ABSTRACT
Objective: To assess the cardio vascular disease [CVD] risk using framingham risk score and frequency of other co-morbidities associated with rheumatoid arthritis [RA]
Study Design: Cross sectional descriptive study
Place and Duration of Study: Rheumatology department of Fauji foundation hospital [FFH], Rawalpindi. The duration of the study was six months, from Nov 2017 to Apr 2018
Material and Methods: RA Patients between 40 to 80 years of age were selected from rheumatology outpatient department [OPD] at Fauji Foundation Hospital [FFH] Rawalpindi. After 12 hours of fasting, venous blood was taken for total serum cholesterol [TC], triglycerides [TG], low density lipoproteins [LDL], high density lipoproteins [HDL] and ESR [mm/1st hour]. Framingham risk score was calculated using online calculator and it was multiplied by a factor 1.5 as per European League against Rheumatism [EULAR] recommendations to find the correct cardiovascular risk. This gave us 10 year cardiovascular risk in each RA patient
Results: The study included 205 RA patients with a mean age [in years] of 53.12 +/- 10.60. Mean duration of disease [years] was 9.71 +/- 7.1. The commonest comorbidity in RA patients was hypertension found in 82 [40 percent] patients. 100 [48.78 percent] patients were overweight with mean body mass index [BMI] of 25.35 +/- 4.96. Diabetes was found in 38 [18.5 percent] patients. 51 [24.87 percent] patients had high low density lipoprotein [LDL] with mean LDL of 116.75 +/- 29.50 [mg/dL] whereas 88 [42.92 percent] patients had either borderline high or high total cholesterol with mean of 194.64 +/- 30.62 [mg/dL]. 104 [50.73 percent] patients had borderline high triglyceride levels with a mean of 166.48 +/- 63.03 [mg/dL]. 25 [12.2 percent] patients were smokers. 24[11.7 percent] patients had dexa scan proven osteoporosis [ T score <-2.5]. Amongst all, 54 [26.3 percent] patients had low cardiovascular risk, 93 [45.4 percent] had moderate risk and 58 [28.3 percent] had high risk according to Framingham risk score
Conclusion: RA patients have high cardiovascular risk. Other co-morbidities like hypertension, high BMI, diabetes, dyslipidemia, smoking and osteoporosis add to the morbidity and mortality of these patients
ABSTRACT
Objective: To study the safety profile of MTX+LEF combination in patients with active RA at 03 and 06 months
Study Design: Quasi-experimental study
Place and Duration of Study: Rheumatology department, Fauji Foundation Hospital Rawalpindi, from Jun 2015 to Dec 2015
Material and Methods: This quasi-experimental study was conducted at Rheumatology department, Fauji Foundation Hospital, Rawalpindi. Seventy two patients who had an active RA despite optimal dose [20- 25mg/week] of MTX were enrolled and leflunomide 20mg/day was added. Patients underwent clinical and laboratory review at 0, 1, 3 and 6 months to note any adverse effects
Results: Seventy two patients were enrolled with a mean age [years] +/- SD of 51.5 +/- 9.1 and a mean duration of disease [years] of 8.25 +/- 6.1. Patients had active disease at baseline with a mean disease activity score [DAS28] of 6.2 +/- 0.7. At 6 months the most frequent side effects [mostly mild]; were abdominal pain and nausea. Fifty Seven patients [79.1%] continued with the combination therapy. Only 3 patients stopped the treatment temporarily [due to raised ALT and vomiting]. Twelve patients discontinued treatment due to diarrhea, severe oral ulcers, markedly raised ALT; [Each affecting 2 patients] and severe vomiting, abscess, MTX Induced pneumonitis, severe chest infection [each affecting 1 patient]
Conclusion: MTX + LEF combination is safe to use in RA patients if vigilant clinical and laboratory monitoring is ensured