American Rheumatism Association Criteria Research Articles

Efficacy and Safety of Muscle Rub Ointment in The Management of Arthritis and Certain Musculoskeletal Disorders

Traditional Indian medicine has long used Muscle Rub Ointment to treat rheumatoid arthritis (RA), but its safety and effectiveness have not been well studied. To bridge this gap, an extensive investigation was carried out to evaluate the efficacy and safety of a specially designed Muscle Rub Ointment for individuals with RA. Over a 7-year period, 290 RA patients received customized care from Ayurvedic doctors in accordance with established practices. The American Rheumatism Association criteria were used for monitoring every six weeks, and treatment regimens varied from one to six months. Based on statistical analysis (repeated measures t-test), 33 discharged patients' first-year data were the subject of the study. There were notable improvements even among the most severely disabled patients in a number of indicators, such as functional class, rheumatoid factor, grip strength, walking time, swollen joints, painful joints, joint count, and erythrocyte sedimentation rate. Despite the fact that some patients did not get regular follow-up, the data that was available indicated persistent gains after discharge, especially in grip strength. The results of this study highlight the potential benefits of using ancient Ayurvedic medicine to treat RA and highlight the need for further emphasizing the need for further controlled investigations into its efficacy.

Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study.

The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients. Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5mg/d for at least 5years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis. One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1. In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission. Key Points • In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. • Median time to long-term remission was 8months. • Absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

English

BACKGROUND The prevalence of rheumatoid arthritis (RA) in India is 0.28% to 0.7%, 15-45% of patients with RA develop ocular manifestations. Ocular disabilities can be reduced with timely interference by an ophthalmologist. Keratoconjunctivitis sicca (Sjogren’s syndrome) is the most common ocular association of RA. This study was done to find out various ocular manifestations in rheumatoid arthritis patients. METHODS A cross sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years were screened and further evaluated at regional institute of ophthalmology, Trivandrum. Screening for RA was done using the American Rheumatism Association criteria. A complete ophthalmic examination was done for those who satisfied the criteria. The various ocular manifestations in RA are described and presented as proportions. RESULTS Ocular manifestation was found in 38% of total patients attending the rheumatology clinic. There were 54 females (80.5%) and 13 males (19.4%). Age group mainly affected were in 46-50 yr (17.9%). The duration of rheumatoid arthritis ranged from few months to 25 years. Keratoconjunctivitis sicca was the commonest manifestation found, detected in 22(84%) patients, episcleritis was noted in two patients (7.6%), scleritis in 1 patient (3.8%) and marginal furrowing in 1 patient (3.8%). CONCLUSIONS In this clinic-based study there was a high proportion (38%) of ocular involvement in RA and hence it is essential to include ophthalmic evaluation as a routine in RA patients. The most common manifestation was keratoconjunctivitis sicca followed by episcleritis, diffuse anterior scleritis and marginal corneal furrowing. KEY WORDS Rheumatoid Arthritis, Keratoconjunctivitis Sicca, Ocular Manifestations, Scleritis, Episcleritis

English

BACKGROUND RA Factor positivity is one of the criteria for diagnosis of Rheumatoid arthritis. High levels of rheumatoid factor (generally above 20 IU/mL. 1:40 or over the 95th percentile) are indicative of Rheumatoid arthritis (present in 80 %). Rheumatoid Factor positivity is associated with more severe and more active disease and extraarticular disease. This study was done in Rheumatoid arthritis patients to assess the proportion of ocular manifestations in them and also an association between RF positivity and ocular manifestation and treatment-related ocular complications among Rheumatoid arthritis patients. METHODS A cross-sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years who satisfied the American Rheumatism Association criteria were selected for the study and all of them underwent complete ophthalmic examination as well as RA Factor assessment by latex agglutination. The qualitative variables were expressed in proportion. The chi-square test was used to determine the association between qualitative variables. RESULTS A total of 67 RA patients were screened of which 26 (38.8 %) had ocular manifestations and among the total patients, 57 (85 %) were rheumatoid factor positive. Among the total patients with ocular manifestations, 24 (92 %) patients were rheumatoid factor positive. The association between RF positivity and ocular manifestation was found to be statistically not significant (P-value -0.33). In the present study, no other treatment-related ocular complications were seen except for one patient on long term steroids who had subcapsular cataract. CONCLUSIONS The presence of the RA factor does not show a positive association with the occurrence of ocular manifestation and the use of a low dose of methylprednisolone and DMARDs in RA has reduced the incidence of steroid-related complications. The more commonly used DMARDs -methotrexate, salazopyrin and hydroxychloroquine were found to be safe since no drug toxicity was noted in the present study. KEY WORDS RA Factor, Rheumatoid arthritis, Ocular Manifestation.

Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient’s functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient’s perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (β = −0.069), perceived health (β = −0.172), physical domain (β = −0.425), psychological domain (β = −0.432), social domain (β = −0.415), environmental domain (β = −0.317). Malnutrition was a significant independent determinant of QoL in the “perceived health” domain (β = −0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (β = 1.414) and environmental domains (β = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.

CLINICAL ASSESSMENT OF THE ROLE OF KANSA HARITAKI AND VIRECHANA IN THE MANAGEMENT OF AMAVATA

Amavata is a clinical condition described in Ayurveda that closely resembles with the clinical features of Rheumatoid Arthritis. A Clinical Study was conducted at IPGT and RA, Jamnagar in Kaya Chikitsa de-partment to evaluate the efficacy of Virechan Karma with Eranda Taila and Trivrita Kwatha in patients suffering from Amavata and compared with the trial drug Kansa Haritaki described in Charak Samhita. Efficacy of both of these was compared with the known common drug Trayodashanga Guggulu. In this study, 38 patients of Amavata were registered, of which 29 patients completed the course of the treatment and 9 patients discontinued before completion of course against medical advice. The disease was diag-nosed on the basis of signs and symptoms as described in Ayurvedic and Modern text, aided by American Rheumatism Association Criteria (1988). RA factor test was done in all the patients. The Routine Blood examination (CBC, ESR) with Serum Uric acid, Urine and Stool examination was done to rule out other pathological conditions.

A Three Year Retrospective Analysis Of Anti-Tnf Treatment Outcomes In Rheumatoid Arthritis And Ankylosing Spondylitis Patients

AbstractBackground/Aims:To investigate the effectiveness and reliability of anti-TNF treatment in Ankylosing Spondylitis-Rheumatoid arthritis patients.Methods:180 patients (110 Rheumatoid arthritis (RA) patients diagnosed according to 1987 American Rheumatism Association criteria, 70 Ankylosing Spondylitis (AS) patients diagnosed according to Modified NewYork Criteria) admitted to the hospital for arthritis and related compliants who were followed up and treated with anti-TNF treatment in the department of Rheumatology&amp;amp;Immunology from 2009 to 2011. We enrolled 100 patients with RA (76 women, 24 men) and 60 patients with AS (16 women, 44 men) to the study, excluded 20 patients according to the exclusion criterias. The response of the patients to the anti-TNF treatment was evaluated by comparing the clinical parameters BASDAI, DAS28 and VAS score; and laboratory measurements of erytrocyte sedimentation rate, C-reactive protein levels of rheumatoid arthritis and ankylosing spondylitis before and six months after the treatment.Results:After the six months of anti Tnf treatment, BASDAI score for AS, DAS28 score for RA, VAS, ESR and CRP levels for both diseases showed a statistically significant improvement, moreover it was determined that demographic variations did not affect these values.Conclusions: Our results demonstrated that anti-TNF treatment is safe and effective treatment modality in patients with Ankylosing Spondylitis and Rheumatoid arthritis. These findings are short-term results of a study, and therefore future studies with larger patient series and long term follow-up are needed to look at outcomes of long term therapies.

Subjective sleep disturbances at the time of diagnosis in patients with polymyalgia rheumatica and in patients with seronegative elderly-onset rheumatoid arthritis. A pilot study.

