Background Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with variable clinical manifestations that can affect various organs and tissues. Estrogen is an important element that performs a vital role in the pathology of SLE. It acts on target cells through binding to estrogen receptors (ERs). This study aimed to assess the effect of ER alpha gene polymorphism on SLE disease activity and clinical manifestations. This study included 30 SLE female patients and 20 healthy subjects as controls. ERα gene (pvull and xbal) polymorphisms were genotyped using the real-time polymerase chain reaction (RT-PCR) and correlated with clinical and laboratory manifestations of SLE as well as the activity and severity scores. Results Regarding ERα (rs1 2234693 Pvull) polymorphism, the TC and CC genotypes were mainly associated with SLE patients, with a high frequency of the mutant C allele. The TT genotype was found mainly in the control group. Concerning rs2 9340799 Xbal polymorphisms, the AG, AA, and GG genotypes frequencies were not significantly different between patient and controls. The TC/AA, CC/GG, and CC/GG genotypes were the most prevalent combinations among SLE patients, while the later combination is completely absent from the control group. There was a significant statistical association with the AA genotype with the neurological disorders and/or hematological affection in SLE patients. The TC genotype was more related to serositis, leucopenia and pyuria, while the AA polymorphism was associated only with leucopenia. Conclusions We conclude that the study offers a clue to the associations of ERα gene polymorphisms in SLE disease, and the combinations relevant to certain clinical manifestations. Estrogen level itself does not affect SLE susceptibility or activity but the mutations in its receptors are the main pathogenic factor.

Background Sleep disturbance is closely related to inflammation and pain. Good sleep quality is essential for patients’ psychological and physical states as well as their quality of life. The aim of this study was to detect how insomnia as a major sleep disturbance could add to the disease burden in rheumatoid arthritis (RA) and osteoarthritis patients (OA) and to determine the predictor parameters in each of them in order to orient the rheumatologist to this unnoticed symptom that could adversely affect the patients’ life. This study included: 20 RA patients, 20 primary knee OA patients together with 20 healthy controls. RA disease activity was assessed by the disease activity score (DAS-28). All participants were assessed for sleep disturbances by the Athens Insomnia Scale, quality of life (QoL) using the short form QoL (SF-36 QoL) scale, depression by the Beck depression inventory (BDI), and functional disability by the Health Assessment Questionnaire Disability Index (HAQ-DI). OA patients were assessed by the Knee OA Flare Up Score (KOFUS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Radiological evaluation for RA patients was done by the Simple Erosion Narrowing Score, while the Kellgren and Lawrence (K-L) radiological grading system was used for OA patients. Results Insomnia was found in 75% of the studied RA patients, 25% of the studied OA patients and none of the healthy control with significant difference (P < 0.001). Significant correlations of the insomnia scale with the number of tender and swollen joints (r = 0.66, 0.76 respectively and p = 0.001 both), DAS-28 (r = 0.71, P < 0.001), anti-CCP antibodies titre (r = 0.53, p = 0.02) and the BDI (r = 0.65, p = 0.002) among RA patients were found. Correlations among OA patients occurred with morning stiffness duration (r = 0.69, P = 0.001), number of affected joints (r = 0.81, P = 0.001), the BDI scale (r = 0.51, P = 0.02), the WOMAC index (r = 0.57, P = 0.009), the KOFUS score (r = 0.76, p < 0.001) and the K-L score (r = 0.67, P = 0.001). Linear regression analysis indicated that the predictors for insomnia in RA were DAS-28 and the BDI, while in OA were the number of affected joints and the KOFUS score. Conclusions Insomnia is a disease burden especially in RA patients being one of the leading causes of depression and is greatly affected by the disease activity. In general the burden of insomnia is much less in OA except in severe cases with markedly affected joints. Rheumatologists should be aware of this disorder that could affect patients’ health, mood, and functional activity.

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Aim: To determine the level of prolactin in the sera of rheumatoid arthritis (RA) patients and to correlate this level with clinically and radiologically evaluated disease activity and severity parameters.Methods: The study included 30 patients with RA and 20 healthy individuals as controls. All the patients were subjected to clinical and musculoskeletal examination with the assessment of disease activity using the DAS 28 score and disease severity using the Health Assessment Questionnaire (HAQ) and the modified Duke Severity of Illness score (DUSOI). Larsen score was used to assess radiological severity. Laboratory investigations included measurement of serum prolactin (sPRL) using the Enzyme Linked Immunosorbent Technique (ELISA) technique, a complete blood count (CBC), kidney function tests, measurement of the rheumatoid Factor (RF), antibodies to cyclic citrullinated peptides (anti-CCP), the erythrocyte sedimentation rate (ESR) and the C-Reactive protein (CRP).Results: RA patients showed a significantly higher median prolactin level when compared to the control group (p<0.001). The median prolactin level was significantly increased in the positive RF and positive anti-CCP antibodies patients compared to negative cases (p= 0.027 and p= 0.011 respectively). The median prolactin level increased significantly in higher X-ray grades (p= 0.040). The prolactin level showed significant positive correlations with the ESR (p=0.048), DAS28 (p < 0.001), the short HAQ (p <0.001) and the X-ray grading (p=0.042). The prolactin level showed an excellent AUC (AUC=0.926). At a cut-off value of 10.7 ng/mL, its sensitivity was 80%, specificity was 85%, the PPV was 78%, NPV was 92.7%, and the accuracy was 86.5% regarding the discrimination between RA cases and healthy subjects.Conclusion: sPRL level is suggested to be a marker for RA disease activity and severity being significantly higher in RA patients compared to healthy subjects, being significantly correlating with the disease activity and severity parameters as well as having a striking 80% sensitivity and 85% specificity for diagnosis of RA.

Background Martin–Gruber anastomosis (MGA) is one of the most common anomalous innervations of the upper limb. It may alter the usual clinical picture and electrophysiological characteristics of median nerve (MN) injury or ulnar nerve (UN) injury. Aim To determine the mutual relation between MGA and carpal tunnel syndrome (CTS) regarding their association and to explore whether certain patterns of MGA are more prevalent in patients with CTS. Methods This study included 100 forearms of 64 subjects. They were 37 subjects complaining of unilateral or bilateral clinical symptoms of idiopathic CTS according to the criteria of the American Academy of Neurology and 27 subjects healthy or having traumatic lesions in either the upper or lower limbs with no neurological disorders. Electrophysiological studies of the MN and UN for the confirmation of CTS as well as the validation of MGA were done. Results By electrophysiological examination, MGA was encountered in 22% forearms of all the studied groups, mostly females. MGA type II and type III were the commoner types, each occurring in 40.9%, while type I and type IV each occurred in 9.1%. MGA type II was prevalent in the control group, while type III associated subjects with only clinical CT symptoms. Conclusion MGA is not prevalent in patients with CTS. Different types of MGA are present in CTS, but MGA was not implicated in the occurrence, severity, or electrodiagnostic features of CTS.