Abstract Background In secondary Sjogren syndrome (sSS), the presence and extent of hearing and vestibular abnormalities are controversial. Hence, to ascertain if individuals with Rheumatoid arthritis (RA) associated secondary Sjogren syndrome (sSS) had subclinical audio-vestibular impairment as well as to investigate whether serum anticardiolipin and muscarinic receptors type 3 antibodies had a role in its pathogenesis, this cross-sectional study was conducted on 50 RA patients with secondary Sjogren syndrome manifestations and 50 RA patients without such manifestations were included, along with 50 apparently healthy volunteers who were aged, and sex-matched as controls. Full history taking, Otologic examination, Immunologic evaluation, and Audio-vestibular assessment were done for all subjects. Results Twenty-five percent of our patients experienced subjective audio-vestibular symptoms. In the audiogram, 30 (60%) of the 50 RA patients with sSS and 5 (10%) of RA patients without sSS had abnormal hearing loss compared to only 4 (8%) of the controls (p ≤ 0.001) with a predominance of high-frequency sensorineural hearing loss. Also, 20% of our patients experienced a higher frequency of head-shaking nystagmus than they did (p ≤ 0.001). 30% had a statistically significant increase in the frequency of abnormal caloric test results as compared to either controls (0%) or RA patients without sSS (0%); p ≤ 0.001 Finally, all audio-vestibular symptoms and tests exhibit a strong positive correlation with muscarinic receptors type 3 and anticardiolipin antibodies. Conclusion The use of muscarinic receptors type 3 and anticardiolipin antibodies are beneficial for early diagnosis of audio-vestibular dysfunction in RA-associated secondary Sjogren syndrome patients. Therefore, this study is important since it justifies rheumatologists’ screening for inner ear damage in their RA patients especially if associated with secondary Sjogren.

PURPOSE To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. METHODS 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. RESULTS After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. CONCLUSION ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients.

Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.

Background Dry eyes and mouth are symptoms of Sjogren syndrome, which can occur on its own and be referred to as primary Sjogren syndrome or in conjunction with other rheumatic diseases like rheumatoid arthritis and be referred to as secondary Sjogren syndrome. Anti-muscarinic type 3 receptors have been linked to neurological issues as well as secretory dysfunction in Sjogren patients. Consequently, the purpose of this study is to determine the serum level of muscarinic acetylcholine receptor subtype 3 (m3AChR)-specific autoantibodies in rheumatoid arthritis (RA) patients and evaluate its relationship to disease activity, functional disability, and to study its role in the development of secondary Sjogren syndrome manifestations in those patients. Methods In this cross-sectional study, 30 RA patients with secondary Sjogren syndrome signs and 30 RA patients without secondary Sjogren syndrome manifestations were included, along with 30 healthy volunteers who were aged, and sex matched as controls. All participants underwent thorough clinical examination, evaluation of disease activity using the DAS28 score, assessment of functional status using the modified health assessment questionnaire (MHAQ), and evaluation of the serum level of (m3AChR) by (ELISA). Results When compared to RA patients without secondary Sjogren syndrome and healthy controls (20.09 ± 4.24, 18.36 ± 3.59 ng/ml respectively), the serum level of m3AChR antibodies among 30 RA patients with secondary Sjogren syndrome considerably increased (mean 25.98 ± 4.81 ng/ml).Analysis of the m3AChR’s (ROC)-curve revealed that the three groups under study differed significantly ( P < 0.001), with the AUC (0.806), cutoff (> 22.63ng/ml), sensitivity (73.33%), and specificity (86.67%) all exceeding the threshold. Additionally, there was a significant positive connection between the serum level of m3AChR and the following variables ( P < 0.05): DAS scores, MHAQ score, number of tender & swollen joints, and acute phase reactants. Conclusion Autoantibodies against m3AChR may be one of the serum components involved in the pathophysiology of secondary Sjogren syndrome in RA patients, and because of their high sensitivity and specificity, they can be utilized as a diagnostic marker in these individuals.

