Small airway disease and its predictors in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a connective tissue disease, characterized by symmetric peripheral polyarthritis. Extra-articular disease occurs in approximately 50% of the patients with lung being a common site. The presence of functional or morphological abnormalities in small airways has recently been noted in patients with RA but its exact prevalence and clinical significance is still a subject of debate. This study was aimed to determine the prevalence of small airway disease (SAD) in patients with RA and the factors influencing it. METHODS: Fifty consecutive patients with RA were included in this cross-sectional observational study. All patients were subjected to pulmonary function tests (PFT) including Spirometry and Forced Oscillation technique (FOT). Those with features of SAD on PFT were subjected to High-Resolution Computed Tomography (HRCT) of the chest. RESULTS: Spirometry was suggestive of SAD in 17 patients, with 34% prevalence and FOT was abnormal in 9 patients, with 18% prevalence in the study population. Of 17 patients with SAD on spirometry, 8 (47.05%) patients showed mosaic attenuation, a sign of SAD on the HRCT chest. On univariate analysis, age, Disease Activity Score (DAS-28), joint erosions on X-ray, RF and anti-CCP were found to be associated with SAD. CONCLUSION: SAD was present in one-third of the patients with RA, even in those with short duration of disease, low to moderate disease activity and no respiratory symptoms. It is thus inferred that the complete workup of RA patients should include pulmonary function assessment.

Hirsutism: A Clinico-investigative Study.

BACKGROUND: Hirsutism is a common clinical condition characterized by presence of terminal hair at body sites under androgenic influence. Inspite of the significant worldwide prevalence of hirsutism, studies on hirsutism from India are not many. OBJECTIVE: To assess the etiology of hirsutism and correlate its severity with underlying causes and various hormone levels. MATERIALS AND METHODS: In this prospective study, 40 patients of hirsutism enrolled on first come basis were included. All patients underwent detailed clinical assessment and transabdominal ultrasonography. Free and total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone, follicle stimulating hormone, prolactin, free tri-iodothyronine, free tetra-iodothyronine, and thyroid stimulating hormone, and sex hormone binding globulin were estimated. Forty age-matched controls without features of hyperandrogenemia were included for the comparison. RESULTS: Thirteen (32.5%) patients had mild, 52.5% had moderate whereas 15% had severe hirsutism. Positive family history was documented in 42.5% patients. The clinical features found to be associated with hirsutism included acne (55%), menstrual irregularities (40%), acanthosis nigricans (37.5%), obesity (37.5%), and androgenetic alopecia in 27.5% of patients. Polycystic ovarian syndrome (PCOS) was the underlying cause in 70%, non-classical congenital adrenal hyperplasia and hypothyroidism in 7.5% each whereas idiopathic hirsutism was found in 15% patients. CONCLUSION: PCOS was the most common cause of hirsutism found in the instant study. Further, there was positive correlation between severity of hirsutism and free testosterone levels.