ABSTRACT
Systemic lupus erythematosus may present with fever, and it is a challenge to attribute fever to a particular cause. Very rarely it can be due to hyperthyroidism. Thyroid storm is a medical emergency causing unrelenting pyrexia. Here we report a case of a young female who first presented as fever of unknown origin (FUO), was subsequently diagnosed as neuropsychiatric lupus, and in whom the cause of unrelenting high fever, which did not respond to adequate immunosuppression to quell disease activity, was documented to be thyroid storm after excluding all other causes such as infection and malignancy. To our knowledge, this is the first case of this kind reported in literature, although cases of thyrotoxicosis preceding or following the diagnosis of lupus is known. Her fever resolved after starting antithyroid drugs and beta blockers.
ABSTRACT
Background: Non-alcoholic fatty liver disease (NAFLD) is one of the commonest liver pathologies and is increasing due to increasing obesity. Non-alcoholic fatty liver disease-liver fat score is a non-invasive diagnostic tool with a sensitivity and specificity of 95%. Methods: This was a cross-sectional observational study on 50 overweight and obese individuals with a body mass index (BMI) of more than or equal to 25 kg/m2 and fatty liver on ultrasonography (USG). Alcoholics (≥30 g/day for men and ≥20 g/day for women), other etiologies like drugs and patients who had bowel resection surgeries for obesity were excluded from the study. Non-alcoholic fatty liver disease-liver fat score of more than -0.64 ruled in NAFLD. Data were entered into Microsoft Excel and analyzed using the SPSS (Statistical Package for Social Sciences) Software 20. Results: About 33/50 patients had a score of more than -0.64. Metabolic syndrome was present in 29 (58%), dyslipidemia in 38 (76%), and diabetes mellitus (46%) was the commonest comorbidity. There was a statistically significant difference in the mean age, weight, BMI, blood pressure, liver enzymes, fasting lipid profile, serum albumin, glycosylated Hemoglobin A1C (HBA1C), international normalised ratio (INR), and fasting blood sugars between the two groups with scores >-0.64 and ≤-0.64. There was a negative correlation of high-density lipoprotein and a positive correlation of liver enzymes, triglycerides, low-density lipoprotein, total cholesterol, fasting blood sugar level, and HBA1c with a score of >-0.64. Conclusion: Higher BMI, metabolic syndrome, diabetes mellitus, and dyslipidemia were significantly associated with a score of >-0.64. This score confirmed the ultrasonographically diagnosed fatty liver.
ABSTRACT
Background: Axial spondyloarthropathy is a type of disease which affects the axial skeleton affecting productive years. Methods: This was a cross-sectional, observational study in which 28 consecutive patients more than 16 years of age, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial spondyloarthropathy were included. They were further sub-grouped into radiographic and non-radiographic axial spondyloarthropathy. Clinical features, joint involvement, measurements, HLA-B27 serology, and disease activity were evaluated. Data was entered into Microsoft Excel, and SPSS (Statistical Package for Social Sciences) software 2.0 was used for analyzing the data. Results: Mean age was 28.5 ± 6.3 years. 85.7% were males. Inflammatory low back pain was the most common clinical feature at presentation (89.2%). Enthesitis was the most common extra-articular feature seen in 35.7% of patients. 42.8% were non-radiographic axial spondyloarthritis. 85.7% of patients were HLA-B27 positive. 50% of patients had bone marrow edema on MRI, and only one patient had ankylosis indicating predominantly early disease. 50%-70% of our patients had high disease activity and 89.3% were responding well to non-steroidal anti-inflammatory drugs (NSAIDs). There was no significant difference between the radiographic axial spondyloarthritis group and the non-radiographic group except for elevated C-reactive protein (CRP). Conclusion: Ankylosing spondylitis in western India occurs mostly in the age group of 20-30 years, suggesting affection of productive age group. There was a delay of diagnosis for approximately three years from the onset of symptoms. There was a positive association with HLA-B27 in majority of the patients. Most of our patients had early disease based on radiological findings, suggesting that there was room for therapeutic intervention before irreversible ankylosis had set in.
ABSTRACT
Rheumatoid Arthritis is a chronic inflammatory disease of unknown etiology characterised by presence of symmetric involvement of multiple joints, mainly small joints that rapidly progresses to multisystem inflammation. Common haematological abnormalities observed are anemia,leucocytosis, neutropenia, thrombocytosis, thrombocytopenia, eosinophilia and haematological malignancies. This study is aimed at the various haematological parameters observed in newly diagnosed patients of rheumatoid arthritis and correlating it with disease activity measured by indices like DAS 28 CRP and HAQDI. MATERIAL: Patients more than 16 years of age and newly diagnosed cases of rheumatoid arthritis according to the ACR EULAR 2010 criteria who presented in the rheumatology opd were included in the study. A total of 20 patients fulfilling the inclusion criteria were studied.Any patient with active blood loss from any site, infection,chronic liver or kidney disease, malignancies,hematological diseases,those already on disease modifying drugs,other autoimuune diseases were excluded from the study. OBSERVATION: Out of 20 patients of rheumatoid arthritis studied,55%(11) had anemia of chronic disease and 27.5%(5) had iron deficiency anemia,3%(1) had eosinophilia. The disease activity was measured using DAS 28 CRP and HAQ DI. A negative correlation was observed between Hb level and disease activity whereas a positive correlation was observed between platelet count and disease activity. CONCLUSION: In our study it was observed that Hb is significantly lower in patients with high disease activity whereas platelet count and MPV are significantly higher with high disease activity compared to patients with low to moderate disease activity.So, from Hb level, platelet count and MPV, we can predict disease activity in RA patients which can guide us for proper and aggressive management to prevent further disease progression.