Diagnostic accuracy of antinuclear antibodies and anti-double stranded DNA antibodies in patients of systemic lupus erythematosus presenting with dermatological features

Objective: To determine the diagnostic accuracy of antinuclear antibodies [ANA] and anti-double stranded DNA [dsDNA] antibodies in systemic lupus erythematosus patients presenting with dermatological features

Methods: In this cross-sectional study, 82 patients diagnosed as having systemic lupus erythematosus [SLE] per American College of Rheumatology [revised criteria 1997] from October 2012 to October 2013 and fulfilling the study's inclusion criteria were enrolled. These patients were first assessed by the dermatologist for four dermatological features, namely malar rash, discoid rash, photosensitivity and oral ulcers and were than referred to Department of Pathology for assessment of serological markers i.e. ANA and anti-dsDNA antibodies. The diagnostic accuracies of serological markers were analyzed to determine which one of the two serological markers is associated with any of the four dermatological features under observation in our study

Results: Out of 82 SLE patients, 77 [93.9%] patients were females and 5 [6.1 %] were males. Male to female ratio in this study was 1:15. Mean age of patients was 34.91 years and ranged between 8-62 years. Photosensitivity, malar rash, oral ulcers and discoid rash were found in 97.5%, 85.3%, 76.8% and 46.3% patients, respectively. ANA was not found to be statistically significantly associated with any of the dermatological features under observation in our study. However, anti-dsDNA antibodies were strongly associated with photosensitivity 0.024 [p<0.05] and malar rash was 0.003 [p<0.05]

Conclusion: The study proves that anti-dsDNA antibodies have high diagnostic accuracy for photosensitivity and malar rash in SLE patients and can be used alone with confidence in patients presenting with these two dermatological features, without burdening the lab with a lengthy serological evaluation

Identification of laboratory markers of disease activity in rheumatoid arthritis

To identify the laboratory markers of disease activity, by finding relationship of biochemical markers with clinical disease activity measurement in patients suffering from rheumatoid arthritis [RA]. Cross sectional analytical study. Department of Immunology, Armed Forces Institute of Pathology [AFIP], Rawalpindi from January 2009 to January 2010 in collaboration with Fauji Foundation Hospital and Military Hospital Rawalpindi. One hundred patients diagnosed as having rheumatoid arthritis [RA] as per American college of Rheumatology [ACR] revised criteria 1987 and fulfilling the study's inclusion criteria were studied. These patients were assessed clinically according to Simplified Disease Activity Index [SDAI] and divided into three groups which were mild, moderate and severe based on disease activity. These three groups were then assessed for disease activity by Rheumatoid factor [RA factor], Anti Cyclic Citrullinated Peptide antibodies [anti CCP antibodies], Erythrocyte Sedimentation Rate [ESR] and C- Reactive Proteins [CRP]. The association of these laboratory markers with three groups of disease activity was analyzed to detect most sensitive disease activity markers for RA. All the assessed laboratory markers that are RA factor, anti CCP antibodies, ESR and CRP are directly related with RA disease activity and any of them can be used to assess disease activity in RA. However a combination of the tests, analyzed in this study markers maybe used for better prediction of disease activity. The identification of the laboratory markers of disease activity may help physician to diagnose aggressive disease early and evaluate prognosis in RA patients

HLA DR beta1 alleles in Pakistani patients with rheumatoid arthritis

To determine frequencies of HLA DR beta1 alleles in rheumatoid arthritis in Pakistani patients. Cross sectional / analytical study. Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi in collaboration with Rheumatology departments of Military Hospital, Rawalpindi and Fauji Foundation Hospital, Rawalpindi, from January 2009 to January 2010. HLA DR beta 1 genotyping of one hundred Pakistani patients, diagnosed as having RA as per American College of Rheumatology revised criteria 1987, was done. HLA DR beta 1 genotyping was carried out at allele group level [DR beta1[asterisk]01-DR beta1[asterisk]16] by sequence specific primers in RA patients. Comparison of HLA DR beta1 allele frequencies between patients and control groups was made using Pearson's chi-square test to find possible association of HLA DR beta1 alleles with RA in Pakistani rheumatoid patients. HLA DR beta1[asterisk]04 was expressed with significantly increased frequency in patients with rheumatoid arthritis [p <0.05]. HLA DR beta1[asterisk]11 was expressed statistically significantly more in control group as compared to rheumatoid patients indicating a possible protective effect. There was no statistically significant difference observed in frequencies of HLA DR beta1 allele [asterisk]01, DR beta1 allele [asterisk]03, DR beta1 allele [asterisk]07, DR beta1 allele [asterisk]08, DR beta1allele [asterisk]09, DR beta1 allele [asterisk]10, DR beta1 allele asterisk12, DR beta1 allele [asterisk]13, DR beta1 allele [asterisk]14, DR beta1 allele [asterisk]15 and DR beta1 allele [asterisk]16 between patients and control groups. The identification of susceptible HLA DR beta1 alleles in Pakistani RA patients may help physicians to make early decisions regarding initiation of early intensive therapy with disease modifying anti rheumatic medicines and biological agents decreasing disability in RA patients

Influence of gender on disease activity in patients suffering from rheumatoid arthritis

To study the influence of gender on disease activity in patients of rheumatoid arthritis. One hundred patients suffering from Rheumatoid Arthritis [RA], fulfilling the American College of Rheumatology [ACR] revised criteria 1987 and study's inclusion criteria were randomly selected for this study. The influence of gender on disease activity was measured in patients suffering from Rheumatoid Arthritis by the help of Erythrocyte Sedimentation Rate [ESR], C- Reactive Proteins [CRP], Rheumatoid factor [RA factor] and Anti Cyclic Citrullinated Peptide [anti CCP] antibodies. Age and duration of illness in both genders were also compared to find statistically significant differences. The female to male ratio was 7.3:1. Mean age in males was 53 years and in female patients 43 years. Duration of illness was found to have no significant difference in male and female patients. A relative increase in ESR, CRP, RA factor and anti CCP antibodies was observed in the males when compared to females. The median value of ESR in males was 61 mm/hour and in females was 31 mm/hour. The median value of CRP was 31 rng/dl in males and 9.2 mg/dl in females. The median values of anti CCP antibodies were 100 U/ml for the male group and 4.7 U/ml for the female groups respectively. The differences in these parameters between the two groups were found to be statistically significant [p value <0.05]. The median values of RA factor was 43 IU/ml in males and 10 lU/ml in females and the difference was not statistically significant [p value .072]. The prevalence of RA in females is found to be high in this study. Male patients have a significantly later onset of RA and presented with severe disease as compared to female patients suffering from RA