DownLoad Program - The 10 th Annual Meeting

The
10
th
Annual Meeting
3 - 5 March . 2016
Alecandria- Egypt
Honorary President
Prof. Ismail Shabayek
Prof. Khaled Zaky
President
Prof. Bahaa Kornah
Vice President
Prof. Kamal Abdel Rahman
General Secretary
Prof. Hesham Hamoud
w w w . a r o m - e g y p t. c o m
Program Book
The
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W elcome Message
On behalf of the AROM board members It is my pleasure to
welcome and invite you to participate in the 10th AROM
congress that will be held in Alexandria March 3rd - 5th 2016.
Which is a real chance to exchange experience between Egyptian
Rheumatologists, orthopedician and international experts from
France, Italy, Turkey and Bosnia and Pakistan We highly appreciate
your participation to enrich the scientific program and encourage
you to share your academic knowledge and clinical experience
with other colleagues through your scientific work.
Since our beginning in 2007, with support between clinicians,
researchers and the pharmaceutical, technical industries has
significantly contributed to a better understanding and
management of patients with rheumatology and orthopedic
diseasesleading to the progress of the AROM congress.
I would like to take this opportunity to thank all those
chairpersons, speakers, guests, participants and companies that
contribute to the ongoing success of the AROM annual congress.
Finally I wish you a fruitful meeting and enjoyable stay in
Alexandria, the cradle of the mediterranean civilization where
the glory and history of the old Alexandria merges with the
beauty and wonders of the modern state.
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President
Prof. Bahaa Kornah
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Advisory Board (Alphabetical)
Prof. Abdel Azim El Hefny
Prof. Abdel Mohsen Arfaa
Prof. Abdel Rahman Amer
Prof. Abdel Samad El Hewala
Prof. Adel Hamed
Prof. Adel Mahmoud
Prof. Ahmed Badawi
Prof. Amir Youssif
Prof. Atef El Ghaweet
Prof. Basma EL Kadi
Prof. Diaa Mehasseb
Prof. Dalia Fayez
Prof. Eisa Ragheb
Prof. Ezzat Kamel
Prof. Essam Abda
Prof. Faten Ismaeil
Prof. Ismail Ewais
Prof. Ibrahim Khalil
Prof. Medhat Shalaby
Prof. Mervat El Sergany
Prof. Mohamad S. Abdel Baky
Prof. Mohamad Ismail
Prof. Mustafa El-Dahan
Prof. Nagat Mohamad
Prof. Naglaa Gadalla
Prof. Nahed Sherif
Prof. Nahla Gaballah
Prof. Nehal Fathy
Prof. Samia Abdel Hamid
Prof. Sonia Rashad
Prof. Ismail Hamoudah
Prof. Hesham El Desouky
Prof. Kolthoum Abdel Hamid
Prof. Magdy Awadallah
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Organizing
Committee
Prof. Bahaa Kornah
Prof. Hamdy Korayem
Prof. Hesham Hamoud
Prof. Kamal Abdel Rahman
Prof. Sherif Refat
Scientific
Committee
Prof. Abdel Monem Helal
Prof. Ahmed Al Shambaky
Prof. Ezzat Kamel
Prof. Hassan Bassuni
Prof. Faten Ismail
Prof. Mohamad Elwy
Prof. Walaa El Baz
Invited Guest
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Roberto Giacomelli
M. Matucci
M. Cotulo
G. Minisola
Speakers
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Main Topics
1. The Interferonopathies
2. Hot Topics in OA: Nutraceuticals, and Behavioral Interventions
3. Update in Antibody Testing
4. Peripheral Neuropathy in Rheumatic Disease
5. Vasculitis Mimics
6. Predictors of Pre-clinical RA
7. RA -Treatment Advances and Strategies
8. Myositis and Myopathies
9. SpA: Tough Questions Your SpA Patients Might Ask You
10. Exercise After Total Knee Arthroplasty
11. All Things Arthroplasty: Outcomes and Complications
12. Reproductive Issues in Rheumatic Disorders
13. Upper Extremity Arthritis and Ergonomic Interventions
14. Treat the Feet: Improve Foot Health in Rheumatology Patients
15. Osteoporosis Update
16. Osteoimmunology: Cross-talk Between Bone and Immune Cells
17. Pediatric Rheumatology
18. Pearls and Pitfalls in Fibromyalgia and Pain Management
19. Gout Management in 2015: Emerging Therapies for Gout
20. Chronic Nonbacterial Osteomyelitis (CNO): From the
Bedside to Bench
Workshop 1
My Research... From an IDEA to a PUBLISHED Article.
How to submit your work for a peer reviewed international journal
Workshop 2
MSUS by AMSUS
1- Hip,
All About Lower Limb Joints: 3- Ankle,
2- Knee,
4- Foot
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Day 1 Thursday 3 March
Workshop 1 ( 10:00-2:00 )
My Research... From an IDEA to a PUBLISHED Article.
