FRAX calculation with and without bone mineral density for assessment of osteoporotic fracture risk in patients of rheumatic disease: a cross-sectional study.

To compare fracture risk assessment (FRAX) calculation with and without bone mineral density (BMD) in predicting 10-year probability of hip and major osteoporotic fracture in patients of rheumatic diseases. Methodology: A cross-sectional was conducted at outpatient Department of Rheumatology. Eighty-one Patients of more than 40 years of age having either sex. Diagnosed case of Rheumatic diseases were according to American College of Rheumatology (ACR) /European Alliance of Associations for Rheumatology (EULAR) criteria were included in our study. FRAX score without BMD was calculated and information was recorded in proforma. These patients were advised dual energy X-ray absorptiometry Scan and after that FRAX with BMD was calculated, after which comparison between result of two scores was made. The data were analyzed by SPSS software version 24. Effect modifiers were controlled by stratification. Post-stratification χ2 test were applied. P value less than 0.05 was considered as significant. Results: This study consisted of 63 participants, who were assessed for osteoporotic risk fracture, with and without BMD. Data analysis revealed a significant association between the type of fracture and age (p value=0.009), previous fracture (p value=0.25), parent fractured hip (p values) and treatment with bone mineral dismissal. There was no statistically significant association seen of fractures with bone deterioration with sex, weight, height, or current smoking. Conclusion: FRAX may be crucial in rural areas where dual energy X-ray absorptiometry scanning is not available since it is a readily available instrument. FRAX is a useful substitute for estimating osteoporosis risk when funds are scarce. Given the possible effect it will have on healthcare costs, this is extremely pertinent.

Comparison of efficacy three-site versus single-site steroid injections for the treatment of adhesive capsulitis.

Background: Frozen shoulder or adhesion capsulitis is a frequent ailment that causes pain and progressively restricts both active and passive shoulder motions. It is estimated that it affects 2%-5% of the general population and up to 20% of diabetes mellitus patients.We aimed to compare the effectiveness of three-site steroid injections against one-site injections in the treatment of adhesive capsulitis. Methodology: The Rheumatology Department of Pakistan Institute of Medical Sciences in Islamabad conducted this cross-sectional study. Between August 2021 to December 2021. The study comprised a total of 98 patients. This study included patients of both genders with shoulder pain between the ages of 40 and 70.Patients were divided into two groups & dosage was given at Sub-coracoid, Subacromial, and Posterior Capsule.The CONSTANT score was used to assess patients three times (Initial, 3months & 6 months later). Results: The average age, gender distribution, and dominant/non-dominant side ratio of the participants were nearly identical between the two groups. More patients in group B (77.22 8.17) had a higher mean CONSTANT score than those in group A (72.73 7.05). Patients were checked in on again after three and six months. Conclusion: The three-site injection technique is a safe and effective method for frozen shoulder. It provides an early recovery and improved shoulder function with a reduced frequency of relapse as compared to single-site injection techniques.

Association Of Tumour Necrosis Factor-Alpha -308 G/A Promoter Polymorphism With Susceptibility And Disease Profile Of Rheumatoid Arthritis.

BACKGROUND: Single nucleotide polymorphism underlying the auto-immune process governing the pathologic manifestations of rheumatoid arthritis has been the focus of study for quite a while. TNF-alpha -308 G/A promoter polymorphism have been reported to be responsible for a number of manifestations of rheumatoid arthritis. METHODS: This case-control study was conducted at the department of Rheumatology at Pakistan Institute of Medical Sciences Islamabad from 9th May to 9th August 2019 with a focus to determine the Association of tumour necrosis factor-alpha -308 G/A promoter polymorphism with susceptibility and disease profile of rheumatoid arthritis. One hundred and fifty cases with diagnosed rheumatoid arthritis and 150 age and gender matched controls were enrolled in the study. Their genotyping was done for tumour necrosis factor-alpha - 308 G/A promoter polymorphism. RESULTS: The genotypic analysis showed that GG genotype was the most common genotype found in 118 cases (78.66%) followed by GA (18.66%) and AA genotype (2.6%) p=0.0096 in both cases and controls. Overall, G allele was more common than A in both cases and controls pointing towards the preponderance of G genotype in our population. (p=0.003). However, the GA genotype and A allelotype was more common among cases with rheumatoid arthritis (p <0.05). No significant association of G/A polymorphism with smoking and gender, however, within gender, males had a significantly more expression of the GA genotype and A allelotype (p <0.05). CONCLUSIONS: There is a significantly more expression of the GA genotype and the A allelotype of the TNF-alpha -308 G/A promoter gene in rheumatoid arthritis patients in our population. Similarly, more males, compared to females have increased expression of the GA genotype as well as the A allelotype.

