Pulmonary Manifestations In Patients With Rheumatoid Arthritis Visiting Tertiary Care Hospital.

Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Metabolic Syndrome In Young Rheumatoid Arthritis Patients.

BACKGROUND: Metabolic Syndrome is strongly associated with Rheumatoid Arthritis, which significantly increases cardiovascular complications and hence morbidity and mortality. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This study evaluates prevalence of metabolic syndrome in young Rheumatoid Arthritis patients. METHODS: This Cross-sectional study was conducted in rheumatology department of a tertiary care hospital in Karachi. All diagnosed cases of rheumatoid arthritis from April to August 2018 were consecutively included. Disease activity of rheumatoid arthritis assessed by Clinical Disease Activity Index (CDAI). Associate determinants of rheumatoid arthritis were measured along with outcome variables. RESULTS: Out of 104 rheumatoid arthritis patients, 34 (32.7%) found to have metabolic syndrome in whom 20 (58.8%) of patients were seropositive. A significant association of metabolic syndrome was found with age (p-value 0.023), BMI (p-value 0.006), waist circumference (p-value 0.002), FBS (p-value <0.001), SBP (p-value <0.001), DBP (p-value <0.001), TG (p-value <0.001), HDL (p-value 0.022), and Methotrexate drug history (p-value 0.030). CONCLUSIONS: We conclude that metabolic syndrome is highly prevalent in young rheumatoid patients with rheumatoid arthritis. Treating Metabolic Syndrome decreases cardiovascular related disease flares and deaths. This young population base study will help out to estimate the exact burden of Metabolic Syndrome to decrease overall morbidity and mortality.

Prevalence and Pattern of Pulmonary Manifestation in Patients with Connective Tissue Disorder.

Background A substantial number of deaths and morbidities are caused by pulmonary involvement in connective tissue disorders (CTDs). The majority of patients suffering from CTDs show diverse clinical presentations arising in the lungs, the diaphragm, vasculature, and the pleura during the course of their disease. The clinical course is highly variable ranging from asymptomatic to symptomatic and from reversible to an irreversible stage. The most common occurring pulmonary appearance is the interstitial disease of the lung. In our study, we aim to determine the prevalence and pattern of pulmonary manifestation in patients with CTD presenting at a tertiary care hospital of Karachi, Pakistan. Methods A descriptive cross-sectional study was conducted in the department of Rheumatology Medical Unit II, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All patients having CTD were enrolled. Patients with human immunodeficiency virus (HIV) infection, smokers, chronic obstructive pulmonary disease (COPD), bronchogenic carcinoma and patients with underlying cardiac disease were excluded from the study. Pulmonary manifestations like nonspecific interstitial pneumonia (NSIP), pleural effusion, usual interstitial pneumonia (UIP), interstitial pneumonitis, pulmonary arterial hypertension (PAH), tuberculosis, and pulmonary embolism were observed. In addition to this, treatment history and immunological test findings of these patients were also recorded. Results A total of 290 patients with rheumatologic disorders were included in this study, out of which 90.7% (263) were females and the average age of the entire cohort was 35.13 ± 12.53 years. A majority, 71% (206), of the patients were young (≤ 40 years of age). Rheumatoid arthritis (RA) was the most commonly observed rheumatologic disorder in this cohort which was in 70.3% (204) patients. RA was more prevalent in patients above 40 years of age as compared to young patients (≤ 40 years of age) with a frequency of 81% vs. 66%; p=0.012. Pulmonary involvement was observed in 27.2% of the patients while no pulmonary involvement was noted in 72.8% of patients. Conclusion Pulmonary manifestations in patients with CTD is not that uncommon (27.2%). PAH and NSIP collectively account for three-fourth of the total prevalent cases of pulmonary involvement in CTD patients.

Clinical and immunological profile in patients with mixed connective tissue disease.

Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis.

Delayed conventional DMARDs therapy is effective in Rheumatoid Arthritis.

OBJECTIVE: To determine the disease severity in patients with Rheumatoid Arthritis (RA), at baseline and the impact of treatment on disease activity (DA) after six months of disease modifying anti-rheumatic drugs (DMARDs) therapy. METHODS: This prospective study was conducted at the 'Rheumatology Clinic' of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2014 to May 2015. A total of 111 patients, with the diagnosis of RA were included in the study. DA was calculated using 'Clinical Disease Activity Index' (CDAI) score at base line and after 6 months of DMARDs therapy. RESULTS: Out of 111 patients, 17 (15.3%) were male and 94 (84.7%) were female. The mean age was 37.16±11.3 years and the mean duration of joint pain was 3.8±3.6 years (median 2.5 years). The mean Hb was 10.8±1.8 g/dl and the mean ESR at baseline was 59.63±30.9 mm/Hr. The mean initial CDAI score was 18.14±11.69; reflecting moderate to severe disease. Of all of these patients, 32 (28.8%) patients received monotherapy, 78 (70.3%) received dual therapy and 1(0.9%) was given triple DMARDs therapy. The mean ESR was 39.5±27.31 mm/Hr, and mean CDAI was 7.36±7.8 with a median of 6.0 after 6 months of DMARDs treatment. CONCLUSION: The CDAI score and the ESR reflected that majority of our patients were in remission or at low disease activity, after six months of DMARDs therapy. It is possible to control DA in RA, in a low resource health care facility with conventional DMARDs therapy. Continuity of treatment was ensured through motivation, regular supply of drugs and regular follow-up.