Rheumatology OPD Research Articles

<b>Activities limitation in patients with rheumatoid arthritis: A cross sectional study</b>

Background: Rheumatoid arthritis (RA) is an auto immune disease leads to progressive destruction of synovial membrane of joints, causing pain, deformity and functional limitation, which results in severe disability in performing daily and professional activities. The burden of rheumatoid arthritis RA in general population varies high in females. The most common cause of rheumatoid arthritis in individual life is activities limitations. Rheumatoid arthritis is a disease that should be examined and assessed carefully in the general peoples as well as in patients , because if this disease is identified later can lead to a state of irreversible damage of the articular cartilage of the joints , which can lead further disability and increases activities limitation . Objective: to asses activities limitation in patients with rheumatoid arthritis Methodology: Total of 132 patients in the study. Data was collected at rheumatology OPD at arif diagnostic hospital and research center Hayatabad Peshawar. Data from patients were collected through health assessment questionnaire (HAQ) convenient sampling technique was used, data was analyzed using SPSS version 26. Result: total of 132 participated, ranging in age from 25-60 years, mean age was 47.6±10.3. Female patients were more than male patients. Out of 132 patients 2 67.4% have female patients and 32.6% were have male patients with rheumatoid arthritis Conclusion: most of the patients with rheumatoid arthritis were having activities limitations in their daily life. in term of severity most patients were have moderate pain . Keywords: activities limitation, rheumatoid arthritis, HAQ

Low Haemoglobin is Inversely Associated with Disease Activity in Rheumatoid Arthritis: A Cross-Sectional Study from a Tertiary Care Hospital.

Extra-articular manifestations especially haematological abnormalities are common in Rheumatoid arthritis (RA). The aim is to study the haematological parameters and its correlation with disease severity and gender. A cross-sectional study was conducted at a tertiary centre among 50 RA patients who attended the Rheumatology or General Medicine OPD from January 2020 to June 2021. The number of swollen joints, tender joints, the patient's global assessment, rheumatoid factor, and complete blood counts were recorded. Disease Activity Score (DAS-28) was calculated from these variables and data was analysed using SPSS version 29 with p<0.05 considered as statistically significant. Of the study subjects, forty (80%) were females; thirty (60%) belonged to the age group 41-50 years. Median age was 42.4(18, 50) years. 79 % (19 out of 24) of subjects with normal haemoglobin had moderate disease activity on DAS 28 score and 50% (13/26) of participants with low haemoglobin levels had high disease activity. Simple linear regression analysis showed low haemoglobin is inversely associated with DAS 28 score (R2 = 0.407, F= 32.888, p < 0.001). Compared to females, males had a higher haemoglobin level which was statistically significant. Female patients had statistically significant higher DAS 28 scores than males (p = 0.016). Low haemoglobin levels are associated with high disease activity in RA patients and males had less severe disease than females.

Comparative analysis of pediatric rheumatic patient growth patterns against norms: A cross-sectional study conducted in an Eastern Indian hospital

Background. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease. Rheumatic diseases are a major cause of chronic illness in children around the world. SLE is a further prevalent inflammatory illness. Aims and objectives. To study different growth parameters of pediatric patients attending pediatric rheumatology clinic, to compare the growth parameters with age and sex matched controls and to compare growth among different types of pediatric rheumatic patients. Method. Different growth parameters and SMI (for children above 9 years) were recorded for patients attending pediatric rheumatology OPD having disease duration more than one year. Results. Among 121 patients, JIA was most common followed by SLE. Among JIA subtypes, SOJIA is most common. Mean age of presentation was earlier in SOJIA, late in JoAS. SLE patients had larger duration of illness prior to diagnosis than JIA patients. In JIA patients, mean height was significantly less than controls. SOJIA and polyarticular variety had significantly less weight and height compared to controls. SLE patients had significantly less weight and height compared to control. Anthropometric parameters were significantly more in SLE patients compared to JIA cohort. There was significantly more delayed puberty both in JIA and SLE patients compared to controls. Conclusion. JIA was most common, followed by SLE. Among JIA patients SOJIA variety was most common, JIA patients had significantly lower height than controls. SLE patients had significantly lower weight and height than controls. Delayed puberty was significantly more in both JIA and SLE patients compared to controls.

