Can we predict depression in patients with rheumatoid arthritis?

Depression and rheumatoid arthritis [RA] are disabling conditions that, if untreated, are associated with high morbidity and mortality. Depression is common in RA patients. The aims of this study were to evaluate whether depression could be predicted in RA patients at a tertiary- care center and to determine the clinical factors associated with the occurrence of depression in RA patients. Cross-sectional study King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2008 to December 2010. Two hundred patients with RA None Depression was evaluated using the Beck Depression Inventory, and disease activity was evaluated using the 28-Joint Disease Activity Score index. Risk factors that may predispose to depression have been evaluated. The prevalence of depression in RA patients was 18%. Depression was more common in RA patients with high disease activity [56%] than in those with low disease activity [5%]. There was a significant correlation between depression and RA disease activity [r = 0.366, p = 0.001]. Patients with high disease activity had twice the risk of developing depression relative to patients with low disease activity [OR = 2.41 [95% CI 1.09-5.34]]. Whenever a physician found a state of high disease activity in a patient, depression could be predicted to occur 73% of the time. Depression could be expected among RA patients with high disease activity. Rheumatologists should consider assessing the psychological status of their patients, especially those with high disease activity, to optimize medical treatment and to ensure adherence to medication

Central nervous system manifestation in patients with SLE: a 12-year retrospective chart review at a tertiary center

Central nervous system manifestation of systemic lupus erythematosus [CNS-SLE] is a common complication, which is clinically associated with patient morbidity and mortality. To determine the CNS-SLE manifestations and to determine the predictors of death among the studied cohort. Retrospective. King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. All patients diagnosed with SLE were identified, using a computerized retrieval system, for the period January 1, 2000 to May 31, 2012. Data pertaining to demographics, risk factors for cerebrovascular accident and CNS manifestations were collected from the patients' medical charts. CNS-SLE and the predictors of death among the studied cohort. The study included 307 patients [91% females] with a mean [M +/- SD] age of 35.6 +/- 13 years and mean disease duration of 9 +/- 5 years. CNS manifestations were found in 70 patients [23%]. The commonest was stroke in 25 patients [35%] and aseptic meningitis, cerebritis, recurrent stroke and cavernous sinus thrombosis occurred only in one patient each [1.4%]. The most significant predictors for CNS involvement were hyperlipidemia [OR = 5.48] followed by positive Antiphospholipid antibodies [OR = 2.74]. By univariate analysis CNS involvement, negative anti-nuclear antibody [ANA] and combined low complements were found to be predictors of death. Clinical studies have shown varying results with respect to the prevalence of CNS involvement in SLE. Antiphospholipid antibodies [APA] is a known risk factor whereas the role played by hyperlipidemia in escalating the risk of CNS involvement in SLE warrants further clinical evaluation

Vitamin D deficiency in patients with systemic lupus erythematosus

Hypovitaminosis D is common in the general population Many studies that have been conducted to show the association between vitamin D deficiency and systemic lupus erythematosus [SLE] reveal that deficiencies in vitamin D are common in this group of patients. Our aim was to study the relationship between 25 [OH] D and disease activity in patients with SLE, Retrospective cohort study of patients with SLE who were followed up at King Abdulaziz University Hospital, Jeddah, from January 2007 to November 2010. Demographic and clinical data were recorded and the 25 [OH] D levels of the patients were measured. Chi square tests. Students t-test, ANOVA and Pearson tests were used for data analysis. ANOVA test was followed by Bonferroni correction. A p-value <0.05 was considered significant. Ninety-five patients with SLE were enrolled in the study. The levels of 25[OH]D were significantly lower in patients with active SLE [n=41; 43%] than in those with inactive disease [n=54; 57%; p=0, 04]. The mean [SD] levels were 22.3 [14] nmol/L for patients with active disease against 25.0 [14] nmol/L for patients with inactive SLE. No correlation was detected between 25 [OH] D levels and disease activity score evaluated by SLEDAI-2K By Pearson correlation, a significant negative correlation existed between 25 [OH] D and anti ds-DNA [r=-038; p<0.001]; a positive correlation existed between 25 [OH] D levels and C4 [r=0.25; p=0.25]. By chi square testing, azathioprine treatment [OR=3.5], low C4 [OR= 2.23], low C3 [OR=1.92], and active disease [OR=1.6] were associated with 25[OH] D deficiency in SLE patients. Vitamin D deficiency is frequent in patients with SLE, Patients with SLE have a higher risk of developing 25[OH] D deficiency in the presence of low serum C3 and C4 levels, and high anti-dsDNA levels

Vitamin D deficiency in rheumatoid arthritis prevalence and association with disease activity in Western Saudi Arabia

To estimate the prevalence of low serum vitamin D level [25[OH]D] in patients with rheumatoid arthritis [RA] compared with healthy controls, and to analyze the association between 25[OH]D and disease activity. This retrospective analysis included 100 RA patients [85% women] and 100 controls, not on vitamin D supplements from January 2010 to December 2011 at a tertiary care center at the Department of Internal Medicine, King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia. Disease activity was measured using the disease activity score index [DAS28]. According to the DAS28 score, RA patients were divided into 3 groups as high, moderate, and low disease activity. Patients' serum 25[OH]D was measured in a centralized laboratory. The mean 25[OH]D in patients with RA was similar to the control group [32.3 +/- 14.4nmol/L] versus [31.4 +/- 16.4nmol/L] [p=0.41]. Patients with high disease activity had the lowest 25[OH]D levels [18.25 +/- 8.3nmol/L] compared with patients with moderate [35.13 +/- 15.2nmol/L] and low [38.05 +/- 7.3nmol/L] disease activity [p<0.001]. Serum 25[OH]D was negatively correlated with DAS28, which was statistically significant [r= -0.42, p<0.0001]. Serum vitamin D levels in RA patients were similar to the healthy control group. However, significantly lower 25[OH]D values were found in patients who are poorly responding to treatment, and not in a state of disease remission.

