Anti-cyclic citrullinated peptide antibodies as a tool in diffrentiating patients with rheumatoid arthritis from patients with chronic hepatitis C infection-associated polyarticular involvement

To assess the utility of anti-cyclic citrullinated peptide [anti-CCP] antibodies in distinguishing between patients with rheumatoid arthritis [RA] and patients with polyarticular involvement associated with chronic hepatitis C virus [HCV] infection. All the patients enrolled in this study were examined in the outpatient department of medicine unit at Lady Reading Hospital Peshawar from February to December 2010. Serum anti-CCP antibodies and rheumatoid factor [RF] were evaluated in 29 patients with RA, 13 patients with chronic HCV infection a associated with articular involvement and 35 patients with chronic HCV infection without any joint involvement. Anti-CCP antibodies were detected in18 of 29 [62.1%] patients with RA, 7 of 13[53.8%] patients having HCV with RA like arthropathy but not in a single patient with chronic HCV infection with no articular involvement. Conversely, RF was detected in 25 of 29 [86.2%] patients with RA, 9 of 13 [69.2%] patients with HCV-related RA like arthropathy and 8 of 31 [22.9%] patients with HCV infection without joint involvement. This concludes that anti-CCP antibodies can be useful in discriminating patients with RA from patients with HCV-associated arthropathy

relationship between the clinical manifestations and the presence of anti cyclic citrullinated peptide antibodies in very early rheumatoid arthritis

To establish whether the clinical presentation of anti-cyclic citrullinated peptide [Anti-CCP] antibodies and negative disease are distinct at the earliest clinically apparent phase of disease. Patients were seen in outpatient department of Lady Reading Hospital Peshawar from February 2009 to February 2011. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for [RA] in the beginning or at some point during an 18 month follow-up. Data were collected on demographic variables and joint symptoms [tender and swollen joint counts]. C- reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor and Anti-CCP antibodies status were measured. 110 patients were included [57 were Anti-CCP antibodies positive]. The Anti-CCP antibodies positive and negative groups were comparable in terms of demographic variables, inflammatory markers,tender and swollen joint counts and 1987 ACR classification criteria. Rheumatoid arthritis factor was detected more in Anti-CCP antibodies positive patients as compared with Anti-CCP antibodies negative patients. [83.3% vs. 35.8%]. There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in Anti-CCP antibodies positive patients [56.1% vs.17.5%]. Patients with and without Anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into Rheumatoid arthritis

Short-term effectiveness of methotrexate in the treatment of active rheumatoid arthritis

To determine the effectiveness of 6-month treatment with methotrexate in a dose range of 5-15mg once weekly in 103 patients with active rheumatoid arthritis. This descriptive study was conducted in outpatient department of Medical B unit Lady Reading Hospital from October 2008 to August 2009 and included 103 active rheumatoid arthritis patients who received methotrexate in a dose range of 5-15mg once weekly for 6 months. The primary efficacy endpoint was a >/= 20% response according to the American College of Rheumatology response criteria 20 and disease activity score 28 after 6 months. Female patients made up 51.5% of the study population while males were 48.5%. The mean age was 46.1 years and the mean disease duration was 10.90 +/- 3.42 years. According to the disease activity score 28, 30.1% of patients had good while 38.8% had a moderate response. 31.1% were non-responders. Mean improvement in tender joint count were -8.3 +/- 4.59 [from baseline of 15.54 +/- 5.85] and in swollen joint count were -7.37 +/- 3.98 [from baseline of 10.59 +/- 4.96]. ESR improved to 15.24 +/- 10.42 from baseline of 58.7 +/- 11.16 and physical global assessment improves to 34.42 +/- 20.43 from baseline of 66.21 +/- 10.58. At 6 months, the rate of American college of rheumatology response criteria 20 was 68.2%. Treatment related adverse events were reported in 27.2% of patients. The study showed a favorable effectiveness for methotrexate in a dose range of 7.5-15mg once weekly