Immunogenicity of Covishield vaccine in patients with autoimmune rheumatic diseases.

The Coronavirus disease 2019 (COVID-19) pandemic has been the biggest threat to humankind during the last 3 years. It has caused the loss of more than 6.9 million precious lives across the world. The only method by which the massacre could be stopped was by mass vaccination or mass immunization. The patients suffering from autoimmune rheumatic disorders (AIRDs) and treated with immunosuppressants were the high-priority candidates for vaccination. However, the data regarding the efficacy of COVID-19 vaccines in this group of patients are very less. Hence, this study was planned to study the immunogenicity of Covishield in patients with AIRDs attending the rheumatology OPD at DMCH, Ludhiana. It was a prospective cohort study and was planned by the Department of Biochemistry and Department of Clinical Immunology and Rheumatology at Dayanand Medical College and Hospital, Ludhiana. Fifty patients with AIRDs attending the DMCH rheumatology OPD and 52 age and sex-matched healthy controls who had received two doses of Covishield vaccine were included in this study. Patients having any other immunosuppressive conditions like uncontrolled diabetes, hepatitis, malignancy or HIV were excluded. Patients who had suffered from previous laboratory-confirmed COVID-19 infection (by RT-PCR) were also excluded. Blood samples were collected following all aseptic precautions from patients and controls on the 28th day after administration of a second dose of Covishield vaccine and total antibodies to the severe acute respiratory syndrome coronavirus 2 spike (S) protein receptor binding domain was measured using Elecsys Anti-SARS-CoV-2 S kit from Roche. It was observed that no significant difference was there in antibody titre between cases and controls (6213 ± 4418 vs. 8331 ± 7979, P = 0.1022). It was also observed that no statistically significant difference in antibody titre in cases without prednisolone and those taking treatment with prednisolone was found (P = 0.7058). A similar observation was found in terms of methotrexate also (P = 0.457). No significant difference in antibody titres was there when compared with controls (for prednisolone, P = 0.169, for methotrexate, P = 0.078). We found that only the patients receiving mycophenolate mofetil showed a statistically significant decrease in antibody titre in comparison to healthy controls (P = 0.03). Our study showed no statistically significant difference in antibody titres between patients suffering from different AIRDs. Our study supplements the fact that patients with AIRDs in India can receive Covishield as the primary vaccine against COVID-19 without concerns regarding decreased immunogenicity or increased adverse effects.

Vaccine Hesitancy Against COVID-19 Vaccines in Patients with Autoimmune Rheumatic Diseases and Effect of Specialist Counselling on Vaccine-hesitant Patients

Objectives: To assess causes of vaccine hesitancy to COVID-19 vaccines in patients with autoimmune rheumatic diseases (AIRD). Methods: Study design: We conducted a cross-sectional observational survey-based study of patients attending Rheumatology OPD regarding the reason for vaccine hesitancy, counselled by treating rheumatologists and responses regarding willingness recorded after counselling. Convenience sampling was done by including all adults (&gt;18 years) with AIRD attending rheumatology OPD. Those vaccinated, recently infected (within six weeks), and non-AIRD patients were excluded. The questionnaire included details about patients’ demography, medication and reason for vaccine hesitancy. Statistical analysis was performed using measures of central tendency for quantitative variables and using counts and percentages for qualitative variables. Results: A total of 322 patients participated in the study with a mean age of 40 years (18–76), with 73% (234) females and 27% (88) males. Most patients had RA (40%) followed by SpA (27%), SLE (13%) and were on immunosuppressive medications (95%). A significant proportion of patients (60%) had more than one reason for vaccine hesitancy. Almost 60% of the respondents feared disease flare post-vaccination, while almost half (44.4%) feared vaccine side effects and more than one-third (35%) doubted vaccine efficacy while on immunosuppressive medications. Other causes were the inability to get vaccinated (18%), doubts about vaccine efficacy (15%), and fear of injections (10%). Most patients (91%) expressed vaccine acceptance after specialist counselling. Conclusions: Vaccine hesitancy is multifactorial. Addressing reasons for vaccine hesitancy in patients with AIRD like fear of flare of disease post-vaccination, fear of vaccine side effects and doubts over vaccine efficacy while taking immunosuppressive medications are necessary. Most patients were willing to take vaccine after counselling by a rheumatologist.

