Center For Rheumatic Diseases Research Articles

Relapse in patients with ANCA-associated vasculitis: A cohort study from a centre for rheumatic diseases in Colombia

IntroductionRelapses are common in patients with ANCA-associated vasculitis (AAV), which results in a significant burden of morbidity, mortality, impact on quality of life, disability, and cost. However, evidence in the Colombian population is scarce. ObjectiveThe objective of this study was to estimate the relapse-free survival during the first year and describe clinical and serological variables of patients with AAV in a specialized centre for rheumatic diseases in Colombia. Materials and methodsA retrospective follow-up study was conducted on a cohort based on medical records of patients over 18 years old with confirmed diagnosis of AAV by the treating rheumatologist and who had achieved remission. Information on AAV relapse and clinical, immunoserological, and treatment-related characteristics was extracted. The relapse-free survival function during the first year was estimated. ResultsA total of 56 patients were included, 69.9% of whom were women, with a median age of 60 (IQR=48−63). According to the clinical phenotype, 64.3% were classified as granulomatosis with polyangiitis (GPA), 23.2% as microscopic polyangiitis (MPA), and 12.5% as eosinophilic granulomatosis with polyangiitis (EGPA). According to the European Vasculitis Study Group (EUVAS) classification, 39.3% had generalized AAV at debut, 23.2% had localized AAV, 21.4% had severe renal AAV, and 16.1% had systemic AAV. The median Five Factor Score (FFS) was 1 (IQR=0−2). The cumulative relapse-free survival at one year was 82.2%. ConclusionsThe relapse-free survival observed in this cohort was similar to other reports in clinical studies and AAV registries.

Sexual and reproductive health while living with rheumatoid arthritis: The impact of the disease stage on patient perspectives.

Rheumatoid arthritis (RA) is one of the most prevalent rheumatic diseases that harms all aspects of patients' lives, including sexual and reproductive health (SRH), often neglected in patients' care. The study aimed to explore the sexual and reproductive experiences of Mexican outpatients with RA from a narrative perspective. From July 2020 to October 2021, 30 adult patients with RA from the Department of Immunology and Rheumatology outpatient clinic of a national referral center for rheumatic diseases had in-depth interviews audiotaped, transcribed, and analyzed using a thematic analysis approach. Results are presented in a descriptive and interpretative manner and integrated into a theoretical model for the topic understanding. Five intertwined major themes emerged: I) RA onset: Absence of SRH contents, II) Healthcare for RA: Emerging SRH contents, III) RA's impact: Proliferation of SRH contents, IV) Coping with the process of living with RA: SRH-related strategies, and V) The impact of the COVID-19 pandemic on patients' experiences: Increased SRH burden. SRH contents emerged through these major themes (but at RA onset), mostly when inquired and mainly when narrating the RA impact and coping. Patients identified that RA affected their couple dynamics, sexual function, and reproductive project. The SRH care was considered relevant but limited and focused on reproductive contents. It worsened during the COVID-19 pandemic. We proposed a theoretical model where patients' SRH experiences are embedded across their RA biography and integrated with the RA impact and the copy with the disease process. These intertwined experiences were also evident during the COVID-19 pandemic, which challenged participants' biopsychosocial resources. The sexual and reproductive experiences narrated by the RA outpatients concerning their disease-related biography showed that even when the SRH appeared as not prioritized at the disease onset, it was widely expressed during the process of living and coping with the disease and was additionally affected by the COVID-19 pandemic.

