The Pattern of Psoriatic Arthritis in Kashmir: A 6-Year Prospective Study.

BACKGROUND: The prevalence, clinical presentation, and patterns of psoriatic arthritis (PsA) vary in different parts of the world. The scenario of PsA in west is different from that of Asia. Moreover, the oligoarticular type which was considered most prevalent earlier has been replaced by polyarticular type. AIM: The study was to the clinical profile of psoriasis patients associated with PsA in Kashmir valley of India. MATERIALS AND METHODS: This was a noninterventional, observational, prospective, hospital-based study involving 150 successive patients of PsA over a span of 6 years. Severity of the skin and nail involvement was assessed by Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI), respectively. PsA was diagnosed by classification criteria for PsA. The number and pattern of swollen and tender joints was counted and classified by Moll and Wright's classification criteria. RESULTS: Plaque-type psoriasis was the most common clinical type, observed in 122 (81.33%) patients followed by erythrodermic psoriasis in 10 (6.66%) patients and pustular psoriasis in eight (5.33%) patients. PsA occurred between 30 and 40 years of age in 105 (70%) patients. The cutaneous involvement occurred before joint involvement in 113 (75.33%), while they occurred simultaneously in 30 (20%) cases and the PsA preceded the skin involvement in seven (4.66%) cases. Symmetrical polyarthritis was the commonest clinical presentation and was seen in 90 (60%) patients. Nail involvement due to psoriasis was present in 120 (80%) patients. Commonest nail change found was pitting and seen in 60 (40%) patients. CONCLUSION: The clinical pattern of PsA varies in different parts of the world. Knowledge of the clinical presentation of PsA in a given area is necessary for the successful management of this disease.

Pattern of sexually transmitted infections in a Muslim majority region of North India.

BACKGROUND: Changing trends of sexually transmitted infections (STI) and HIV/AIDS has been noted in the literature over years, depending to some extent on the geographical and cultural factors of the region. In Kashmir Valley also, the pattern of STI may be different from the rest of the country. AIMS OF THE STUDY: The aim was to present the experience with patterns of STI in Kashmir. MATERIALS AND METHODS: Retrospective hospital-based study carried out by detailed analysis of case records of 5-year period. RESULTS: A total of 184 patients, 100 males and 84 females, had specific STI. Genital ulcer disease was the presentation in 54 patients (29.35%), out of which herpes genitalis was found in 27 patients (50%), followed by chancroid in 13 (24.07%) and syphilis in 10 (18.52%) patients. 42 female patients (22.83%) presented with vaginal discharge, out of which, 24 (57.14%) had vaginal candidiasis. 24 males (13.04%) presented with urethral discharge, out of which, 15 (62.5%) had nongonococcal and 9 (37.5%) gonococcal urethritis. Genital molluscum contagiosum (MC) was found in 19 patients (10.33%), and warts in 15 (8.15%). HIV positive serology was detected in 3 patients (1.63%). CONCLUSION: The most common STI encountered in our study was genital ulcer, followed by vaginal discharge, urethritis, genital MC, and genital warts. Herpes genitalis was the commonest genital ulcer; candidiasis was the most common cause of vaginal discharge and nongonococcal urethritis the most common cause of urethritis. These findings are by and large similar to those noted in other parts of our country.

Pulmonary involvement in systemic sclerosis: an imaging study from kashmir.

BACKGROUND: Systemic sclerosis (SS) is a chronic, multisystem collagen vascular disorder of undefined etiology, whose prognosis and overall survival is determined by visceral especially the lung involvement. AIM: To evaluate the pulmonary involvement in SS by imaging methods. MATERIALS AND METHODS: Clinical examination, pulmonary function tests, chest X-ray and high resolution computed tomography (HRCT) scans were carried out in a series of 25 patients prospectively over a period of 3 years (2009-2011AD). RESULTS: Of the total 25 patients of the study, the group with abnormal HRCT chest (n = 20), 16 had clinical symptoms of respiratory involvement, only 7 had an abnormal chest X-ray and 15 had abnormal forced expiratory volume/forced vital capacity (FEV1/FVC) spirometric parameter. While the group with normal HRCT chest (n = 5), 1 had clinical symptoms of respiratory involvement and 4 had abnormal FEV1/FVC spirometric parameter. The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless. Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20). Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO. CONCLUSION: The HRCT outscores Chest X-ray in detecting early lung involvement in SS patients more so early in the course of the disease thereby underscoring its importance in identifying SS patients who will be potential candidates for early institution of therapy that might reverse/limit pulmonary involvement by the disease.

Prevalence of metabolic syndrome in patients with psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin and is associated with an increased risk of cardiovascular atherosclerosis. Metabolic syndrome, a conglomerate of various clinical and biochemical parameters is a significant predictor of atherosclerotic disease and the associated risk for cardiovascular events in such patients. AIM: To investigate the prevalence of metabolic syndrome in patients with psoriasis. METHODS: The study was a prospective, hospital based case-control study involving 150 adult patients with chronic plaque psoriasis and 150 healthy controls. Venous samples were taken at the enrollment visit after the subjects had fasted overnight (at least 8 h). Serum cholesterol and triglycerides were measured with enzymatic procedures. Plasma glucose was measured using a glucose oxidase method. Metabolic syndrome was diagnosed by the presence of three or more criteria of the National Cholesterol Education Programme's Adult Panel III (ATP III). Statistical analysis of the data was done using statistical processing software (SPSS-17) and epi-info software. RESULTS: Metabolic syndrome was significantly more common in psoriatic patients than in controls 42(28%) vs 9(6%), odds ratio (OR) = 6.09, P<0.05. Psoriatic patients also had a significantly higher prevalence of hypertriglyceridaemia (73/150 among cases vs 24/150 among controls; P<0.05), arterial hypertension (74/150 among cases vs 24/150 among controls; P<0.05) and impaired fasting plasma glucose levels (27/150 among cases vs 04/150 among controls; P<0.05). Psoriatic patients with metabolic syndrome had mean disease duration of 13.67±11.87 years against 6.46±5.80 years in those without metabolic syndrome. CONCLUSION: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to general population and so is the risk of having atherosclerotic adversity. While managing the psoriatic plaques of these patients, concerns should extend to the atherosclerotic plaques as well.