Frequency of Thyroid Disorders in Rheumatoid Arthritis Patients and its Association with Disease Activity: A Hospital Based Study

Objective: To establish the frequency of thyroid disorders among Rheumatoid Arthritis patients and its association with disease severity measured by DAS28-ESR.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Rheumatology, Federal Government Policlinic Hospital, Islamabad Pakistan, from Jan to Jun 2021.&#x0D; Methodology: The study included 87 consecutive patients either gender with Rheumatoid Arthritis visiting Rheumatology OPD. Thyroid profile and DAS28-ESR were performed in all the patients.&#x0D; Results: Out of 87 patients, 73(83.9%) were females, and 14(16.1%) were males. The mean age was 45.54±13.50 years. The mean DAS28-ESR was 4.45±0.68, with a minimum DAS28-ESR of 1.25 and a maximum of 8.40. The Disease severity calculated by DAS28-ESR was mild in 19(21.8%), moderate in 44(50.6%) and severe in 24(27.6 %) patients. The thyroid gland was abnormal in 23(26.1%) patients. 18(78.2%) of 23 patients with thyroid disorders belonged to the moderate to severe Rheumatoid arthritis disease activity group.&#x0D; Conclusion: Thyroid disorders are very common in Rheumatoid Arthritis patients. Thyroid workup should be part of investigations of Rheumatoid Arthritis for early detection of thyroid disorder and better disease control.

Safety Profile of Methotrexate in Patients with Rheumatoid Arthritis

Background: Methotrexate (MTX) is recommended as first-line therapy in patients with active Rheumatoid Arthritis (RA) as monotherapy or in combination with other disease-modifying anti-rheumatic drugs (DMARDs). Despite being considered a safe drug, some toxicities of MTX are inevitable and patients discontinue further treatment with MTX for the same.&#x0D; Objective: To evaluate the safety profile of Methotrexate in patients with RA.&#x0D; Methodology: An observational cross sectional study was conducted at a tertiary care hospital from 1st January 2020 to 31st December 2020 at rheumatology OPD in department of medicine, KLES, Dr. Prabhakar Kore Hospital, Belagavi. 117 patients diagnosed with RA who had been undergoing methotrexate treatment for at least six months as monotherapy or in combination with other DMARDs were included. Patient demographics, disease and treatment characteristics, side effects, and blood and laboratory markers specific to RA were studied with regards to methotrexate. Continuous variables were presented as mean and standard deviation, while categorical variables were presented as frequency and percentage. Association between categorical variables was done using Fisher exact test and chi square test.&#x0D; Results: The study predominantly consisted of females (85.5%), and the mean age of patients was 47.92±13.398 years. Patient-reported side effects were seen/observed in 47% of patients. Commonly reported minor side effects were fatigue (17.1%), nausea (16.2%), anorexia (11.1%), stomatitis/oral ulcers (10.3%), epigastric burning (8.5%), hair fall (3.4%), and vomiting in 0.9% of patients. Demographic and clinical factors were not associated with side effects. There was no significant association between side effects and type of treatment.&#x0D; Conclusion: Use of methotrexate in combination with other DMARDs is safe and should be encouraged as first line treatment of RA on routine basis. However, periodic blood and laboratory monitoring along with patient follow-ups are essential for early detection of toxicities.