ObjectivesTo investigate subjective sleep disturbances in patients with recent-onset polymyalgia rheumatica (PMR) and in patients with recent-onset seronegative elderly-onset rheumatoid arthritis (SEORA).Material and methodsThe study involved patients consecutively referred to two outpatient clinics from January to June 2018, with a diagnosis of PMR according to 2012 European League Against Rheumatism and American College of Rheumatology provisional criteria, and patients with a diagnosis of SEORA according to 1987 American Rheumatism Association criteria + age + absence of rheumatoid factor and anti-citrullinated peptide antibodies. All patients were naive to glucocorticoid (GC) therapy. After informed consent, we asked the patients to fill out a questionnaire including the Medical Outcomes Study – Sleep Scale (MOS-SS), pain Visual Analogic Scale (VAS), Cumulative Illness Rating Scale (CIRS), Neuropsychiatric Inventory (NPI), and how many minutes their morning stiffness (MS) lasted, at baseline and after 1 (T1) and 12 (T2) months. Differences between groups were calculated with the t-test; all p-values were two-sided and p < 0.05 was used to determine statistical significance. The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration.ResultsThe MOS-SS scores and MS duration were the only variables to show at T0 a significant difference between the two groups. In particular, MOS-SS scores were 47.6 ±8.4 (PMR) and 28.26 ±12.4 (SEORA), with p-values = 0.000. The MS duration was 90 ±9.9 minutes and 45 ±5.5 minutes, with p-value = 0.000. At T1 and T2, MOS-SS scores and MS duration decreased in the two groups, and no significant differences were found.ConclusionsThe study suggests that the assessment of subjective sleep disturbances can be useful in the differential diagnosis between recent-onset PMR and SEORA.

CLINICAL CHARACTERISTICS OF THREE COHORTS OF PATIENTS WITH EARLY- AND LATE-ONSET RHEUMATOID ARTHRITIS (AT 50 YEARS OR OLDER). GENERALIZATION OF 40 YEARS’ EXPERIENCE

The paper presents three cohorts of patients with early rheumatoid arthritis (RA) who fell ill at 50 years or older and had a disease duration of 1.5 months to 1 year. To establish its diagnosis, the investigators used classification criteria for each cohort of its period: 1) the 1958 American Rheumatism Association (ARA) criteria; 2) the 1987 ARA criteria, and 3) the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Along with a change in the criteria, diagnostic methods were improved in this period. Many qualitative laboratory parameters were replaced with their quantitative equivalent; new disease markers (including anti-cyclic citrullinated peptide antibodies) emerged; imaging methods were improved; treatment policies were changed, and targeted biological agents and numerous analogs of the original drugs appeared. Conflicting opinions about the course of RA in older age groups have repeatedly been published in the literature. In the period when the 1958 classification criteria were applied, the opinion that RA has a relatively favorable course was prevalent. Later on, when a more rigid approach to diagnosing RA was applied, there were more and more specialists who considered it to be a severe disease. In this study, the authors try to answer the question of whether the course of the disease changed in the older age groups at the earliest possible date after its onset, by comparing the three cohorts of patients. The findings are discussed.

Mood Disorders in Rheumatoid Arthritis

The mood disorder refers to a sequence of mood episodes. Mood disorder are further classified as depressive (major depressive or bipolar) The course of this disorder is characterized as unipolar or bipolar. The aim of the study is to show the relationship between the mood disorder and rheumatoid arthritis and to classify some of the relationship between etiology,symptoms and underlying biochemical processes. Method :Use in this study Three appendix to asses the cases A cohort study composes of 50 patient suffering from rheumatoid arthritis with repeated mood disorders the samples was chosen from both outpatient in Rheumatology unit in IMAM- Al -Sadek teaching hospital and Margin teaching hospital the study was carry out during the period from the first Oct. 2018 through the first April 2019 for each patient critical interview was done by sociodemographic data was recorded according to- appendix A-. The interview was based on national institute of mental health diagnostic interview schedule (NIMH-DIS). Quetionnare designed t0 assess Mood Disorders which include question specific for the diagnosis of depression (72-99) and for mania (100-117) where used to confirm the diagnosis- appendix B-. and proposed 2007 Revised American Rheumatism Association criteria for Rheumatoid Arthritis -appendix C-3. The Result of study revealed the following result the feature of the mood disorder in rheumatoid arthritis where studied in 50 patient a total of 40% meat criteria for mood disorders based on (NIMH-DIS) it’s This slightly more in females and more in married patients Conclusion: This study proved that most of the mood symptoms in rheumatoid arthritis case appeared to be of mild severity and more often showed symptoms of fatigability work retardation, sadness and less suicidal feeling

