Measuring disease activity in giant cell arteritis: development and initial validation of a composite disease activity score Yasser El Miedany, Maha Elgaafary, Mathias Toth, Deborah Palmer, Sami Bahlas, Safaa Mahran, Mohamed Hassan Abu Zaid, Waleed Hassan, Rahma A. Elziaty, Samar Abd Alhamed Tabra, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2026 1. To develop a scoring system for the GCA Disease Activity 2. To validate the composite of the GCA Disease Activity Score (GCA-DAS). 3. To assess the GCA-DAS feasibility and effectiveness in the routine clinical setting for monitoring and assessment of treatment outcomes of GCA. The developed GCA-DAS includes acute temporal headache, visual deficit, physician global assessment of disease activity, patient global assessment of well-being, and ESR, rated on 0–10 scale. These variables have been identified as the main GCA outcome measures and criteria for improvement. Validation analyses were conducted on 124 patients and included assessment of construct validity, discriminant validity, and responsiveness to change. The GCA-DAS was found to hold face and content validity, good construct validity, satisfactory internal consistency, appropriate dimensional structure, fair discriminative validity and strong responsiveness to clinically important change over time. The devised GCA-DAS was feasible and easily recorded in standard practice. This has been supported by the parallel significant improvement in the patients’ functional ability (p < 0.001) and patient satisfaction (86.3%). The GCA-DAS was found to be a valid instrument for assessment of GCA disease activity and is potentially applicable in standard clinical care, observational studies, and clinical trials. What is already known on this topic: There is growing interest in the clinical assessment of the prognosis of Giant Cell Arteritis, however, so far, there are no valid instrument, able to facilitate regular quantitative assessment of the disease activity status. What this study adds: This study was carried out to develop and validate a composite disease activity score for Giant Cell Arteritis (GCA), the Giant Cell Arteritis Disease Activity Score (GCA-DAS). Also, to assess the feasibility of the GCA-DAS in the routine clinical setting for monitoring and assessment of treatment outcomes of GCA. How this study might affect research, practice or policy: In validation analyses, the developed GCA-DAS was found to possess good measurement properties, which makes it convenient and valid for both standard clinical practice and research settings, including clinical trials. Limitation: the next step is to do external validation in a multicentre study.
Egyptian guideline on the management of paediatric, adolescent, and adult patients with idiopathic inflammatory myopathy and its major subgroups Yasser El Miedany, Samia Salah, Hala M Lotfy, Waleed A Hassan, Safaa A Mahran, Maha El Gaafary, Hala Salah, Nahla Zakaria, Samar AbdAlhamed Tabra, Walaa Elwakil, Eiman Soliman, Rahma A. Elziaty, Jessica Perfetto, Mohammed Hassan Abu-Zaid Egyptian Rheumatology and Rehabilitation, 2026 The Idiopathic Inflammatory Myopathies (IIM) are a heterogeneous group of autoimmune diseases characterised by muscle inflammation (myositis), interstitial lung disease (ILD), and skin manifestations and many systemic manifestations, with high morbidity and functional disability. This document presents the first national, evidence-informed consensus guidelines for the diagnosis, treatment, and long-term surveillance of Inflammatory Myopathy, in paediatric, adolescent and adult Egyptian patients. Twenty-two key clinical questions were identified by the scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes, and Timing (PICOT) approach. The Literature Review team performed a systematic review to summarize evidence advocating the diagnosis, assessment, and management of IIM. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A two-round Delphi process was conducted with 13 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. An online questionnaire was sent to expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 22 recommendation items stratified as 12 recommendations for diagnosis and assessment, and 10 recommendations for management. Consensus was reached (90% of respondents strongly agreed or agreed) on the wording of all 22 recommendations. This study successfully culminated in the development of the first national, evidence-informed consensus guidelines for the diagnosis, treatment, and long-term surveillance of Idiopathic Inflammatory Myopathy (IIM) in Egyptian patients across all age groups.