Glasgow Alumni Column - An Interview with Prof. Rev. Sturrock and Eddie Carberry

For our first Surgo alumni column we wanted to include an interview between formerstudent Eddie Carberry and rheumatology consultant and medical school chaplainProf. Rev. Roger Sturrock. I trained in medicine at the Westminster Medical Schoolin London and worked in London before coming up toGlasgow to work as a lecturer. The opportunity arose forme to work in Nigeria for a little while and I taught in theAhmadu Bello University hospital which at the time wasthe only medical school in the North of Nigeria. I laterreturned to Glasgow to head up the Centre For RheumaticDiseases. Teaching and clinical research have always beenan important part of my working week.I have been involved in church life since my teenage years.Towards the end of my career I trained as a Reader in theChurch of Scotland and subsequently was ordained as aChurch of Scotland minister after returning to universityas a student, graduating in Divinity. I am now an honoraryChurch of Scotland chaplain to the University and I havejust taken on the role as chaplain to the medical school.I see myself as hopefully providing Spiritual Care andadvice to all students of whatever faith group or none.Roger Sturrock Eddie Carberry, FY1Having dropped in to Roger's Wednesday afternoonclinic in the Wolfson Library Room 10, I can say that hisskills of relating ethical and spiritual guidance to thetrials and tribulations of life as a medical student areincredibly useful. I would personally recommenddropping by for a chat if you have anything on yourmind An Interview with Prof. Rev. Sturrock and EddieCarberry I took the opportunity to attend one of Roger's Sunday morning sermons at KelvinsideHillhead Church. Interestingly, Roger manages to weave the religious aspects of hissermons into relevant advice and guidance for his congregation- Eddie. “ Your title is Revered Professor, whatwould you prefer students called you?” Roger.“ What is the best cytokine?” It depends on your perspective! Somecytokines are good - enhancing theinflammatory response to tumourswhereas others have the opposite effect.My favourite cytokine is TNF alpha!"What is the link between rheumatoidfactor and The X-Factor?" (the singingcontest TV show run by Simon Cowell). They are both easy to spot but withuncertain outcomes.“ Do you believe in hell?” If you mean fiery flames and devils withhorns and tails, then the answer is no.Sometimes we create our own hell forourselves."And unrelated to the previous question:Have you ever had to present a patient ata morning ward round after too manypints of Fun the night before?" (a 'pint offun' is now the signature drink at theGlasgow University Union, it's a deadlycocktail made with a triple measure ofvodka and tastes like fruit juice. It'sresponsible for the majority of studenthangovers). The short answer is no but as a juniorDoctor on one occasion I had to guide aninebriated consultant on a ward round!“ What's important about spiritual carein healthcare workers?” The NHS is now recognising theimportance of spiritual care forhealthcare workers. It is about helpingthe inner person to cope with thestresses of health care and to get thingsin the right perspective. How to copewith suffering and death etc.“ Would following all religions increasemy chances of getting into an afterlife?” No! I guess that it would be veryconfusing to follow every religion. It isnot quantity that counts but quality!“ There have been many famousscientists who were also greatlyreligious, have you ever found it difficultto think like a scientist and keep faith inreligion?” No. If anything religion helps to spur oneon to understand how God works increation

Serum Interleukin-17 and its Correlation with Anti-CCP antibodies, Vitamin D3, and Obesity in Rheumatoid Arthritis women Patients

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Members of the IL-17 cytokine family have various biological functions, including enhancing defense against multiple pathogens while promoting inflammatory pathology during autoimmune disease. Additionally, it has been suggested that vitamin D may be connected to the etiology of RA. Therefore, this study aimed to assess serum IL-17 and vitamin D3 concentrations in RA women and determine how these levels relate to anti-CCP, obesity, and age.Methods: This work included eighty women aged between (22-60) years. Sixty were afflicted with RA and attended the department of rheumatology and medical rehabilitation centre for rheumatic diseases at Rzgary teaching hospital-Erbil, Iraq, compared to twenty healthy women. The concentrations of Anti-CCP antibodies as a diagnostic test, Vitamin D3 and IL-17, were assessed by ELISA. The Mann-Whitney U test and normality were applied for the statistical analysis of the results. Also, the relationship between the study parameters was examined using Pearson's correlation. The ideal cutoff value for IL-17 with the highest sensitivity and specificity was detected using a Receiver Operating Characteristic (ROC) Curve. Results: This study revealed that serum IL-17 levels were significantly higher in RA women than in the control group (p < 0.001) and that serum VD3 levels were significantly lower in RA women than in healthy controls. Seropositive anti-CCP Ab was found in about 42% of RA patients. The pro-inflammatory IL-17 serum level was positively correlated with vitamin D, age, and obesity in RA women. The best IL-17 cutoff for predicting the presence of RA was 69.5 pg/ML, with a sensitivity of 96% and a specificity of 75%. Conclusion: In patients with RA, vitamin D deficiency was common and correlated with age. Consequently, a high level of suspicion is needed when assessing at-risk patients, particularly women who complain of vitamin D deficiency.

