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1.
Int J Rheum Dis ; 21(5): 1010-1017, 2018 May.
Article in English | MEDLINE | ID: mdl-27455886

ABSTRACT

OBJECTIVE: To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patients in split doses at 2-3 days' interval, would result in equal or better efficacy, tolerability and compliance, without increasing toxicity compared to single weekly dose given orally or parenterally. MATERIALS AND METHODS: One hundred and thirty-five patients fulfilling the American College of Rheumatology (ACR) 2010 criteria for RA, on 7.5 mg of MTX weekly orally, with the Simplified Disease Activity Index (SDAI) > 11 were enrolled for a 24-week period. Patients were randomly divided into three groups and were given MTX: Group 1 7.5 mg twice or thrice weekly orally, Group 2 15 mg or 22.5 mg in a single dose weekly orally and Group 3 15 mg or 22.5 mg in a single dose weekly as an intramuscular injection. The primary outcomes were low disease activity (LDA) and mean change in SDAI at week 24, whereas secondary outcomes included remission, adverse events and compliance. RESULTS: At week 24, adherence to treatment was maximum in Group 1, 69% (P = 0.09). In intention-to-treat analysis at 24 weeks, Group 1, 49%, Group 2, 36% and Group 3, 47% achieved LDA (P = 0.4). There was significant difference in mean change in SDAI at week 24 from baseline (P = 0.008) among the groups. Group 3 patients were more uncomfortable with the mode of administration of MTX (P = 0.003). There was no significant difference in adverse events. CONCLUSION: Oral split doses of MTX are better than an oral single dose and similar to parenteral MTX in terms of efficacy.


Subject(s)
Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Methotrexate/administration & dosage , Administration, Oral , Adult , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Drug Administration Schedule , Female , Humans , India , Injections, Intramuscular , Intention to Treat Analysis , Male , Medication Adherence , Methotrexate/adverse effects , Middle Aged , Remission Induction , Severity of Illness Index , Time Factors , Treatment Outcome
2.
Int J Rheum Dis ; 21(11): 1933-1939, 2018 Nov.
Article in English | MEDLINE | ID: mdl-28608433

ABSTRACT

BACKGROUND/PURPOSE: To compare the performance of Disease Assessment Score of 28 joints - C-reactive protein (DAS-28-CRP), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) composite measures to assess status of patients with rheumatoid arthritis (RA) on methotrexate, versus DAS-28 CRP as the gold standard. METHODS: One hundred and thirty-five patients with RA as per the 2010 American College of Rheumatology/European League Against Rheumatism criteria were included in the prospective study. The disease activity was assessed at baseline and at every 6 weeks for 24 weeks, by DAS-28-CRP, CDAI and SDAI. Patients were divided into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28-CRP, CDAI and SDAI. A Spearman correlation between composite measures and inter-group comparison of the measures was performed. RESULTS: There was an excellent positive correlation between DAS-28-CRP and CDAI (linear weighted κ baseline - 0.545), DAS-28 CRP and SDAI (linear weighted κ - 0.689) at baseline. There was moderate agreement between DAS-28-CRP and CDAI (linear weighted κ final visit - 0.458) at final visit. There was moderate correlation between SDAI and DAS-28-CRP at final visit (linear weighted κ - 0.470). However, correlation between CDAI versus SDAI remained excellent at baseline and final visit. Patients in remission as per DAS-28-CRP had significantly more residual disease activity compared to SDAI and CDAI remission criteria. CONCLUSION: The study shows an excellent strong positive correlation between DAS-28-CRP, CDAI and SDAI at initial evaluation but not at final visit. SDAI- and CDAI-based remission criteria seem to be better than DAS-28-CRP-based remission criteria.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , C-Reactive Protein/metabolism , Inflammation Mediators/blood , Methotrexate/therapeutic use , Adult , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/immunology , Biomarkers/blood , Female , Health Status , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Remission Induction , Reproducibility of Results , Severity of Illness Index , Time Factors , Treatment Outcome
3.
Int J Rheum Dis ; 20(11): 1638-1647, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29077271

