Clinicopathological study of cutaneous vasculitides

To study the different patterns of cutaneous vasculitides along with their underlying etiologic factors and to assess the clinicopathological correlation. A cross sectional study was conducted on 30 consecutive patients, histologically diagnosed as cutaneous vasculitis in the department of dermatology and venereology, BSMMU, Dhaka. All patients were subjected to a baseline workup consisting of complete hemogram, serum-creatinine levels, liver function tests, chest X-ray, urine [routine and microscopic] examination besides antistreptolysin O titer, antinuclear antibody assay, rheumatoid factor assay, antineutrophilic cytoplasmic antibodies and hepatitis B and C. Histopathological examination was done in all patients while immunofluorescence was done in 9 patients. Out of a total of 30 patients diagnosed histologically as cutaneous vasculitis, 22 were classified as cutaneous small vessel vasculitis [CSVV], 6 as Heinoch-Schonlein purpura, and one each as urticarial vasculitis, and Behcet's syndrome. Approximately 30% of the patients had a significant drug history, 23.3% were attributed to infection. No cause was found in 46.7% cases. Only 9 patients could undergo direct immunofluorescence [DIF], out of which 4 were positive for vasculitis. Cutaneous small vessel vasculitis was the commonest type of vaculitis presenting to the dermatology outpatient department. The workup of patients with cutaneous vasculitis includes detailed history, clinical examination and investigations to rule out multisystem involvement followed by skin biopsy and DIF at appropriate stage of evolution of lesions. Follow up of these patients is very essential as cutaneous manifestations may be the formc fruste of serious systemic involvement

Efficacy and safety of leflunomide in psoriatic arthritis

To compare the effectiveness and safety of leflunomide with methotrexate [MTX] in the treatment of psoriatic arthritis. An open, randomized clinical trial was conducted in 32 patients of psoriatic arthritis at the department of Dermatology and Venereology and Rheumatology wing of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from June 2002 to December 2003. 17 patients of leflunomide group were treated with oral leflunomide l00 mg for first three days followed by 20 mg daily. 15 patients of MTX group were treated with methotrexate 10 mg weekly. Both groups were allowed to take ibuprofen, maximum 1400 mg daily. For both groups hematological and biochemical tests were done at baseline and at every follow-up. All patients were assessed clinically for articular features, psoriasis area and severity index [PASI] for effectiveness and for side effects of drugs was listed for safety measure. Sixteen patients of leflunomide group and 14 of MTX group completed 24 weeks follow-up. Male: female ratio was 14:2, in leflunomide and 13:1 in MTX group. Significant improvement was observed in tender joint count, swollen joint count, joint tenderness index, NSAIDs score and PASI score in both groups. Adverse effects in both groups were tolerable and did not require any withdrawal or dose reduction. Asthenia, alopecia, nausea and vomiting were common side effects noticed by patients but overall there was no significant difference in between two groups. Leflunomide appears to be as effective and safe as methotrexate in psoriatic arthritis