Adverse effects of low dose methotrexate in rheumatoid arthritis patients. A hospital-based study

To evaluate the side effects of methotrexate [MTX] in rheumatoid arthritis [RA] patients and to evaluate the possible predisposing variables. A retrospective analysis conducted for all patients diagnosed with RA and treated with MTX over 3-years [January 2006 to December 2008] at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Frequency of MTX side effects and the predictive variables were recorded and analyzed statistically. Out of 116 RA patients, 71 patients used MTX. The most frequent side effect was gastrointestinal [GIT] disturbance in 31%, followed by central nervous system symptoms in 18%, hepatotoxicity in 14%, stomatitis and alopecia in 10% each, macrocytosis 7%, fever, malar rash and pancytopenia in 4%, and MTX-induced lung injury with increase in the size of rheumatoid nodule in 1% of patients. By Logistic regression analysis, renal impairment was the most significant variable increasing the risk of the side effects [OR=7.14, p<0.05]. Other associated variables were male-gender, non-Saudi nationality, smoking, steroids use, hypoalbuminemia, and the presence of extra-articular manifestations. Methotrexate is the most commonly drug used in the treatment of RA. Gastrointestinal disturbances were the most common side effect while lung involvement was the least. The impact of each clinical variable on MTX side effects requires paying more attention on the disease management as not all variables can be considered as risk factors

value of single complement testing in SLE

Complement proteins are important in humoral immunity. In the hospital setting, complement component 3 [C3] and 4 [C4] are requested to determine the etiology of certain illnesses in addition to monitoring disease activity, particularly systemic lupus erythematosus [SLE]. The aim of this study was to evaluate the correlation between C3 and C4, and to evaluate the significance of ordering both tests in patients with SLE during follow up. Retrospective review King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia Complement levels were evaluated over a six month period [January 1, 2009 - June 30, 2009]. Patient's sera were classified into three groups: Group I with SLE, Group II with rheumatoid arthritis [RA] and Group III with other rheumatological and non-rheumatological disorders. Intervention: Serum level test Main Outcome Measure: The correlation between C3 and C4 One hundred and one [101] blood requests for C3 and C4 were evaluated. C4 hypocomplementemia was detected in 47/60 patients [78.3%], 9/16 patients [56.3%] and 1/25 patient [4.4%] in Groups I, II and III respectively. This was in contrast to C3 hypocomplementemia which was detected in 21/60 patients [35%], 3/16 patients [18.8%] and 1/25 patient [4%] in Groups I, II and III respectively. There was a simple linear regression between C3 and C4 level [p < 0.001]. C4 hypocomplementemia is more frequently found than C3 hypocomplementemia in SLE patients. A correlation exists between the two tests, suggesting the adequacy of ordering a single test [C4] for the purpose of cost effectiveness

Medical conditions associated with a positive anti-double-stranded deoxyribonucleic acid

To explore the associated diseases with positive anti-double stranded [ds] DNA other than systemic lupus erythematosus [SLE], and to determine an association if any, between its level in non-SLE causes. This is a retrospective review of all patients with positive anti-dsDNA assay [more than 200 IU/ml] tested for any underlying etiology from January to December 2007 at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Two hundred and twelve patients with anti-dsDNA antibody testing were evaluated. Of these, 124 patients had SLE [58.5%], while 88 patients [41.5%] had other diseases. Representing non-SLE diseases were: rheumatological disorders in 29 patients [33%], infections in 11 [12%], and malignancy in 6 patients [7%]. Strong positive results [>800 IU/ml] were found in only 8 patients [4%] with diagnoses of antiphospholipid antibody syndrome, tuberculosis, osteomylitis, thymoma, lymphoma, sarcoidosis, and 2 autoimmune hepatitis patients. There was a statistically significant association between highly positive anti-dsDNA testing and rheumatological disorders. Although positive anti-dsDNA test is common in SLE patients, other diseases should be considered when the anti-dsDNA level is equivocal, and the clinical criteria are not in favor of SLE

Extra-articular manifestations of rheumatoid arthritis: a hospital-based study

The frequency of extra-articular manifestations in rheumatoid arthritis [ExRA] differs from one country to another, so we investigated ExRA frequency in a well-defined hospital patient population with rheumatoid arthritis [RA] in Saudi Arabia. We also examined possible predictors of the development ExRA. A retrospective analysis was conducted of all patients diagnosed with RA at a university hospital during a 4-year period. Cases were classified according to the 1987 American College of Rheumatology criteria for RA, and the frequency of ExRA was recorded. Of 140 patients who fulfilled the criteria for the diagnosis of RA, 98 [70%] developed ExRA features. Anemia occurred in 61%, thrombocytosis in 16%, pulmonary involvement in 10%, and renal amyloidosis, vasculitis and Felty syndrome were present in 6%, 2% and 1%, respectively. The mortality rate was high [16%] in patients with ExRA. The predictors for mortality were lung involvement, age over 50 years and kidney amyloidosis. ExRA were present in a substantial proportion of our patients, which lead to a worse disease outcome. Anemia, thrombocytosis and respiratory system involvement were the commonest. Early recognition and treatment are important to decrease mortality