Prevalence of Depression in Patients with Juvenile Idiopathic Arthritis Presenting at a Tertiary Care Hospital.

Background and objective Juvenile idiopathic arthritis (JIA) is an idiopathic autoimmune rheumatic disorder in children. JIA has been associated with depression and has a negative psychological impact on patients' quality of life. The aim of the study is to determine the prevalence of depression in patients with JIA presenting at a tertiary care hospital in Islamabad, Pakistan. Materials and methods This cross-sectional study, conducted at the Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, included 100 children aged >6 years who had been diagnosed with JIA according to the 2004 revised International League of Associations for Rheumatology classification. Physical disability was measured using the Childhood Health Assessment Questionnaire disability index (CHAQ-DI), whereas depression was assessed by measuring their Center for Epidemiological Studies Depression Scale for Children (CES-DC) scores. Results were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.), with p-values ≤ 0.05 considered statistically significant. Results The 100 patients included 54 male patients (mean age, 16.3 ± 4.9 years) and 46 female patients (mean age, 18.6 ± 5.1 years). CES-DC scores showed that 72 patients with JIA had significant depression. Of these 72 patients, 50 (69.4%) had mild, 21 (29.2%) had moderate, and one (1.4%) had severe disability according to CHAQ-DI criteria. Age was the only effect modifier significantly associated with significant depression in patients with JIA (P < 0.05). Conclusion A cross sectional survey was carried out to find prevalence of depression in children with JIA. Physical disability and depression were measured using standardized tools. The percentage of significant depression among children with JIA is very high in our local population and was significantly associated with disease severity. Our findings emphasize the need to initiate early and prompt measures to prevent depression and reduce overall morbidity in patients with JIA.

The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis.

Background Ankylosing spondylitis (AS) is a chronic rheumatological condition affecting sacroiliac joint and spine and occurs more often in younger patients than in the elderly population. Objective The purpose of the study was to determine the association of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the disease activity of AS. Methodology This case-control study was conducted in the rheumatology department at the Pakistan Institute of Medical Sciences (PIMS) hospital in Islamabad from September 2018 to July 2019. The study consisted of two groups of 59 patients per group. We assessed a full blood count with erythrocyte sedimentation rate (ESR) for each participant using the PIMS hospital laboratory. NLR and PLR were calculated. Results The mean age of the participants in the control group and the cases group was the same (32 ± 4 years). The control group NLR was 1.30 ± 0.16, the PLR was 94.98 ± 17.96, and the ESR was 16.88 ± 3.76 mm/hour. For the cases group, the NLR was 3.08 ± 0.91, the PLR was 171.50 ± 38.06, and the ESR was 29.30 ± 9.20 mm/hour. There was a significant increase in cases for NLR, PLR, and ESR as compared to control samples (p<0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of participants with active diseases was 5.91±1.28. In the same group, the mean ESR was 27.65 ± 9.07 mm/hour, the NLR was 3.46 ± 0.80, and the PLR was 184.39 ± 36.13. For those in the inactive disease group, the mean BASDAI score was 2.84 ± 0.46, the ESR was 33.42 ± 8.48 mm/hour, the NLR was 2.17 ± 0.37, and the PLR was 139.71 ± 26.05. NLR and PLR were significantly higher in the active disease group (p<0.05). Conclusion NLR and PLR are good markers of inflammation in AS patients, and higher values indicate more active disease activity.

Disease activity score in rheumatoid arthritis with or without secondary fibromyalgia.

OBJECTIVE: To correlate disease activity score (DAS-28) in the patients with rheumatoid arthritis (RA) with and without secondary fibromyalgia. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, from November 2011 to April 2012. METHODOLOGY: 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. RESULTS: 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). CONCLUSION: 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.