Trends in Guideline-Adherent Chemoradiation Therapy for Locally Advanced Cervical Cancer Before and After the Affordable Care Act

This study assessed trends in guideline-adherent chemoradiation therapy (GA-RT) for advanced-stage cervical cancer relative to Patient Protection and Affordable Care Act (ACA) implementation in the year 2010.National Cancer Database patients treated with definitive chemoradiation for locally advanced cervical cancer (FIGO 2018 Stage IB3-IVA) from 2004-2016 were included. GA-RT was defined according to NCCN guidelines and included: 1) delivery of external beam radiation, 2) brachytherapy, and 3) chemotherapy, 4) no radical hysterectomy. Univariable and multivariable logistic regression were used to determine trends in GA-RT relative to the ACA and identify patient factors independently associated with GA-RT. Survival of GA-RT was also estimated using Kaplan-Meier analysis.Thirty-seven thousand seven hundred and seventy-two patients met inclusion criteria (Pre-ACA: 16,169; Post-ACA: 21,673). A total of 33,116 patients had squamous cell carcinoma, and 4,626 patients had other histologies. Forty-five percent of patients were node positive. A total of 14.6% of patients were Stage I, 41.8% were Stage II, 36.4% were Stage III, and 7.9% were Stage IVA. Compared to commercial insurance, patients with Medicare had decreased odds of receiving GA-RT (OR = 0.65; 95% CI:0.61-0.69). Black patients (OR = 0.9; 95% CI:0.85-0.95) were associated with decreased odds of receiving GA-RT. Compared to squamous cell carcinoma, adenocarcinoma and carcinoma NOS were associated with decreased receipt of GA-RT (OR = 0.87; 95% CI: 0.80-0.93 and OR = 0.64; 95% CI: 0.55-0.75, respectively). Increasing T-stage was associated with greater receipt of GA-RT (stages 1B2 [OR = 1.89, 95% CI: 1.53-2.37], 2A2 [OR = 2.29, 95% CI: 1.81-2.92], 2B [OR = 2.1, 95% CI: 1.71-2.61], and 3B [OR = 1.47, 95% CI: 1.19-1.83]). Patients with nodal stage NX were less likely to receive GA-RT compared to N0 (OR = 0.6, 95% CI: 0.52-0.68). Increasing Charlson-Deyo score was associated with decreased receipt of GA-RT (OR = 0.86, 95% CI: 0.82-0.89). In multivariate analysis, all factors remained statistically significant except for race. The percentage of population that was guideline adherent significantly increased post-ACA (pre-ACA 28%; post-ACA 34%; P < 0.001). On univariate analysis, patients were 34% more likely to receive GA-RT after the ACA compared to before the ACA. In the multivariate model, receipt of GA-RT increased by 30% (P < 0.001). Adherence to treatment guidelines increased 2-year overall survival by 15% (GA 76%; Not GA 61%; P < 0.001). The post-ACA cohort was associated with increased 2-year overall survival compared to the pre-ACA cohort (pre-ACA 62%; post-ACA 69%; P < 0.001).Patients were more likely to be guideline adherent and receive GA-RT after the implementation of the ACA. This increase in guideline adherence was also associated with an increase in 2-year survival, indicating implementation of the ACA may have improved patient outcomes.R.J. Thomas: None. D. Provenzano: None. S. Goyal: Partner; Center for Rheumatic Diseases. M. Loew: None. B. Long: None. M. Lopez-Acevedo: None. Y.J. Rao: None.

Clinical Description of Patients with Systemic Lupus Erythematosus Evaluated in a Specialized Center for Rheumatic Diseases in Guatemala City

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease characterized by the production of autoantibodies generating systemic inflammation and multiorgan involvement. In this study we describe the classificatory criteria, activity index, organ damage index and treatment of patients treated at the headquarters of the Guatemalan Association Against Rheumatic Diseases (AGAR) located in Guatemala City

William Smith Mitchell

William Smith Mitchell (“Bill”) was a consultant general physician and rheumatologist at Furness General Hospital in Barrow for over 30 years. He did his initial medical training, including an intercalated...