How to submit your work for a peer reviewed international journal
Chairman:
Prof. R. Giacomilli
Prof. Bahaa Kornah
Prof. Hesham Hamoud
Prof. Mohamad Salah
Prof. Omar Atef
Prof. Manar Moneer
10:00-10:30 Get Started … The Research Question
10:30-11:00 Study Design … The Plan
11:00-11:30 Study Population …Sampling
11:30-12:00 Methods … Data Collection, Analysis and interpretation
12:00-12:30 Coffee Break
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12:30-1:00
Write …Title, Introduction, and Abstract
1:00-1:30
Write … Results, Discussion, References
1:30-2:00
Go Publish … e-submission
2:00 - 3:00
Lunch
3:00 - 3:30
Opening
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Day 1 Thursday 3 March
Session 1
3:30 - 5:30
Chairman
Prof. Abdel Monem Helal
Prof. Abdel Rahman Amer
Prof. Eisa Ragheb
Prof. Mohamad Hanafy
3:30-3:50: Cartilage – Bone Crosstalk
Prof. R.Giacomilli
3:50-4:10: Mono-articular Hip Pain.
Prof. Eisa Ragheb
4:10-4:30: Muscle-Bone Crosstalk.
Prof. Hesham Hamoud
4:30-4:50: All Things Arthroplasty: Outcomes and complications
Prof. Bahaa Kornah
4:50-5:00 : Discussion
5:00-5:30: Promotion Presentation
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Day 1 Thursday 3 March
Session 2
5:30 - 7:30
Chairman
Prof. Bahaa Kornah
Prof. Hassan Bassuni
Prof. Khaled Zaky
Prof. Sherif Refaat
5:30-5:45: Myositis and its Specific antibodies
Prof. Khaled Zaky
5:45-6:00: Pearls & Pitfalls in Fibromyalgia
Prof. Mohamad Elwy
6:00-6:15: Vasculitis mimics
Dr. Hanan Hamdy
6:15-6:30: Updates in antibody testing in Rheumatology
Dr. Mohamad Gamal
6:30-6:45: Serum Dickkopf-1 (Dkk1) and Arthritis in SLE Patients
Dr. Samah Nasef
6:45-7:00: Discussion
7:00 -7:30: Symposium
7:30:
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Dinner
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Day 2
Friday 4 March
Workshop 2 9:00-2:00
MSUS by AMSUS
All About Lower Limb Joints:
1- Hip,
2- Knee,
3- Ankle, 4- Foot
Session 3
9:00-9:15
9:00-10:30
Case 1
Prof. Hamdy Korayem
9:15-9:30
Case 2
Prof. Wagida Abouraya
9:30-9:45
Case 3
Prof. Khalida El-refaei
9:45-10:00
Case 4
Dr. Basmah El Naggar
10:00-10:15 Case 5
Dr. Mohamad Akl
10:15- 10:30 Discussion
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Chairman:
Prof. Atef Al Ghawit
Prof. Hamdy Korayem
Prof. Samia Abdel Hamid
Prof. Seef El deen Farag
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Day 2
Friday 4 March
Chairman:
Pro. Amira El-Gerby
Prof. Basma Al Kady
Prof. Manal Tayel
Prof. Nahed Sherif
Session 4
10:30 -12:00
10:30-10:45
Updates in Osteoimmunology
Prof. Manal Tayel
10:45 -11:00 Reproductive issues in rheumatology
Prof. Walaa Elbaz
11:00 -11:15 Rheumatic-like manifestation in pregnancy
Dr. Ahmad Negm
Spondyloarthritis Patient Education: Tough questions
11:15-11:30
your patients might ask you
Dr. Soha Senara
11:30- 11:45 Spinal sagittal imbalance syndrome
Dr. Mohamad Moawwad
11:45 - 12:00 Discussion
12:00 - 1:30
Praying
1:30 – 2:00
Coffee Break
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Day 2
Session 5
Friday 4 March
2:00 - 3:30
Chairman:
Prof. Abdel Azim Al Hefny
Prof. Adel Mahmoud
Prof. Kalthom Abd El Hamid
Prof. Nahla Gaballa
2:00-2:15: Predictors of Pre-clinical RA.