Background: Osteoarthritis (OA) is a chronic protracted inflammatory joint disorder that frequently coexists with other comorbidities.Previous studies analyzed peptidase activity in synovial fluid in knee OA (KOA) patients, but they did not investigate whether type of therapy influences enzyme activity.Moreover, it is yet unknown if the activity of any particular enzyme can be taken into account as a reliable prognostic marker for the severity and progression of KOA.Objective: The aim of the current study is to assess synovial fluid peptidase's potential role as a biomarker for KOA in Egyptian patients as well as to determine whether it can predict the clinical progression of such disease.Patients and methods: A cross-sectional study was estimated on 75 KOA patients (Ahlback grade 3 or higher and indicated for arthrocentesis), who were subjected to sociodemographic and clinical characteristics, as well as Functional and Physical Health Status assessed every month.Puromycin sensitive aminopeptidase (PSA), neutral aminopeptidase (NAP), prolyl endopeptidase (PEP), aminopeptidase B (APB) glutamyl aminopeptidase (GLU), aspartate aminopeptidase (ASP), and pyro glutamyl aminopeptidase (PGAP) are among the peptidases shortlisted for their activity as biomarkers in synovial fluid.Results: A significant association between NAP (P=0.038) and APB (P=0.05)peptidases and pain generation on movement in patients with KOA was noticed.Only ASP peptidase showed significant correlation with range of motion (P=0.049).Another clinical condition of knee failure significantly influenced by the presence of ABP (P=0.013) and PEP (P=0.033)peptidase presence.When diagnosing knee effusion, PEP (P=0.050) and PGAP (P=0.018)differ significantly depending on the clinical symptom.PSA was protective (P=0.003),whereas GLU and PEP were risk factors, according to a binary logistic regression (P values 0.001 and 0.019, respectively).Conclusion: Peptidase activity is considered an important synovial fluid biomarker to determine disease progression in osteoarthritic patients, which could aid in early disease detection and the development of better treatment protocols.

Objective: To evaluate the efficacy of anti-CCP3 as a diagnostic marker in Egyptian early rheumatoid arthritis patients. Subjects and Methods: A total of 60 rheumatoid arthritis patients and 30 aged and sex matched volunteers participated in the study. Basic demographic, functional and clinical data were collected alongside laboratory assessment of Anti-cyclic citrullinated peptide 3 (Anti-CCP3) by ELISA. Results: Anti-CCP3 level was significantly higher in RA patients compared to controls (p 0.001) .At cut off value 20.65 (U/mL) and AUC 0.950, Anti-CCP 3 could significantly distinguish between RA patients and controls (p 0.001) .The sensitivity and specificity were 83.33%, and 93.33% respectively. Also, Anti-CCP 3 levels significantly correlated with the number of swollen and tender joints (P 0.05), VAS (P 0.05), DAS-28 (P 0.05), m HAQ (P 0.001), bone erosions (P 0.001), and narrow joint space (P 0.001). Conclusion: Anti-CCP3 is a potent diagnostic as well as prognostic laboratory marker and its positivity resulted in more specific identification of RA patients. Moreover, anti-CCP3 is considered the most acceptable choice for diagnosing early rheumatoid arthritis especially sero-negative type, with 83.33% sensitivity and 93.33% specificity.