Case Report on Henoch-Schonlein Purpura Vasculitis

Henoch-Schonlein purpura is a type III hypersensitivity leukocytoclastic small vessel vasculitis caused by the IgA-immune complex that primarily affects children and has the potential to escalate to many complications. A female patient of age 17 years came with the complaint of asymptomatic red rashes over their left lower leg since 3 weeks back. It soon involved the other leg within 3-4 days. Also Associated ankle pain. on clinical examination Pulse Rate-86/min, BP-120/80 mm/Hg, RR-20/minute, non-pitting edema and palpable purpura of bilateral lower legs and few over the thighs. skin biopsy was done, also received fresh tissue for IF, which shows 1-granular IgA along upper dermal vessels, she was given Tab. Augmentin 625mg, Tab. Colchicine 500 mcg, Mupimet ointment and other supportive measures for two days. When the patient's condition improved, discharged with medication Tab. Augmentin 625mg, Tab. pantoprazole 40mg, Mupimet ointment each for 4 days and Tab. colchicine 500mcg for 7 days with advice to review in dermatology OPD and rheumatology OPD with prior appointment after one week. Continued collaboration and knowledge-sharing within the medical community will ultimately improve patient outcomes and contribute to the advancement of care for individuals affected by this rare vasculitis disorder.

STUDY OF SKIN CHANGES, HAND ABNORMALITIES AND PULMONARY MANIFESTATIONS IN DIFFUSE SCLERODERMA IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

Introduction: Scleroderma is a connective tissue disease characterized by brosis affecting the skin and internal organs.Joint involvement has been reported to occur in 46%- 97% of SSc patients. Bone and soft tissues may also be targeted; calcinosis and acro-osteolysis are thought to be the main characteristic ndings in SSc. Pulmonary disease in SSc falls into two major categories: interstitial lung disease (ILD) and pulmonary hypertension. Using PFTs, signicant pulmonary involvement is detectable in 25% of the patients with SSc within 3 years of initial diagnosis. The gold standard for determination of PAH in patients with SSc is right heart catheterization. The HRCT features of lung disease are ground-glass opacication predominant or admixed with reticular abnormalities in the majority of cases and little or no honeycombing. To study the demographic prole, Clini Aims and Objectives: cal Manifestations, Radiological abnormalities, Lung involvement and PAH. 35 newly diagnosed Sclederma patients Materials and Methods: attending Medicine and Rheumatology OPD of Medical College Kolkata were studied in this Cross-sectional observational study. Clinical Manifestations are noted and Radiological Investigations were recorded in structured Proforma. Data analysed using standard statistical methods. In Results and Analysis: our study, the study population had an F: M ratio of 10:1. majority of population (38%) having age group(30-40) yrs followed by less than 30 yrs &amp; 41yrs or more (31% each). In our study clinically hand abnormality was evident in 69% patients &amp; radiologically hand abnormality was evident in 74% patients. In our study population 29% patients have had acroosteolysis, 26% patients had erosion &amp; 19% patients had exion contracture. In our study we found all the patient with documented ILD had abnormal PFT. In our study group restrictive pattern in PFT was evident in 63% patients &amp; mixed pattern was evident in 23% patients. Twelve patients (35% of the total cohort) had pulmonary hypertension dened as PAs of 30 mm Hg or greater. In our study we found Out of 30 patients with documented ILD in HRCT 20 patients had PAH &amp; 10 patients had no PAH. Females are more affected than males. Majority Conclusion: of the patients affected are in the age group of 30-40 years.69% patients had clinically evident hand abnormality and 74% patients had radiologically evident hand abnormality.CXR showed ILD in 63% patients whereas86% patients had documented ILD in HRCT.Restrictive pattern of PFT abnormality is more than mixed pattern.57% patients had documented PAH in echocardiography.HRCT is more sensitive than chest radiography for detection of ILD.

