Rheumatoid Arthritis-related Disease Research Articles

Prescribing Patterns of Methotrexate in Libyan Patients with Rheumatoid Arthritis

Chronic rheumatoid arthritis (RA) is a systemic inflammatory disease that leads to cartilage and bone erosion. Untreated disease is linked with joint deformity and substantial health care related costs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) are the main tool to treat any form of RA. Methotrexate (MTX) is the key conventional DMARDs. It is recommended as a first-line treatment for patients with RA. However, MTX is potentially associated with various toxicities. No clear pattern of MTX use in patients with RA in Libya, since no national guideline has been implanted so far. The aim was to investigate the prescribing patterns of MTX in Libya. A hundred and twenty patients who were on treatment with MTX and follow up in RA clinic of Tripoli University hospital were evaluated for therapy during the period of 2018 and 2019. Patient distribution data, disease duration, other related diseases and drug prescribed as well as adverse drug reactions were considered to analyze the pattern of drug use. The demographic distribution findings indicate that female patients are more than male patients and the ratio of disease among female to male was 1:9. A range of age between 41 - 60 years was the highest affected compared with other ages. Among of these about 75% of patients were no occupational works. RA related diseases were found to be more with diabetes mellitus, hypertension and osteoporosis. Low use of NSAIDs in this group of patients but with high use of steroid. A high group of patient's use of low dose of MTX for up to five years. This study concludes that MTX is an effective drug in controlling the disease with less and tolerated incidence of side effects.

FDG uptake observed around the lumbar spinous process: relevance to Baastrup disease.

In positron emission tomography (PET) with F-18-fluorodeoxyglucose (FDG), non-tumorous focal uptake is often observed around the lumbar spinous processes (LSPs). Close approximation of LSPs with sclerosis is often seen, which is called Baastrup disease. The aim of this study was to characterize this finding in terms of location and subjects' age and investigate the relation between PET and CT findings. The PET/CT scans of 40 patients each in the fifth, sixth, seventh, eighth, and ninth decades were screened for FDG uptake around the LSPs from L1-2 through L5-S1. Patients with metastasis to the lumbar spine or recent chemotherapy or rheumatoid arthritis-related disease were excluded. Focal uptake greater than blood pool activity was considered positive. Positive uptake was compared among the ages and locations. We also evaluated the relationship between FDG uptake and CT morphology. Overall, focal uptake was observed in 122 LSPs in 71 patients. At least one positive uptake was seen in 9, 21, 15, 12, and 14 of 40 patients (16, 30, 30, 20, and 26 of 200 regions) in each age group of 40s through 80s, respectively (p = 0.12). As for the location, uptake around L1-2, L2-3, L3-4, L4-5, and L5-S1 was observed in 19, 22, 39, 35, and 7 regions, respectively (p < 0.01). There was no statistically significant difference in PET positivity among the five age groups, but positive uptake was predominantly seen in L3-4. Degeneration on CT was apparent in 58, 74, 108, 123, and 144 regions in each age group, respectively (p < 0.01), and in 38, 79, 131, 151, and 108 regions in each location, respectively (p < 0.01). The PET positive ratio was higher in CT positive group than in CT negative group (14 vs. 10 %, p < 0.05), but there was no significant difference of quantitative values (p = 0.10). Of 42 regions in 27 patients who had serial PET/CT scans that were initially PET-positive, 35 regions (83 %) turned negative on a later PET-scan. Focal uptake around the LSPs was commonly seen in the mid-lumbar vertebrae, independent of age, and was not always correlated with morphological changes. This uptake should not be assumed to represent osseous metastasis.

Magnetic resonance imaging of palindromic rheumatism

A 44-year-old man with intermittent asymmetric migratory oligoarthritis lasting the recent decade was admitted to our hospital. Considerable specific biomarkers for rheumatoid arthritis such as anti-agalactosyl IgG antibody are all negative. He was diagnosed as palindromic rheumatism (PR). Although hand X-rays showed no remarkable findings, hand magnetic resonance imaging (MRI) detected pannus and bone erosion. PR is defined as the disease characterized by short-lasting attacks of acute oligoarthritis, without radiographic changes. To our knowledge, the findings of MRI for PR have not been previously described. We propose that MRI findings in patients with PR is useful tool to distinguish PR from rheumatoid arthritis (RA) or other RA related diseases.