Ghina Haidar’s research while affiliated with Damascus University and other places

Introduction: Erythema nodosum (EN) is a self-limited septal panniculitis that presents with fever, arthralgia, and arthritis. Tumor necrosis factor alpha (TNF-α) inhibitor such as golimumab has been found to treat EN in inflammatory bowel diseases (IBD). We herein report the paradoxical occurrence of EN following golimumab for ankylosing spondylitis. Case presentation: A 34-year-old female presented in June 2022 with a complaint of 'sores' on her feet that intermittently presented for approximately 5 months but that had worsened dramatically in the last 24 h. The patient had an 8-year history of ankylosing spondylitis for 7 years. Subcutaneous golimumab was administered every 4 weeks as she had not responded to other treatments. Twenty-four hours after the fifth subcutaneous injection, painful, erythematous nodules appeared, histologically compatible with EN. Despite this side effect, we continue therapy due to the good response and efficacy. Discussion: Skin reactions were associated with the treatment with golimumab, including warm tender skin around the injection site, eruptions, itchiness, and sometimes a full-body rash. Golimumab was successfully used in treating EN in Crohn's disease. Because our patient continued on golimumab, the temporal association of EN flares with therapeutic injection and the lack of any etiology support a direct causal relationship between EN and golimumab treatment. Conclusion: TNF-α inhibitors are useful in treating Crohn's disease patients with EN, although it may present as an adverse effect of this treatment. Further work is needed.

Unlabelled: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects many organs. In this report, we discuss the case of a patient with SLE who presented to an out-hospital clinic, complaining of fever and pain with genital ulcers. Negative evaluations for other causes of genital ulcers, indicated these ulcers as related to SLE. This case highlights the importance of including SLE ulcers in the differential diagnosis of genital ulcers. Learning points: Determining the cause of genital ulceration is a clinical challenge, especially in sexually active individuals.Genital ulcers associated with SLE are often underdiagnosed. Any patient with a history of SLE presenting with genital discomfort and/or pain must be evaluated for genital ulcers without delay.

Background: Behçet's disease is a chronic autoimmune disorder that affects various organs, including oral aphte, genital ulceration, cutaneous manifestation, ocular involvement, and positive pathergy test according to International Study Group for Behçet’s Disease criteria. This study aimed to investigate the oral health condition of patients with Behçet's disease and to assess how it correlates with the patients' gender, clinical symptoms, and severity of the disease. Methods: A total of 92 participants, including 42 patients with Behçet's disease and 50 healthy controls, were enrolled in this cross-sectional study. The periodontal indices were measured and compared between the two groups. Logistic regression analysis was used to identify potential risk factors for disease severity. Results: This study assessed the periodontal health of patients with Behçet's disease and found that they had significantly higher plaque, gingival, bleeding, and probing depth scores compared to healthy controls (P<0.05). Logistic regression analysis revealed that plaque accumulation was a significant risk factor for higher severity scores in Behçet's disease. Gender-specific approaches may be necessary in the management and treatment of periodontal disease in Behçet's disease patients. Conclusions: The findings of this study suggest that patients with Behçet's disease are at increased risk for periodontal disease and its associated symptoms. Specifically, plaque accumulation appears to be a significant risk factor for more severe periodontal health issues in these patients. Therefore, it is important for clinicians to be aware of this increased risk and to develop tailored treatment plans that address both the underlying Behçet's disease and the associated periodontal disease.

Unlabelled: Although central nervous system demyelinating lesions as a side effect of tumor necrosis factor (TNF)-alpha inhibitors have been reported, this treatment is still used in some autoimmune diseases. Case presentation: A 34-year-old Syrian male presented with difficulty walking and tingling, and numbness on the left side of his body over the next 4 days, during golimumab treatment. Over the past 2 months, fatigue, recurrent calf spasms, and extremity numbness were found. Sense disturbance and hyper-reflexes of the lower extremities were found on neurological examination. MRI demonstrated variant demyelinating lesions. Steroid therapy was initiated, and golimumab was discontinued, with good outcomes as the symptoms have disappeared. Discussion: The incidence of demyelination following anti-TNF therapy is uncommon. Most studies have reported that the average time between the anti-TNFα inhibitor treatment and the demyelinating lesion presence is from 5 months to 4 years, and these lesions may appear even after the cessation of the anti-TNFα inhibitor; meanwhile, a total cure of the symptoms after treatment cessation happened in our case, which suggests a causal relation, although a temporal relationship, in this case, cannot be established. The authors believe that golimumab plays a role in the demyelinating lesions development, although it may be a clinical manifestation during the course of Behcet's disease. Conclusion: Caution should be taken for the side effects of Golimumab treatment, such as demyelinating lesions, and long-term monitoring of patients with Bechet disease is required.