A STUDY OF INSULIN RESISTANCE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background Systemic lupus erythematosus (SLE) is the prototypic autoimmune chronic inammatory disorder that predominantly affects women during their reproductive years and characterized by multisystem organ involvement and by high titres of auto-antibodies against several nuclear and cytoplasmic antigens. Increased risk of CHD in SLE is not explained by classic CHD risk factors.Insulin resistance and Metabolic syndrome are clearly strong candidates to justify the increase in CHD in patients with SLE and they provide insights into the pathogenesis of insulin resistance associated with inammation. Insulin resistance is a key component of the World Health Organization–dened metabolic syndrome that is increased in patients with SLE. The study was carried out in All SLE patients attending Rheumatology OPD and other outpatientMethods department or in various ward of Department of medicine at Assam medical College and hospital satisfying the inclusion criteria.continuous variables were expressed as mean +-standard deviation.categorical variable were expressed as frequency and percentage.p value were considered statistically signicant when it was less than 0.05 In our study ,the most common age group was found to be between 21-25 years(28%)Results followed by 16-20 years(20%).The female accounts for 96% and male accounts for 4%.From the study ,it was found that 47% of the study population had insulin resistance compared to 16% of that of healthy control.it indicates presence of signicant insulin resistance in the study group (p value&lt;0.05). The mean HOMA-IR score in the case was 3.54±3.41 and that in the control was 1.97±1.27. In the study conducted by C_intia N. H. Miyake et al , they found the similar result. The mean HOMA-IR score in the case and control were 1.85±1.68 and 1.40±0.86 respectively. (p value &lt;0.05). Sanaa Gazareen et al study also showed signicant insulin resistance in study group compared to control group. The mean HOMA-IR score in case was 1.5±0.86 and that in the control was 0.84±0.27.There was no signicant difference in insulin resistance between male and female.There was no signicant difference in insulin resistance between the newly diagnosed cases and the previously diagnosed cases who were on treatment.from the study it was also found that, as the disease activity increased,insulin resistance was also increased with co-relation coefcient(R) is 0.6053 and it was statistically signicant (p value&lt;0.05). Systemic lupus erythematosus (SLE) is a chronic,Conclusions multifaceted inammatory disease that can attack every organ system of the body. As the overall prognosis for persons with SLE has improved in recent time due availability of medications but cardio-vascular morbidity or mortality has been increasing rapidly. In recent studies of SLE, we have seen a marked increase in the prevalence of the metabolic syndrome. Insulin resistance is a key component of the World Health Organization–dened metabolic syndrome that is increased in patients with SLE In this part of the country, 47% of the SLE cases were having insulin resistance compared to 16% of the healthy population ( p value &lt;0.05). There was no difference in insulin resistance in SLE cases who were newly diagnosed not on medication and the diagnosed cases those were on medication. Insulin resistance was signicantly associated with disease activity. There was no co-relation of insulin resistance with disease duration. Fasting serum insulin level was signicantly higher in SLE cases with insulin resistance compared to cases without insulin resistance. Though triglyceride level was signicantly higher in SLE cases compared to healthy population but there was no difference in fasting lipid prole parameters in cases with insulin resistance and in cases without insulin resistance.

A PROSPECTIVE STUDY COMPARING ULTRASONOGRAPHIC FINDINGS AND INFLAMMATORY MARKERS AS A PREDICTOR OF JOINT EROSIONS IN RHEUMATOID ARTHRITIS.

Rheumatoid arthritis is chronic inammatory disease that affects the joints. This results in painful joints, swelling and stiffness in the joints. The present prospective comparative study aimed to compare the USG Doppler ndings with the inammatory marker levels in being a better predictor of joint erosions in rheumatoid arthritis. Total 50 patients coming rheumatology and medicine OPD were studied for inammatory markers and ultrasonography ndings. Radiological investigations such as High resolution USG power Doppler (4-12 MHz) and x-ray of the affected joints were carried out. Majority of participants (60%) belonged to 31-50 years of age group and female gender (86%). The change in inammatory markers were found to be poorly correlated to joint erosions, while that of USG erosions was found to be strongly positively correlated with the same. Multivariate regression analysis showed that in presence all others also only delta USG erosion signicantly impacts delta VDH, or the gold standard(X Ray) for evaluation joint erosion This strongly proves that USG erosion is a better predictor of joint erosions than the other independent variables(inammatory markers).

Clinical profile of osteonecrosis in systemic lupus erythematosus - Experience from a tertiary care centre in South India.