Development and evaluation of disease-specific patient-reported outcome measures questionnaire for polymyalgia rheumatica: validity, reliability, and responsiveness Yasser El Miedany, Maha Elgaafary, Sami Bahlas, Waleed Hassan, Safaa Mahran, Ali El Miedany, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background Polymyalgia rheumatica is an inflammatory disease characterized by stiffness and pain around the proximal muscles of both arms and hips and a peak incidence in adults over 50 years of age. The aim of this work was to assess the reliability, validity, and sensitivity to change of a devised self-reported, disease-specific, outcome measures assessment tool for polymyalgia rheumatica. The questionnaire was developed adopting the framework conceptualized in the Food and Drug Administration principles. and the Outcome Measures in Rheumatology (OMERACT) framework for polymyalgia rheumatica. Results The questionnaire was completed by 65 polymyalgia rheumatica patients. Assessment of the reliability of the polymyalgia rheumatica-patient-reported outcome measure questionnaire revealed a high standardized alpha (0.641–861). Content construct assessment revealed a significant correlation (p < 0.01) between the European Quality of life - 5 Dimension (EuroQol - 5D) and Health Assessment Questionnaire in relation to both quality of life and functional disability as assessed in the questionnaire. Variation in both quality of life and functional disability in response to therapy showed significant changes (p < 0.01) in relation to the disease activity status. Conclusions The developed polymyalgia rheumatica-patient -reported outcome measure questionnaire is a valid and reliable tool for the evaluation of polymyalgia rheumatica patients in standard practice. Based on the attained information, a management strategy tailored to the individual patient’s health-related quality-of-life measures, disease activity status, preferences, risk factors, and any accompanying comorbidities is feasible in standard care management.
The spectrum of giant cell arteritis and polymyalgia rheumatica: a longitudinal prospective study to assess for subclinical giant cell arteritis in new onset polymyalgia rheumatica Yasser El Miedany, Maha El Gaafary, Mathias Toth, Sami Bahlas, Waleed Hassan, Safaa Mahran, Mohammed Hassan Abu-Zaid, Ali El Miedany, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) frequently overlap, with each disease potentially presenting as a manifestation of the other. The strong relationship between PMR and GCA raises the question of whether it is a “co-occurrence of different diseases” or a “common spectrum of inflammatory diseases.” The objectives of the current study were to assess the applicability of using ultrasound (US) and clinical data as a monitoring tool to identify PMR patients with subclinical GCA and determine possible predictors of GCA among PMR patients. Results One hundred eight PMR patients and 62 GCA patients were included in this study. The study found that 20.4% of the PMR cohort had subclinical GCA, which later progressed to classical GCA, while 31.5% experienced a PMR relapse. The presence of intimal media thickening of the temporal/axillary artery at baseline was a very early predictor of GCA development; the OGUS score was significantly higher in the PMR group who developed GCA than the standard GCA cohort (p < 0.01). Conclusion The key finding of this study is the incorporation of the concept that vascular inflammation mainly precedes the classical clinical manifestations. Routine screening for subclinical GCA in PMR patients should be considered as part of standard care for PMR patients. Physicians should be attentive to the presence of mural inflammatory changes at the time of diagnosis and monitoring of the ultrasound composite scores in the follow-up course.
