Mervat Eissa

AB0270 Serum Sclerostin Level among Egyptian Rheumatoid Arthritis Patients: Relation to Bone Mineral Density, Disease Activity and Radiological Grading

Background Bone loss in rheumatoid arthritis (RA) is caused by increased bone resorption, however, there is no increased bone formation1. The Wnt pathway is important in the control of bone formation through regulation of osteoblast activity2. Sclerostin is an important regulator of the Wnt pathway by blocking Wnt binding to its receptor and thereby inhibiting bone formation3. An increased sclerostin expression in synovial tissues of RA was found compared to osteoarthritis patients4. Objectives This work aimed to study serum sclerostin level in a group of Egyptian rheumatoid arthritis patients and to correlate its level with bone mineral density (BMD), disease activity and radiological grading. Methods Forty RA patients, 26 (65%) were females and 14 (35%) males. Their ages ranged from 21 years to 68 years with a mean of 48.9±11.6 years, their mean value of disease duration was 8±6.4 years and 40 age and sex matched apparently healthy subjects were included. Routine laboratory investigations and testing for serum sclerostin level were done. Plain radiographs of hands & feet and dual-energy x-ray absorptiometry (DXA) test were done for all patients. Results In RA patients, serum level of sclerostin ranged from 0.1 to 1.1 ng/ml with a mean of 0.4±0.2 ng/ml. In the controls, it ranged from 0.2 to 2.3 ng/ml with a mean value of 0.5±0.4 ng/ml. No significant difference was found between RA patients & healthy controls as regard mean value of serum sclerostin level. Postmenopausal RA patients had higher levels of serum sclerostin than premenopausal RA patients (mean value 0.46±0.26 and 0.29±0.18 ng/ml repectively). However, it was statistically significant on comparing healthy postmenopausal to healthy premenopausal with mean values 0.5±0.39 and 0.32±0.14 ng/ml respectively and P value =0.02. Serum sclerostin had significantly positive correlations with age of RA onset (r=0.328, P=0.039), weight of RA patients (r=0.32, p=0.043) and negative correlation with ESR in RA patients (r= -0.34, P=0.03). Forteen (35%) of RA patients had osteoporosis on DXA test. There was no statistically significant correlation between serum sclerostin and BMD, disease activity or radiographic grading. Conclusions Serum sclerostin level in RA patients did not differ significantly from healthy subjects. Serum sclerostin levels have no correlation to disease activity, radiographic joints damage or BMD in RA. For better identification of the role of sclerostin on bone loss in RA, larger sample size is needed. More studies on serum sclerostin levels among different grades of RA activity are encouraged. References Eggelmeijer F, Papapoulos SE, Westedt ML, et al. Bone metabolism in rheumatoid arthritis; relation to disease activity. Br J Rheumatol 1993; 32: 387–391. van Bezooijen RL, Svensson JP, Eefting D, et al. Wnt but not BMP signaling is involved in the inhibitory action of sclerostin on BMP-stimulated bone formation. J Bone Miner Res 2007; 22:19–28. Weidauer SE, Schmieder P, Beerbaum M, et al. NMR structure of the Wnt modulator protein Sclerostin. Biochem Biophys Res Commun 2009; 380:160–165 Kim J. H., Liu X., Wang J., et al. Wnt signaling in bone formation and its therapeutic potential for bone diseases. Ther Adv Musculoskel Dis 2013; 5(1), 13–31. Acknowledgements I would like to express my deepest gratitude and thankfulness; first to Allah for giving me the will and strength to fulfill this work then to my family, Dr. Somaya Anwar, Dr. Sahar Fakhreldin and Dr. Dina Mehaney. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1169

Combined gemfibrozil (peroxisome proliferator-activated receptor alpha agonist) with reduced steroid dose gives a similar management picture as the full steroid dose in a rat adjuvant-induced arthritis model

