ABSTRACT
Objective To study the relationship between sleep disorders, pain and C-reactive protein in patients with rheumatoid arthritis. Methods A total of 115 patients with rheumatoid arthritis admitted to the Department of Rheumatology and Immunology of the hospital from March 2014 to March 2016 were selected by convenient sampling. The demographics of each patient were recorded. Each selected patient was assessed for sleep disorder by the Sleep Disorders Questionnaire (SDQ). Pain assessment was performed for each patient using a simplified McGill pain score. At the time of admission, our department nurses was responsible for blood collection and C-reactive protein (CRP), and >10 mg/L was positive for CRP. The 37 questions of sleep disorders were stratified, and each stratification variable was correlated with pain scores. Each patient demographic variable, sleep disorder questionnaire score, pain score, and CRP adjusted for CRP were used to correct the disordered multi-class Logistic regression analysis. Results All patients had a sleep score of 21.2 ± 10.3 and a pain score of 5.4 ± 3.6. There were 9 items in the sleep disorder that were statistically significantly associated with pain scores, including apnea, sleep hypopnea, difficulty falling asleep, limb convulsions during sleep, limb numbness during sleep, nightmares during sleep, wakefulness during sleep, snoring during sleep Pain was significantly positively correlated (r=0.22-0.57, P<0.01). Diabetes, hypertension, sleep disturbance, and pain in the regression analysis were independent factors of CRP (β=0.21-0.33, P<0.05). Conclusions Sleep disorders and pain in patients with rheumatoid arthritis can increase CRP and aggravate the disease. The care process requires special attention to patients with sleep disorders and pain.
ABSTRACT
Objective@#To study the relationship between sleep disorders, pain and C-reactive protein in patients with rheumatoid arthritis.@*Methods@#A total of 115 patients with rheumatoid arthritis admitted to the Department of Rheumatology and Immunology of the hospital from March 2014 to March 2016 were selected by convenient sampling. The demographics of each patient were recorded. Each selected patient was assessed for sleep disorder by the Sleep Disorders Questionnaire (SDQ). Pain assessment was performed for each patient using a simplified McGill pain score. At the time of admission, our department nurses was responsible for blood collection and C-reactive protein (CRP), and >10 mg/L was positive for CRP. The 37 questions of sleep disorders were stratified, and each stratification variable was correlated with pain scores. Each patient demographic variable, sleep disorder questionnaire score, pain score, and CRP adjusted for CRP were used to correct the disordered multi-class Logistic regression analysis.@*Results@#All patients had a sleep score of 21.2±10.3 and a pain score of 5.4±3.6. There were 9 items in the sleep disorder that were statistically significantly associated with pain scores, including apnea, sleep hypopnea, difficulty falling asleep, limb convulsions during sleep, limb numbness during sleep, nightmares during sleep, wakefulness during sleep, snoring during sleep Pain was significantly positively correlated (r = 0.22-0.57, P < 0.01). Diabetes, hypertension, sleep disturbance, and pain in the regression analysis were independent factors of CRP (β=0.21-0.33, P<0.05).@*Conclusions@#Sleep disorders and pain in patients with rheumatoid arthritis can increase CRP and aggravate the disease. The care process requires special attention to patients with sleep disorders and pain.
ABSTRACT
Rituximab has a myriad of clinical uses, ranging from its disease modifying action in rheumatoid arthritis, to its role in chemotherapy for cancer. Being an anti CD20 monoclonal antibody, it controls inflammation by targeting peripheral B cells including those present in the synovium. The use of Rituximab is associated with some side effects such as cytopenias and increased risk of infections such as JC virus reactivation leading to multifocal encephalopathy. The role of Rituximab as an immunosuppressant has been established. However, its association with tuberculosis in endemic countries like India is yet to be understood well. The study was a cross sectional study of the two cases reported about the incidence of tuberculosis in patients receiving infusions of rituximab for rheumatoid diseases. These adverse drug reactions were reported to the nearest pharmacovigilance center through the Vigiflow portal of WHO and were assessed for their causality as per the WHO scale. A 45 year old male patient, a known case of Systemic Lupus Erythematosus, presented to a tertiary care hospital with high grade fever with chills and rigors after which he was diagnosed with pleural effusion due to tuberculosis. The patient was on immunosuppressants which included Rituximab, Mycophenolate Sodium, Prednisolone and Hydroxychloroquine. Rituximab was withdrawn and the remaining medications were continued as per the initial plan. A 19 year old male patient, a known case of dermatomyositis and dilated cardiomyopathy, presented to a tertiary care hospital with complaints of fever with chills and rigors, and breathlessness on exertion which was followed by the diagnosis of miliary tuberculosis. Earlier, the patient was on Rituximab, Cyclophosphamide, Hydroxychloroquine and Prednisolone. Plan of further infusions of Rituximab and Cyclophosphamide was terminated while the remaining medications were continued. Both the patients were put on anti tubercular therapy and are now improving. The association of bacterial infections like tuberculosis with the use of Rituximab is not well understood. However, Rituximab being an immunosuppressant can be considered to be related to this infection. In our case series we readdress this association through a literature review.
