Spironolactone (an adjuvant therapy) in rheumatoid arthritis: a case control study.

OBJECTIVES: Disease-modifying anti-rheumatic drugs (DMARDs) are conventionally used in rheumatoid arthritis (RA). The role of spironolactone as add on therapy to DMARDs in RA patients was evaluated. MATERIAL AND METHODS: A total of 100 patients with rheumatoid arthritis diagnosed as per 1987 criteria having evidence of active disease despite ongoing DMARD therapy were enrolled in this study. Patients were assigned randomly to two groups. Group I (n = 50) patients were treated with 50 mg/day of spironolactone along with their maintenance DMARD and NSAID therapy. Group II (n = 50) patients continued their maintenance DMARD therapy without spironolactone. Disease activity was assessed using the Disease Activity Score-28 (DAS28) and the Clinical Disease Activity Index (CDAI) in each patient of each group was evaluated monthly for the next three months. RESULTS: All patients completed the study. Mean age of group I was 46.44 ±11.67 and of group II 44.52 ±11.82. DAS28 assessed in time according to the schedule was for group I 6.78 ±0.74, 5.34 ±0.74, 3.98 ±0.7, 3.00 ±0.75, while in group II it was 6.61 ±0.82, 5.49 ±0.90, 4.58 ±0.81, 3.55 ±0.93 at baseline, 4, 8, and 12 weeks respectively. CDAI in group I was 41.68 ±11.14, 24.36 ±8.13, 12.34 ±5.73, 6.42 ±4.4 and in group II 37.84 ±11.12, 24.54 ±9.4, 16.38 ±6.81, 9.62 ±6.1 at baseline, 4, 8, and 12 weeks respectively. Group I showed significant improvement in disease activity in the form of tender joint count (p = 0.001), swollen joint count (p = 0.023), patient global assessment (p = 0.001), physician global health (p = 0.001), DAS28 (p < 0.001) and CDAI (p = 0.001) but other parameters showed non-significant improvement compared to group II. No serious adverse events were observed in either group during the course of the study. CONCLUSIONS: Spironolactone as an adjuvant therapy can improve the effect of conventional DMARD treatment of patients with RA.

Assessment of fatigue in rheumatoid arthritis (by Functional Assessment of Chronic Illness Therapy-Fatigue score) and its relation to disease activity and anemia.

BACKGROUND: Patients with rheumatoid arthritis (RA) mention fatigue as one of their most annoying problems. Measuring fatigue, understanding its contributory factors, and treating it as a feasible target lead to better patient outcome and improved quality of life. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System is a collection of health-related quality-of-life questionnaires targeted to the management of chronic illness. OBJECTIVE: The objective of this study was to evaluate fatigue using FACIT-Fatigue (FACIT-F) score and its relation to disease activity (using Disease Activity Score [DAS28] and Clinical Disease Activity Index [CDAI] score) and anemia in RA patients. METHODS: A total of 100 RA patients were evaluated for fatigue using FACIT-F score, for disease activity using DAS28 and CDAI scores, for anemia using hemoglobin levels. Correlation studies were done using Pearson test. RESULTS: Functional Assessment of Chronic Illness Therapy-Fatigue showed positive association with DAS28 (P < 0.001; r = -0.80) and CDAI (P < 0.001; r = -0.83). Considering various components of DAS28 and CDAI, FACIT-F showed significant correlation with tender joint count (P < 0.001; r = -0.73), swollen joint count (P < 0.001; r = -0.76), patient global assessment (P < 0.001; r = -0.72), and evaluator global assessment (P < 0.001; r = -0.75). Erythrocyte sedimentation rate had no association with the fatigue (P = 0.217). No association was observed between fatigue and hemoglobin levels (P = 0.203). CONCLUSION: The fatigue experienced by the patients with RA is strongly associated with the severity of disease activity and is independent of anemia.

Exacerbation of latent lupus: is the culprit acid-fast bacilli or antitubercular therapy?

Typical as well as atypical presentations of systemic lupus erythematosus are being increasingly recognized due to improved diagnostic methods. In a tuberculosis-endemic country like India, it was traditionally believed that the occurrence of tuberculosis in lupus was due to the chronic immunosuppression caused by lupus or because of the use of steroids or isoniazid-induced lupus. Increasingly several patients with no recorded predisposition to lupus with a history of treatment for tuberculosis are coming with evidence of systemic lupus erythematosus rather than a drug-limited story. Whether the development of an autoimmune state is a mere conjecture or the presence of acid-fast bacilli in the body for a prolonged duration causes complex antigenic interactions leading to an antigenic response needs to be looked into. We present a report of three such patients and review the pathogenetic interactions that could possibly explain the role of mycobacterial antigens as a putative antigen in the pathogenesis of lupus.