MD, PhD, FRCP
Kasr Alainy School of Medicine Cairo University
Cairo | Egypt
Main Specialties: Internal Medicine, Rheumatology
Additional Specialties: Rheumatology and Clinical Immunology
Primary Affiliation: Kasr Alainy School of Medicine Cairo University - Cairo , Egypt
19PubMed Central Citations
Objectives To study the frequency of different autoantibodies to extractable nuclear antigens (ENAs) in rheumatoid arthritis (RA) patients and to correlate findings with clinical manifestations, disease activity and radiological damage. Methods A total of 230 RA patients were included and 75 healthy controls. In all patients rheumatological assessment was done and routine laboratory investigations and immune profile were performed in both patients and controls, including: RF, ACPA, ANA and anti-ENAs (Ro/SSA, La/SSB, U1-RNP, anti-Jo-1 and anti-Sm). Radiological damage was scored using Sharp/van der Heijde, and disease activity was evaluated by DAS28-ESR and DAS28-CRP. Results RF was positive in 101 (43.9%), ACPA in 220 (95.7%), ANA in 58 (25.2%), anti Ro in 31 (13.5%), anti-La in 10 (4.3%), anti-Jo1 in 5 (2.2%) and anti-RNP in 2 (0.9%). Anti-Ro/SSA positively correlated with sicca symptoms (p = .02), RF titer (p < .001), ANA (p < .001), DAS28-ESR (p = .026), and DAS28-CRP (p = .003). Anti-La antibodies correlated positively with SJC (p = .001), TJC (p = .001), ANA (p < .001), DAS-28 ESR (p = .007). Anti-Jo-1 correlated positively with interstitial lung disease (ILD) (p ≤ .001), RF titer (p = .037) and ANA (p ≤ .001). Anti-RNP antibodies correlated positively with disease duration (p ≤ .001), ACPA titer (p ≤ .001) and ANA (p = .014). In the controls ANA was positive in two (2.7%), anti-Ro in three (4%), and none of the controls tested positive for other autoantibodies. Conclusions In RA patients, positive ANA is frequent and positively associated with anti-Ro, anti-La and anti-Jo1 autoantibodies. Screening for autoantibodies against other anti-ENAs seems mandatory in RA patients especially when ANA is positive. RA cases with positive Anti-Jo-1 may develop anti synthetase syndrome and ILD.
BMC Rheumatol 2019 8;3:10. Epub 2019 Mar 8.
6Department of Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Elgesh Street, Tanta, Gharbeia Egypt.
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J Med Ultrason (2001) 2019 Jan 16;46(1):137-146. Epub 2018 Oct 16.
Rheumatology Department, Università Politecnica delle Marche, "Carlo Urbani" Hospital, Iesi, Ancona, Italy.
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New Developments in the Pathogenesis of Rheumatoid Arthritis Edited by Lazaros I. Sakkas, ISBN 978-
New Developments in the Pathogenesis of Rheumatoid Arthritis Edited by Lazaros I. Sakkas, ISBN 978-953-51-2970-7, Print ISBN 978-953-51-2969-1, 162 pages,
Abstract “Mutualism” is a well-defined relationship that describes a form of cooperation between two living organisms of different species that ends up with a beneficial outcome for each one. Any disruption to such a relationship by an external trigger or a potential intruder puts at risk the well-being of both. In humans, oral and gut microbiota provide a noteworthy model of beneficial mutualism. Multiple recent evidences point to the possible pathologic consequences of a disruption to this ecosystem (altered microbiota profile or dysbiosis) on human well-being. The gut-joint axis found its clear way “Proof of Principle” in the pathogenesis of autoimmune rheumatic diseases including rheumatoid arthritis (RA), seronegative spondyloarthropathies, and Behcet’s disease in a number of studies. Current therapeutic trends are directed towards the diverse biologic and immune-pathogenic factors involved in the disease process. Addressing dysbiosis in RA features an attractive future therapeutic target. In this chapter, authors aim to explore the recent evidences regarding the pathogenic role of “gut dysbiosis” in rheumatoid arthritis (RA), highlighting the spectrum of immune-pathogenic events that might contribute to disease evolution and inspecting future directives of research. Keywords: Mutualism, microbiota, dysbiosis, pathogenesis, autoimmune rheumatic diseases, rheumatoid arthritis
Journal of clinical and cellular immunology
Hypo-vitaminosis D and its relevance to the stability of the immune system represent an interesting investigational topic in the field of rheumatology. Objectives: survey hypo-vitaminosis D and its relation to disease activity parameters in a population of patients with autoimmune diseases. Materials and methods: case control study including 70 patients: 30 patients with rheumatoid arthritis (RA), 30 patients with systemic lupus erythematosus (SLE) and 10 patients with ankylosing spondylitis(AS). In vitro quantitative determination of serum 25-hydroxyvitamin D3 using the electro-chemi-luminescence immunoassay "ECLIA" was done. Serum concentrations ≥ 30 ng/ml has been considered sufficient and levels between 11 ng/ml-29 ng/ml has been considered insufficient, whilst patients with levels ≤ 10 ng/ml has been considered deficient. Fifty healthy control subjects were included. Results: Hypo-vitaminosis D was reported in 91.4% of the patients vs. 68% of the control group. The mean values of vitamin D in the population with AID was significantly lower than in controls (16.14 ± 9.32 ng/ml vs 24.61 ± 8.36 ng/ml, t=-5.05, P<0.01**, 95% CI=-12.31-5.31). The majority of patients (57.1%) had insufficiency vs 34.3% with vitamin D deficiency. Vitamin D levels inversely correlated with the ESR (r=-0.23, P=0.04) and with the SLEDAI score in SLE (r=-0.419, P=0.02). Regression analysis identified the presence of an autoimmune disease as a potentially significant risk factor for vitamin D deficiency (P<0.001). Conclusion: The study reported a higher prevalence of hypo-vitaminosis D with autoimmune diseases. Lower levels of vitamin D correlated with higher ESR in all patients and with the SLEDAI score.
