Lipid abnormalities in patients with rheumatoid arthritis

Objective: To determine the frequency of dyslipidemia in patients with Rheumatoid Arthritis

Methods: This is a prospective, cross-sectional, observational study, conducted at the 'Rheumatology Clinic' of Jinnah Postgraduate Medical Center [JPMC], Karachi, from November 2013 to May 2014. A total of 200 patients of Rheumatoid Arthritis [RA], diagnosed according to the ACR/EULAR criteria 2010, were included in the study. Laboratory investigations including creatinine, ALT, CBC, TSH and fasting lipid profile [LDL, HDL, and Total cholesterol] were done for all patients

Results: Out of 200 patients, 23 [11.5%] were male and 177 [88.5%] were female. The mean age was 36.31 +/- 10.46 years and the mean duration of disease was 3.82 +/- 3.03 years. A total of 107 [53.5%] patients had dyslipidemia, and the commonest abnormality was a low HDL, seen in 83 [41.5 %] patients

Conclusion: Dyslipidemia was frequently observed in Rheumatoid Arthritis. This may be considered as a secondary impact of chronic inflammatory state, seen in RA. Lipid abnormalities should be sought at regular intervals, and corrective actions taken to mitigate increased cardiovascular disease risk

Delayed conventional DMARDs therapy is effective in Rheumatoid Arthritis

Objective: To determine the disease severity in patients with Rheumatoid Arthritis [RA], at baseline and the impact of treatment on disease activity [DA] after six months of disease modifying anti-rheumatic drugs [DAAARDs] therapy

Methods: This prospective study was conducted at the 'Rheumatology Clinic' of Jinnah Postgraduate Medical Centre [JPMC], Karachi, from June 2014 to May 2015. A total of 111 patients, with the diagnosis of RAwere included in the study. DA was calculated using 'Clinical Disease Activity Index [CDAI] score at base line and after 6 months of DMARDs therapy

Results: Out of 111 patients, 17 [15.3%] were male and 94 [84.7%] were female. The mean age was 37.16+/-11.3 years and the mean duration of joint pain was 3.8+/-3.6 years [median 2.5 years]. The mean Hb was 10.8+/-1.8 g/dl and the mean ESR at baseline was 59.63+/-30.9 mm/Hr. The mean initial CDAI score was 18.14+/-11.69; reflecting moderate to severe disease. Of all of these patients, 32 [28.8%] patients received monotherapy, 78 [70.3%] received dual therapy and 1[0.9%] was given triple DAAARDs therapy. The mean ESR was 39.5+/-27.31 mm/Hr, and mean CDAI was 7.36+/-7.8 with a median of 6.0 after 6 months of DAAARDs treatment

Conclusion: The CDAI score and the ESR reflected that majority of our patients were in remission or at low disease activity, after six months of DAAARDs therapy. It is possible to control DA in RA, in a low resource health care facility with conventional DAAARDs therapy. Continuity of treatment was ensured through motivation, regular supply of drugs and regular follow-up

Ankylosing spondylitis: a rheumatology clinic experience

Objective: To determine the frequency, demographics, laboratory and radiological features in patients with Ankylosing Spondylitis

Methods: This is a retrospective analysis of prospectively collected data of patients with a diagnosis of Ankylosing Spondylitis [AS], based on Modified New York criteria. The study was conducted at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre [JPMC], from February 2004 to February 2014. Detailed history, examination and laboratory investigations were recorded in a pre-designed structured proforma. The frequency, demographic characteristics, extra-articular features and associated comorbidities were studied

Results: A total of 603 patients were registered in our Rheumatology Clinic during this period, with a definitive diagnosis of inflammatory rheumatological disorders. Out of these, Ankylosing Spondylitis [AS] was diagnosed in 32 [5.3%] patients. 24 were male and 8 patients were female. The commonest affected age group was between 21-40 years. Majority of the patients belonged to Pathan ethnicity

Conclusion: The demographic features of AS are same as reported in earlier studies from other parts of the world. The predominance of AS in specific ethnic groups is a fact that needs to be studied. Larger studies are required for clarifying the triggers of this disease. It often leads to severe disability, hence an early diagnosis and prompt treatment is required for better disease control and quality of life