Pakistani Ankylosing Spondylitis Cohort with modifiable cardiovascular risk factors (PAS-CVD) study.

Objective: To determine the frequency of modifiable cardiovascular risk factors in the Pakistani cohort with Ankylosing Spondylitis (AS). Method: After IRB approval, a cross-sectional study was conducted among patients of AS, at the Department of Rheumatology Indus Medical College, Tando Mohammad Khan, from 15th March to 15th September, 2022. After obtaining demographic data, other parameters such as blood pressure (BP) and body mass index were recorded. In addition, a 5 ml blood sample was collected to assess their serum lipid profile, and fasting blood sugar levels. Using the laboratory data, the Framingham cardiovascular risk score was calculated for each patient and they were categorized into low, intermediate, or high-risk categories. Results: Total 131 cases of ankylosing spondylitis: frequency of modifiable risk factors were: obesity (75.6%), high TG level (62.6%), high risk FRS score (40.5%), high LDL level (38.1%), low HDL (34.4%), hypertension (30.5%), diabetes mellitus (26.7%), high cholesterol level (17.6%), smoking (16%). In univariate analysis AS cases shows that increasing disease duration was associated with more risk of modifiable risk factors (p<0.05), on multivariate analysis, a positive association of age, diastolic blood pressure, smoking, diabetes mellitus, DMARDS, herbal medication-but not statistically significant (p>0.05). Conclusion: In chronic AS there's higher prevalence of modifiable cardiovascular risk factors, earlier recognition and effective management helps in prevention of future cardiovascular events.

Un-resolving frozen shoulder: Are we really treating it?

Objective: To perform ultrasound examination in un-resolving frozen shoulder disorder, in Pakistani cohort visiting rheumatology clinic. Methods: This cross sectional study was carried out at Department of Rheumatology, Indus Medical College Tando Mohhamad Khan, from 16th March 2022 to 30th October 2022. Patients diagnosed as unilateral frozen shoulder on clinical grounds and received intra-articular injection (s) in last six months, never been investigated, still persisting with pain and restricted range of shoulder motion were enrolled. After the demographic details and shoulder examination, ultrasound examination of both shoulder joints was performed by senior musculoskeletal radiologist, to know the exact diagnosis. Results: In 138 cases on ultrasound examination following injuries were noted: rotator cuff tendinopathy (RCT) (61%), adhesive capsulitis (21%), mixed lesion (rotator cuff tendinopathy and adhesive capsulitis) (14%).In age group < 50 years rotator cuff tendinopathy was the major lesion, while in cases >50 years age group: adhesive capsulitis (AC) was predominant lesion (p-0.05).Rotator cuff tendinopathy had significant association with supraspinatus tears (p<0.5). Conclusion: In Un-resolving frozen shoulder pain, ultrasound examination of involved joint helps in reaching the exact cause which may differ from the existing diagnosis and guides to further management.

Osteoarthritis knee and modifiable cardiovascular risk factors: play in tandem.

Objective: To know the frequency of modifiable cardiovascular risk factors in knee osteoarthritis patients. Method: Cross sectional study was done at Department of Rheumatology Indus Medical College, Tando Mohammad Khan from March 25, 2022 to November 24, 2022. Total 246 Osteoarthritis of knee cases with (Kellgren-Lawrence grad-II and above) on x-ray, were selected after demographic details, blood pressure, body mass index and physical examination was done, 5ml of venous blood was drawn by phlebotomist, sent for fasting blood sugar, serum lipids analysis and Framingham 10years risk score was calculated afterward for each participant. Results: In this study males (126) and females (120). Overall (78%) had risk factors, Patients having one CVD risk factor were (22.8%), two risk factors in (21.1%), three in (21.5%), four (9.8%) and five factors in (1.6%) while frequency of modifiable cardiovascular risk shows obesity (45.5%) hypertension (40.2%) intermediate to high risk of framingham score (40%) diabetes mellitus (25%), smoking (17%), high low density lipoproteins (8.1%). In males obesity(54.2%), hypertension (47.5% ) and (45.8%) were on medication, diabetes mellitus(31.7%), smoker(31%), high risk FRS(39.2%), K-L grade-IV(58.4%) and in females: obesity (42%), hypertension (43.7%) and (40.5%) were on medication, diabetes mellitus in (19%), smoking (4%), high risk FRS (13.5%), K-L Grade-4 (42%), significant association of diabetes mellitus, smoking, FRS and K-L grades with gender (p<0.05). Conclusion: In OA knee there is high prevalence of modifiable cardiovascular risk factors and together these imposes a major health risk for future cardiac events and disability.