Impact of lower limb osteoarthritis on health-related quality of life: A cross-sectional study to estimate the expressed loss of utility in the Spanish population.

Osteoarthritis of the lower limb (OALL) worsens health-related quality of life (HRQL), but this impact has not been quantified with standardized measures. We intend to evaluate the impact of OALL on HRQL through measures based on individual preferences in comparison to the general population. A cross-sectional study was designed. A total of 6234 subjects aged 50 years or older without OALL were selected from the Spanish general population (National Health Survey 2011-12). An opportunistic sample of patients aged 50 years or older diagnosed with hip (n = 331) or knee osteoarthritis (n = 393), using the American Rheumatism Association criteria, was recruited from six hospitals and 21 primary care centers in Vizcaya, Madrid and Tenerife between January and December 2015. HRQL was measured with the EQ-5D-5L, and the results were transformed into utility scores. Sociodemographic variables (age, sex, social group, cohabitation), number of chronic diseases, and body mass index were considered. The clinical stage of OALL was collected using the Western Ontario and McMaster Universities Osteoarthritis Index and the Oxford hip score and Oxford knee score. Generalized linear models were constructed using the utility index as the dependent variable. HRQL expressed by OALL patients was significantly worse than this of the general population. After adjustment for sociodemographic and clinical characteristics, the mean utility loss was -0.347 (95% CI: -0.390, -0.303) for osteoarthritis of the hip and -0.295 (95% CI: -0.336, -0.255) for osteoarthritis of the knee. OALL patients who were treated at a hospital had an additional utility loss of -0.112 (95% CI: -0.158, -0.065). OALL has a great impact on HRQL. People with OALL perceive a utility loss of approximately 0.3 points compared to the general population without osteoarthritis, which is very high in relation to the utility loss reported for other chronic diseases and for arthritis in general.

Performance of the 2015 American College of Rheumatology/European League against Rheumatism Classification Criteria for Gout in Korean Patients with Acute Arthritis.

BackgroundWe aimed to assess the performance of the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for gout in Korean patients with acute arthritis and to compare the performance of the ACR/EULAR criteria to that of other sets of criteria for gout classification.MethodsPatients with acute arthritis who underwent diagnostic arthrocentesis at one of the four participating rheumatology clinics were consecutively enrolled between February and December 2017. Crystal-proven gout was diagnosed upon confirming the presence of monosodium urate (MSU) crystals in patients with a clinical impression of gout as judged by the rheumatologist. The performance of the ACR/EULAR and other gout classification criteria, including the Rome, New York, American Rheumatism Association (ARA), Mexico, and Netherlands criteria, was analyzed regardless of the presence/absence of MSU crystals.ResultsThe study enrolled 118 gout patients (all crystal-proven) and 95 non-gout patients. According to the area under the curve, the diagnostic performance was the highest for the ACR/EULAR classification criteria (sensitivity, 80.5%; specificity, 95.8%; area under the curve, 0.966), followed by the Netherlands, Rome, ARA, New York, and Mexico criteria. All six sets of criteria demonstrated lower sensitivity in patients exhibiting the first episode of acute arthritis.ConclusionIn Korean patients with acute arthritis, the ACR/EULAR classification criteria outperformed other sets of gout classification criteria even in the absence of information regarding the presence of MSU crystals. However, to enhance diagnostic sensitivity, synovial fluid analysis should be considered in patients with the first episode of acute arthritis.

