The expression of rheumatoid arthritis in Kuwaiti patients in an outpatient hospital-based practice.

OBJECTIVE: To describe the characteristic clinical, serologic and radiological features of rheumatoid arthritis (RA) in Kuwaiti patients in a tertiary outpatient hospital-based practice. SUBJECTS AND METHODS: An outpatient hospital-based study on 100 consecutive consenting Kuwaiti patients with RA was done at the Rheumatology Unit, Al-Amiri Hospital, one of the main teaching hospitals in Kuwait. The study group included 11 men and 89 women. The duration of their disease ranged from 2 to 30 years with a mean duration of 10.7 (SD 7.5) years. The age at disease onset ranged from 21 to 71 years with a mean age of 39.1 (SD 11.2) years. RESULTS: Joints most commonly involved in RA were metacarpophalangeal, wrist, knee, and proximal interphalangeal joints. Extra-articular manifestations were present in 24 patients; the most common was the sicca complex in 14 individuals. Rheumatoid factor seropositivity was found in 60 patients and erosive arthropathy in 42 patients. CONCLUSION: The findings indicate a low incidence of radiological erosive arthropathy in Kuwaiti patients. The sicca complex was the most common extra-articular manifestation of RA in these patients.

Hyperhomocysteinaemia and risk of thrombosis in systemic lupus erythematosus patients.

Hyperhomocysteinaemia is strongly associated with increased relative risk of occlusive vascular disease, mainly of the carotid and coronary arteries. The aim of our study was to assess whether raised plasma homocysteine is a risk factor for thrombotic events in patients with systemic lupus erythematosus (SLE), a condition known to be associated with premature atherothrombotic complications. The study included 34 consecutive consenting SLE patients who were seen in the Rheumatology Unit of Al-Amiri hospital, one of the main teaching hospitals in Kuwait. Twenty consenting healthy subjects were included in the control group. Twenty-four patients were grouped as SLE without thrombosis and 10 had different types of thromboses. Vitamin B(12), folate, anticardiolipin antibodies (IgG and IgM), activated partial thromboplastin time (APTT) and total homocysteine level were measured for both patients and controls. A raised homocysteine concentration was defined as plasma homocysteine level above 9.4 mmol/l. Hyperhomocysteinaemia was found in 21 (61.8%) SLE patients. Low levels of folate and vitamin B(12) were significantly associated with high concentrations of plasma homocysteine (r = -0.35 and -0.39, respectively, P<0.01). SLE patients with elevated homocysteine concentration have a threefold increase in odds ratio of thrombotic events after adjusting for other risk factors (male sex, shortened APTT, treatment with prednisone, low folate and vitamin B(12) levels). We concluded that homocysteine is an independent risk factor for thrombosis in patients with SLE and is potentially modifiable.

Urine levels of type 1 collagen cross-linked N-telopeptides and deoxypyridinoline correlate with disease activity in rheumatoid arthritis.

OBJECTIVES: The aim of this study was to find out whether spot urinary concentrations of type 1 collagen cross-linked N-telopeptides (NTx) and deoxypyridinoline (Pyrilinks-D) can differentiate between active and inactive disease in rheumatoid arthritis (RA) and to investigate the extent to which they correlate with indices of disease activity. METHODS: Using enzyme-linked immunosorbent assays, the concentrations of NTx and Pyrilinks-D were estimated in spot urine samples from 25 females with active disease, 25 females with inactive disease, and in 25 controls. RESULTS: In Patients with active disease, urinary concentrations of NTx and Pyrilinks-D were significantly higher (p < 0.01) than in those with inactive disease or in healthy controls. In active disease there were significant positive correlation between urinary NTx and ESR, the swollen joint count, the tender joint count, and the patient's global assessment.

Rheumatic manifestations and immunological abnormalities in patients with chronic hepatitis C. A study in the Middle East.

Hepatitis C virus infection and rheumatic disorders are both common in the Middle East and share many clinical and immunological manifestations, raising diagnostic problems. We compared the prevalence of extrahepatic clinical manifestations and immunological disorders in 40 patients with chronic hepatitis C and in 42 carefully matched healthy controls. Polyarthralgia or polyarthritis was the most common rheumatic manifestation (35%) in the cases, followed by cutaneous vasculitis (15%). Glomerulonephritis and xerophthalmia were uncommon, and none of the cases had systemic vasculitis. Immunological abnormalities included serum rheumatoid factor (47.5%), cryoglobulins (30%), and one or more antitissue antibodies (37.5%). The prevalences of polyarthralgia, cutaneous vasculitis, rheumatoid factor, cryoglobulinemia, and anti-tissue antibodies were significantly higher in the hepatitis C group than in the control group. Our data suggest that patients in the Middle East who present with features of rheumatic or autoimmune diseases should be screened for hepatitis C.

Hughes syndrome: a common problem in Kuwait hospitals.

The objective was to study antiphospholipid antibody syndrome (APS or Hughes syndrome) in two major teaching hospitals in Kuwait. patients with suspected Hughes syndrome were investigated with tests for anticardiolipin antibodies (aCL) and lupus anticoagulants (LAC) over 1 yr. Diagnosis was considered confirmed if significant levels of either or both antibodies with no obvious cause (primary), or with systemic lupus erythematosus (SLE) or SLE-like illness (including SLE serology) (secondary) were present. Twelve (37.5%; seven females, 58%) primary and 20 (62.5%; 18 females, 90%) secondary Hughes syndrome patients were seen during this period. patients were Kuwaiti, Middle-Eastern and North-African Arabs (29). Filipinos (2) and White (1). None were from the Indian subcontinent. The main presentation was thrombosis in 75% (arterial in 25% and venous in 50%), and recurrent abortions in 50% of married women. Haematological and dermatological manifestations were limited entirely to the secondary variety, seen in 25% and 19%, respectively. Clinical manifestations were severe, leading to death in one, intensive-care management in 31% and with partial or complete warfarin resistance or brittleness in 25%. Neurological/eye and cardiac manifestations were not seen, as these patients may be attending separate speciality hospitals for these diseases in Kuwait. The approximate prevalence of this syndrome was 2.66/1000 admissions in medical wards. Projected to the total referral areas of the two hospitals, an approximate figure of 52 patients/million population/year was obtained. Hughes syndrome was a common problem among Arabs, Filipinos and possibly Whites in Kuwait. Its manifestations were severe, often requiring intensive-care management, and in one case it was fatal. Patients from the Indian subcontinent were conspicuous by their absence, despite the fact that they were well represented in all other rheumatic disease groups. Ethnic and/or geographical factors could be important in this syndrome. To the best of our knowledge, this is the first report of Hughes syndrome from the Middle East.

Nifedipine induced bradycardia in a patient with autonomic neuropathy.

An 80 year old diabetic male with evidence of peripheral and autonomic neuropathy was admitted with chest pain. He was found to have atrial flutter at a ventricular rate of 70/min which slowed down to 30-40/min when nifedipine (60 mg) in 3 divided doses, during which he was paced at a rate of 70/min. This is inconsistent with the well-established finding that nifedipine induces tachycardia in normally innervated hearts. However, in hearts deprived of compensatory sympathetic drive, it may lead to bradycardia.