Prof. Medhat Shalaby
2:15-2:30: Rheumatoid Foot
Prof. Samia Abdel Hamid
2:30-2:45: 2015 EULAR update for CVD management in
patients with RA
Prof. Abdel Azeim Elhefny
Hot topics in OA
2:45-3:00: Dr. Hany Aly
3:00-3:15: Spot lights on PCL reconstruction
Prof. Ezzat Kamel
3:15-3:30: Discussion
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Day 2
Session 6
Friday 4 March
3:30 - 5:00
Chairman:
Prof. Ezzat Kamel
Prof. Medhat Shalaby
Prof. Mohamad Elwey
Prof. Walaa Elbaz
3:30-3:45: Environmental Influences and Rheumatic Diseases
Prof. Adela Gad
3:45- 4:00: Neuropathies in Rheumatic Diseases
Prof. Hegazy Mogahed
4:00-4:15: Ultrasound guided injection of carpal tunnel
syndrome: a Comparative study to blind injection
Prof. Gihan Omar
4:15-4:30: Total knee in RA Patients
Dr. Wael Nassar
4:30-4:45: Exercise after total knee Arthroplasty
Dr. Hatem Saad
4:45-5:00: Discussion
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Day 2
Session 7
Friday 4 March
5:00 - 6:30
Chairman:
Prof. Diaa Mehasseb
Prof. Ibrahim Khalil
Prof. Mervat El Sergany
Prof. Faten Ismaeil
5:00-5:15: Upper extremity arthritis & ergonomic intervention
Dr. Ahmad Fahmy
5:15- 5:30: Monogenic Auto inflammatory Syndromes
Dr. Yasser Abd El-Motaleb
5:30-5:45: Recent trends in management of frozen shoulder
Prof. Faisal Hasan
5:45-6:00: Updates in Acromioclavicular joint disorders
Prof. Emad Zayed
6:00-6:15: Joint Hypermobility Syndrome (JHS) Recognition,
Diagnosis & Management
Prof. Amir Yossouf
6:15-6:30: Awards & closing remarks
6:30
15
Dinner
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Abstracts
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Muscle-Bone Crosstalk
Prof. Hesham Hamoud
Sarcopenia and osteoporosis have recently been noted for their relationship
with locomotive syndrome and increased number of older people.
Sarcopenia is defined by decreased muscle mass and impaired muscle
function, which may be associated with frailty.
Several clinical data have indicated that increased muscle mass is related
to increased bone mass and reduced fracture risk.
Genetic, endocrine and mechanical factors as well as inflammatory and
nutritional states concurrently affect muscle tissues and bone metabolism.
Several genes, including myostatin and Đ-actinin 3, have been shown in a
genome-wide association study (GWAS) to be associated with both
sarcopenia and osteoporosis.
Vitamin D, growth hormone and testosterone as well as pathological
disorders, such as an excess in glucocorticoid and diabetes, affect both
muscle and bone.
Basic and clinical research of bone metabolism and muscle biology
suggests that bone interacts with skeletal muscle via signaling from local
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and humoral factors in addition to their musculoskeletal function.
However, the physiological and pathological mechanisms related to muscle
and bone interactions remain unclear.
In this review, I’ll revise briefly several aspects of the interactions between
muscle and bone such as:1. Bone And Muscle Interactions During Development
2. Genetic Factors
3. Muscle And Bone Relationship
4. Mechanical Factors
5. Sarcopenia And Osteoporosis
6. Bone And Body Composition
8. Humoral Or Systemic Factors Linking Muscle To Bone:1) Endocrine factors
2) Sex hormones
3) Vitamin D
4) GH/IGF- I axis
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5) GCs excess and DM
6) Disease linking muscle to bone
9. Relationships Between Muscle And Bone In Clinical Studie
Referencs
1. Zacks SI, Sheff MF. Periosteal and metaplastic bone formation in mouse
minced muscle regeneration. Lab Invest 1982;46:405-12.
2. Montgomery E, Pennington C, Isales CM, Hamrick MW. Muscle-bone
interactions in dystrophin-deficient and myostatin-deficient mice.
Anat Rec 2005;286A:814-22.
3. Harry L, Sandison A, Paleolog E, Hansen U, Pearse M, Nanchanal
J. Comparison of the healing of open tibial fractures covered with either
muscle or fasciocutaneous tissue in a murine model. J Orthop Res
2008;26:12384. Landry P, Marino A, Sadasivan K, Albright J. Effect of soft-tissue trauma
on the early periosteal response of bone to injury. J Trauma 2000;48:479-83.
5. Zacks SI, Sheff MF. Periosteal and metaplastic bone formation in mouse
minced muscle regeneration. Lab Invest 1982;46:405-12.
6. Montgomery E, Pennington C, Isales CM, Hamrick MW. Muscle-bone
interactions in dystrophin-deficient and myostatin-deficient mice.
Anat Rec 2005;286A:814-22.
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All Things Arthroplasty
Outcomes and complications
Prof. Bahaa Kornah
Prof.Orthopedic - Al Azhar University
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Myositis and its Specific antibodies
Prof. Khaled Zaky
Idiopathic inflammatory myositis (IIM), including polymyositis and
dermatomyositis (PM/DM) are systemic inflammatory disorders that involve
the skin, lung and muscle.
A number of autoantibodies can be detected in PM/DM patient sera,
some of which are specific to PM/DM (known as myositis-specific
autoantibodies [MSAs]) or myositis overlap syndrome (known as
myositis-associated autoantibodies [MAAs]).
