ABSTRACT
Objective: To determine adherence to methotrexate [MTX] therapy in patients with Rheumatoid Arthritis [RA] and to identify factors that promote either adherence or non adherence
Methods: One hundred Rheumatoid Arthritis patients on MTX for at least two months were enrolled. Questionnaire was completed by direct interview. Details recorded were, demographics [age, sex, education, monthly income], disease duration, duration on MTX and current dose. Disease Activity Score on 28 joint counts [DAS 28] at the current visit, concomitant drugs taken and number of doses of MTX missed in the previous 8 weeks were noted. Non adherence was defined as omission of any three or more prescribed doses of MTX in previous 8 week. Patients were asked for the factors that motivated their adherence to MTX as well as factors for non adherence. Presence of side effects due to MTX was also recorded
Result: Non adherence was found among 23% of cases. Patients of low socioeconomic group [p <0.0001] and on MTX for longer duration [p <0.001] had higher non adherence. Non adherent patients had significantly higher disease activity as measured by DAS 28 [p<0.001]. Good counseling and education by the doctor was a strong predictor of adherence [p <0.001]. Lack of affordability [p <0.001]; lack of availability at local pharmacy [p <0.001]; lack of family support [p <0.001] and lack of awareness regarding need and importance of MTX [p < 0.001were found as significant factors for non adherence
Conclusion: MTX non adherence in RA is noted in about one fourth of study group. Various economical and social issues lead to non adherence but good patient education and counseling by doctor could promote adherence in this study group
ABSTRACT
Objective: To determine the pattern of initial clinical manifestations of Systemic Lupus Erythematosus [SLE] and to compare these features with those recorded elsewhere in Pakistan
Methods: This cross-sectional, descriptive study was performed in the Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan, from November 2015 to January 2016. Sixty one patients of SLE diagnosed as per ACR [American College of Rheumatology] 1982 revised criteria, were enrolled. The patients were evaluated for the initial clinical manifestations of SLE. The information was collected on a specially designed proforma and analyzed by using SPSS version 17
Results:Out of 61 patients, 49 [80.3%] were females and 12 [19.7%] males, showing a female to male ratio of 4:1. The mean age of patients was 26.2 +/- 7.9 years. Fatigue was the most common presenting feature in 56 [91.8%] patients, followed by joint pains in 55 [90.2%] and fever in 54 [88.5%]. Renal involvement was found in 46 [75.4%]. Comparison of these presenting features was made with other studies carried out in Northern Pakistan [Islamabad] and in central Punjab [Pakistan]. There were statistically significant differences in fever, fatigue and arthritis between our patients and the other two above mentioned study groups. However, comparison of renal manifestations showed significant difference only with Islamabad study, and not with previous study from central Punjab
Conclusion:In this study, majority of patients presented with combination of fatigue, fever, rash and arthritis. Almost three-fourth of patients had renal manifestations at initial presentation. Therefore, it is important for clinicians to have high index of suspicion for SLE, when patients present with above symptoms
ABSTRACT
A 17 years old boy presented with warm, tender and swollen joints of both upper and lower limbs along with inflammatory back pain and heel pain since 7 months. He had developed continuous high grade fever 3 days ago and complained of marked weight loss during the last 6 months. On examination his liver, spleen and cervical lymph nodes were palpable. X ray of the affected joints revealed osteolytic lesions in tibia, fibula, and humerus and fracture head of femur. Bone marrow examination revealed infiltration by sheets of lymphoid cells which were positive for leukocyte common antigen and CD[20]. The bone biopsy from a lytic lesion in proximal left tibia revealed a similar picture of infiltration with sheets of CD[20] positive lymphoid cells. Need to remember that lymphoproliferative disorders can mimic rheumatological disorders in clinical practice. The case is presented to share the experience of others