Abstract Objectives: The study aimed to evaluate the efficacy of combined gemfibrozil with prednisolone in the management of adjuvant-induced arthritis (AIA) rat model. Methods: Seventy two adult male Wistar albino rats were divided equally into 1-control group, three diseased groups: 2- Adjuvant induced arthritis (AIA), 3- high fat diet (HF), and 4- combined AIA-HF, and treated groups: 5- gemfibrozil 30 mg/kg treated AIA group (AIA-G) and the combined AIA-HF treated groups: 6- prednisolone equivalent to human 10 mg (AIA-HF-P10), 7- prednisolone equivalent to human 5 mg (AIA-HF-P5) 8- gemfibrozil (HF-AIA-G) and 9- combined treatment (HF-AIA-G-P5) Results: HF diet represents a precipitating factor for knee arthritis. Gemfibrozil improved the inflammatory findings in both AIA and AIA-HF groups. Combined administration of gemfibrozil with reduced steroid dose gave a similar therapeutic effect to the full steroid dose. Fortunately, we reported more reduction in the nuclear factor kappa-B (NF-κB) and high mobility group box 1 (HMGB1) in the HF-AIA-G-P5 compared with the HF-AIA-P10 group. The improvement was proved by the histological findings. Conclusion: Combined reduced prednisolone dose with gemfibrozil potentiates its anti-inflammatory activity. This could be a target in the management of rheumatoid arthritis.

Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center:

Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can vary among different ethnic and racial groups. Objective The objective of this paper is to study the prevalence of various manifestations of SLE in a sample of the Egyptian population. Patients and methods Information in this study was derived from the medical records of SLE patients who sought medical advice at a private clinic in Cairo from January 1980 to June 2016. Results This study included 1109 SLE patients, of whom 114 (10.3%) were males and 995 were females (89.7%). Mean age of onset was 25.89 ± 10.81 years, while the median of disease duration from the onset of the disease till the last recorded visit was 26 months. The most common cumulative manifestations were arthritis (76.7%), malar rash (48.5%), leukopenia (45.7%), and photosensitivity (45.6%). A total of 33.1% of the patients had nephritis, and neuropsychiatric lupus was present in 6.4% of the patients. Secondary antiphospholipid syndrome was present in 11.5% of the patients. Antinuclear antibody and anti-double-stranded deoxyribonucleic acid were present in 1060/1094 (96.9%) and 842/1062 (79.3%) of the patients, respectively. Antiphospholipid antibodies were present in 266/636 (41.8%) of the patients, anti-Smith in 54/240 (22.5%), anti-SSA/Ro in 61/229 (20.4%), and anti-SSB/La in 32/277 (11.6%) of the patients. Male patients had a statistically higher prevalence of nephritis (p = 0.01), whereas arthritis and alopecia were statistically higher in females (p = 0.012 and p = 0.006, respectively). Patients with juvenile onset had a statistically higher prevalence of nephritis and seizures (p < 0.001 and p = 0.012, respectively). Conclusions Arthritis and malar rash represented the most common clinical manifestations. Male and juvenile-onset patients had a predilection toward a more severe disease. These results are in agreement with many studies conducted in the Middle East and worldwide. On the other hand, major organ involvement was exceptionally low, which is contradictory to several reports from the Middle East and across the globe.

410 Clinical characteristics of systemic lupus erythrematosus in an egyptian population: a descriptive retrospective case series