Moreover, these autoantibodies are closely associated with clinical
manifestations of PM/DM, such as symptoms, complications, reactivity to
therapy and prognosis
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Pearls & Pitfalls in Fibromyalgia
Prof. Mohamad Elwey
Prof.Rheumatology ,Ein Shams University
What Is Fibromyalgia Syndrome?
Is it a musculo-skeletal disorder?
Is it a mental condition or is it all in their heads?
Is it an inflammatory, rheumatologic problem?
Is it an illness of the central nervous system?
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Vasculitis mimics
Prof. Hanan Hamdy
The diagnosis of vasculitis requires careful assessment of all available
clinical, laboratory, radiologic and pathologic information, and
consideration of many competing differential diagnoses. Awareness of
noninflammatory mimics of vasculitis is essential to avoid unnecessary
and potentially harmful treatment with immunosuppressive agents.
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Update in antibody test
Prof. Mohamed Gamal
Lecturer of Rheumatology - Al Azhar University
The detection of circulating non-organ-specific 'autoantibodies' in the
connective tissue disorders has permitted a more rational classification
of these groups of often confusing and overlapping disorders. However,
the detection of certain autoantibodies is undoubtedly useful at a purely
diagnostic level, particularly in the early stages of disease, and as the
quantitation of these antibodies has become increasingly reproducible
their levels have often been shown to have both prognostic significance
and value in monitoring response to therapy. The demonstration that some
of these autoantibodies may induce tissue damage, usually by virtue of
forming immune complexes with subsequent complement activation either
in circulation or synovial fluid, lends further support to their importance.
Other autoantibodies appear to have dual activities, reacting with cell
surface antigens on a variety of organs and also exerting an effect on the
immune regulation system by virtue of their anti-T cell activity.
Yet other autoantibodies, while having clinical diagnostic value, have not
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as yet been shown to have any pathogenic.
Assuming the importance of these antibodies in inducing tissue damage,
then what is the impetus to their synthesis? It cannot be argued that
antibody production is stimulated by exposure of otherwise hidden
antigens and nuclear antigens are repetitively released into the
circulation following tissue injury.
Moreover, low titers of many of these antibodies are present in normal
subjects. Systemic rheumatic diseases such as systemic lupus erythematous,
Sjogren syndrome, systemic sclerosis, mixed connective tissue diseases,
dermatomyositis, and polymyositis affect 3%–5% of the population.
A common feature of these diseases is the presence of autoantibodies,
particularly antinuclear antibodies (ANAs), which are useful markers for
identification and diagnosis. Positive results for both ANAs and the presence
of antibodies against double-stranded DNA (dsDNA) or Sm constitute 2 of the
11 criteria of the American College of Rheumatology for the diagnosis of SLE.
Increased concentrations of autoantibodies are often present many years
before the onset of clinical disease and diagnosis. Because the worldwide
economic outlay for diagnosing and monitoring rheumatic diseases is
increasing, there is a growing demand for new medium- to high through
put analytical procedures for cost-efficient detection of thesediseases.
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Case Presentation
Prof. Wagida abouraya
Case presentation Male patient present by limping due to left hip pain
also patient c/o of other attacks of joint pain in sequential pattern and
left knee effusion on two attacks on the past he also c/o of costosternal
joint pain and swelling.
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Case Presentation
Prof. Khalida El-refaei
A 31 years old female, is complaining of recurrent swelling of left upper
limb associated with hotness and redness alternating with bluish
discoloration.
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Osteoimmunology
Prof. Manal tayel
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Case Presentation
Prof. Walaa F. ELbaz ,MD
Prof. Internal Medicine & Rheumatology Al-Azhar University
A 36 Y. old Male patient, he was manual worker but stopped working
since 6 months because of his illness. exsmoker 3 years ago , he has
no other special habits of medical importance .
The patient is complaining of swelling of both lower limbs of gradual onset,
progressive course 4 month duration.
The condition started since 2006, when the patient developed unilateral
lower limb edema on right lower limb , associated with hotness , redness
and pain of culf muscle, diagnosed as D.V.T. of right lower limb. was
treated by heparin and marivan then maintained on marivan 5 mg.
tab /day……………..
8 month ago the patient developed bilateral lower limb oedema of
gradual onset , progressive course associated with puffiness of both
eye lids
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Reproductive Issues In Rheumatic
Diseases
Prof. Walaa F. ELbaz ,MD
Prof. Internal Medicine & Rheumatology Al-Azhar University
Physiologic adaptation in pregnancy may influence the course of
rheumatic diseases like increased intravascular volume, BP changes
and coagulation changes.
Many immunologic changes occur in uncomplicated pregnancy.
Hormonal changes of pregnancy may affect the coarse of the primary
rheumatic disorder.
Pregnancy can induce abnormalities similar to rheumatic diseases, so
if treatment is directed to 1ry disease, not to complications of pregnancy
it will be harmful for the patients. Pregnancy also may alter the coarse of
rheumatic diseases
Rheumatic Disease may affect the fertility stat, pregnancy outcome or
the fetus.