Introduction:Osteonecrosis or Avascular necrosis of bone (AVN) is a well recognized complication of systemic lupus erythematosus (SLE) leading to significant morbidity.Methods:We did a cross sectional descriptive study in cohort of SLE patients, on regular follow-up at our Rheumatology OPD over a period of 5 years from 2012 to 2017.Results:Of the total 415 SLE, 5.1% (n = 21) patients were diagnosed to have osteonecrosis. The mean age was 32.8 ± 7.6 years. Male: female were 1:4.2. Mean time interval between the onset of SLE and diagnosis of osteonecrosis was 4.1 ± 2.7 years. Pain (100%) was the most common presenting symptom followed by limping gait (42.8%). Most common site affected by osteonecrosis was femoral head (80.9%) (n = 17). 14.3% (n = 3) had multifocal involvement. The most common systemic involvement was musculoskeletal system (80.9%). In total 28.5% had secondary antiphospholipid syndrome. Mean SLEDAI-2K at the time of diagnosis of osteonecrosis was 5.3 ± 2.9. Hypertension 19%, hypothyroidism 9.5%, osteoporosis 24%, and chronic HCV infection 4.7% were the associated comorbidities. The most common stage by imaging at diagnosis was stage IV (38%), followed by 24% stage V, 19% stage III and 9.5% stage II and 9.5% stage VI. Medical management include bisphosphonates (100%), statins (90.4%) and anticoagulant therapy (28.5%), while 9.5% received core decompression surgery and 14.3% underwent total hip replacement. The mean daily dose of prednisolone at diagnosis of osteonecrosis was 8.5mg (range 5–20mg).Conclusion:This study described the prevalence and epidemiology of osteonecrosis in our cohort of SLE patients.

Fatty liver in Pakistani cohort with rheumatoid arthritis.

Objective:To determine the frequency of fatty liver (non-alcoholic) disease, Framingham 10-year cardiovascular risk score in rheumatoid arthritis patients.Methods:This study was conducted from September 1st to March 19, 2019, at Rheumatology OPD, Central Park Medical College Lahore. One hundred ninety two seropositive rheumatoid arthritis patients were recruited. Demographic details were noted, BP, BMI, smoking habits, and waist circumference were noted, then sent to radiology department for ultrasound scan of abdomen by an expert radiologist. On next day 10 ml blood was taken by phlebotomist for lipid profile and fasting blood sugar levels, after availability of results 10-years Framingham cardiovascular risk score was calculated.Results:Females were (81.3%) mean age of (45.4) years, fatty liver was present in n=39 (20.3%). In positive cases comorbid like metabolic syndrome was present (71.8%), diabetes mellitus (33.3%), hypertension (59%) FRS score (intermediate to high in (33.3%), history of hakeem/desi medication use (51.3%), while on regression analysis all study parameters except DMARD’s had significant association with fatty liver (p<0.05).Conclusion:Nonalcoholic fatty liver disease is very widely prevalent in rheumatoid arthritis patients. As in general population, it is multifactorial in origin and needs careful monitoring and treatment.

Myositis as initial presentation of sarcoidosis: A rarity

Sarcoidosis is a multisystem chronic inflammation characterized by noncaseating granulomas with internal organ involvement. Lung and lymph nodes are most commonly affected with muscles are involved in up to 3% of patients. Here, we discuss a 39-year-old male patient consulted in rheumatology OPD with chief complaints of localized swelling over the left calf since 6 months. Routine blood investigations were normal. Magnetic resonance imaging of the left thigh muscles was done which was suggestive of features of inflammatory myositis. Muscle biopsy was suggestive of epithelioid granulomas, more in favor of sarcoidosis. Contrast-enhanced computed tomography chest revealed symmetrical nodules in upper lobes of both lungs. We made a diagnosis of granulomatous myositis secondary to sarcoidosis. Steroids and azathioprine were started. The patient responded well to treatment and muscle swelling subsided.

The Lag Time of Diagnosis of Axial Spondyloarthritis: A Bangladesh Perspective

Background & Objective: The lag time of diagnosis of axial spondyloarthrits varies from country to country. The aim of this study was to find out the lag time of diagnosis of axial spondyloarthritis in Bangladesh based on the patients visiting the morning Rheumatology OPD of a tertiary-care hospital. Materials & Methods: This study was conducted in the Department of Rheumatology of Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from October, 2018 to December, 2019. Ninety six patients with axial spondyloarthritis were recruited and they were enquired about their ages, places of residence, educational qualifications and duration of axial pain as well as peripheral pain. The participants also underwent estimation of ESR by Westergren method. Results: Mean age of the participants was 39.98 years. The mean and median lag times of diagnosis were 58.17 and 36 months respectively. The lag time of diagnosis followed a nonnormal (right-skewed) distribution. There was no significant difference between males and females (p≈0.921), between rural and urban participants (p≈0.221), between those with and without peripheral involvement (p≈0.387) as well as between those with and without elevated ESR according to Mann-Whitney U test. But the median lag time in those who were highly educated, ie. those who completed at least a bachelor degree was significantly (p≈0.016) shorter than that in those who were not highly educated. Conclusion: There is a considerable median delay in the diagnosis of axial spondyloarthritis in Bangladesh. Further research is required to identify the factors contributing to the delay so that those can be addressed to shorten the lag time.