Background: Knee osteoarthritis (KOA) may lead to disabilities and affect work and daily activities. There is no specific blood test for its early diagnosis. Serum adropin is however a promising biomarker. Aim of the work: To determine the levels of serum adropin in primary KOA andassess its relation with the different radiographic grades of the disease. Patients and methods: A total of 40 primary KOA patients (64 affected knees) and 20 healthy control participated in this study. KOA grades was assessed using ultrasonography (US) and X-ray according to KL grading system. Serum adropin levels were measured. Results: KOA was bilateral in 24 (60%) patients and knee effusion was present in 46 knees (71.9%). Serum adropin level in KOA patients (46.3 +/- 27.9 pg/ml) was significantly lower than in controls (76.5 +/- 27.2 pg/ ml) (p < 0.00001). Serum adropin was lower in females than in males in patients (40.2 +/- 17.7 pg/ml vs 75. 2 +/- 47.2 pg/ml; p = 0.0016). Serum adropin has significant negative correlation with the KL radiographic grading (r = -0.54, p = 0.0003).At cut off value of 54 and an AUC = 0.85, serum adropin could significantly distinguish between patients and controls (p < 0.05) at a sensitivity of 80%, specificity 90%. Conclusions: Serum adropin levels were significantly low in KOA patients with specificity of 90% and sensitivity of 80%, with a negative significant correlations with the degree of radiographic severity evaluated by KL grading scale and ultrasound. These findings suggest that low serum adropin levels could be a sensitive and specific test for the detection of KOA. (c) 2022 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective: The main objective of this study was to evaluate the association of IL6-174 G/C gene polymorphisms and the response to tocilizumab (TCZ) in patients with systemic juvenile idiopathic arthritis (s-JIA). Methods: Sixty patients with s-JIA (37 males and 23 females with median age at onset of 5.2 years) who received TCZ were recruited. Basic demographic, laboratory and clinical data were collected alongside the IL-6 haplotype status. The overall response to treatment with TCZ was assessed according to a number of variables including the extent of disease activity reduction, the achievement of clinically inactive disease, the necessity to switch to another biologic disease modifying anti-rheumatic drug (bDMARD) and the achievement of a glucocorticoid-free state. Results: Three IL6 -174 genotypes, including, GG, GC, and CC were found with higher frequencies of GC genotype. These genotypes had non-significant association with the response of s-JIA patients to IL-6 blockade in this cohort study. However, a longer time frame from disease onset to diagnosis was associated with poorer long-term treatment response. Conclusion: We observed no significant impact of IL6 -174 G/C gene polymorphisms on treatment response to TCZ in s-JIA Egyptian patients. The observation that a shorted timeframe between symptom onset and diagnosis is associated with better long-term response to TCZ provides evidence for a therapeutic “window of opportunity” in patients with s-JIA.

Results Serum14-3-3η levels were significantly higher in all RA patients than in controls (P < 0.001), its sensitivity was 86.7% and 88.3% in early and established RA patients with a significant difference with RF and ACCP at early disease, and the specificity was 96.7%. There was a significant reduction of 14-3-3η levels 6 months after treatment in the first group (p=0.004), and there was a significant positive correlation between serum 14-3-3η levels and parameters of disease activity and severity. Conclusion 14-3-3η could be a novel, potent, and efficacious diagnostic, and prognostic marker for RA with high sensitivity, that may become a new therapeutic target for RA.

Aim of the work To identify the role of serum IL-13, and its receptor subunit expressions as a serologic marker of rheumatoid arthritis (RA)-associated ILD (RA-ILD). Patients and Methods Fifty RA patients with ILD and 50 RA patients without ILD were examined, in addition to 50 controls. Disease Activity Score in 28 joints (DAS-28), the Health Assessment Questionnaire (HAQ), and medication history were evaluated. ESR, CRP, RF, Anti-CCP, Serum Krebs von den Lungen-6 (KL-6), surfactant protein D (SP-D) levels, Interleukin 13 and its receptors (IL-13 R alpha 1 and L-13 R alpha 2), and mRNA relative expression levels in peripheral blood mononuclear cells (PBMCs) were measured. High-resolution computed tomography (HRCT) scores were used with all RA patients with interstitial lung disease. Results Mean age, percent of male affection, duration of the disease, DAS28 and MHAQ were significantly higher in the RA-ILD group than in the RA-no ILD group. ESR, CRP, RF, anti-CCP, serum KL-6, SP-D, IL-13 levels, IL-13 R alpha 1and IL-13 R alpha 2 mRNA expressions were significantly increased in RA patients compared to controls; in addition, their levels were significantly higher in the RA-ILD group than in the RA-no ILD group. Serum IL-13 levels and IL-13 R alpha 1and IL-13 R alpha 2 were positively correlated with RF, Anti-CCP, KL-6, SP-D, and the HRCT score (P < .001). Conclusions Serum IL-13 and its receptor subunit expressions are useful biomarkers which can be used in detecting severity of the interstitial lung disease in RA patients.

