Effect of disease activity on the clinical outcome of SARS CoV-2 in patients with underlying rheumatic diseases; data from global rheumatology alliance.

Objectives: To determine the effect of disease activity on clinical outcomes of coronavirus disease-2019 in patients with rheumatic diseases. METHODS: The prospective, cohort study was conducted from January 1st to June 30th, 2021, at Rheumatology department, Fauji Foundation Hospital, Rawalpindi. It comprised patients of rheumatic disorders who were affected by coronavirus disease-2019. The patients were categorised according to rheumatic disease activity into remission group I, low disease activity group II, moderate group III and high-activity group IV. Coronavirus disease-2019 outcomes compared included recovered vs death, hospitalisation yes vs no, mechanical ventilation yes vs no. The association of disease activity status with coronavirus disease-2019 outcomes was explored. Data was analysed using SPSS 23. RESULTS: Of the 100 patients, 78(78%) were females and 22(22%) were males. The overall mean age was 45.60±13.7 years. There were 23(23%) patients in group I, 42(42%) patients in group II, 21(21%) patients in group III and 14(14%) patients in group IV. Overall,17(17%) patients died and 83(83%) patients survived. In group III, 7(33.3%) patients died, followed by 6(42.9%) in group IV (p<0.05). In total, 7(7%) patients needed mechanical ventilation, with 3(21.4%) being in group IV (p<0.05). Hospitalisation was needed in 33(33%) cases, and intergroup comparison was non-significant (p>0.05). CONCLUSIONS: Patients with severe rheumatic autoimmune disease affected by coronavirus disease-2019 were more likely to die and require invasive ventilation.

Posterior reversible encephalopathy syndrome: A rare complication of rituximab therapy in rheumatoid arthritis.

Rituximab, a murine-human chimeric monoclonal antibody targeting CD20-positive B lymphocytes, has established itself as an effective and relatively safe biologic therapy for patients with refractory rheumatoid arthritis. Most common side effects associated with its use include infusion related reactions and cytopenia. Rare adverse effects such as progressive multifocal leukoencephalopathy and posterior reversible encephalopathy syndrome (PRES) have also been reported. Diagnosis of PRES following rituximab treatment requires a high index of suspicion correlated with clinical and radiological features in individuals at risk. Early diagnosis and prompt treatment is associated with a favorable prognosis. We present a case of a young man who developed PRES following rituximab administration on account of active rheumatoid arthritis. Timely diagnosis and prompt treatment ensured his uneventful recovery without residual neurological deficit.

Factors associated with low bone mineral density in postmenopausal women with rheumatoid arthritis.

OBJECTIVE: To determine the factors related to low bone density in postmenopausal women with rheumatoid arthritis. METHODS: The prospective cross-sectional study was conducted at the Rheumatology Department of Fauji Foundation Hospital, Rawalpindi, Pakistan, from June 1 to November 30, 2020, and comprised postmenopausal women with rheumatoid arthritis. On the basis of dual-energy X-ray absorptiometry scan of total hip, femoral neck, and lumbar spine, the subjects were categorised into osteoporosis, osteopenia and normal bone density groups. The risk factors were compared across these subgroups. Data was analysed using SPSS 21. RESULTS: Of the 114 women, 74(64.9%) had osteoporosis, 31(27.2%) had osteopenia and 9(7.9%) had normal bone mineral density. Those with osteoporosis were older (p<0.05), had low body mass index (p<0.002) and had a longer duration since menopause (p<0.004) compared to the other groups. Age and body mass index were significant factors associated with the condition (p<0.05). CONCLUSIONS: Older age, lesser body mass index and time since menopause were the factors significantly associated with osteoporosis.

Translation and validation of Modified Health Assessment Questionnaire score in local language Urdu in patients with rheumatoid arthritis presenting in a tertiary care center of Pakistan.