Management of rheumatic diseases should be tailored carefully
according to patient condition.
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Prof. Ahmed Negm
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Rheumatic-like manifestation
in pregnancy
Normal alterations in pregnancy can mimic some Rheumatic
manifestation. These include clinical symptoms and signs as well
as laboratory findings, frequently used by rheumatologists to
diagnose and follow their patients.
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Dr. Soha H. Senara
Fayoum University
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Spondyloarthritis Patient Education:
Tough questions your patients
might ask you
As an integral part in established recommendations for the management
of early arthritis and ankylosing spondylitis (AS) Patient education (PE) is highly
recommended [1, 2]
PE comprises all educational activities provided for patients, including
aspects of therapeutic education, health education and health promotion
[3]. Patients have been recognised as active agents in managing their
illness and own healthcare [4]
The principle of ‘shared decision making’ allowing patients and their
providers to make healthcare decisions together, based on the best
scientific evidence available, as well as the patient’s values and preferences,
is increasingly accepted [5].
EULAR, 2015 recommendations for patient education for people with
inflammatory arthritis (IA) concluded eight evidence-based and
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expert-opinion-based recommendations for PE for people with IA [6].
I think we need to evaluate them to ensure relevance and effective
application in our societies.
About ankylosing spondylitis and other forms of Spondyloarthritis (SpA); Patients
have questions which often are serious, difficult, questions.
In ACR, 2015 Dr. Robert Inman gave an excellent talk on SpA in an engaging
format of questions and answers with case-based examples and supporting
data. I'll try to summarize some of the pearls from this talk based on questions
all of us have heard from our patients.
The primary and main goal of accurate answer to these questions and
continuous PE is no longer only knowledge transfer and disease control,
but also to enable patients to manage their illness, improve their
psychological state, adjust to their condition and maintain quality of life.
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Reference:
1- Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR
recommendations for the management of ankylosing spondylitis.
Ann Rheum Dis 2006;65:442–52.
2- Combe B, Landewé R, Lukas C, et al. EULAR recommendations for the
management of early arthritis: report of a task force of the European Standing
Committee for International Clinical Studies Including Therapeutics (ESCISIT).
Ann Rheum Dis 2007;66:34–45.
3- Albano MG, Giraudet-Le Quintrec JS, Crozet C, et al. Characteristics and
development of therapeutic patient education in rheumatoid arthritis: analysis
of the 2003–2008 literature. Joint Bone Spine 2010;77:405–10.
4- Hoving C, Visser A, Mullen PD, et al. A history of patient education by health
professionals in Europe and North America: from authority to shared decision
making education. Patient Educ Couns 2010;78:275–81.
5- Chewning B, Bylund CL, Shah B, et al. Patient preferences for shared
decisions: asystematic review. Patient Educ Couns 2012;86:9–18.
6- Heidi A Zangi, Mwidimi Ndosi, Jo Adams, et al. EULAR recommendations for
patient education for people with inflammatory arthritis. Ann Rheum Dis 2015;74:
954–962. doi:10.1136/annrheumdis-2014-206807
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Spinal sagittal imbalance syndrome
Dr. Mahmoud Moawwad
Fixed sagittal imbalance (a syndrome in which the patient is only able
to stand with the weight-bearing line in front of the sacrum) has many
etiologies.
The most commonly reported techniques for correction is discussed
here .
Radiographic analysis included assessment of thoracic kyphosis, lumbar
lordosis, , and the C7 sagittal plumb line
Methods
Twenty-seven consecutive patients in whom sagittal imbalance was
treated by different
method Outcomes analysis was performed with use of a before-and-after
pain scale, items from the Oswestry questionnaire, and the Scoliosis
Research Society (SRS) questionnaire after a minimum duration of follow-up
of two year
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Predictors of Pre-clinical RA
Prof. Medhat A.F.Shalaby
Prof of Rheumatology ,Al-Azhar University
RA is a chronic, inflammatory systemic diseases that produce its most
prominent manifestations in the diarthrodial joints.
It is characterized by persistent progressive synovitis and joint damage
develops in peripheral joints causing severe disability in young people.
Early diagnosis and early treatment of RA is associated with less severe
joint damage and increase chance of achieving DMARDS free sustained
remission. Can we detect RA very early or there is transition period or per
clinical state before the patient develop RA?
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Foot and Ankle in Rheumatic
Diseases Rheumatoid Artrihs
Prof. Samia A. Hamid
During Normal Walking and Running the Regions of the foot are in
krrelated Functionally in Pronation / Supination Cycle the Centre of Mass
passes Over The Weight Bearing our Face of The Foot.
In Pathological State The Pronation Supination Cycle May be Impaired
resulting in Over Pronation or over supinate which increase the Presseere
Under The Foot ___ Joint Pain, Soft Tissue Change And Skin Changes - R.A Related Foot problem.
The Foot is involved in 80 - 90% in early shage 60% and later on 40%.