Adverse Events Profile of Low-dose Methotrexate in Nepalese Patients with Rheumatoid Arthritis: an Observational Study.

Methotrexate is considered as the anchor drug for the treatment of rheumatoid arthritis. However, various adverse effects limit its use leading to frequent discontinuation of treatment. This study aimed to evaluate the common adverse effects of methotrexate in patients with rheumatoid arthritis. A prospective observational study was conducted at National Center for Rheumatic Diseases from June 2018 to May 2019 among patients with rheumatoid arthritis using methotrexate monotherapy. Laboratory tests like liver function tests, renal function tests, complete blood count, C-reactive protein, erythrocyte sedimentation rate were done at baseline and every 3 months. Data on patients' comorbidities, disease activity and side effects of drug were collected on every follow- up. Statistical analysis was carried out with the help of SPSS 23.0. Out of 232 patients experiencing at least one adverse effect while on methotrexate monotherapy, 87.5% were female and mean age was 46.9±10.8 years. The mean dose of methotrexate was 16.6 ± 3.9 mg/week with the most frequently used dose of 20mg/week. Among the variety of adverse reaction observed, the most common was transaminitis (75.0%) with approximately 50.0% as isolated liver function abnormality, followed by nausea (19.4%), anorexia (12.9%), leukopenia (12.5%), oral ulcer (8.2%) and psychological intolerance (4.7%). Multiple regression analysis showed significant predictive value of body mass index for transaminitis (p-value 0.007). Asymptomatic liver function test derangement was the most frequent adverse-effect of methotrexate observed, whereas nausea and anorexia were the most common patient reported events. The frequent dose associated with side-effects in Nepalese patients was around 20mg/week.

Diagnosis and management of gout by clinicians in Nepal: a web-based survey.

Patients with gout in Nepal are usually attended by medical graduates, family medicine, internists, and orthopedic surgeons. The study aimed to evaluate knowledge, attitude, and practice (KAP) of point-of-care clinicians of Nepal regarding diagnosis and management of gout and assess the quality of treatment provided to the patients. A web-based descriptive, cross-sectional study was conducted among doctors managing gout patients. The questionnaire comprises 38 multiple choice questions; 9 questions for demographic data, 8, 11, and 10 questions each for knowledge, attitude, and practice, respectively. A pilot study was conducted to observe comprehensibility of the questionnaire before subjecting it to the participants. Ethical approval was obtained from review committee of National Center for Rheumatic diseases, Nepal. Simple descriptive statistics was used to describe the correct responses. Among 1200 clinicians invited, 32% (380) participated in the survey. Maximum respondents were of age group 25-45years (82%) with majority being internists (43%). Although only 32% understood that the disease is not curable, knowledge regarding disease was acceptable in majority (60-90%). Around 83% denied attending any gout-related seminars and 34% denied being updated with the recent guidelines. The majority of postgraduates (72%) managed the cases themselves. Although there was acceptable practice accuracy on use of therapy for acute attacks (75%), target urate levels (57%), and use of urate-lowering agents (92%), they lacked in adequate screening of co-morbidities and initiation of long-term treatment. The point-of-care clinicians have adequate knowledge to diagnose and treat acute events. However, there is poor reflection in practice and frequent update of treatment guidelines is warranted.

Clinico-demographic Profile of Undifferentiated Inflammatory Arthritis Patients.