Background: Alopecia areata (AA) is a non-scaring alopecia which can affect any body hairy area. Excimer light 308 nm is a UVB irradiation with immunosuppressive effects. Low level light therapy (LLLT) emits low energy visible and infrared irradiation to modulate biological processes in cell. This study aimed to evaluate efficacy and safety of excimer light 308 nm versus LLLT in treatment of AA. Methods: Thirty patients with multilocular AA of the scalp were collected after excluding those with alopecia totalis, universalis, AA in other body sites than scalp, those with other systemic or dermatological diseases, those received topical therapy in the last 2 weeks or systemic therapy for AA in the last three months, pregnant and lactating females. Patients were distributed into two equal groups; group A was treated by excimer lamp and group B was treated by LLLT. Sessions were repeated twice weekly for 3 months and patients were followed for 3 months. Treatment efficacy was evaluated by severity of alopecia tool score (SALT score) and Dermoscopy; at baseline, at end of sessions and at follow up. Results: A statistically significant improvement was detected in treated patches of both groups than control patches at end of sessions and only in group A at follow up. There was no statistically significant difference between both groups according to short vellus hair and regrowing hair at end of sessions and at follow up in dermoscopy. Side effects reported were minimal and transient in both groups. Conclusion: Both excimer light and LLLT are safe and effective in treatment of AA. Apart from its relatively higher cost, Excimer light induced better and more sustained improvement than LLLT.

Objective To detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients. Methods A total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints. Results SUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level. Conclusion Elevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.

Aim of the work: To study the frequency of cranial and peripheral neuropathies in systemic lupus erythematosus (SLE), their clinical characteristics, electrophysiological pattern and relation to disease activity. Patients and methods: The study included 30 SLE patients and 20 matched healthy controls. Electrophysiological assessment included routine nerve conduction studies for assessment of peripheral nerves and visual evoked potential, blink reflex, and brain stem auditory evoked potential for assessment of the second, fifth, seventh, and eighth cranial nerves, respectively. Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) was assessed. Results: The mean age of the patients was 35.8 +/- 8.6 years, 27 females and 3 males (9:1) with median disease duration 4.5(1.2-8) years and SELENA-SLEDAI of 12.09 +/- 4.94. The mean complement-3 (C3) level was 81.2 +/- 26.9 mg/dl and C4 was 11.5 +/- 4.4 mg/dl. Peripheral neuropathy was detected electrophysiologically in 66.7% and clinically in 53.3% of the patients and was sensory more than motor. Sensory neuropathy was found in 9(30%), sensorimotor in 11(36.7%), demyelinating in 9(30%), axonal in 6(20%) and both axonal and demyelinating in 5(16.7%) patients. 13.3% had subclinical neuropathy. Sensorimotor and sensory neuropathies were detected in 36.7% and 30% of patients, respectively. Cranial neuropathy was not detected in any patient or control clinically or electrophysiologically. Peripheral neuropathy significantly correlated with SELENA-SLEDAI (r = 0.55, p = 0.002) and negatively with C3 and C4 (r = -0.65, p = 0.012 and r = -0.63, p = 0.015 respectively). Conclusion: Peripheral neuropathy is a well-recognized but underestimated manifestation of neuropsychiatric SLE with predominance of sensorimotor variant. Peripheral neuropathy is associated with disease activity and complement consumption. (C) 2021 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.

