ABSTRACT
Objective: To determine the frequency of cognitive dysfunction in patients with Systemic Lupus Erythematosus in a Pakistani population, presenting at a tertiary care Rheumatology setting
Methods: This cross-sectional study was conducted at the Division of Rheumatology, Fatima Memorial Hospital, Lahore, from March to June 2016. A total of 43 consecutive patients, who fulfilled the 2012 SLICC [Systemic Lupus International Collaborating Clinics] classification criteria for Systemic Lupus Erythematosus [SLE], were enrolled. Cognitive function was assessed using Montréal Cognitive Assessment [MoCA] questionnaire. Demographic data and disease dynamics were collected in a proforma. Cognitive dysfunction was defined as score < 26/30, adjusted for duration of formal education. SPSS version 16.0 for windows was used to analyse data and to calculate frequency of cognitive dysfunction
Results: Out of 43 enrolled patients, 95.3% were females and 4.7% were males, with mean age of 28.72 +/- 9.25 years and mean formal education duration of 10.98 +/- 3.29 years. The mean disease duration was 24.21 +/- 30.46 months. Anti-nuclear antibodies [ANA] were present in all patients and anti-ds DNA in 93% patients. Cognitive dysfunction according to MoCA score was found in 65.1% [n=28] patients. For patients with disease duration more than two years, cognitive dysfunction was found in 60% patients [p>0.05] and for duration of formal education less than 12 years in 74.1% patients [p>0.05]
Conclusion: In this study, two third of SLE patients had Cognitive dysfunction. Hence, there is an increasing need to recognise and initiate early therapy for this overlooked aspect of SLE with an aim to achieve better quality of life
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Objective: To determine the frequency of dyslipidemia in patients with lupus nephritis and its association with the degree of proteinuria
Methods: This cross-sectional analytic study included 65 patients who fulfilled the ACR [American College of Rheumatology] criteria for SLE and had renal involvement, presenting to the Division of Rheumatology, Fatima Memorial Hospital [FMH], and Lahore from 21[st] Sep 2016 to 20[th] Dec 2016. After 12 hours overnight fast their blood samples were assessed for total cholesterol [TC], triglycerides [TG], high density lipoprotein [HDL] and low density lipoprotein [LDL]. Patient demographic variables [age, sex] and disease characteristics [disease duration, degree of proteinuria, steroid dose] were noted. Patients were categorized into two groups on the basis of degree of proteinuria: having proteinuria >1gm or
Results: Most common lipid abnormality found in our study was hypertriglyceridemia [58.5%]. Total Cholesterol and LDL-C was high in 55.4% and 30.8% subjects respectively. Low HDL was found in 21.5% subjects. Increased frequency of dyslipidemia was noticed in those subjects who had proteinuria >1gm [P value < 0.05]
Conclusion: Dyslipidemia was observed in a high frequency in patients with lupus nephritis and was strongly associated with their degree of proteinuria
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
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
To determine the frequency of patients with early Rheumatoid Arthritis [RA] achieving disease remission and/or low disease activity after 6 months of treatment with conventional Disease Modifying Anti-Rheumatic Drugs [DMARDs] by using treat-to-target approach in routine clinical practice. Descriptive study. Division of Rheumatology, Fatima Memorial Hospital [FMH], College of Medicine and Dentistry, Lahore, from March 2011 to February 2012. Patients with early RA defined as disease duration
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To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis. This cross sectional analytical study was conducted from March 2014 to May 2014. Total 102 cases of Rheumatoid Arthritis [RA] diagnosed as per ACR [American College of Rheumatology] 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire [HAQ] and disease activity score [DAS - 28] while severity of depression was measured by Beck Depression Inventory [BDI] scale II questionnaire. The relationship between depression and disease activity [severity] of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score [DAS 28] of Rheumatoid Arthritis and health assessment questionnaire [HAQ]. Out of 102 patients, 77 [75.5%] were females and 25 [24.5%] males. The mean age of patients was 43.5 +/- 11.9 years and the mean duration of disease was 7.8 +/- 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 [22.5%] and 19 [18.6%] patients respectively. In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly
Subject(s)
Humans , Male , Female , Depression , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Anserine Bursitis [AB] is often associated with Knee Osteoarthritis [OA], and if identified can be easily treated. The objective of this study was to determine the percentage of patients with painful OA knees having accompanying, clinically diagnosed AB. This case series was conducted at Division of Rheumatology, FMH College of Medicine and Dentistry, Lahore from September 18[th], 2009 to February 28[th], 2010. Sixty consecutive rheumatology out-patients meeting the American College of Rheumatology [ACR] criteria for the diagnosis of OA knees. Patients with rheumatoid arthritis, other inflammatory arthritis and trauma were excluded. Patients with OA were examined specifically for any tenderness on the upper medial aspect of the tibia. Radiographic severity of OA knees was scored for each patient by a rheumatologist on a standing X-ray of knees in antero-posterior view. The Kellgren-Lawrence [K-L] grading scheme was used to score the severity of OA. In these 60 patients, AB was clinically present in 23[38]%. Females were 57[95%]. The mean age of patients with AB was 58.6 +/- 8.1 years whereas it was 57.9 +/- 9.2 years in patients without AB [p-value 0.66]. The mean BMI was 30.6 +/- 4.9 in patients with AB whereas it was 30.0 +/- 4.9 in patients without AB [p-value 0.64]. K-L score >/= 3 was present in 61% of the patients with AB Vs 78.4% of the patients of OA without AB [p-value 0.06]. Anserine Bursitis was present in about one third of patients with painful OA knees and its presence was found to be un-related to age, weight and severity of OA
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To determine various types of Juvenile rheumatoid arthritis [JRA] seen in patients visiting our rheumatology clinic. A retrospective review of case records of 91 patients ages
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Three cases of systemic fungal infections in renal transplant patient are described here. One patient had mucormycosis. The second patient had aspergillosis and the patient had candidiasis. All three patients died inspite of treatment. These fungal infections and their treatment is discussed