Premature Ejaculatory Dysfunction in Rheumatoid Arthritis (PED-RA Study).

Objective: To determine the frequency of premature ejaculatory dysfunction in rheumatoid arthritis patients. Methods: After approval from IRB, cross sectional study was conducted from November 1st, 2020 to August 1st, 2021 at Department of Rheumatology, Indus Medical College, Pakistan. RA patients were included, written and informed consents were taken. Demographic data was noted and detailed history and examination was carried out. Each participant BMI and Blood pressure was measured. Afterward 5-ml of blood was drawn by a trained phlebotomist for CBC, ESR, fasting blood sugar levels, HBs Ag and anti HCV Antibody test.DAS-28 Calculator was used for RA clinical activity. Premature ejaculation diagnostic tool was used for the assessment of premature ejaculation. Results: Total 168 patients with mean age 32.27 (SD=±9.49) and mean disease duration of 6.35 (SD=±3.95) years were included,. Prevalence of premature ejaculation dysfunction was (44.6%), with mean PED of score 9.17 (SD=±5.23). Hypertension, HCV, Hakeem medications, use of DMARDS had positive association while High BMI and higher DAS-28 has negative association with PED (p<0.05). Conclusion: There is high prevalence of PED in RA, it needs proper evaluation, treatment and urgent research is needed to know more about it.

Fatigue assessment by FACIT-F scale in Pakistani cohort with Rheumatoid Arthritis (FAF-RA) study.

OBJECTIVE: To fine out fatigue frequency and severity by FACIT-F scale in Pakistani cohort with rheumatoid arthritis. METHODS: This study was conducted at department of Medicine division of rheumatology CPMC Lahore. After the approval of IRB, 192 patients of RA were recruited. Written, informed consent was taken, demographic details were noted, patients filled the URDU version of FACIT-F (fatigue severity scale). 5-ml of blood was taken for fasting blood sugar, viral markers and ESR by a trained phlebotomist. Each individual's disease activity was assessed by DAS-28 and FACIT-F score was calculated. RESULTS: The Mean age (39.9±10.5) years, (71.9%) were females. Fatigue frequency was 62% (n=126), age, education, hypertension, DAS-28, exercise levels and HCV gives significant association with fatigue score. Linear regression analysis, results showed one unit increase in DAS-28 will gives 2.71 unit increases in fatigue scores(P <0.05). CONCLUSIONS: We have very high frequency of fatigue in RA, increases with disease activity & associated conditions.

Fatty liver in Pakistani cohort with rheumatoid arthritis.

OBJECTIVE: To determine the frequency of fatty liver (non-alcoholic) disease, Framingham 10-year cardiovascular risk score in rheumatoid arthritis patients. METHODS: This study was conducted from September 1st to March 19, 2019, at Rheumatology OPD, Central Park Medical College Lahore. One hundred ninety two seropositive rheumatoid arthritis patients were recruited. Demographic details were noted, BP, BMI, smoking habits, and waist circumference were noted, then sent to radiology department for ultrasound scan of abdomen by an expert radiologist. On next day 10 ml blood was taken by phlebotomist for lipid profile and fasting blood sugar levels, after availability of results 10-years Framingham cardiovascular risk score was calculated. RESULTS: Females were (81.3%) mean age of (45.4) years, fatty liver was present in n=39 (20.3%). In positive cases comorbid like metabolic syndrome was present (71.8%), diabetes mellitus (33.3%), hypertension (59%) FRS score (intermediate to high in (33.3%), history of hakeem/desi medication use (51.3%), while on regression analysis all study parameters except DMARD's had significant association with fatty liver (p<0.05). CONCLUSION: Nonalcoholic fatty liver disease is very widely prevalent in rheumatoid arthritis patients. As in general population, it is multifactorial in origin and needs careful monitoring and treatment.

Impaired renal functions in Pakistani cohort of rheumatoid arthritis.

