Extra-articular manifestations of rheumatoid arthritis: a hospital-based study

The frequency of extra-articular manifestations in rheumatoid arthritis [ExRA] differs from one country to another, so we investigated ExRA frequency in a well-defined hospital patient population with rheumatoid arthritis [RA] in Saudi Arabia. We also examined possible predictors of the development ExRA. A retrospective analysis was conducted of all patients diagnosed with RA at a university hospital during a 4-year period. Cases were classified according to the 1987 American College of Rheumatology criteria for RA, and the frequency of ExRA was recorded. Of 140 patients who fulfilled the criteria for the diagnosis of RA, 98 [70%] developed ExRA features. Anemia occurred in 61%, thrombocytosis in 16%, pulmonary involvement in 10%, and renal amyloidosis, vasculitis and Felty syndrome were present in 6%, 2% and 1%, respectively. The mortality rate was high [16%] in patients with ExRA. The predictors for mortality were lung involvement, age over 50 years and kidney amyloidosis. ExRA were present in a substantial proportion of our patients, which lead to a worse disease outcome. Anemia, thrombocytosis and respiratory system involvement were the commonest. Early recognition and treatment are important to decrease mortality

Fatty liver overweight and obese patients in western part of Saudi arabia

the aim of the study is to determine the association of fatty liver diagnosed by ultrasound and obesity in patients presented to King Abdul aziz university hospital. A clinical notes review as performed of all patients undergoing evaluation for fatty liver associated with obesity over one year period between April 2003- to April 2004. Data included age, gender, nationality, BMI serum level of alanine [ALT] and aspartate [AST] transaminases, bilurubin, albumin, HbAIc, cholesterol, triglyceride, LDL, and TSH,and clinical presentation of abdominal pain or the presence of hepatomegaly. A total of 235 subjects were enrolled in the study. The mean age of the study group was 46 +/- 14.4 years with 82 males [35%] and 153 females [65%]. Mean +/- SD aspartate aminotransferase level was 43.9 +/- 6.18.1 units/ L, alanine aminotrnsferease was 36.2 +/- 5.1 units/L. Values of transaminase above the normal range was present in 15 [6.4%] patients only. Whereas values of cholesterol and triglyceride above normal range was seen in [7.2%] 17 patients. Over weight and obesity were the main risk factors in our study group. Mean BMI was 33.6 +/- 7.5 Kg/m2. Obesity with diabetes is the most important risk for fatty liver. 78 [33%] of our study group patient were diabetic. Other risk factors associated with fatty liver are metabolic syndrome which reported in 14.9% and hypothrodism in 3.8% subjects. Conclusion and recommendations: Overweight and obesity is the most important risk factor for fatty liver in Saudi Arabia. It is more prevalent in females. Ultrasound appears to be a useful non- invasive tool to determine liver involvement with fatty liver in obese adult even in the absence of hypertraninasemia. We should encourage obese subjects for gradual weight reduction to improve the liver abnormalities