Spectrum of systemic sclerosis in patients presenting to a tertiary care hospital in Pakistan

To examine the clinical and laboratory features in the patients of systemic sclerosis coming to a tertiary care hospital in islamabad, pakistan. Observational cross-sectional study. Study was conducted at the department of rheumatology in pakistan institute of medical science between May 2012 and April 2013. Both male [n=5] and female [n=40] patientsof systemic sclerosis [SSc] who presented in the rheumatology outpatient department [OPD] were recruited in the study with informed consent. All the patients enrolled in the study fulfilled the american college of rheumatology [ACR] criteria for diagnosis of SSC. The mean age of the patients was 35.77 +/- 13.10 years. Out of 45 patients, 28 [62%] had limited cutaneous systemic sclerosis[LcSS] and 17 [38%] had diffuse cutaneous systemic sclerosis [DcSS]. Mean duration of disease was found to be 4.72 +/- 4.78 years. Anti-nuclear antibody [ANA] positivity was seen in 80% of the patients. The most common clinical feature of the disease was raynaud's phenomenon [100%] followed by microstomia [98%], sclerodactyly [91%], digital pitting [89%], digital ulcers [82%] and arthralgias [73%]. Among the constitutional symptoms fatigue was the most common one reported by 93% of the patients. Clinical features of systemic sclerosis examined in this cohort of patients were found to be consistent with the findings from other asian countries

Disease activity score in rheumatoid arthritis with or without secondary fibromyalgia

To correlate disease activity score [DAS-28] in the patients with rheumatoid arthritis [RA] with and without secondary fibromyalgia. Comparative cross-sectional study. Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, from November 2011 to April 2012. Patients aged above 16 years diagnosed to have rheumatoid arthritis according to ACR/EULAR criteria 2010 were included in the study. Fibromyalgia [FM] was diagnosed by ACR 1990 criteria. Patients of other autoimmune diseases or psychiatric illnesses were excluded. DAS was determined and compared using t-test with significance at p < 0.05. The mean age of study subjects was 42.9 years. Thirty one out of total 138 patients had fibromyalgia [22.4%]. Female gender was predominant [92.0%]; being 96.8% in patients with and in 88.2% without fibromyalgia. The average DAS score was high [5.3 + 1.5] in fibromyalgia patients compared to those without fibromyalgia [3.9 + 1.2]; this difference in mean value was statistically significant [p = < 0.001]. DAS-28 is a useful tool for assessing rheumatoid arthritis disease status in outpatient setting, however, increased disease activity must be assessed for possible co-existence of fibromyalgia which can spuriously give high DAS value and adversely affect treatment decision

Optimal dose and adverse effects of methotrexate used in rheumatoid arthritis in a tertiary care hospital of Pakistan

To find out optimum dosage and frequency of side effects with methotrexate [MTX] used in rheumatoid arthritis [RA]. Quasi experimental study. Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad from November 2011 to April 2012. Patients of rheumatoid arthritis were treated with methotrexate [MTX]. Dosage of MTX ranged from 7.5 to 30 mg per week. In patients who were tolerating MTX and still had an active disease according to DAS 28 index, their dose was increased further. The dose was increased till the disease activity was controlled or they developed side effects. Each case was followed on monthly basis for a total of 6 months. In the end all the data was analyzed. Out of 103 patients, 78 successfully completed the study. Mean age of patients was 42.4 +/- 12.7 years and disease duration was 4.9 +/- 4.6 years. After 6 months of therapy, it was observed that an average dose of 13.9 +/- 4.2 mg per week of methotrexate was well tolerated by the patients. Side effects included: gastrointestinal 38[48.7%], neuropsychiatric 22[28.2%], dermatological 10[12.8%], reproductive 3[3.8%] and respiratory 1[1.3%]. An average of 13.9 +/- 4.2 mg per week of MTX was found to be the optimum dose which was used and tolerated by most of the patients. Most common adverse effects were gastrointestinal while respiratory were the least common in the study