ABSTRACT

OBJECTIVES: To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow. METHOD: The survey was carried out in a cluster of rural (n = 5118) and urban (n = 5053) communities of Lucknow through a door-to-door survey. Demographic data were collected and subjects with musculoskeletal pain (MSK pain) were identified. A Hindi adapted version of the Community Oriented Program for the Control of Rheumatic Diseases questionnaire was used. Trained community volunteers completed the questionnaire. RESULTS: Present and past MSK pain was the most common self-reported problem in urban areas (34.1%), while it was the third most common self-reported problem in rural areas (15.1%), after abdominal pain and cough. Females (214.9 and 419.5 per 1000) were more affected than males (118.8 and 265.2 per 1000) in rural and urban areas, respectively. Point prevalence of MSK pain (pain in last week) was higher in urban areas (28.2%) compared to rural areas (14.1%). In rural as well as urban areas, knee (rural: 49.3%, urban: 50.6%) and spine (rural: 56%, urban: 43.6%) were highly reported pain sites. Fatigue ([n] rural: 328, urban: 368) weakness ([n] rural: 310, urban: 324) and anorexia ([n] rural: 84, urban: 142) were most common systemic symptoms reported by urban as well as rural people. Urethritis/balanitis and ulcers in the mouth were the most common other symptoms reported by people in both the areas. CONCLUSION: MSK pain is a predominant health problem of both rural and urban areas. Sex-adjusted prevalence is higher among females than males. Knee and back were highly prevalent pain sites in both rural and urban areas of Lucknow.


Subject(s)
Arthralgia/epidemiology , Back Pain/epidemiology , Musculoskeletal Pain/epidemiology , Rheumatic Diseases/epidemiology , Rural Health , Urban Health , Abdominal Pain/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Arthralgia/diagnosis , Arthralgia/therapy , Back Pain/diagnosis , Back Pain/therapy , Child , Child, Preschool , Cough/epidemiology , Cross-Sectional Studies , Disability Evaluation , Female , Health Surveys , Humans , India/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/therapy , Pain Measurement , Patient Acceptance of Health Care , Prevalence , Rheumatic Diseases/diagnosis , Rheumatic Diseases/therapy , Socioeconomic Factors , Young Adult
5.
J Assoc Physicians India ; 65(11): 26-29, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29322706

ABSTRACT

AIM AND OBJECTIVE: To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthritis (OA) in India, where there is widespread Vitamin D deficiency (VDD). MATERIAL AND METHODS: 75 postmenopausal women (PMW) fulfilling ACR criteria for Knee OA between 40 - 60 years of age, having OA grade 2 or more as per Kellgren Lawrence grade on anterior- posterior radiograph of the right knee were enrolled. 34 PMW of the same age with normal right knee radiograph were taken as controls. Bone mineral density (BMD) of lumber spine (L1- L4), total hip and left forearm was performed using DXA in all patients and controls. The results were expressed in absolute values (g/cm2) and as per WHO criteria - Osteoporosis: T score < -2.5, Osteopenia: T score between -1 and -2.5. Vitamin D Level was done by ELISA. RESULTS: Body mass index (BMI) of patients was significantly higher than controls (p 0.006). There was no difference in BMD between patients and controls at any site. Forty percent patients and 53% controls had osteopenia (p ns), while 34.6% patients and 41.1% controls had osteoporosis at any site (p ns). When this comparison was made at each site there was no difference between patients and controls. CONCLUSION: Prevalence of osteoporosis in PMW with primary knee OA is similar to that in general population.


Subject(s)
Bone Diseases, Metabolic , Osteoarthritis, Knee , Osteoporosis, Postmenopausal , Vitamin D Deficiency , Aged , Body Mass Index , Bone Density , Bone Diseases, Metabolic/diagnosis , Bone Diseases, Metabolic/epidemiology , Bone Diseases, Metabolic/etiology , Female , Humans , India/epidemiology , Lumbar Vertebrae/diagnostic imaging , Middle Aged , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/epidemiology , Osteoarthritis, Knee/etiology , Osteoporosis, Postmenopausal/blood , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/epidemiology , Prevalence , Radiography/methods , Statistics as Topic , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/epidemiology
8.
Indian J Endocrinol Metab ; 18(2): 159-65, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24741510

ABSTRACT

With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM). Therefore, there is a need to change the focus from microvascular complications to cardiovascular disease and osteoporosis. Though number of studies from other parts of the world show that patients with T1DM are at increased risk of osteoporosis and fractures, there is a paucity of data from India. A number of factors and mechanisms affecting bone health in patients with T1DM have been proposed. The main defect in genesis of osteoporosis is osteoblastic function, rather than osteoclastic overfunction. Assessment of bone mineral density by dual X-ray absorptiometry and other risk factors for osteoporosis, as a part of diagnostic procedure can help to design tailored treatment plans. A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis. Treatment of osteoporosis is not evidence based but it is proposed to be similar to osteoporosis associated with other conditions. Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM. However, more studies are needed to make definitive guidelines on prevention and treatment of osteoporosis in patients with T1DM.

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