Springerplus 2015 1;4:207. Epub 2015 May 1.
Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
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Austin Publishing group
Autoimmune diseases represent a set of disorders of indefinite etiology. In such category of immune disorders, the immune system of a genetically susceptible individual encounters a potentially pathogenic external trigger that initiates the spark for breakdown of tolerance to self antigens provoking a self directed immune attack. The immune-pathogenic constructs in many of the recognized autoimmune diseases appear quite heterogeneous, certain diseases are predominantly B cell driven while others are primarily T cell driven and many undoubtedly represent a combination of both. The knowledge of the exact nature of the initial drive in these diseases is crucial for designing an effective therapeutic strategy. The role of B cells in adaptive immunity encompasses a vast array of immune-stimulatory as well as immune- regulatory responses passing from the secretion of autoantibodies to autoantigen presentation, reciprocal interactions with the T cells, secretion of pro-/anti-inflammatory cytokines and the generation of ectopic germinal centers with chronic inflammation. A hyperactive B cell status with defective regulatory functions can therefore facilitate break down of immune tolerance. A large body of experimental evidence validates the potential effects of B-cell depletion therapies in multiple autoimmune diseases. B cell depletion therapeutic strategy has been successfully employed in a number of autoimmune diseases. Many of these diseases are classified as typically of B-cell in
aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years' study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + -17.9 years, mean disease duration 7.3 + -5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P <0.05. EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P < 0.05 & r = 0.30, P < 0.03 respectively), negatively correlated with the baseline HAQ. Regression analysis identified higher serum hemoglobin concentration, lower baseline HAQ scores, and the absence of radiographic erosions as significant predictors of good as well as sustained responses after adjustment for potential covariates. Methotrexate was associated with favorable responses and remission at 6 months (ORs = 1.13, 1.30 respectively). The study concluded that a lower baseline DAS-28 and HAQ scores, the lack of radiographic erosions favored EULAR good response and were significant predictors of sustained response to TNF-I. KEYWORDS: DAS-28 remission; EULAR good response; Refractory rheumatoid arthritis; Sustained responses; Tumor necrosis factor inhibitors
The goal of the present study was to prospectively assess the long-term clinical outcome of biologic modifying drug therapy in a population of Saudi rheumatoid arthritis (RA) patients. PATIENTS AND METHODS: This is the first prospective, long-term report on the efficacy and safety of biologic therapy in Saudi RA patients. It is a single center, observational study with a follow-up period of 3 years. Enrolled were 120 biologic naïve patients (94 women, 78.3 %; mean age 48.4 ± 17.9 years, mean disease duration 7.3 ± 3.9 years) with the diagnosis of RA (ACR/EULAR, 2010 criteria) who were inadequate responders to methotrexate and synthetic DMARDs. RESULTS: After 3 years, the mean Disease Activity Index-28 (DAS-28), Health Assessment Questionnaire (HAQ), Pain Score, ESR, and CRP values improved significantly. Of the 99 patients completing the 3-year follow-up, 35.3 % of patients achieved DAS-28 remission and 53.5 % achieved low disease activity, and 11.1 % of patients had moderate to high activity scores. At the 3-year follow-up, 80 % of patients had no evidence of significant radiographic progression (achieved < 0.5 of the mean total Sharp score). Infections were reported in 11.7 % and significantly correlated with conjugate use of oral prednisolone at doses above 5 mg/day, with chest infections being the most common type of infection (6.7 %). CONCLUSION: The results of this study can be understood as real-life clinical experience displaying the incremental benefit of biologic therapy in refractory disease when it is added to other optimal strategies. The study showed satisfying clinical and functional benefit with considerable safety.
