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.

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.