Towards a holistic approach of Giant Cell Arteritis management: Predictors of relapse after initial treatment - results of a prospective follow up study Yasser El Miedany, Maha Elgaafary, Mathias Toth, Sami Bahlas, Waleed Hassan, Safaa Mahran, Mohamed Hassan Abu-Zaid, Ghada A. Wassif, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background This study was carried out aiming to: 1. Assess the prognostic role of the clinical as well as ultrasound (US) measures of inflammation for predicting the risk of relapse, and the need for adjunctive biologic therapy. 2. Evaluate the rapidity and sensitivity to change of US measures in the initial months following the diagnosis and initiation of treatment of GCA. 3. Stratify Giant Cell Arteritis (GCA) patients according to their risk of relapse and the possibility of early prediction and classification of the individual subject. This was based on a prospective follow up study which included 67 GCA patients diagnosed according to the EULAR/ACR classification criteria and monitored for 12-months period. Results Ultrasound OMERACT ultrasonography score for giant cell arteritis (OGUS) scores significantly improved between baseline and 4 weeks (P = 0.001) and the improvement was persistent from 2–12 months (P = 0.01) in non-relapsing patients, whereas negative changes in the OGUS scores, as early as 8-12-weeks of therapy, in comparison to the baseline or last assessment visit, were an early predictor of relapse. Negative changes in the patient’s functional ability and worsening of the disease activity score were also predictors of relapse (p< 0.001). Conclusion The extent and severity of GCA disease assessed and monitored by health-related quality of life measure, disease activity status as well as ultrasound measures have a prognostic role. US is a useful tool for monitoring GCA disease activity and in association with other conventional biomarkers and disease activity score, they can predict the disease relapse.
The critical window of very early systemic sclerosis: a framework for a specialized early systemic sclerosis clinic Yasser El Miedany, Maha Elgaafary, Mary Wadie, Safaa Mahran, Rahma A Elziaty, Waleed Hassan, Mohamed Hassan Abu-Zaid, Yousra Hisham Abdel-Fattah, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background This study, led by the Egyptian Society for Microcirculation in Rheumatic Diseases, aimed to address the oversight of very early systemic sclerosis (SSc) as a pre-systemic sclerosis stage, hypothesizing that current clinical practices primarily focus on diagnosing SSc only when it meets established classification criteria. Identification of this patients’ cohort at such an early phase is a window of opportunity to treat those at high risk of skin fibrosis or organ involvement before such events occur. Objective The aim of this work was to establish a standardized, multidisciplinary clinic dedicated to the early assessment, diagnosis, and management of patients with very early systemic sclerosis (veSSc). Methods The methodology adhered to the PRISMA guidelines for reporting systematic reviews. To develop the clinical care standards framework, key clinical questions were systematically formulated using the PICO framework (Population, Intervention, Comparison, Outcome); a comprehensive literature review was conducted from 2010 to 2025 across multiple databases, and a geographically diverse task force of national experts was assembled to participate in a two-round Delphi process to assess consensus levels. Results Twelve key clinical questions were systematically developed using the PICO (Population, Intervention, Comparison, Outcome) framework. Following a review of the literature, and with the endorsement of the Egyptian Society for Microcirculation in Rheumatic Diseases, a Delphi process was carried out. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording, the grade of recommendation, and the level of evidence of all the clinical standards identified by the scientific committee. Conclusion Setting up a very early systemic sclerosis (veSSc) clinic involves establishing a system for early detection and management of SSc, focusing on patients with Raynaud’s phenomenon and other early symptoms. The goal is to identify individuals at risk of progressing to SSc and offer prompt, targeted interventions.