Heart Involvement in Systemic Lupus Erythematosus

Pericardial effusion is considered as one of criteria to diagnose systemic lupus erythematosus (SLE) based on American Rheumatism Association (ARA) criteria. There is limited data about the incidence and characteristic pericardial effusion in SLE patients in our country. The aim of this study is to report and assess the incidence of and characteristic heart involvement in SLE. This is cross-sectional study conducted in secondary referral hospital in Tangerang county, west part of Jakarta, capital city of Indonesia. We evaluated from medical record and echocardiogram data from 2013-2015 patients diagnosed with SLE according to ARA criteria. From 33 SLE medical records reviewed, we found 13 patients (40%) with pericardial effusions. All patients were in active stage. Clinical assessment and transthoracic echocardiogram were used to diagnose pericardial effusions. Eighty percent pericardial effusion positive patients had minimal effusion. The others had moderate effusion. No tamponade patients were recorded. Ninety six percent patients were female with median age 24(13-51) years old. Three patients were reported having pulmonary arterial hypertension. One patient had thrombus in left ventricle. All patients had clinical symptoms of cardiac such as heart failure and chest pain. For the conclusion, the incidence of pericardial effusion in SLE patient was 40 percent. Eighty percent patients had minimal effusion. All patients had cardiac symptoms related.

Frequency and associations of chronic kidney disease among gout patients from aUniversity Teaching Hospital in Nigeria.

ObjectivesTo highlight common precipitants and co-morbidities of gout in Nigerians; determine the frequency of chronic kidney disease (CKD) in Nigerian gout patients, as well as identify significant associations of CKD in gout patients.Material and methodsRetrospective cross-sectional study of gout cases seen at the Rheumatology Clinic of the Lagos State University Teaching Hospital over five years from January 2011 to December 2015. Gout was diagnosed using the 1977 American Rheumatism Association (ARA) criteria. Clinical and laboratory data were extracted and examined for the presence of CKD defined using Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines as estimated glomerular filtration rate (eGFR, CKD-EPI) < 60 mls/min/1.73 m2 body surface area for > 3 months.ResultsOne hundred and six gout patients were identified representing 4.5% out of a total of 2330 cases seen during the study period. There were 94 males and 12 females. Oligoarthritis was most frequent (41.5%) with the knee mostly affected (20.1%). Diuretic use was the most frequent precipitant (37.9%) with hypertension the commonest co-morbidity (62.9%). Of 70 patients with complete results, 29 had eGFR (CKD-EPI) < 60 mls/min (41.4%). Age, proteinuria, body mass index (BMI) and packed cell volume (PCV) were significant associations of CKD. Gout patients with CKD were significantly older (61.79 vs. 54.41 years, p = 0.003) with a significantly higher proportion developing proteinuria (15 vs. 4 patients, p ≤ 0.0001) compared to those without CKD. In contrast, those with CKD had a significantly lower BMI (27.31 vs. 29.65 kg/m2, p = 0.026) and PCV (31.97 vs. 37.95%, p = 0.005).ConclusionsThiazide diuretic use is the most common precipitant while hypertension is the commonest comorbidity in Nigerian gout patients. About two in five Nigerian gout patients had chronic kidney disease at presentation with age, proteinuria, BMI and PCV as significant associations. It is thus imperative to screen for chronic kidney disease when managing gout patients.

The effect of Siwan therapy in management of patients with rheumatoid arthritis: A single blind randomized controlled trial

Background: There is a growing interest in treatments involving natural means and procedures, alternative to those of conventional medicine. Some special sands are being used worldwide in therapeutic applications, especially in musculoskeletal problems. Objectives: To compare the effect of Siwan traditional therapy versus conventional therapy for functional disability and pain in rheumatoid arthritis. Design: A prospective, randomized, single-blind, pre-post-test, controlled trial. Setting: Four physical therapy departments in four multidiscipline, outpatient medical centers, located in Marsa Matrouh. The study was conducted between June 2015 and August 2016. Participants: Thirty patient’s rheumatoid arthritis (aged between 20 and 50 y) according to the American Rheumatism Association criteria 2010, participated in the study. Interventions: The patients were randomly assigned into 2 equal groups. Group (A) received Siwan traditional therapy in the form of sand bathing, followed by massage with olive oil for 7 d and group (B) received conventional physical therapy for two months’ day after day in the form of heat application, electrical stimulation (TENS), and exercise. Main outcome measure: The primary outcome was pain severity measured by visual analogue scale while the secondary outcome was functional disability measured by Health Assessment Questionnaire (HAQ). Results: Thirty patient with rheumatoid arthritis (group (A) n=15; group (B) n=15) were randomized and analysed. Comparing both groups post-program revealed that there were significant differences (P<0.05) in pain level and HAQ between both groups with a significant reduction in favor of the group (A). Conclusion: The Siwan therapy program was more effective than traditional physical therapy program in the treatment of rheumatic patients.