The R.A – Patients suffer from Walking Impairment due to Synovitis and
Mechanical stress several
1 - Postural Control
2- Functional Capacity
3- Motions and forces in specific joints
4- Forces and Presseere underneath the foot
The Aim of conservation line of Treatment:
1- Relief planter Presseere
2- Relief pain
3- Functional improvement
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Gout management in 2015
Dr. AbdelAzeim Elhefny MD
Prof. of Internal Medicine, Rheumatology & Immunology,
Ain Shams University
Gout is a metabolic disorder of purine metabolism, & the most common
form of inflammatory arthritis in adults; characterized by acute
intermittent episodes of sever arthritis It may progress to a chronic
intermittent & further to chronic tophaceous gout. The prevalence of
gout is increasing among adults in US; ranging from 2.0 % in women to
6% in men. This rise has paralleled the increase in prevalence of
conditions associated with hyperuricemia, eg. obesity, HTN,
hypertriglyceridemia, hypercholesterolemia, type 2 DM and met. S, CKD,
& RI. & thiazide diuretics.
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2015 EULAR update for CVD
management in patients with RA
Dr. AbdelAzeim Elhefny MD
Prof. of Internal Medicine, Rheumatology & Immunology,
Ain Shams University
RA, a common chronic multi-organ inflammatory disease (≈ 1% of
the population), is associated with increased morbidity & mortality.
This increase in mortality is predominantly due to accelerated coronary
artery atherosclerosis, as well as CHF. RA has been shown to be an
independent risk factor for multi-vessel CHD nearly similar to T2DM.
RA patients had a 3-fold increase in carotid atherosclerosis.
The enhanced vascular risk is not only restricted to individuals with
established RA, but also patients with early seropositive rheumatoid have
increased mortality. Patients with RA are more likely to have clinically silent
CAD and are less likely to report chest pain during an acute coronary event.
 A history of anginal equivalent symptoms, such as dyspnea on exertion,
should be sought from these patients. In addition, patients who have chest
wall pain on clinical examination may have coexistent underlying cardiac
ischemia; therefore, the threshold for excluding CAD should be low.
Comprehensive cardiac MRI is a useful & less-invasive diagnostic tool for
assessing cardiac involvements in those patients. In this talk we will focus
on the updated practical recommendations of the 2015 EULAR for CVD
management...
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Hot topics in OA
Dr. Hany Aly
Osteoarthritis (OA) treatment is limited by the inability of prescribed
medications to alter disease outcome. As a result, patients with OA
often take food substances called nutraceuticals in an attempt to affect
the structural changes that occur within a degenerating joint.
The role of nutraceuticals in OA management can be defined only by
an evidence-based approach to support their use.
Medications containing narcotic analgesics such as codeine or
hydrocodone are often effective against osteoarthritis pain.
But because of concerns about the potential for physical and
psychological dependence on these drugs, doctors generally reserve
them for short-term use.
The adoption and maintenance of health behaviors are crucial parts of
symptom reduction strategies and therefore, are promoted in arthritis
self-management interventions. Regular exercise, relaxation activities,
and breathing techniques are among the behaviors demonstrated to
be effective. Studies show that practice of these behaviors increases the
psychological. and physical well-being of arthritic people.
42
The
Abstracts
10
th
Annual Meeting
Spot lights on PCL reconstruction
Prof. Ezzat Kamel
Professor of orthopedic surgery Ainshams university
Pcl injuries are inceasingly recognised now adays partly because
of increased awarness among doctors and athletes, and partly
because of increased practice.
Recent practice among orthopedic sports doctors needs
continously increasing learnning curve.
43
The
Abstracts
10
th
Annual Meeting
Environmental Influences and
Rheumatic Diseases
Dr. Adela Gad
Most rheumatic diseases are complex disorders for which pathogenetic
mechanisms are poorly understood. Nonetheless, increasing evidence
suggests that many of these illnesses result from one or more specific
environmental exposures in genetically susceptible individua
ls. In Rheumatoid Arthritis, the environmental risk factors have been
considered important in the development of RA, including early life
environmental factors especially high birth weight, breast feeding, and
smoking, infection, vitamin D deficiency; diet factors especially Protein and
red meat and drugs especially Oral contraceptives. In systemic lupus
erythematosus (SLE), environmental risk factors such as UV light and drugs,
including estrogen, may trigger the disease; silica exposure may also be
important. Scleroderma is associated occupational risk factors such as silica
exposure and organic solvents such as vinyl chloride and drugs such as
bleomycin may induce scleroderma-like diseases. The systemic vasculitides
and in particular cutaneous vasculitis may be induced by drugs and
possibly chemical factors. In ANCA-associated vasculitides (AAV),
environmental factors have been considered important in the development
of ANCA, including silica, infection especially with Staphylococcus aureus,
and drugs. The toxic oil syndrome and eosinophila-myalgia syndrome are
best known examples of connective tissuediseases induced by chemical
exposure.