Undifferentiated inflammatory arthritis is a group of inflammatory joint diseases that do not fulfil the classification criteria for any other rheumatic or connective tissue disorders. This study aims to describe the clinical, demographic and serological features of undifferentiated inflammatory arthritis cases presenting at a tertiary level rheumatology centre from Nepal. A descriptive cross-sectional study conducted at National Centre for Rheumatic Diseases, Kathmandu, Nepal which represents a midterm analysis of the undifferentiated inflammatory arthritis registry maintained at the centre. Patients more than 18 years of age, who consented for the study having least one swollen or tender joint were enrolled. Ethical approval was obtained from Nepal Health Research Council. A total of 1120 patients were enrolled in the study out of which 941 (84%) were females. The mean age at diagnosis was 46.0±12.8 years and most of them were in overweight range (mean BMI: 27.0±5.8) with 818 (73%) patients having BMI more than 24.0. Patients mostly had low disease activity at presentation (DAS 28 score of 2.5±0.8). Other markers of inflammation and patient reported outcome measures (health assessment questionnaire, patient global assessment and visual analogue scale) were also in the moderate range. Seropositivity for anti-citrullinated peptides and anti-nuclear antibodies was seen in 5 (0.45%) and 43 (3.8%) patients respectively. Majority of patients were non-smokers (77%). Inflammatory arthritis on musculoskeletal ultrasonography was seen in 638 (57%). Undifferentiated inflammatory arthritis was more common in overweight females. Serological markers and smoking status are not common features in these patients.

A Study of Metabolic Parameters in Patients with Gout: A Single Center Study from Nepal.

To study the prevalence of deranged metabolic parameters in patients with gout. This was a prospective, cross-sectional observational study conducted at a tertiary level rheumatology center in Nepal. Patients over 18 years and diagnosed as gout using the ACR/EULAR 2015 classification criteria were included in the study. Known cases of chronic kidney disease, liver disease and heart diseases were excluded. Baseline demographic data along with records of weight, waist circumference, lipid profile, glucose profile, blood pressure measurement, serum uric acid level and inflammatory markers were taken. Diagnosis of metabolic syndrome (MS) was made according to the National Cholesterol Education Program criteria. Approval was obtained from the ethical review board of the National Center for Rheumatic Diseases. A total of 523 patients with gout were enrolled in the study, out of which 97.0% were male. The mean age at diagnosis was 49.1±12.8 years. Most of the patients were overweight with a mean BMI of 27.0±3.6 kg/m2. About 8.1% had preexisting diabetes mellitus, 24.6% had hypertension, 5.1% had hypothyroidism and 45.1% had dyslipidemia. Patients fulfilling 2 out of 5 criteria of MS were 60.6% whereas 30.6% fulfilled 3 out of 5 criteria. Gout was commonly observed in middle-aged men. The prevalence of metabolic syndrome and its components was high in patients with gout. Management of gout should also include screening and management of the metabolic syndrome.

Translation, validation and cross-cultural adaptation of the Nepali version of WOMAC® LK 3.1.

Among many self-reported outcome measures, Western Ontario and McMaster Universities Arthritis Index (WOMAC) is one of the commonly used indexes for osteoarthritis patients. Despite high prevalence of musculoskeletal problems in Nepal, there is no validated tool available in the local language. Thus, this study aimed to translate the English WOMAC® into Nepali, and validate it for use in the future. Guidelines by Beaton et al were followed for translation and cross-cultural adaptation of the original WOMAC into Nepali language. Diagnosed cases of knee osteoarthritis (OA) attending the rheumatology outpatient department of National Center for Rheumatic Diseases, Kathmandu were enrolled in the study. These patients were interviewed with the Nepali version. Internal consistency was measured by Cronbach's alpha and test-retest reliability by intra-class correlation coefficient (ICC). Correlation between domains of WOMAC was tested with visual analog scale (VAS) and numerical rating scale (NRS) of pain and stiffness. The test-retest reliability was good with ICC of >0.75 for all domains and items. Internal consistency was acceptable with Cronbach's alpha scores of 0.852, 0.704 and 0.955 for pain, stiffness and physical function domains, respectively. Strong correlation was observed between WOMAC stiffness domain and VAS for stiffness and NRS for stiffness with rho (ρ) values of 0.750 and 0.759, respectively. Moderate correlation was seen between WOMAC pain and VAS for pain and NRS for pain with ρ of 0.658 and 0.584, respectively. Nepali WOMAC is a reliable and valid instrument for assessment of disease severity and its impact in Nepali-speaking patients with OA.

Synovial fluid uric acid level aids diagnosis of gout.