Gout and pregnancy: A report of a new case and systematic review

IntroductionUnlike other rheumatic diseases, gout is rare in women of childbearing age. Due to the low number of cases available for the study, current information is based mainly on case reports. ObjectiveTo describe the characteristics and the outcome of the pregnancy of women with gout. MethodsA systematic literature search was undertaken by the investigators in the PubMed and Embase databases, from the inclusion date to August 2016. Patients were included if they met the definition of gout according to the American Rheumatism Association criteria, and that they had the description of its follow-up during the pregnancy. Data collection and analysis: each pregnancy was treated as a separate observation for analysis. The maternal and fetal-neonatal outcomes data were extracted from the articles finally selected. ResultsThe search identified 125 potentially relevant articles, but after a full-text review only 12 articles met the inclusion criteria. Of the 23 pregnancies described, there were 16 (69.5%) live births, 5 (21.7%) were aborted, in one (4.3%), the pregnancy was terminated, and in one case report (4.3%) there was no description on the term of pregnancy. No maternal deaths were reported. Two babies died a few hours after birth. Congenital malformations were not described in any case report. The most frequent maternal complications were renal damage, anemia, preeclampsia, and postpartum uremia. ConclusionsGout during pregnancy is not common, but it is known to occur. While the majority of women with gout delivered healthy infants, they were at increased risk of having maternal complications.

Gota y embarazo: revisión sistemática, incluyendo el reporte de un nuevo caso

IntroductionUnlike other rheumatic diseases, gout is rare in women of childbearing age. Due to the low number of cases available for the study, current information is based mainly on case reports. ObjectiveTo describe the characteristics and the outcome of the pregnancy of women with gout. MethodsA systematic literature search was undertaken by the investigators in the PubMed and Embase databases, from the inclusion date to August 2016. Patients were included if they met the definition of gout according to the American Rheumatism Association criteria, and that they had the description of its follow-up during the pregnancy. Data collection and analysis: Each pregnancy was treated as a separate observation for analysis. The maternal and foetal-neonatal outcomes data were extracted from the articles finally selected ResultsThe search identified 125 potentially relevant articles, but after a full-text review only 12 articles met the inclusion criteria. Of the 23 pregnancies described, there were 16 (69.5%) live births, 5 (21.7%) were aborted, in one (4.3%), the pregnancy was terminated, and in one case report (4.3%) there was no description on the term of pregnancy. No maternal deaths were reported. Two babies died a few hours after birth. Congenital malformations were not described in any case report. The most frequent maternal complications were renal damage, anaemia, preeclampsia, and postpartum uraemia. ConclusionsGout during pregnancy is not common, but it is known to occur. While the majority of women with gout delivered healthy infants, they were at increased risk of having maternal complications.

Neurological Manifestations in Systemic Lupus Erythematosus: A Single Centre Study from North East India.

