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O32 Simplified disease activity index as an index of disease activity in rheumatoid arthritis
S24
Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl)
O31 The prevalence and impact of fibromyalgia in rheumatoid arthritis
O33 Time lag before institution of DMARDs and radiological outcome in patients with RA
V Dhir, A Aggarwal, R Misra, A Lawrence
S Jayaprakash1, Ashok Kumar1, Atin Kumar2, R Gupta1, Uma Kumar1
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India.
1
Background: Fibromyalgia is a pain disorder characterized by widespread pain and tender points. It may coexist with rheumatic diseases leading to worse outcomes. We looked at the prevalence of fibromyalgia in rheumatoid arthritis and its impact on pain, function, quality of life and mood. Methods: Out patients with RA fulfilling ACR 1987 criteria and healthy individuals (controls) not having renal failure or metabolic bone disease were included. Age, sex, overall pain and fatigue (Likert scale of 1–10), disease duration, current treatment, disease activity (DAS28–3) and functional status (mHAQ) were noted. Quality of life was assessed using WHOQol Bref, depression using BPHQ (brief patient health questionnaire) and HADS (hospital anxiety and depression scale). All have Hindi and English versions. Tender point examination was done and fibromyalgia was defined using ACR 1990 criteria. Statistical analysis was done using the t test and chi square test for univariate and linear regression for multivariate analysis. Results: Two hundred patients with RA and 100 controls were included with female to male ratio 5.6:1, 2.1:1; age 46.7 years (± 10.8), 40.4 years (± 9.6); College educated 52%, 92% (all P < 0.01) respectively. In RA disease duration was 8.7 years (± 6.3) and 78% were RF +. RA patients had higher prevalence of fibromyalgia, depression and anxiety (Table 1). RA patients with and without fibromyalgia show differences in the disease activity, function, pain and fatigue (Table 2); there is no difference in age, sex ratio, DMARDs, steroid dose, quality of life or depression. In a linear regression model, number of tender points and DAS 28 are independent predictors of pain and fatigue. Table 1
RA controls Depression BPHQ Anxiety HADS Depression HADS
F
M
P
16% 30% 25% 17.9%
2% 5% 8% 14.8%
.001 .05 .05 NS
Table 2
DAS28-3 HAQ Pain Fatigue
Oral presentations
RA with FM
RA without FM
P
5.4 ± 1.2 1.1 ± 0.7 5.4 ± 2.1 5.9 ± 2.4
4.3 ± 1.2 0.7 ± 1.3 3.5 ± 2.6 3.5 ± 2.6
< 0.01 0.05 < 0.001 < 0.001
Clinical Immunology and Rheumatology Service, Department of Medicine and Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
2
Introduction: Early DMARD therapy is believed to retard the radiological progression of disease. This retrospective study analyzed the relationship between ‘time lag’ before institution of DMARDs in the first 5 years of rheumatoid arthritis and its radiological outcome. Materials and methods: Two hundred adults with RA of > 5 years duration and taking DMARDs for at least one year were recruited. Patients who had received no DMARDs in the first 5 years of disease, discontinued DMARDs for > 6 months, undergone hand surgery or had overlap with other rheumatic disease were excluded. Work up included detailed clinical evaluation, X-rays of both hands and feet AP view, Van Der Heijde-modified sharp score, RF, HAQ-DI and deformity score. Radiological score was correlated with time lag before starting DMARDs. Results: The mean age was 43.7 years and 92% were females. Median duration of disease was 7 years (IQR 5, 10) and 83% were RF positive. Time lag before starting DMARDs was divided into < 3 months, 3 to 12 months, > 1–3 years and > 3–5 years and the number of patients in these subgroups was 16, 86, 63 and 35, respectively. The corresponding median radiological scores were 5 (IQR 0, 30), 9.5 (IQR 0, 27), 22 (IQR 16, 36) and 36 (IQR 26, 56), respectively. There was a significant rise in radiological score with increasing time lag but the difference between < 3 months and 3–12 months categories was not statistically significant. Conclusion: Crucial therapeutic window in rheumatoid arthritis appears to be the first year, after which the radiological score tends to rise significantly.