ABSTRACT
Introducción: Las enfermedades reumáticas, debido a su evolución natural, provocan afectaciones a la calidad de vida de las personas afectadas por eso es de vital importancia el diagnóstico temprano, el tratamiento oportuno y la prevención. El conocimiento de los adelantos contemporáneos en la atención de salud es una herramienta que ayuda a tomar decisiones clínicas en la práctica diaria, aunque la decisión final sobre el diagnóstico y el tratamiento de un paciente determinado dependerá de las características particulares de cada uno. Objetivo: Discutir algunos avances en la atención de salud a los pacientes con en enfermedades reumáticas. Desarrollo: Debido a que en la práctica clínica se encuentran con frecuencia resultados discordantes, la actualización de temas como este permite socializar los resultados obtenidos con profesionales del gremio, mostrar las estrategias más efectivas o los mejores métodos para el diagnóstico precoz, tratamiento y cuidado de estas enfermedades sobre la base de experiencias asistenciales e investigativas en varias regiones del mundo o en contextos diferentes. Conclusiones: Para controlar mejor las enfermedades reumáticas se necesita una estrategia organizativa en el marco de la cual se aprovechen las fortalezas de la prevención primaria, secundaria y terciaria y que los profesionales, de acuerdo con sus conocimientos y competencias, lleven a cabo acciones que prevengan las graves complicaciones de estas enfermedades. En varios estudios clínicos y ensayos terapéuticos se trabaja con novedosos fármacos biológicos, donde se evalúa su efectividad, se identifican los efectos adversos y se valora la relación riesgo-beneficio(AU)
Rheumatic diseases, due to their natural evolution, bring with them effects on the quality of life of the people carrying this conditions, which is why their early diagnosis, timely treatment and prevention are of vital importance. The knowledge of contemporary advances in health care is a tool to help when making clinical decisions in daily practice, although the final decision on the diagnostic or therapeutic approach of a specific patient will depend on the characteristics of the same. Objective: to discuss some advances in health care in rheumatoid diseases. Development: due to the fact that in clinical practice discordant results are frequently found, the updating of topics such as these allows to socialize the results obtained with professionals of the guild, to show the most effective strategies or the best methods for the early diagnosis, treatment and management of these diseases, on the basis of assistance and research experiences in various regions of the world or in different contexts. Conclusions: for a better control of rheumatic diseases requires a strategy of articulation where the strengths of primary, secondary and tertiary prevention are exploited, where the professionals in accordance with their competence execute actions that prevent the serious complications of these diseases and where properly treat infectious processes in particular, those produced by Streptococcus A, among others. Results of several clinical trials and therapeutic trials work with novel biological drugs, assessing their effectiveness, identifying adverse effects, assessing the risk-benefit ratio and the convenience of these forming part of the treatment scheme against various targets(AU)
Subject(s)
Humans , Male , Female , Primary Prevention , Rheumatic Diseases/prevention & control , Mental Competency , Tertiary Prevention , Early DiagnosisABSTRACT
The incidence of rheumatoid disease is presented which either shows the rarity of the disease in the Philippines or proves the possibility or likelihood of its being underdiagnosed. The symptomatology was briefly described as well as the new concept of the different types of rheumatoid disease. In this article rheumatoid disease is accepted as its proper designation since systemic symptoms are important clinical features and Stills criteria for diagnosis of juvenile rheumatoid arthritis are but a component part of the disease. Five cases from the Free Clinics of the Santo Tomas University Hospital and three from the North General Hospital were reported with arthritis as the prominent symptom and were grouped according to the types proposed by Kelley. (Summary)