Neurological manifestations although common in Systemic Lupus Erythematosus (SLE), are often not recognized due to their diversed and varied presentation. Therefore, the study was planned to highlight the pattern of neurological involvement in SLE to help in early recognition. To study the pattern of neurological involvement in SLE and its correlation with disease activity and different investigation. This hospital based prospective observational study was carried out from August 2009 to July 2010. Diagnosed cases of SLE [based upon American Rheumatism Association (ARA) criteria] who presented with neurological manifestations at the time of diagnosis or develop during the course of the disease were included in the study. They were assessed clinically and investigated with neuroimaging and neurophysiological tests as applicable. In total, 52 consecutive patients with SLE were evaluated, 92% were female. The most common age group was 21 to 25 years. Nervous system involvement was found in 19 (36.54%) patients. Cognitive impairment was the most frequent manifestation, present in 11 (57.89%) patients followed by seizure disorder in eight patients (42.1%). Peripheral neuropathy was diagnosed in eight (42.1%), acute confusional state in six (31.57%) and headache and depression was diagnosed in five (26.31%) patients each. Less common manifestations were psychosis, movement disorder and aseptic meningitis. Percentage of neurological manifestations directly correlated with disease activity. A significant difference was found in Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score between the patients with Neuro Psychiatric Systemic Lupus Erythematosus (NPSLE) and those without NPSLE (32.42±16.34 Vs 17.3±10.6). Neurological involvement in SLE is seen relatively early in the course of the disease with cognitive impairment being the most common manifestation and correlate with disease activity.

Cutaneous Manifestation of Systemic Lupus Erythematosus [SLE], Correlation with Specific Organ Involvement, Specific Auto Antibodies and Disease Activity and Outcome

Background: Cutaneous lesions are important as a diagnostic aid as these account for 4 out of 11 revised American Rheumatism Association criteria for disease classification Cutaneous manifestation of systemic lupus erythematosus (74.4%) and most patients had Butterfly rash (48.8%), Photosensitivity (41.9%), acute cutaneous lupus erythematosus (SCLE) (32.6%), Discoid lupus (20.9%), Nail lesions (16.3%), Alopecia (23.3%), oral nasal ulcer (37.2%), purpuric rash (23.3%), Raynaud phenomenon (16.3%), Livedo reticularis (9.3%), Telangiectasia’s (4.6%), and Urticarial lesion (2.3%). Lupus profundus (2.3%), Cutaneous manifestation of systemic lupus erythematosus are association with disease activity (97.7%), Cutaneous manifestation of systemic lupus erythematosus are association with musculoskeletal (MSK) (62.8%), Renal disease (27.9%), Hematologic disease (23.3%), Serositis (9.3%), Neurologic disease (14%),and cardiac disease (9.3%), Results: Cutaneous manifestation of systemic lupus erythematosus are association with positive ANA (90.3%) and negative ANA (9.3%), positive ds DNA (74.4%), positive Anti-Ro (69.8%), positive Anti-La (9.3%), positive Anti-SM (48.8%),and positive Anti-RNP (39.5%%). outcome of cutaneous manifestation of systemic lupus are skin atrophy and scarring (27.9%). pigmentation (25.6%) and alopecia (23.3%). Conclusion: The cutaneous lesions can provide valuable diagnosis of systemic lupus erythematosus. The most cutaneous manifestations are epidermal lesion then mucous-cutaneous lesion then vascular lesion, are associated with disease activity, and associated with high titer auto antibodies.

Clinical evaluation of periodontal disease in patients with rheumatoid arthritis: A cross-sectional study.

The aim of this study was to determine the presence of periodontal disease among patients with rheumatoid arthritis (RA) in comparison with a control group. The study included 44 patients diagnosed with RA according to American Rheumatism Association (ARA) criteria, who were attending the Morales Meseguer Hospital Rheumatology Service (Murcia, Spain), and 41 control subjects. Patients younger than 18 years or patients suffering systemic diseases that could affect the immune system were excluded. Age, sex, smoking habits, alcohol consumption, and body mass index were registered. Each patient underwent a full periodontal examination. Bleeding on probing was significantly greater in the RA group (0.9 ± 0.36) than the control (P < .001). The Plaque Index was significantly higher in the RA group (0.76 ± 0.34) versus the control group (0.55 ± 0.2) (P < .001). RA patients showed a 0.13 increased risk of periodontal disease (95% confidence interval, 0.05-0.37). Patients with RA suffered a higher risk of periodontal disease and for this reason these patients must be instructed to intensify their oral hygiene regimes.