Examination of urate crystal in synovial fluid (SF) remains the gold standard for diagnosis of gout, but is not universally available. SF uric acid (UA) level may be measured by the uricase method with an automated analyzer. The present study aimed to evaluate the utility of SF to serum UA ratio (SSR) for diagnosis of gout. A cross-sectional study was conducted at the National Center for Rheumatic Diseases, Nepal. Patients presenting with acute (<1 day) joint pain and/or swelling were included. Aspiration was performed in all patients and fluid was subjected to testing for urate level, pH and cell counts and microscopy. Serum samples were also assessed for urate levels, and the SSR was calculated for each patient. A receiver operating characteristic curve was plotted to determine the cutoff value for indicating diagnosis of gout. The difference in SSR between gout and non-gout effusion was evaluated by one-way analysis of variance. A total of 181 patients were included of which 77 had gout. The remaining cases included osteoarthritis, pseudogout, rheumatoid arthritis and ankylosing spondylitis. SSR was significantly higher in gout patients than in any other group (P<0.05). An SSR of ≥1.01 had the highest sensitivity and specificity at 89.6 and 66.3%, respectively, for identifying gout effusion. The present results indicated that SSR may be used as an aid for gout diagnosis when polarizing microscopy is not available.

Efficacy of high dose vitamin D supplementation in improving serum 25-hydroxyvitamin D among laboratory personnel working at the Nepal National Center for Rheumatic Diseases.

Vitamin D deficiency is a highly prevalent condition worldwide. However, few studies have been conducted to examine the vitamin D status of laboratory personnel and the correlation between vitamin D deficiency and working conditions. The aim of the present study was to assess changes in serum 25-hydroxyvitamin D [25(OH)D] concentration with a weekly dose of oral cholecalciferol (60,000 IU) for two months. The prospective, open-label, interventional study was conducted from January 2016 to March 2016 at the National Centre for Rheumatic Diseases, Kathmandu, Nepal. The serum level of 25(OH)D in 19 healthy laboratory volunteers was measured at baseline and following the 2-month regimen with cholecalciferol supplement at 60,000 IU (1,500 µg)/week in oral tablet form. At baseline the mean serum 25(OH)D level was 10.31±7.78 ng/ml, which was increased following completion of the course of oral cholecalciferol to 59.78±14.74 ng/ml. This difference in the mean serum level of 25(OH)D compared with baseline was significant to P<0.001. These results indicate that vitamin D deficiency is prevalent among laboratory workers, and that high dose vitamin D3 (60,000 IU cholecalciferol) in tablet form may be effective in achieving sufficient serum 25(OH)D among laboratory personnel who tend to have lower baseline serum 25(OH)D. In conclusion, vitamin D deficiency may be common among laboratory workers, and guidelines should be formulated to implement vitamin D supplementation among laboratory personnel, as well as indoor workers, in Nepal.

Manifestations of Cervical Spine Involvement in Longstanding Ankylosing Spondylitis: Atlantoaxial Ankylosis and Atlantoaxial Subluxation

Objective. To analyze radiologic findings of cervical involvement in ankylosing spondylitis (AS) patients, determine its association with structural severity and clinical variables, and to divide radiologic findings of atlantoaxial ankylosis (AAA) in AS patients into three anatomical components. Methods. The study includes 150 AS patients with either AAA (62 patients) or atlantoaxial subluxation (AAS, 88 patients) who underwent plain radiography of the cervical spine on flexion at our tertiary center for rheumatic diseases. The study subjects` medical records were reviewed. Lateral plain radiographs of the cervical spine were analyzed by a musculoskeletal radiologist. We compared the results of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) between AAS and AAA patients to determine if mSASSS was related to severity or duration of AS. Results. The mean duration of illness in AS patients with AAA was 19.3 years, and in AAS patients 13.7 years (p＜0.01). The mean total mSASSS of AS patients with AAA was 40.1, and of AAS patients 16.5 (p＜0.001), and was positively associated with the development of AAA and AAS. The odds ratio (OR) of AAA development by cervical spine mSASSS change was higher (OR, 1.079) than the OR (1.049) of lumbar spine mSASSS even after adjusting for age, sex, and disease duration. Conclusion. Although AAA is described infrequently, we found from our data that it is another manifestation of cervical spine involvement in longstanding AS and is related to severity of AS reflected by higher cervical mSASSS. (J Rheum Dis 2017;24:21-26)

The epidemiology of Takayasu arteritis: a hospital-based study from northwestern part of Turkey.