Background: Systemic Juvenile Idiopathic Arthritis (sJIA) is a unique category of juvenile arthritis in which interleukin 6 plays a major pathogenic role. This study aimed to describe the therapeutic short-term outcomes among patients with sJIA starting tocilizumab (TCZ) therapy and to identify possible predictors of treatment response. Methods: We conducted a prospective observational study including 65 patients with sJIA meeting ILAR classification criteria with active disease despite conventional therapy that were treated by TCZ between August 2019 and October 2020 as the first-line biological therapy. Clinical and serological parameters were recorded at baseline and after 1 year of TCZ therapy. Results: After 1 year, 25% of the patients achieved minimal disease activity and 35% achieved clinically inactive disease. A significant reduction of the 10-joint juvenile arthritis disease activity score and acute phase reactants was also observed. Patients with younger age (≤7 years), shorter disease duration (≤3 years), lower disease activity, and higher serum ferritin and systemic manifestations showed more favorable results. Conclusion: Patients with sJIA showed favorable disease outcomes with TCZ treatment for 1 year, especially if the drugs were administered earlier in the disease course and in younger patients with a more pronounced inflammatory status. Our results may help to define the profile of patients with sJIA who are more likely to benefit from IL-6 blockade.

Objective: To determine how frequently Egyptian RA patients receiving biological and/or traditional DMARDs experience asymptomatic bacteriuria and urinary tract infections (UTI). Methods: 100 RA patients and 100 age- and sex-matched healthy controls made up this cross-sectional study. For urine analysis and culture, each participant provided mid-stream urine sample. Each participant's blood was drawn for ELISA testing to measure the levels of IgG antibodies against Proteus mirabilis and E. coli, the most frequently isolated pathogen from RA patients’ urine samples. Additionally, RA patients' clinical assessments were carried out. Results: (5%) of healthy controls and (40%) of RA patients had asymptomatic bacteriuria, respectively. E. coli (25%), followed by Proteus mirabilis (42.5%), were the two most frequently isolated organisms. IgG antibody levels against Proteus mirabilis were significantly different between the two study groups (P 0.001). Regarding the levels of IgG antibodies against E. coli, there was no discernible difference between the two study groups (P 0.571). Proteus mirabilis IgG antibody levels were observed to significantly positively correlate with ESR, CRP, DAS28, m HAQ, duration of morning stiffness, and conventional DMARDs in RA patients.

In the field of pulmonary medicine, respiratory mechanics and physiology are obviously affected by most pathological lesions and diseases, either primary disease or part of systemic ones. In the era of rheumatoid arthritis (RA), airway abnormality and interstitial lung pneumonia and/or fibrosis are the most common findings that face physicians during the disease course and affect morbidity, survival, and quality of life of patients with RA. Impulse oscillometry (IOS) is a noninvasive technique that needs minimal patient cooperation, which makes it suitable for any age including even children and can be performed by most patients. To describe the respiratory measures done by IOS in patients with RA and to correlate them with those measured by spirometry. A total of 60 patients with RA were recruited in this cross-sectional observational study. They were investigated via pulmonary function assessments, including spirometry and IOS, to measure forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC, and maximal expiratory flow at 25% (MEF 25%)in addition to R5% of predicted, R20% of predicted, R5–20, X5, and area under the curve. IOS measures indicated increased airway resistance (R5%, R20%, and R5–20) with decreased lung reactance (X5). Moreover, a positive correlation between disease duration and X5, between X5 and area under the curve and each of FEV1%, FVC%, and MEF 25%, whereas a negative correlation between R5–20 and each of FEV1%, FVC%, and MEF 25%. IOS is an easy and rapid maneuver that requires minimal patient cooperation. It can identify lung affection in those who have mild or even normal spirometric changes. It is just a good screening test in patients with RA to detect early pathophysiologic lung changes. However, it needs further investigations to clarify the mechanism of these changes.

