Prevalence and risk factors of carotid plaques detected with B-mode ultrasound in rheumatoid arthritis

To determine the prevalence of increased intima-media thickness [IMT] of the carotid arteries and its relationships with classical atherosclerosis risk factors and disease features in patients with rheumatoid arthritis [RA]. Twenty female RA patients were included in the study. All patients were subjected to full history taking, thorough clinical examination and laboratory investigations. In addition, intima-media thickness [IMT] and presence of carotid plaques were assessed using carotid B-mode ultrasound. Presence of traditional cardiovascular [CV] risk factors was also investigated. Plaques could be detected in 40% of our patients. There was a statistically highly significant correlation between the presence of plaques and patients' age, disease duration and deformed joint count [p<0.001]. There was also a statistically significant relationship between the presence of plaques and increased ESR and CRP levels, lower body mass index, presence of diabetes mellitus, hypertension, hypercholesterolemia and higher cumulative glucocorticoid doses [P<0.05]. It did not correlate significantly with tender or swollen joint count, subcutaneous nodules or rheumatoid factor positivity. Increased IMT was statistically significantly correlated with age, disease duration, ESR, diabetes mellitus, hypertension and hypercholesterolemia. RA patients with carotid plaques had significantly longer disease duration, higher deformed joint count, higher ESR, higher levels of CRP and higher cumulative glucocorticoid dose than those without plaque. Increased IMT was correlated with the disease duration and ESR. These findings suggest that there is increased risk of atherosclerosis in patients with rheumatoid arthritis especially those with more severe disease and longer disease duration

Evaluation of postural instability in IDDM patients: relationship with staging of diabetic peripheral neuropathy

The objective of this study was to use posturography to assess control of balance under static and dynamic conditions in patients with insulin dependent diabetes mellitus [IDDM], and to investigate relationship between the severity of IDDM peripheral neuropathy [PN] and postural stability. Computerized dynamic posturography [CDP] was used to assess postural stability and to investigate its relationship with staging of PN using sensory Organization Test [SOT]. Sixty IDDM patients were included in the study. According to the clinical and electrophysiological evaluation, patients were divided into four groups: severe, moderate, mild and absent neuropathy. Patients with absent neuropathy were taken as controls for other groups. SOT showed significant dysfunction of somatosensory function of type two diabetic patients with peripheral neuropathy. Posturographic parameters [Dynamic test conditions SOT4, SOT5, SOT6 and Composite Equilibrium score [ES] were all significantly impaired in IDDM patients with PN. ES also showed a direct relationship to the severity of neuropathy. Posturographic study allows a disclosure of the failure of postural control in IDDM patients with PN even in the absence of clinical evidence of postural instability