Takayasu arteritis (TA) is a chronic, inflammatory large vessel vasculitis that affects aorta and its main branches. We aimed to evaluate the incidence and prevalence of TA in the northwestern part of Turkey. We retrospectively evaluated 23 TA patients followed by our clinic. Clinical features, treatments and responses were recorded. Our hospital is the single tertiary referral center for rheumatic diseases for a mixed rural and urban population of 620,447 people for >16years (306,036 males, 314,411 females). Nineteen of the 23 patients were females (82.6%) and four were males (17.4%). The annual incidence rate for TA was 0.34/100,000. The overall prevalence of TA in our region was 3.3/100,000 (95% CI 1.9-4.8) in individuals >16years. The most common findings at the time of presentation were blood pressure difference (73%) and headache (60.4%). The most common angiographic type was type 1 (12 patients, 52.2%). Median follow-up period was 48months (range 10-132). Three (13%) of the patients had stent replacements to different vascular sites. One patient had an operation for aortic aneurysm, and aortic valve replacement surgery has been made. One patient had renal artery bypass operation. Eleven patients (47.8%) had recurrency at follow-up period and two patients (8.7%) died. In northwestern part of Turkey, the annual incidence and prevalence of TA were higher than western population, but similar to East Asian data.

Nailfold capillaroscopic findings in patients with Raynaud’s phenomenon: Preliminary report

Back grounds and Aims: Microvascular involvement of nailfold often occurs in systemic rheumatic diseases, especially scleroderma and related conditions. Nailfold capillaroscopy is easily performed non-invasive, simple, repeatable, sensitive, safe and inexpensive method to examine nailfold architecture by microscope.The normal capillaries are thin, symmetrical and have hair-pin appearance. Anomalies include dilated capillary loops, dropouts, tortuosity, avascular area, arborifications, megacapillaries, infracts,thrombsis and haemorrhages. This study aims to see the morphological changes in microcirculation in nailfolds of patients with Raynaud’s, which can be helpful in predicting the presence of connective tissue disorder.Methods: It is an observational study conducted at National Center for Rheumatic Diseases, Kathmandu from 26th March 2014 to 30th March 2015. Nailfolds of 8 fingers of both hands in 105 patients were examined using a hand held microscope.Results: Of 105 patients, 91 patients (86.6%) had abnormal morphological changes while 14 (13.4%) had no significant changes in microvessels. Normal patients had no underlying connective tissue disease(CTD) but those with abnormal findings had proven underlying CTD which included Lupus 6.5%, Scleroderma 17.5%, Rheumatoid Arthritis 14.2%, Mixed CTD7.6%, Undifferentiated CTD1.0%, Undifferentiated inflammatory arthritis 14.2%, Psorasis 1.0%, Rheumatoid Arthritis with scleroderma overlap 4.3%. No primary diagnosis was found in 32.9% of patients.Conclusion: Nailfold capillaroscopy allows direct examination of microvascular structure of a patient. Abnormal findings in a patient with Raynaud’s phenomenon might help to identify the presence of or future evolution into systemic connective tissue disorder.Journal of Advances in Internal Medicine 2015;04(01):13-15

'50 years of the Centre for Rheumatic Diseases in Glasgow' (in conjunction with the Scottish Society for Rheumatology), 22 May 2015: Poster Abstracts.

'50 years of the Centre for Rheumatic Diseases in Glasgow' (in conjunction with the Scottish Society for Rheumatology), 22 May 2015: Poster Abstracts.

“50 years of the Centre for Rheumatic Diseases in Glasgow” (in conjunction with the Scottish Society for Rheumatology), 22 May 2015: Oral Presentations

Restricted accessAbstractFirst published online August 10, 2015“50 years of the Centre for Rheumatic Diseases in Glasgow” (in conjunction with the Scottish Society for Rheumatology), 22 May 2015: Oral PresentationsVolume 60, Issue 3https://doi.org/10.1177/0036933015594112

50th anniversary of the Centre for Rheumatic Diseases

50th anniversary of the Centre for Rheumatic Diseases