OBJECTIVE: To determine the frequency of impaired renal functions and hypertension in rheumatoid arthritis. METHODS: This study was conducted between May 1st 2018 to February 1st 2019 at Rheumatology Division, Department of Medicine Central Park Medical College Lahore, total 260 study participants were selected, demographic detail were asked in detail, disease duration of RA and hypertension, DMARD's, self-use NSAID's,/hakeem medications, smoking were asked in detail, BMI and blood pressure were measured,5 ml of blood was taken by trained phlebotomist, and sent for the estimation of serum urea and creatinine on (COBAS-III) machine, after availability of results each individuals eGFR (creatinine clearance) was calculated by Cockroft Gualt(CG) and Modification in diet in renal disease method (MDRD). RESULTS: In this study the mean age of study participants was 42.4 (± 9.5) years with disease duration of 7.7(±4.8) years, prevalence of Impaired renal functions of 14.6% (n=38) and hypertension in 53.5% (n=139).Regression analysis shows there is significant association between hypertension, smoking and self/hakeem medications with impaired renal functions (p-0.5). Kappa analysis shows both (MDRD & CG methods) had uniformity in picking up cases of impaired renal functions 75.6% (p-0.05). CONCLUSION: In RA decline in renal functions is seen with self-use NSAID's/hakeem medications along with other modifiable factors like smoking and hypertension, while conventional DMARD's don't show association with decline. There is very high prevalence of hypertension in rheumatoid arthritis.

Modifiable cardiovascular risk factors in Rheumatoid Arthritis.

OBJECTIVE: To determine the frequency of modifiable cardiovascular risk factors in Rheumatoid Arthritis patients at tertiary care hospital. METHODS: During this study 246 patients of Rheumatoid Arthritis were enrolled from outpatients department of Medicine of Central Park Medical College Hospital, Lahore from July 1, 2016 to January 31, 2017. Demographic data and questions related to study were noted. After 14 hours of fasting 5ml of venous blood was drawn for Cholesterol, triglycerides, HDL and blood sugar level. Blood tests were performed on COBAS c III (ROCHE), Framingham 10 year Risk score was calculated for every individual. RESULTS: The mean age of male population was (50.2 ±7.5) and females (48.4±7.6) and female gender was common. Seventy eight (78%) of study population has one modifiable risk factor. Most frequent risk factor found in this study was BMI>30 in 48.4% (n=119), High LDL 43.5% (n=107), moderate to high FRS score 40.2% (n=99), Hypertension 37.4% (n=92), Diabetes Mellitus was present in 22.8% (n=56), while smoking was least frequent risk factors with frequency of 15.9% (n=39). Framingham cardiovascular risk score was significantly different, males were having higher mean 10 year risk score (19.7%) and females (8.7%) with (p-<0.01). Regression analysis revealed that older patients of Rheumatoid Arthritis with disease duration of more than seven years are four times more likely to have High Framingham risk score, moderate to high LDL and diabetes mellitus with significant high Odds ratio (p-value <0.05). CONCLUSION: Rheumatoid Arthritis patients are having increased chances of developing cardiovascular risk factors leading to cardiovascular events with male sex, increasing age and disease duration.

Cardiovascular risk score in Rheumatoid Arthritis.

OBJECTIVE: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups. METHODS: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III (ROCHE). QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score. RESULTS: In this study the mean age of RA group was (45.1±9.5) for Non RA group (43.7±8.2), with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group (14.2±17.1%) and Non RA group was (13.2±19.0%) with (p-value 0.122). The 10-year score with Framingham risk score in RA group was (12.9±10.4%) and Non RA group was (8.9±8.7%) with (p-value 0.001). In RA group QRISK-2 (24.5%) and FRS (31.1%) cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups (Kappa = 0.618 RA Group; Kappa = 0.671 Non RA Group). CONCLUSION: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score.

Frequency of metabolic syndrome in Pakistani cohort of patients with rheumatoid arthritis.

OBJECTIVE: To determine the frequency of metabolic syndrome in rheumatoid arthritis patients and its association with different factors i.e., age, gender, disease duration and treatment. METHODS: The cross-sectional study was conducted at Shaikh Zayed Hospital, Lahore, from July 2014 to June 2015, and comprised consecutive rheumatoid arthritis of either gender between the ages of 20 and 60 years. Frequency of metabolic syndrome was assessed by the National Education Cholesterol Programme 2004. SPSS 22 was used to compare the frequency of the syndrome among different treatment, age and gender groups. RESULTS: Of the 384 patients, 287(74.7%) were females, and 97(25.3%) were males with an overall mean age of 43.8±10.6 years (range: 20-60 years). Overall, 173(45.0%) patients were in >45years of age, and metabolic syndrome was found in 120 (31.3%). A negative association with metabolic syndrome was found when compared with treatment group of methotrexate alone and methotrexate in combination (p>0.05). CONCLUSIONS: Metabolic syndrome, an important risk factor for cardiovascular diseases, was more prevalent in rheumatoid arthritis patients.