OBJECTIVE: To translate and validate the Modified Health Assessment Questionnaire from English to Urdu. METHODS: The validation study was conducted at the Rheumatology outpatient department of Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 1 to September 30, 2019. Two translators were given the modified health assessment questionnaire for translation from English to Urdu. It was then back-translated by two independent translators. The translated version of the tool was applied to rheumatoid arthritis patients to check for reliability, test-retest and internal consistency. It was applied to another group of patients to check for criterion validity. Reliability analysis was checked by applying Cronbach alpha. Criterion validity was checked by assessing disease activity score-28 and its correlation with Modified Health Assessment Questionnaire. Data was analysed using SPSS 23. RESULTS: Of the 30 patients in the initial testing, 28(93%) were females and 2(6.6%) were males, with an overall mean age of 38±13.2 years. Of the 100 patients in the second group, 97(97%) were women and 3(3%) were men, with an overall mean age of 42±12.37 years. The mean disease duration of the cohort was 8.4±4.8 years. The Cronbach alpha value was 0.797 and interclass coefficient was 0.7, reflecting good reliability. A significantly high correlation between Modified Health Assessment Questionnaire and disease activity score-28 was noted along with pain, tenderness, swollen joints, patient global assessment, age and erythrocyte sedimentation rate (p<0.05), while poor correlation was found with gender, disease duration, rheumatoid arthritis factor and anti-cyclic citrullinated peptide antibody (p>0.05). CONCLUSIONS: The Urdu version of the Modified Health Assessment Questionnaire was found to be a reliable tool for the indigenous population.

Corona Virus Disease-19 Vaccine-associated Autoimmune Disorders.

Coronavirus disease is a highly infectious viral disease caused by severe acute respiratory syndrome virus (SARS nCoV2). It was declared a pandemic within a few months of identification of its index case. The spread of COVID-19 across the globe was rampant, overwhelming healthcare systems and crippling global economies. Since the world was caught off guard by the pandemic, vaccine programs had to be rolled out in emergency to curb its spread. Ten vaccines have been granted Emergency Use Authorization thus far. Much of the side effects we know today are post-marketing adverse effects. Most of them are mild like myalgia and injection-site reactions, but a few of them such as post-vaccination autoimmune diseases have alerted the medical community. These include vaccine-induced thrombotic thrombocytopenia, autoimmune hepatitis, myocarditis, and Graves' disease. We attempt to summarize the diverse autoimmune phenomena reported after COVID-19 vaccination, with an aim to sensitize the medical community so that they can be better equipped in management when confronted with these diseases. This review by no means refutes the potential benefit of COVID-19 vaccination which has consolidated its place in preventing infections and substantially reducing severity and mortality.

A Comparison Of Mycophenolate Mofetil And Cyclophosphamide As Lupus Nephritis Induction Therapy.

BACKGROUND: Lupus nephritis and its induction therapies are understudied subjects in rheumatology especially in our population. The objective of this study is to compare the renal response to Mycophenolate mofetil (MMF) and Cyclophosphamide (CYC) as induction therapy in the Pakistani population with lupus nephritis. METHODS: This is a comparative retrospective study conducted at the department of rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi, and the duration of the study was 1.5 years from July 2016 to December 2017. The study includes 28 patients, all females, ages between 18 to 50 years. All have biopsy proven lupus nephritis (LN). All 28 LN patients have either stage III, IV, V. They were investigated and analysed over 1.5 years. 14 patients were given MMF (2.5 gram/day) (MMF group) and 14 patients were given CYC (NIH protocol/monthly) (CYC group) for 24 weeks as induction therapy. Comparison of baseline characteristics, complete and partial renal responses to treatment was seen in the MMF and CYC groups. RESULTS: Primary end point (complete response) is achieved in 6 (42.85%) in MMF group and 5 (35.71%) in the CYC group. The secondary end point (partial response) was achieved in 5 (35.71%) patients in the MMF group and 6(42.85%) in the CYC group. The difference in the cumulative probability of complete and partial response was not statistically significant between the two groups (P-0.470 for CR) and (p-value 0.132 for PR). CONCLUSIONS: Mycophenolate mofetil is a new therapy for LN and it has equal efficacy as compared to CYC for LN induction.