Radiographic appearance in hands and feet of rheumatoid arthritis patients at a tertiary care hospital in Pakistan

Objective: The aim of the study was to see the radiographic appearance [erosions and joint space narrowing [JSN]] in hand and foot joints of patients of rheumatoid arthritis [RA]coming to a tertiary care hospital in Islamabad, Pakistan

Study Design: Cross-sectional descriptive study

Place and Duration of Study: The study was conducted in Department of Rheumatology at Pakistan Institute of Medical Sciences from June, 2013 till December, 2013

Subjects and Methods: Both male and female patients of RA coming to Rheumatology outpatient department were recruited in the study after taking their consent. X-rays of both hands and feet were performed in each of these patients. These X-rays were scored using simple erosion narrowing score

Results: There were total 153 patients in the study, 121 [79.10%] females and 32 [20.90%] males. The mean duration of RA was 6.36 +/- 5.47 years. Joint erosions were found in 142 [92.81%] patients. All of these 142 [100%] patients had hand joint erosions. Only 63 [44.36%] patients had foot joint erosions as well. Radiographic changes [combined erosions and JSN] were found in 3712 [39.13%] hand joints and 335 [9.12%] foot joints

Conclusion: Both erosions and JSN were seen predominantly in hand joints of our RA patients, with the foot joints showing much less radiographic changes. Therefore, doing X-Rays of only hands may be sufficient in RA patients for diagnostic and prognostic purposes

Spectrum of systemic sclerosis in patients presenting to a tertiary care hospital in Pakistan

To examine the clinical and laboratory features in the patients of systemic sclerosis coming to a tertiary care hospital in islamabad, pakistan. Observational cross-sectional study. Study was conducted at the department of rheumatology in pakistan institute of medical science between May 2012 and April 2013. Both male [n=5] and female [n=40] patientsof systemic sclerosis [SSc] who presented in the rheumatology outpatient department [OPD] were recruited in the study with informed consent. All the patients enrolled in the study fulfilled the american college of rheumatology [ACR] criteria for diagnosis of SSC. The mean age of the patients was 35.77 +/- 13.10 years. Out of 45 patients, 28 [62%] had limited cutaneous systemic sclerosis[LcSS] and 17 [38%] had diffuse cutaneous systemic sclerosis [DcSS]. Mean duration of disease was found to be 4.72 +/- 4.78 years. Anti-nuclear antibody [ANA] positivity was seen in 80% of the patients. The most common clinical feature of the disease was raynaud's phenomenon [100%] followed by microstomia [98%], sclerodactyly [91%], digital pitting [89%], digital ulcers [82%] and arthralgias [73%]. Among the constitutional symptoms fatigue was the most common one reported by 93% of the patients. Clinical features of systemic sclerosis examined in this cohort of patients were found to be consistent with the findings from other asian countries

Disease activity score in rheumatoid arthritis with or without secondary fibromyalgia

To correlate disease activity score [DAS-28] in the patients with rheumatoid arthritis [RA] with and without secondary fibromyalgia. Comparative cross-sectional study. Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, from November 2011 to April 2012. Patients aged above 16 years diagnosed to have rheumatoid arthritis according to ACR/EULAR criteria 2010 were included in the study. Fibromyalgia [FM] was diagnosed by ACR 1990 criteria. Patients of other autoimmune diseases or psychiatric illnesses were excluded. DAS was determined and compared using t-test with significance at p < 0.05. The mean age of study subjects was 42.9 years. Thirty one out of total 138 patients had fibromyalgia [22.4%]. Female gender was predominant [92.0%]; being 96.8% in patients with and in 88.2% without fibromyalgia. The average DAS score was high [5.3 + 1.5] in fibromyalgia patients compared to those without fibromyalgia [3.9 + 1.2]; this difference in mean value was statistically significant [p = < 0.001]. DAS-28 is a useful tool for assessing rheumatoid arthritis disease status in outpatient setting, however, increased disease activity must be assessed for possible co-existence of fibromyalgia which can spuriously give high DAS value and adversely affect treatment decision

Prevalence of dyslipidemias in autoimmune rheumatic diseases

To determine the frequency of dyslipidemias in various autoimmune rheumatic diseases and the difference in lipid profile according to the activity of these diseases. Cross-sectional study. The Rheumatology Department of Pakistan Institute of Medical Sciences [PIMS], Islamabad, from May 2010 to April 2011. All patients who presented to Rheumatology Department with various autoimmune inflammatory rheumatic diseases were included. Fasting lipid profiles of patients were obtained after an overnight fast of 12 hours. Various diseases were classified as active or inactive on the basis of clinical features and relevant laboratory tests. Data were entered in SPSS 17 and analyzed. Association between disease activity and abnormal lipid profile was also determined. A total of 100 patients were included in the study. Out of these, 82% were females. Mean age was 34.15 +/- 7.73 years. Rheumatoid arthritis [RA] was the most common disease present in 78 patients. Various types of dyslipidemias were found in 54% of patients. Low HDL and deranged cholesterol levels were significantly associated with active disease [p = 0.044 and p = 0.048 respectively]. Patients with RA also had dyslipidemias in 45% of the cases. Disturbed cholesterol level was observed in active RA [p = 0.044]. Dyslipidemias are frequent among the patients with autoimmune rheumatic diseases [AIRD]. Disturbance in total cholesterol is the most common abnormality with a significant association with disease activity