Demographic and socio-economic characteristics of rheumatoid arthritis patients attending public rheumatology clinics, South Trinidad, 2016

Objective: To examine the demographic and socio-economic characteristics of Rheumatoid Arthritis patients (RA) attending public rheumatology clinics, South Trinidad, 2016. Design and Methodology: Design: Cross-Sectional; Interview-administered questionnaire. Settings: In 2016, the public rheumatology clinics, South Trinidad enrolled 385 adults with a confirmed diagnosis of RA. Main Outcome Measures: A score ≥ 6 on the ACR/ EULAR 2010 Classification Criteria for RA. Statistical Methods: Descriptive statistics to characterize the population in the domains of demographic and socio-economic factors. Results: 385 patients fulfilled the American College of Rheumatology / European League Against Rheumatism (ACR/EULAR) 2010 classification criteria for RA. The median age of the population was 59.0 years. The male to female ratio was 1:10.3. 324 (84.2%) were East Indians and 134 (66.7%) achieved up to a secondary school education. Most patients were seen from the urban areas: Victoria North 122 (31.7%); Caroni South 83 (21.5%) and St. Patrick East 73 (19.0%). 192 (49.9%) were unemployed. 114 (29.6%) had to stop working due to RA. Of these, 41 (10.6%) received disability assistance grants. Conclusions: Epidemiological studies on RA in the Caribbean are sparse. In South Trinidad, RA seemed to affect predominantly unemployed East Indian women, who completed up to a secondary school level of education. The independent value of each prognostic factor needs to be further evaluated. The economic impact of the burden of disease and the impact on the patients' quality of life needs to be further explored as a high percentage of RA patients had to stop working due to the disease and receive disability grants.

Surgical reconstruction of the rheumatoid hand

PATHOPHYSIOLOGY: The pathophysiology involved in rheumatoid arthritis of the hand will be discussed, focusing on the anatomical derangements of the joints that result from the disease process. The consequences of these deformities on overall had function will be addressed. SURGERY: The pioneering work in implant arthroplasty of the rheumatoid hand was done by Alfred B. Swanston, M.D., of Grand Rapids, Michigan in the 1960s. The paper will focus on the indications for surgery as well as the currently accepted surgical techniques utilized in surgical reconstruction of the rheumatoid hand and wrist. REHABILITATION: After reconstruction hand surgery, a properly supervised rehabilitation programme is essential to guarantee a satisfactory outcome in the restoration of hand function. ECONOMICS OF RECONSTRUCTIVE HAND SURGERY: In the current era of cost effective health care delivery, this type of surgery does not have to be performed in a major hospital setting. With effective regional anaesthesia and proper instrumentation, the surgery can be successfully performed in a free standing speciality clinic(AU)

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans

The HLA phenotypes were investigated in 30 Jamaican patients with systemic lupus erythematosus (SLE), 30 with rheumatoid arthritis (RA) an d forty healthy controls. HLA phenotypes were determined by the microcytotoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statiscally significant. However, a statistically significant lack of HLA-A9 (p<0.01;CP<0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant associations was noted with HLA-A2 (RR5.1; CP<0.01). No HLA class 11 associations were noted with SLE. Class 11 associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted (AU)

Low prevalence of rheumatoid arthritis in Black-Caribbeans compared with whites in inner city Manchester

OJECTIVES- to compare the prevalence of rheumatoid arthtitis (RA) in Black-Caribbeans and whites living in the same urban area. METHODS- cases of inflammatory joint disease were ascertained initially from a postal screening survey of 1851 blacks and 1829 age and sex-matched non-Blacks identified from general practices in the Moss Side and Hulme districts of Manchester. The ethnicity of the respondents was confirmed using data from a postal screening questionnaire. Those reporting joint swelling or a history of arthritis were reviewed by a rheumatologist at surgeries held in each practice. The clinical records of the questionnaire non-responders and questionnaire-positive non-attenders at surgery were reviewed. RESULTS- in an adjusted denominator population of 1046 Black-Caribbeans and 997 whites, the cumulative prevalence of RA was 2.9/1000 in Black-Caribbeans and 8/1000 in whites, representing a prevalence in Black Caribbeans of 0.36 times that found in whites (95 percent confidence interval 0.1-1.3). CONCLUSIONS- rheumatoid arthritis occurs less commonly in Black-Caribbeans than in Whites. The findings are consistent with published studies showing a low RA prevalence in rural black populations (AU)

Infective arthritis due to Blastocystis hominis

A patient with rheumatoid arthritis taking prednisone developed Blastocystis hominis acute diarrhoea, which was associated with increased inflammation and effusion of the left knee. B. hominis organisms were found in synovial fluid from the left knee. The patient responded dramatically to metronidazole treatment. B. hominis may become disseminated in immunosuppressed patients with diarrhoea and may cause infective arthritis. (AU)

Acute rupture of the knee joint in rheumatoid arthritis

Two cases of acute rupture of the knee joint are described. The use of arthrography in diagnosis is demonstrated, and the aetiology and management briefly discussed (AU)

Idiopathic chondrolysis of the hip

The radiographic changes in nine cases of chondrolysis of the hip joint are described. The series consists of eight Negro girls and one Indian girl, whose ages ranged from eleven to eighteen years. The incidence of periarticular osteoporosis, joint space narrowing, erosion of articular cortex, femoral head enlargement, increase in width of the femoral neck and growth plate narowing are reported. The difficulty in the diagnosis of chronic monarticular disease of the hip is stressed and the observed changes are discussed with particular reference to monaticular rheumatoid arthritis. The material presented supports the view that `chondrolysis of the hip' is a distinct entity (AU)

Degenerative joint disease in a Jamaican rural population

The prevalence of degenerative joint disease has been measured in a random sample of adults aged 35-64 years living in a rural area in Jamaica and compared with that found in similar surveys in the United Kingdom. Radiological evidence of osteo-arthrosis in general showed the same prevalence in the two races, with the exception of certain joints which showed significant differences. Lumbar disk degeneration was also found to have a similar prevalence, though the involvement of multiple disks was significantly more common in Jamaica. Cervical disk degeneration was both more common and more severe in Jamaica. Symptoms in Jamaica were less frequent in relation to all sites of osteo-arthrosis except the cervical spine, and Jamaicans seemed to have fewer symptoms and less incapacity than Englishmen with the same degree of disk degeneration.(Summary)

Geographical studies on rheumatoid arthritis

The prevalence of rheumatoid arthritis has been compared in eight population samples in America and Europe, in which routine x rays were taken of the hands and feet. All the x rays were read by one observer. No relationship to lattitude was discovered. The prevalence of "definite" arthritis was not significantly different in the three racial groups included in these surveys, but "probable" disease was more common in the Negro population in Jamaica than in the Amerindians or Caucasians. Radiological evidence of erosive arthritis was more frequent in the Jamaican than in the Amerindian, and the Amerindian than the Caucasian. Serological tests for rheumatoid factor were more often positive in the Amerindian and erosive changes more severe. The implications of these findings are discussed.(Summary)

The influence of thyroid activity on the treatment of rheumatoid arthritis with cortisone

The effects of cortisone on thyroid radio-iodine metabolism has been demonstrated in a patient. Two other patients, one euthroid and the other hyperthyroid who were receiving long term treatment with cortisone for rheumatoid arthritis, showed evidence of an enhanced response to cortisone after commencing anti-thyroid therapy with carbimazole