Résumé
Objectives: To describe the prevalence of rheumatoid nodules [RN] in patients with rheumatoid arthritis [RA] and to compare their features with those of patients without RN
Subjects and Methods: Adult RA patients [n = 952] in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry
Results: Of the 952 RA patients, 22 [2.3%] had RN and 930 [97.7%] did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 [50%] vs. 326 [35.1%], p = 0.016. There was no difference in rheumatoid factor [RF] or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 [36.4%] vs. 152 [16.3%], p = 0.025, a higher mean score on the visual analogue scale pain [3 +/- 2.9 vs. 2 +/- 2.7, p < 0.001], more tender joints [6.4 +/- 8.8 vs. 4.2 +/- 7.2, p = 0.001], a higher patient global assessment of disease activity [3.3 +/- 2.7 vs. 2.3 +/- 2.7, p < 0.001], and more deformities, i.e. 3 [13.6%] vs. 74 [8%], p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN [p = 0.08]. Patients with RN had a low disease activity [means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4], similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN [i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001]
Conclusion: In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy
Résumé
Takayasu arteritis [TA] is a chronic inflammatory disease of the aorta and its major branches. It most often affects young women in the second and third decades of life. TA has been reported in children as young as six-month-old to adults of all ages. The initial complaints may be non-specific constitutional symptoms [e.g., fever, weight loss, lethargy]. Because these complaints lack specificity, the correct diagnosis may be delayed for months or years. There have been reported cases of TA associated with other auto-immune diseases as well as cases of atypical initial localizations [e.g., pulmonary] which had a late onset of disease. We present a case of TA in a 52-year-old Srilankan woman referred from the polyclinic with a chief complaint of headache of three months duration and arthralgia of 15-year duration