The Lag Time of Diagnosis of Axial Spondyloarthritis: A Bangladesh Perspective

Background &amp; Objective: The lag time of diagnosis of axial spondyloarthrits varies from country to country. The aim of this study was to find out the lag time of diagnosis of axial spondyloarthritis in Bangladesh based on the patients visiting the morning Rheumatology OPD of a tertiary-care hospital. Materials &amp; Methods: This study was conducted in the Department of Rheumatology of Enam Medical College &amp; Hospital, Savar, Dhaka, Bangladesh from October, 2018 to December, 2019. Ninety six patients with axial spondyloarthritis were recruited and they were enquired about their ages, places of residence, educational qualifications and duration of axial pain as well as peripheral pain. The participants also underwent estimation of ESR by Westergren method. Results: Mean age of the participants was 39.98 years. The mean and median lag times of diagnosis were 58.17 and 36 months respectively. The lag time of diagnosis followed a nonnormal (right-skewed) distribution. There was no significant difference between males and females (p≈0.921), between rural and urban participants (p≈0.221), between those with and without peripheral involvement (p≈0.387) as well as between those with and without elevated ESR according to Mann-Whitney U test. But the median lag time in those who were highly educated, ie. those who completed at least a bachelor degree was significantly (p≈0.016) shorter than that in those who were not highly educated. Conclusion: There is a considerable median delay in the diagnosis of axial spondyloarthritis in Bangladesh. Further research is required to identify the factors contributing to the delay so that those can be addressed to shorten the lag time.

Study of new onset cutaneous manifestations in Rheumatic Diseases

Background: Skin manifestations are an important clue to underlying rheumatological conditions and at times the first manifestation of the disease. Their identification helps in diagnosis, classification and follow up of these diseases. Hence we conducted this study to assess the new onset cutaneous lesions in patients with rheumatic diseases and correlate skin lesions with disease activity and study the response to therapy over a period of 3 months. Materials and Methods: This prospective observational study was done in KEM Hospital, Mumbai over 18 months recruiting 78 patients, presenting to Rheumatology OPD / wards with new onset skin manifestations. Disease activity was calculated as per standard indices for each rheumatological disease. Skin lesions appearing due to adverse effects of drugs or unrelated to the disease were excluded from the study. The outcome of the skin lesions was assessed at 3 months follow up. Results: Mean age of patients was 38 years with 91% being females. SLE was the most common diagnosis. The most common skin lesions were malar rash among SLE patients; rheumatoid nodules in patients of RA; Sclerodactyly in the Scleroderma patients and Heliotrope rash amongst the dermatomyositis patients. The mean SLEDAI score in the group with LE non -specific lesions was significantly higher compared to the group with LE-specific lesions (P<0.0001). At 3 months there was statistically significant reduction in SLEDAI score after treatment in SLE patients. In patients of RA, 74% patients showed reduction in DAS 28 ESR score with treatment at 3 months. Systemic sclerosis patients failed to show significant improvement in Modified Rodnan’s Skin Score after 3 months of treatment. Conclusions: Among all rheumatological conditions SLE presents most often with skin involvement. Patients with LE specific lesions have lower disease activity (SLEDAI score) as compared to LE nonspecific lesions. At 3 months follow up the response to treatment is good in SLE patients with reduction in SLEDAI scores and also in RA patients with reduction in DAS 28 ESR scores.