Short-term effectiveness of leflunomide in the treatment of active rheumatoid arthritis

To measure the effectiveness of 6-month treatment with Leflunomide in patients with active rheumatoid arthritis. This descriptive study was conducted in Medical B Unit, Lady Reading Hospital Peshawar from August 2008 to August 2009 and included 103 active Rheumatoid Arthritis patients who received Leflunomide 20mg daily for 6 months. The primary effectiveness endpoint was a >/= 20% response according to the American College of Rheumatology criteria 20 and disease activity score 28 response after 6 months. All the 103 selected patients were treated with Leflunomide. The mean age was 56.12% +/- 4.796 years. According to the disease activity score 28, 46.6% of patients had a good response, 41.7% had a moderate response and 11.7% were non-responders. Improvements in tender joint count were-8.63 +/- 3.418 [from baseline of 15.74 +/- 2.9], in swollen joint count were-4.26 +/- 3.058 [from baseline of 9.34 +/- 2.383], Erythrocyte Sedimentation Rate improves to 14.74 +/- 11.527 from baseline of 60.58 +/- 9.608 and physical global assessment improves to 17.38 +/- 15.35 from baseline of 70.24 +/- 7.933. The American College of Rheumatology criteria 20 response criteria show improvement in 87.4% patients. Treatment related adverse events were reported in 23.3% of patients. 17% of total patients discontinue the due to non compliance and side effects. This 6-month study carried out under daily routine practice conditions showed a favorable treatment response for Leflunomide in a dose of 20 mg daily in a typical sample of Rheumatoid Arthritis patients

Dural sinus thrombosis: frequency and imaging diagnosis

To determine the frequency of dural sinus thrombosis [DST] and highlight diagnostic importance of its subtle imaging findings in patients presenting for workup of their varied neurologic complaints and symptoms. Observational case series. Study Period: June 2002- May 2005. All new patients undergoing cranial computed tomography [CT] and magnetic resonance [MR] imaging were included in this study which consisted of 1676 consecutive subjects with 1780 examinations. These were reviewed in real time on monitors [as they were being performed] for evidence of DST before printing of hard copies prior to disposition of patients. CT studies were performed on Toshiba Auklet scanner with 5 mm thick axial slices and 1cm inter slice gap. MR imaging was performed on 1.5 Tesla Toshiba Visart scanner with T1 and T2 weighted [T1 and T2W], spin echo, FLAIR and post contrast T1 weighted [T1W] imaging in multiple planes. Subjects with inconclusive but suspicious conventional imaging [CT, MR] were evaluated by magnetic resonance venography [MRV]. Patients presenting for follow-up of established diagnoses including neoplasia, arterial infarcts, hypertensive parenchymal haemorrhages and postsurgical status were excluded. Delta and empty delta were the most commonly observed CT and MR signs diagnostic of DST on pre and postcontrast images and were present in 43 patients. Thrombus was also directly visible within lumen of superior sagittal, transverse and sigmoid sinuses on T1W MR images in 21 individuals. In 12 patients, these signs were either absent or too subtle to be conclusive. However, presence of venous haemorrhagic or non-haemorrhagic brain parenchymal edematous lesions prompted further evaluation by MRV, which confirmed presence of DST in these subjects as well. As a result, a total of 55 patients with a frequency of 3.3% were diagnosed and treated for DST. Frequency of DST in patients with neurological complaints and symptoms is 3.3%, which is significantly higher than has been clinically suspected or recognized. On routine CT and MR studies, diagnostic imaging signs, while highly specific for DST, can be absent or may be masked due to technical factors or associated complications. Presence of brain parenchymal venous haemorrhagic or non-haemorrhagic edematous lesions should prompt judicious and close scrutiny of images on monitors by changing viewing parameters to detect subtle signs of DST. If still in doubt, MRV must be pursued for definitive diagnosis