Z Rheumatol 2014 Sep;73(7):650-6
Rheumatology and Rehabilitation, Kasr Aleini school of Medicine, Cairo University Hospitals, Kasr Aleini Str., Garden City, Cairo, Egypt,
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OBJECTIVE: The goal of the present study was to investigate patient outcome when using the TNF receptor fusion protein etanercept in addition to conventional immunosuppressive drugs in ameliorating disease intensity and reducing relapses in refractory Behçet's disease (BD). PATIENTS AND METHODS: A single center, prospective study was conducted over 1 year. A total of 15 patients with the established diagnosis of BS were enrolled (mean age: 36.5 ± 6.75 years, mean disease duration: 3.86 ± 1.30 years). Clinical features were classified as refractory if the patients failed to achieve the desired response within 6 months of immunosuppressive and oral glucocorticoid therapy or flare of lesions developed while on the maximum tolerable doses of these drugs. The study included 2 patients who were on previous infliximab therapy for refractory disease. Inflammatory biomarkers (ESR and CRP) were investigated. RESULTS: Baseline clinical features in the study prior to inclusion showed recurrent oro-genital ulcers were observed in 100 % of patients, the pathergy test was positive in 17.6 %, ocular involvement was observed in 86.7 %, and acne lesions were recorded in 73.3 %. The following values were also recorded: mean ESR 22 ± 16.97 mm/h, mean CRP level 6.87 ± 4.44 mg/l, mean visual analog score 5.46 ± 1.55, and mean patient global score 5.13 ± 1.30. At the beginning of the study, all patients were on oral prednisolone (mean dose: 20.16 ± 11.81 mg/day), azathioprine (mean dose: 126.66 ± 25.81 mg/day), and oral colchicine (mean dose: 1.08 ± 0.10 mg/day), then etanercept was added at a regular weekly dose of 50 mg subcutaneously for 1 year. By 8 weeks, 100 % of the patients achieve the primary endpoint, which included clinical resolution of refractory mucocutaneous, joint, and active ocular lesions with normalization of the acute phase symptoms. CONCLUSION: Patients with refractory BD who received a 12-month treatment with etanercept in addition to conventional immunosuppressive therapy achieved a good therapeutic response with successful reduction of oral prednisolone to a mean dose of 6.66 ± 2.24 mg/day. No serious infections or drug-related adverse events reported.
NCBISkip to main contentSkip to navigationResourcesHow ToAbout NCBI Accesskeys Sign in to NCBI PubMed US National Library of MedicineNational Institutes of Health Search databasePubMedAll DatabasesAssemblyBioProjectBioSampleBioSystemsBooksClinVarCloneConserved DomainsdbGaPdbVarEpigenomicsESTGeneGenomeGEO DataSetsGEO ProfilesGSSGTRHomoloGeneMedGenMeSHNCBI Web SiteNLM CatalogNucleotideOMIMPMCPopSetProbeProteinProtein ClustersPubChem BioAssayPubChem CompoundPubChem SubstancePubMedPubMed HealthSNPSRAStructureTaxonomyToolKitToolKitAllToolKitBookToolKitBookghUniGene Search term Search AdvancedHelp Result Filters AbstractSend to: Clin Rheumatol. 2012 Jul;31(7):1033-40. doi: 10.1007/s10067-012-1953-0. Epub 2012 Mar 14. Vascular neurobehcet disease: correlation with current disease activity forum and systemic vascular involvement. Mohammed RH1, Nasef A, Kewan HH, Al Shaar M. Author information Abstract Behcet's syndrome (BS) is a chronic relapsing vascular inflammatory disease of unknown etiology with high morbidity and mortality. This research aims to study the clinical patterns of CNS disease in a group of patients with BS as well as the frequency and type of the associated radiographic findings suggestive of structural cerebral vascular disease. The findings were studied in relation to disease activity and features of systemic vascular involvement. Forty patients fulfilling the diagnostic criteria of the International Study Group for Behcet's Disease, mean age of 33.56 ± 9.7 years, were enrolled. Patients were subjected to magnetic resonance imaging with conjugate survey of cerebral blood vessels' flow pattern abnormalities by transcranial Doppler study. Thirty healthy controls were included. Behcet's Disease Current Activity Form Score was used. Neuro-Behcet's syndrome (NBS) was diagnosed in 37.5% with headache being the most common (86.6% of cases), pyramidal affection (signs of upper motor neuron lesions/hemiplegia) was reported in 33.3%, attacks of disturbed conscious level in 26.6%, and cranial nerve affection in 6.5%. Of the patients, 66.6% with clinical features of NBS had statistically significant radiographic evidences of cerebrovascular disease (p = 0.01). Patients with NBS had significantly higher disease activity index score (r = 0.69, p = 0.0001). Radiographic findings and flow abnormalities were significantly less in patients on immune suppressants and antiplatelet drugs (p = 0.003, 0.04). BS patients with clinical neurologic disease were found to have radiographic findings suggestive of cerebral vascular disease with high disease activity index score. Drugs like immunosuppressants and oral antiplatelets might retard cerebral vascular disease progression and flow abnormalities, respectiv
Reem H. A. Mohammed and Hesham I El-Makhzangy (2011). Hepatitis C Related Vasculitides, Advances in
Advances in the Etiology, Pathogenesis and Pathology of Vasculitis Edited by Luis M. Amezcua-Guerra, ISBN 978-953-307-651-5, 448 pages, Publisher: InTech, Chapters published October 21, 2011 under C
Rheumatol Int 2011 May 13;31(5):667-71. Epub 2010 Jan 13.