Background and aims Systemic lupus erythrematosus (SLE) is an autoimmune disease with a myriad of manifestations, that could vary among different ethnic and racial groups. Aim of the study: To study the prevalence of various manifestations of SLE in an Egyptian population. Methods Information in this study was derived from the medical records of SLE patients, who followed up in 2 private clinics in Cairo from January 1980 to June 2016. Results This study included 1109 SLE patients, of which 114 (10.3%) were males and 995 were females (89.7%). Age of onset showed a mean of 26±11.19 years, and the mean of disease duration was 48.78±58.46 months. The most common manifestations were synovitis (76.7%), malar rash (48.5%), leukopenia (45.7%), and photosensitivity (45.6%). At least one of the antiphospholipid antibodies was present in 41.8% of the patients, with thromboembolic manifestations and/or recurrent fetal loss present in 18.3% of the patients. Neuropsychiatric manifestations were evident in 7.8% of the patients, with seizures being the most common neuropsychiatric manifestation, present in 4%. 33.1% of the patients had nephritis, which succeeded the onset of the disease by a mean duration of 20±21.3 months. 29.3% of the patients continued follow up and received induction therapy according to the guidelines at the time of presentation (cyclophosphamide: 11.8%, mycophenolate mofetyl: 7.6%, and azathioprine: 9.8%). Of which, 24.9% continued follow up and achieved partial (9.9%) and complete (15%) remission. Conclusions Synovitis and malar rash were the most common manifestations in our study. Secondary antiphospholipid was present in 18.3% of the patients.

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.

AB0367 Prevalence and Impact of Hepatitis C Virus Infection on Egyptian Rheumatoid Arthritis Patients

Background Hepatitis C virus (HCV) infection is a global health problem, Egypt has the highest prevalence rate reach 20%. HCV infection is associated with extrahepatic manifestations including rheumatic autoimmune manifestations, on the other hand; there is growing interest in the impact of HCV on Egyptian rheumatoid arthritis patients (RA). Objectives The aim of this work was to determine the prevalence of HCV infection in a cohort of patients with RA, and to identify the impact of its presence on the pattern of RA disease, disease activity, functional assessment & radiological damage. Methods 110 RA patients fulfilled the ACR 1987 revised criteria for the classification of RA were included. Disease activity was assessed using the disease activity score 28 (DAS28) and Functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ). The following laboratory tests were done; 1-Rheumatoid Factor (RF) was assayed with immunonephelometry test. 2- anti-citrullinated protein antibody (ACPA) was measured using the microparticle enzyme immunoassay (MEIA) method. 3-ANA was done using indirect immunofluorescence. 4-HCV infection was diagnosed by HCV-antibody using MEIA test and detection of quantitative HCV-RNA using reverse transcriptase polymerase chain reaction. Plain radiographs for both hands, wrists and feet were taken for each patient (in postero-anterior view) and radiological damage was assessed by a Modified Larsens score. Results Ninety seven patients were females (88.2%) and 13 were males (11.8%) with mean age (44.6±12.7) and disease duration (7.92±6.56 years). HCV antibody was detected in 22 out of 110 RA patients (20%). Positive HCV RNA by PCR was present in 14 RA patients (12.7%). HCV-Ab positive patients were significantly older, more frequently male and had a longer disease duration than HCV-Ab negative patients (P<0.05). Regarding pattern of arthritis; all patients included in this study had symmetric polyarthritis but HCV-Ab positive patients had significantly more frequent deformities, higher MHAQ scores (P<0.05) and also significantly higher ESR than HCV-Ab negative ones (p<0.05). Regarding extraarticular manifestations in RA patients; HCV-Ab positive RA patients had significantly more frequent vasculitis (in the form of palpable purpura & mononeuritis multiplex), (P<0.05) and hepatomegaly (P<0.05) and significantly higher frequency of bronchial asthma (P<0.05) than HCV-Ab negative patients. However, there were no differences in DAS28 and modified Larsens score, RF, ACPA and ANA frequencies were detected between both groups (P>0.05). Conclusions A high prevalence of HCV infection is present among Egyptian RA patients which reflects the high prevalence of HCV infection in Egypt, so routine screening for HCV infection in Egyptian RA patients is recommended. Moreover, HCV infection in RA patients is associated with significant disability and comorbidities in form of bronchial asthma, hepatomegaly and vasculitis. Disclosure of Interest None declared