Clinical profile of systemic lupus erythematosus among children less than 12 years

Background: Systemic lupus erythematosus (SLE) is an episodic multisystem autoimmune disease characterized by widespread inflammation of blood vessels and connective tissues and by the presence of antinuclear antibodies especially antibodies to native double stranded DNA. The aim was to study the clinical profile of SLE among children less than 12 years attending an urban referral hospital, SLEDAI scoring at onset and follow up at 1 year and SLICC/ACR damage index at 1 year.Methods: A descriptive, prospective and observational study was conducted in Medical, Nephrology, Rheumatology OPD wards, in ICH and HC, from November 2007 to August 2009 among all children diagnosed to have SLE. Results: In this study there were 50 cases over the last 2 years. Majority of the children were diagnosed within a year of their initial manifestation. The mean age at the time of onset of symptoms was 7.94 years. Female to male ratio in our study is 2.5:1.Conclusions: Efforts should be directed in diagnosing at earlier stage itself for better outcome. SLEDAI and SLICC/ACR DI can be incorporated in routine follow up to detect mild to moderate and severe flare and extent of organ damage.

Efficacy and safety of a centrally acting analgesic flupirtine in primary knee osteoarthritis in comparison to tramadol: a randomized controlled trial

Background: Osteoarthritis (OA) is a chronic, degenerative joint disorder responsible for considerable morbidity, particularly in old age. Flupirtine, a new centrally acting analgesic, is devoid of the adverse effects of NSAIDs and opioid analgesics. In this study author compared the effectiveness and safety of flupirtine with tramadol in knee OA.Methods: An open label, randomized, controlled trial was done with patients of primary knee OA of both sexes, age &gt;50 years. Patients were recruited from Rheumatology OPD of SSKM Hospital. A minimum WOMAC score of 35 was essential for recruitment. Patients with serious comorbidities were excluded. They were treated orally with either flupirtine (100mg thrice daily) or tramadol (50mg thrice daily) for 12 weeks.Results: Ninety patients were recruited and data of 42 on flupirtine and 41 on tramadol were analysed. There was significant improvement in pain, stiffness and physical function compared to baseline in both the groups. However, there was no significant difference between groups at 4, 8 and 12 weeks. Responder rate (50% reduction in pain score from baseline) was 66.67% with flupirtine and 48.78% with tramadol (p = 0.122). Flupirtine caused 4 adverse events compared to 16 with tramadol. However, both the drugs were well-tolerated.Conclusions: The effectiveness of flupirtine in knee OA is comparable to tramadol, while causing minimal adverse effects. Long-term benefits need to be explored.

Dyslipidemia in Patients With Active Rheumatic Disease

INTRODUCTION: Rheumatic diseases have been found to be associated with an increased risk of cardiovascular disease (CVD) and dyslipidemia. Constant state of inflammation among patients with active rheumatic diseases predispose to endothelial damage leading to increased risk of dyslipidemia and CVD. Dyslipidemias are being increasingly recognized as an important contributory factor towards the development of CVD and also the leading cause of death in various autoimmune diseases. We aim to study the prevalence and pattern of dyslipidemia in these patients.MATERIALS &amp; METHODS: Consecutive patients with active rheumatic disease of &gt;3months duration and fibromyalgia attending rheumatology OPD were included from January 2013 to January 2014. Patients with diabetes, hypertension, hypothyroidism, CAD, CKD and those on statin or fibrates were excluded. Activity was determined by clinical features, ESR and CRP levels. Data were collected on predesigned excel sheet including fasting lipid profile.RESULTS: A total of 560 patients were enrolled (RA-255, SLE-70, other-45, FMS-190). Any form of dyslipidemia was found in 75.9% of patients. Isolated raised triglyceride &gt;300mg/dl was seen in 178 (41.9%) of them, whereas LDL&gt;120mg/dl was seen 235(55.3%) of patients (23.7% had LDL&gt;200). Almost all patients (98.7%) had LDL:HDL ratio of &gt;2.5. Dyslipidemia was seen in 86 (45.2%) patients with fibromyalgia but none of them had LDL&gt;120 mg/dl.CONCLUSION: Patients with active rheumatic disease are likely to have significant dyslipidemia which can contribute to excess cardiovascular mortality in these patients. Early identification and correction of significant lipid abnormalities may help to reduce the morbidity and mortality in these patients.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, page: 6-9