 3. Ultrasonographic findings were: Effusion/synovitis of ankle joints (100%), High Doppler activity (grade 2 or 3) in ankle joint was present in 92.3% of our patients, bone irregularities in distal fibula 73.1%, bone irregularities in distal tibia were found in 34.6%, tendonitis of tibialis posterior 65.4%, proneal tendonitis were found in 50%. Double contour sign were present in 2 ankle joints (7.7%). Arthritis (effusion/synovitis) in mid tarsal joints were found in 92.3% of patients with high Doppler activity in 65.4% and bone irregularities in57.7%. Conclusions The main US features of neuropathic (Charcot) arthropathy of ankle joint are: effusion, synovitis, high grade Doppler activity, bone irregularities of the distal fibula and involvement of mid tarsal joints (synovitis, high Doppler activity and bone irregularities). Disclosure of Interest None declared

SAT0522 Efficacy and Safety of Ultrasonographic Guided Percutaneous Needle Planter Fasciotomy as A Treatment for Chronic Planter Fasciitis: Table 1.

Background Plantar fasciitis (PF) is the most common cause of heel pain. Approximately 10% of the cases develop recalcitrant symptoms and are offered various forms of surgical intervention. Ultrasound guided needle planter fasciotomy is a minimal invasive method that may help this group of patients (1). Objectives To assess the efficacy and safety of ultrasonographic guided percutaneous needle planter fasciotomy as a treatment for chronic planter fasciitis. Methods ultrasound guided planter fasciotomy (1) was carried out in one hundred and seven patients who had chronic planter fasciitis that did not respond to conservative treatment including medical treatment, physiotherapy and local corticosteroid injection. Following induction of local anesthesia, a 14-gauge needle was guided toward and into the plantar fascia by real-time sonography.Visual analogue scale (VAS) for heel pain and ultrasonographic character of planter fascia (thickness and echogenicity) were assessed on the initial (W0), 2 weeks later (W2) and 6 months after treatment (W24). Results A highly significant difference was found between VAS and sonographic findings before and after fasciotomy. Patients improved significantly at 2 weeks compared to baseline and also at 6 months compared to baseline and 2 weeks (table 1). Nighty seven (90.7%) of patients stated that “the procedure had been worthwhile”. There were no complications during or following needle fasciotomy.Table 1. Comparison between VAS and sonographic findings at Baseline, 2 weeks and 6 months post-injection Baseline Two weeks Six months P VAS 80 (60–100) 20 (10–60) 10 (0–80) 0.000** Sonography  Fascia thickness 6.9 (4.8–8.3) 6.1 (5.1–7.9) 5.3 (4.6–7.3) 0.000**  Echogenecity 2.5 (1–3) 2 (1–3) 1 (0–3) 0.000** VAS visual analogue scale. **Highly significant difference p<0.001. Analysis was done by Kruskal Wallis tests. Post-Hoc tests were done also and revealed highly significant difference between baseline & 2 weeks (P=0.000), between baseline & 6 months (P=0.000), and between 2 weeks & 6 months (P=0.000) regarding VAS and sonographic findings. Conclusions Ultrasonographic guided percutaneous needle planter fasciotomy is a safe and an effective method in patients with chronic planter fasciitis who did not respond to conservative treatments including local corticosteroid injections. References Folman et al, Foot and Ankle Surgery 11 (2005) 211–214 Disclosure of Interest None declared

AB0761 Efficacy of per-Cutaneous Ultrasound Guided Drainage of Degenerative Meniscal Cysts in Knee Osteoarthritis Patients

Background Meniscal cysts presented in about 4% of patients with knee osteoarthritis [1]. Meniscal cysts may result in pain and disability in the knee. Ultrasound may be used for therapeutic aspiration of the cyst [2]. Objectives To evaluate the efficacy of ultrasound guided percutaneous drainage of symptomatic meniscal cysts in patients with knee osteoarthritis. Methods Ultrasound guided percutaneous drainage of symptomatic meniscal cysts were performed in 38 patients with Knee osteoarthritis in the period between January 2013 and December 2015. Thirty cysts were related to the medial meniscus and 8 cysts were related to the lateral meniscus. Cysts were injected with local anaesthetic before completion of procedure. All 38 patients were subsequently followed up one month and 6 months after the aspiration with the primary outcome measures were the Western Ontario and McMaster Universities OA Index total pain score WOMAC (a Likert scale), patient global assessment (PGA) questionnaires and musculoskeletal ultrasonography assessment. Results In every case the procedure was well tolerated. Complete aspiration of the cyst were performed in 15 patients (39.5%) and partial aspiration were performed in 23 patients (60.5%). Before aspiration US meniscal cyst measurements 29.5±9.2 mm * 13.6±4.5 mm. At the end of the 1st month, there was a reduction of 50% in the WOMAC pain score. 89.4% (34 patients) felt that their knee pain had improved compared to baseline. At this time point just US meniscal cyst measurements 19.5±5.2 mm * 11.6±4.1 mm. At the end of the 6th month post aspiration, there was a reduction in the WOMAC pain score of 30%. At this time point just 78.9% (30 patients) felt that their knee pain had improved compared to baseline. At this time point just US meniscal cyst measurements 25.5±6.2 mm * 13.6±3.6 mm. Patient outcomes did not significantly correlate with any meniscal cyst characteristic. Complete aspiration was associated with better outcomes. Conclusions Ultrasound-guided percutaneous aspiration of degenerative meniscal cysts is a well-tolerated, simple, and safe procedure for patients with knee osteoarthritis. References Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location, and clinical significance. AJR Am J Roentgenol. 2001;177 (2): 409–13. P. J. MacMahon, D. D. Brennan, D. Duke, S. Forde, and S. J. Eustace, “Ultrasound-guided percutaneous drainage of meniscal cysts: preliminary clinical experience,” Clinical Radiology, vol. 62, no. 7, pp. 683–687, 2007. Disclosure of Interest None declared