44
The
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10
th
Annual Meeting
Neuropathies in Rheumatic Diseases
Prof. Hegazy Mogahed Altamimy
Ass.Prof.of rheumatology and Rehabilitation
Alazhar Faculty of Medicine
Patients with multi-system rheumatic conditions may have disease affecting
the central and peripheral nervous systems. Early assessment is often helpful
in averting the development of serious complications, which in some
conditions can be prevented by the prompt institution of treatment.
We review the spectrum of neurological disease in patients with a
rheumatological diagnosis. The wide variety of associated neurological
complications is discussed in the context of specific rheumatic conditions,
varying from spinal cord involvement in rheumatoid arthritis, to
neuropsychiatric involvement in systemic lupus erythematosus and
neurological sequelae in vasculitic disorders. We discuss diagnostic criteria
and recommended management options (where available), and describe
the role of Electrophysiology(Nerve Conduction studies And Needle EMG) in
the diagnosis of disease. We also discuss the potential for development of
neurological complications from the use of anti-rheumatic drugs .
45
The
Abstracts
Prof. Gihan Omar
10
th
Annual Meeting
Ultrasound guided injection of carpal
tunnel syndrome: a Comparative study
to blind injection.
Minia University
Background: Carpal tunnel syndrome (CTS) is the most common upper limb
neuropathy with increasing incidence especially among females, having a
high economic and social impact on patients. CTS can be treated either with
conservative measures or surgically. Steroid injection, as a conservative
treatment, could be carried out using anatomical landmarks, or via
ultra-sonographic guidance.
Aim of this study was to compare the clinical outcomes of the ultrasound
guided injection Vs blinded one for management of carpal tunnel syndrome.
30 patients with carpal tunnel syndrome, recruited from Rheumatology and
Rehabilitation outpatient clinic, Minia University Hospital, were included in this
study. Diagnosis based on clinical, electro-physiological and ultrasound
imaging. According to the electrophysiological studies, there were 28 patients
with moderate CTS and 2 patients with mild CTS .15 patients were injected
with ultrasound guidance technique and other 15 patients were injected
blindly with o.5 ml of lidocaine 1% and 80 mg of triamcinolone.
Results: Evaluation at baseline and at 4 weeks after injection including Boston
carpal tunnel questionnaire (CTS symptom severity scale and functional
assessment score), nerve conduction study, ultrasound parameters
(cross-sectional area, flattening ratio) were determined and compared
among methods of injection. Patients with ultrasound guided injection had
significant improvement of clinical, neurophysiological, ultrasound parameters
outcomes than blind injected patients.
46
The
Abstracts
10
th
Annual Meeting
Total knee in rheumatoid stiff knee
Prof. Wael Nassar
Assisstan professor of orthopedic surgery, Ainshams university
Knee affection by rheumatoid arthritis is a very common issue
now adays.
Many difficulties face orthopedic surgeons upon dealing with
such cases.
Certain tips and tricks should be known in considered in such
difficult cases.
47
The
Abstracts
10
th
Annual Meeting
Exercise after total knee Arthroplasty
Dr. Hatem Saad
Lecturer of Rheumatology, physical medicine &Rehabilitation
AL-AZHAR UNIVERSITY
The goal of `any rehabilitation protocol should be to control pain,
improve ambulation ,maximize range of motion ,develop muscle strength ,
and provide emotional support.
Over 85%of total knee arthroplasty (TKA)patients will recover knee function
regardless of which rehabilitation is adopted .However, the remaining 15%
of patients will have difficulty to obtain proper knee function secondary to
significant pain ,limited preoperative motion ,or the development of
arthrofibrosis . this subset will require a special , individualized rehabilitation
program that may involve prolonged analgesia , continued physical
therapy additional diagnostic studies, and occasionally manipulation.
controlling pain is main stay of any treatment plan. Finally, physiotherapy
rehabilitation may be administered at several points after surgery, including
Phase I – Immediate Post Surgical Phase (Day 0-3)
Phase II – Motion Phase (Day 3 – Week 6)
Phase III – Intermediate phase (week 7-12)
Phase IV – Advanced strengthening and higher level function stage
(week 12-16)
48
The
Abstracts
10
th
Annual Meeting
Upper extremity arthritis & ergonomic
intervention
Prof. Ahmad Fahmy
Ergonomics (or human factors) is the scientific discipline concerned
with the understanding of interactions among humans and other
elements of a system, and the profession that applies theory, principles,
data and methods to design in order to optimize human well-being and
overall system performance.
Human factors and ergonomics (HF&E), also known as comfort design,
functional design, and systems,[1] is the practice of designing products,
systems, or processes to take proper account of the interaction between
them and the people who use them.
49
The
Abstracts
10
th
Annual Meeting
Recent Trends in Management of Frozen
Shoulder
Faisal Zayed
Ass.Prof. Orthopedics Surgery - Al Azhar University
Frozen shoulder is defined as:
"An idiopathic global limitation of humeroscapular motion resulting from
contracture and loss of compliance of the glenohumeral joint capsule".