Longitudinal patterns of physical activity, sedentary behavior, and sleep lifestyle in a representative sample of the Egyptian population 50 years and older: a cross-sectional study Yasser El Miedany, Israa Qutob, Nada Elkastawy, Hager Abdelaziz, Israa Hanafy, Aseel Elkhouly, Gena Hany, Abdelrahman Maan, Hossam Ghorab, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background In 2018, the World Health Assembly approved a new Global Action Plan on Physical Activity 2018–2023 and endorsed a global target to reduce global levels of physical inactivity in adults and adolescents by 15% by 2030. Egyptian older adults, similar to those in industrial countries, have also reported a lack of physical activity. Earlier data revealed that less than 10% of the older Egyptian population practice regular exercise; of them, the most inactive population were those over the age of 60 years old. A comprehensive understanding of the patterns of physical activity (PA), as well as sedentary and sleep behaviors, would positively impact health professionals and policymakers in adopting national campaigns that promote a healthy, active lifestyle among Egyptian seniors. Results The current study included 679 participants, who were invited to complete a self-reported sedentary, physical activity, and sleep quality self-assessment questionnaire. Our results revealed that only 37% of the participants do not adopt a sedentary lifestyle. Moreover, 55.67% of the participants rarely practice regular PA, and only 30.63% of the participants were physically active. Results of multivariate regression analysis showed that age, female sex, and high BMI were predictors of low PA score. Conclusion The majority of the Egyptian adults and older adults included in this work failed to meet the WHO and the national Egyptian recommendations for physical activity per day. Older adults should do varied multicomponent physical activity at moderate or greater intensity on 3 or more days a week in order to enhance functional capacity, prevent falls, and ensure high-quality sleep. Non-classic approaches, such as social media, can be used to positively change people’s physical activity and diet-related behaviors.
Vitamin D management update: evidence-based guidelines for vitamin D optimization by the Egyptian Academy for bone and muscle health Yasser El Miedany, Mathias Toth, Maha Mohamed El Gaafary, Safaa A. Mahran, Waleed Hassan, Mohammed Hassan Abu-Zaid, Walaa Elwakil, Walaa Basyoni Selim, Eman Ahmed Sultan, Ghada Saber Ibraheem, Salwa Galal Moussa Egyptian Rheumatology and Rehabilitation, 2025 Background Vitamin D plays a crucial role in bone health, calcium homeostasis, and prevention of chronic diseases. Deficiency and insufficiency of vitamin D poses a global health concern, particularly in specific populations such as the elderly, individuals with limited sun exposure, and those with dietary restrictions. The Egyptian Academy for bone and muscle health is issuing an updated guidelines influenced by a substantial body of research conducted in recent years. For the diagnosis, prevention, and management of vitamin D deficiency. Aim of the work To establish clear, evidence-based guidelines for healthcare professionals and the public on the why, how and when to recommend vitamin D supplementation with objectives to optimize vitamin D levels, prevent deficiency, minimize adverse effects, and inform public health policies. Results A systematic review of 28 studies and five major international guidelines was conducted, with expert consensus recommendations was achieved through a Delphi process among experts. Key findings highlight daily intake guidelines, testing protocols, management of deficiency, and public health interventions. The role of empirical vitamin D dosing in high-risk individuals was emphasized. Key considerations include age, body weight, lifestyle, dietary habits, individual health risks as well as comorbidities. Testing is recommended for symptomatic individuals or those with specific conditions such as osteoporosis or renal impairment. The guideline highlights the role of FGF23 in high dosing of vitamin D, relation between vitamin D deficiency and fall risk, it encourages oral over intramuscular administration and discourages routine population-wide screening. Conclusion Effective management of vitamin D levels involves tailored supplementation strategies based on individual needs and risk factors. Maintenance of serum 25(OH)D levels above 30 ng/mL is advised for optimal health outcomes. Public health efforts should focus on lifestyle modifications, safe sun exposure, and dietary education, alongside targeted supplementation for at-risk groups.
Consensus evidence-based clinical practice guide for the diagnosis and management of osteoporosis in childhood and adolescence Yasser El Miedany, Hala Lotfy, Maha El Gaafary, Naglaa Gadallah, Annie Nasr Mehanna, Safaa Mahran, Waleed Hassan, Mohammed Hassan Abu-Zaid, Samar Abdelhamed Tabra, Mohamed Mortada, Ahmed R. Radwan, Dalia El Mikkawy, S. Esam Maher, Ghada Eldrainy, Hala Abdulhady, Marwa Mahgoub, Youmna Amer, Walaa Elwakil Egyptian Rheumatology and Rehabilitation, 2025 Background The incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included. Results Thirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed. Conclusion For the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.