OBJECTIVE: This study compared the effectiveness of regenerative injection therapy (RIT), i.e. prolotherapy, and repetitive transcranial magnetic stimulation (rTMS) in the treatment of fibromyalgia syndrome. PATIENTS AND METHODS: This study included 120 female, age-matched fibromyalgia patients. All patients underwent a clinical examination, pain assessment by VAS, assessment of tender points, psychiatric and functional assessment using the Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire Revised (RFIQ), and measurement of cortical auditory evoked potentials CAEPs elicited at 1000 Hz. Patients were divided into two equal groups; Group 1 received prolotherapy three times, two weeks apart, and Group 2 received rTMS sessions every other day for one month. Assessment was performed before treatment, immediately after treatment, and one month later. RESULTS: A significant improvement of pain measured by the mean score of VAS was remarked in Group 1 compared to Group 2 immediately after treatment and one month later. There was statistically significant difference of mean scores for the number of tender points in Group 1 compared to Group 2 after treatment and one month later. The patients improved functionally, with a statistically significant difference in mean score of RFIQ, in Group 1 compared to Group 2 one month after treatment. However, there was a significant difference in mean score of BDI in Group 2 compared to Group 1 after treatment and one month later. Further, CAEPs showed better improvement, with a significant difference in Group 2, one month after treatment. CONCLUSION: RIT had the advantage in clinical and functional improvement in fibromyalgia patients, while rTMS had better results regarding depression and the cortical component of AEPs. These results might draw attention to the evaluability of a combination of both techniques for a better therapeutic response.

Aim of the work: To study the ability of ultrasound to detect subclinical synovitis in children with oligoarticular and polyarticular juvenile idiopathic arthritis (JIA) and to assess the disease activity according to the clinical, laboratory, and musculoskeletal ultrasonographic (MSUS) evaluation. Patients and methods: The study included 40 children with oligoarticular or polyarticular JIA diagnosed according to the ILAR criteria. 800 joints (20 joints for each patient: knees, wrists, 2nd-5th metacarpophalangeal and 2nd-5th proximal interphalangeal joints) were subjected to MSUS scanning for synovial hypertrophy, joint effusion and power Doppler (PD) signals. Disease activity assessment using Juvenile Arthritis Disease Activity Score (JADAS-10), and functional assessment By Childhood Health Assessment Questionnaire (CHAQ) were done for all patients. Results: The mean age of patients was 10.3 +/- 3.9 (3-16) years, 24 females and 16 males and the disease duration was 3.7 +/- 2.8 (0.5-12) years. There was a significant difference between number of clinically (n = 192; 24%) and MSUS (440 by gray scale and 240 by PD) affected joints (p < 0.001). Comparing clinical and ultrasound activity, 70 joints were clinically inactive but showed PDUS signals. There was a significant (p < 0.05) correlation of the MSUS findings with the disease duration, number of clinically activite joints, JADAS10, CHAQ and acute phase reactants. Conclusion: MSUS is superior to clinical examination in early detection of synovitis. It is a reliable method for disease activity assessment in JIA patients, so it can be used in association with standard clinical examination for better classification, diagnosis, treatment strategy and prognosis of JIA subtypes. (C) 2018 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.

Aim To evaluate the efficacy of botulinum toxin A on relieving the clinical symptoms caused by median nerve compression in patients with carpal tunnel syndrome. Patients and methods An imbalanced randomization (3 : 1) placebo-controlled parallel group study for efficacy and safety was conducted in Tanta University, Egypt. Group I received Botox injection. Group II received the same amount of normal saline as Botox injection and at the same injection points as group I. All patients were subjected to clinical assessment and electrophysiological assessment of the median nerve before and after 12 weeks. Results Highly significant improvements were noted in group I regarding clinical symptoms and electrophysiological study of the median nerve, whereas group II showed significant improvement in clinical symptoms but no improvement in the electrophysiological study, with significant difference between the two groups. Conclusion Botox injection can be used safely as a treatment option in moderate carpal tunnel syndrome.