Disease stages:
1- Freezing stage (10-36 Ws),
2- Frozen stage (4-24 M) and
3- Thawing stage (12 M to 4 years)
Although primary adhesive capsulitis of the shoulder is generally thought to
be self-limiting, many studies reported on less than normal return to motion at
long-term follow up.
Treatment:
Initial treatment is non-operative with good result in most of the patients.
Operative treatment should be considered only after failure of all conservative
measures.
Arthroscopic capsular release has gained popularity over the years and offers
a predictably good treatment in patients with frozen shoulder.
50
The
Abstracts
10
th
Annual Meeting
Joint Hypermobility Syndrome (JHS)
Recognition, Diagnosis & Management
Prof. Amir. A. Youssef MD, ph D (LONDON).
PROFESSOR OF RHEUMATOLOGY
MANSOURA UNIVERSITY,EGYPT
It was estimated that up to 10% of the general population may have
some degree of hypermobility, with women affected about three times more
often than men.
In the UK approx. 15 -30 per cent of children have the condition, which can
affect just one or two joints or every joint in their body.
Most hypermobile people do not develop any problems from their loose
joints, but some suffer chronic pain and other symptoms.
Muskuloskletal signs of JHS include: Acute or traumatic Sprains e.g recurrent
ankle sprain & Meniscus tears. Acute or recurrent dislocation or subluxation of
the Shoulder, Patella, Metacarpophalangeal joint, Temporomandibular joint,
Traumatic arthritis, Bruising
Fractures Chronic or non traumatic Soft tissue rheumatism such as :Tendonitis ,
Epicondylitis , Rotator cuff syndrome , Synovitis , Juvenile episodic synovitis
and Bursitis , in addition to : Chondromalacia , Back pain , Scoliosis ,
Fibromyalgia and Temporomandibular joint dysfunction. Nerve compression
disorders may also occur include: Carpal tunnel syndrome, Tarsal tunnel
syndrome, Acroparethseia, Thoracic outlet syndrome, Reynaud's
51
The
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10
th
Annual Meeting
phenomenon in addition to: Flat feet, unspecified arthralgia or effusion of
affected joint (s), Osteoarthritis and Congenital hip dislocation
People with hypermobility syndrome may have a whole group of other
conditions, in addition to joint problems, because of excessive stretchiness
of other body tissues.
For example, mitral valve prolapse and uterine prolapse, hernias, and gastro
esophageal reflux disease (GERD) are more common in people with
hypermobility syndrome.
Beighton score are generally used to assess the degree of hypermobility
and Brighton criteria are used for the diagnosis of JHS.
Management of JHS include: Physiotherapy with Low or non-resistance
exercise, Start low, go slow and avoid (minimize) Hyperextension, Impaction
(compression) and Resistance. Muscle Spasm is treated with Heat, massage,
TENS, acupuncture in addition to skeletal muscle relaxants, also Analgesics
& Anti-inflammatory drugs are used for pain relief and Opioids are the last
resort.
External bracing for Joint Instability can be used.
Psychological Treatment include: Cognitive Behavioral Therapy, Conscious
relaxation, Hypnosis and Meditation.
52
The
Abstracts
10
th
Annual Meeting
The Study of the Effect of Hyperosmolar
Dextrose Solution Local Intra-Articular
Injections for Frozen Shoulder Treatment
A Randomized Clinical Trial
Aziza Sayed Om, Arwa Mohamed Salah El-Din Mostafa Beltagi ,
Ahmed El-Sayed Ramadan
Physical Medicine, Rheumatology And Rehabilitation Department , Faculty
Of Medicine , Suez Canal University , Ismailia , Egypt
Abstract: Aim Of Work: This Randomized Trial Was Designed To Assess the
Effect of Prolotherapy in Relieving Shoulder Pain and Improving Its Function
Frozen Shoulder Patients
Patients And Methods: The Study Population Included 30 Patients. The Study
Was Carried Out On Patients With
frozen shoulder meeting the following inclusion and exclusion criteria. All
Patients Received Dextrose Solution
Injection intraarticularly in the affected shoulder joint three times after a
baseline, preinjection and final assess.
Ment by using the visual analogue scale (VAS) and the Constant-Murley
Shoulder Outcome (CMSO)
Score for assessing the outcomes of the treatment of shoulder disorders.
53
The
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10
th
Annual Meeting
Results:
There was statistically significant difference in shoulder pain and
function before and after shoulder intraarticular injections by Constant shoulder
Murley outcome score showing better results after the injections.
Conclusion: local Dextrose solution intraarticular shoulder injection proved to be
an effective from of treatment for patients with frozen shoulder.
Not only does it provide patients with pain relief, but it also made a significant
improvement in the shoulder function. In addition, local injection of dextrose
solution proved to be a safe option regarding patients that have
contraindications to other types of injections and patients considering surgery
as a Choice of management for their condition.
54
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