Department of Rheumatology and Rehabilitation, Kasr Eleini Teaching Hospitals, Cairo University, Cairo, Egypt.
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Clin Rheumatol 2010 Dec 22;29(12):1373-80. Epub 2010 Apr 22.
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt.
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Egyptian Rheumatolpgy and Rehabilitation Journal
The aim of the study was to assess serum levels of interleukin (IL)-18 and IL-10 in systemic lupus erythematosus (SLE) patients and their relationship with disease activity. Patients and methods Thirty patients with SLE and 20 healthy controls were investigated in this study. The serum IL-18 and IL-10 levels were determined using enzyme-linked immunosorbent assay and their correlations with the disease activity were measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and laboratory parameters, including erythrocyte sedimentation rate, anti-ds DNA antibody, complement 3, and complement 4 levels were analyzed. Results The serum IL-18 and serum IL-10 levels were significantly higher (mean values 1770.2 ± 360.4 and 842.65 ± 315.37 pg/ml for IL-18 and IL-10, respectively) in SLE patients compared with the controls (110.65 ± 30.37 vs. 76 ± 14.2 pg/ml, respectively, P < 0.001). The increase in serum levels of IL-18 and IL-10 directly and significantly correlated with each other (r = 0.404, P = 0.037). Furthermore, such an increase in the levels of these two cytokines showed a highly significant positive correlation with the SLEDAI scores and anti-ds DNA in the studied patients (P < 0.001). Conclusion The circulating IL-18 and IL-10 concentrations were significantly elevated in SLE patients and correlated with the SLEDAI score. The study emphasized that there exists an upregulated proinflammatory as well as anti-inflammatory responses in patients with active SLE; however, the anti-inflammatory response is not enough to suppress the active disease. Identifying the exact contribution of the currently studied cytokines might provide future insights for targeted therapeutic strategies in SLE. Keywords: interleukin-10, interleukin-18, systemic lupus erythematosus, Systemic Lupus Erythematosus Disease Activity Index
Mohammed RHA, el- Fetouh SA, Abozaid HS (2013) Diagnostic Value of Antibodies Against a Modified Ci
Journal of clinical and cellular immunology
Abstract Objective: To investigate the sensitivity and specificity of sero-positivity to antibodies against modified citrullinated vimentin antibodies (anti-MCV) in comparison with anti-CCP2- in rheumatoid arthritis (RA) among Egyptians, considering the possible correlation to demographic and disease related features in the study group. Patients and methods: This study included forty patients with Rheumatoid arthritis (RA) and thirty matching healthy controls. Patients’ assessment measures involved the disease activity score (DAS-28), visual analogue scale (VAS) and health assessment questionnaire (HAQ). Thirty healthy subjects matched for age and sex served as a control group. Blood samples were obtained from patients and controls for erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor (RF). Anti-CCP2 and anti-MCV were determined using ELISA technique. Results: Estimated serum levels of anti-CCP2 and anti-MCV were significantly higher in patients compared to controls (p<0.001). Serum levels of anti-MCV didn’t show any significant variations with age, disease duration, duration of morning stiffness, number of swollen and tender joints, HAQ or ESR in patients with RA, yet serum levels of anti-MCV correlated significantly with DAS28, VAS and CRP (p<0.05). Anti-CCP2 correlated significantly with DAS28, VAS and CRP and ANA (p<0.05). Serum levels of anti-MCV and anti-CCP2 showed a consistently significant correlation with each other (r=0.483; p<0.001). Statistical analysis showed that anti-MCV had diagnostic specificity, sensitivity of 93.3%, 75.5%, respectively, while anti-CCP2 specificity, sensitivity of 98.1%, 85%, respectively. Conclusion: Serum anti-MCV as well as the anti-CCP-2 assay perform comparably well in the diagnosis of RA. In the high-specificity range, however, the anti-CCP2 assay appears to be superior to the anti-MCV test.