O34 Population based survey at village Mirza, Gauhati Assam for rheumatic and other musculoskeletal disorders based on WHO-ILAR COPCORD Bhigwan model B Thakuria, BP Chakravarty, MP Das, JD Phukan, B Kakoty, A Nag Department of Medicine, Gauhati Medical College and Hospital, India. Introduction: Under the aegis of WHO bone and joint decade; a COPCORD project is being undertaken at Mirza. As no well structured data is available on the prevalence pattern of rheumatic and other musculoskeletal disorders from this part of the country; it is expected to form the base for planning of preventive and therapeutic strategies in future. Materials and methods: The project has been undertaken according to the prescribed methodologies of WHO-ILAR COPCORD. An adult population of 4500 has been targeted. In phase I, eight volunteers went house to house and fill up the questionnaire. Positive respondents in phase I were identified and clinical rheumatologic evaluation were done by doctors of Gauhati Medical College and Hospital; phase II and III of the COPCORD Questionnaire filled up for each of them. Diagnosis was made as per the standard categories laid down.
Discussion: Fibromyalgia is present in a high number of patients with rheumatoid arthritis and is associated with worse overall patient pain and fatigue. High disease activity is associated with the presence of fibromyalgia in RA.
Results: The project is yet to be completed. The phase I survey has finished. Out of the total 4500 population; a positive response was found in 428 subjects. Of these 292 subjects have been evaluated and were entered into diagnostic categories. Most common diagnosis encountered is symptom related problems.
O32 Simplified disease activity index as an index of disease activity in rheumatoid arthritis
Conclusion: This population based survey is sure to be a milestone in the development of rheumatologic database of North-East India.
R Sharma, J Thomas, M Thakare, S Agrawal, L Rajasekhar, G Narsimulu
O35 Radionuclide bone scan to detect sacroiliitis in early spondyloarthropathy
Department of Rheumatology, Nizam’s Institute of Medical Sciences, Hyderabad, India. Introduction: Various factors are known to determine the disease activity in patients of rheumatoid arthritis. The main objective of this study was to establish the validity of the new tool of measurement of disease activity, Simplified Disease Activity Index (SDAI), in patients of RA. Patients and methods: All patients of rheumatoid arthritis fulfilling the ACR criteria attending the rheumatology clinic at Nizam’s Institute of Medical Sciences, Hyderabad over a period of 3months were included in the study. A detailed assessment of each patient including their demographic characteristics, duration of the disease, number of tender and swollen joint counts, westergren’s ESR (mm/FHR) and C-reactive protein (mg/dL), patient’s and physician’s global assessment by VAS (0-10) were recorded. DAS28 and SDAI were calculated for each patient. Statistical analysis was done. Results: Two hundred and sixteen patients were included in the study of these 184 were women and 32 men. Mean age of the patients and duration of disease were 42.94 ± 11.23 and 4.10 ± 4.02 years respectively. Mean DAS28 and SDAI were 5.19 ± 1.48 and 24.2 ± 16.06 respectively. ROC curve revealed that DAS28 had sensitivity and specificity of 92% and 90% respectively and SDAI was found to have sensitivity of 95% and a specificity of 87.5%. Conclusion: SDAI is a valid tool for measurement of disease activity in RA and is as good as DAS28 in its ability to assess the patient’s status.
S Subramanian, A Shankar, A Chaturvedi, K Abhisheka, PG Kumar, RK Ganjoo Rheumatology Division, Department of Medicine, Command Hospital (Air Force), Bangalore, Karnataka, India. Background: Nuclear scintigraphy (radionuclide bone scan) is a promising modality to pick up inflammation of sacroiliitis in early spondyloarthropathy before their presence is detected in plain radiographs. Objectives: To assess the role of Tc-99m MDP bone scan in patients with early SpA of < 2 years. Methods: Patients with inflammatory low backache of less than 2 years duration were included. Controls had mechanical low backache. Evidence of sacroiliitis on radioisotope (Tc 99 MDP) bone scan was determined by the uptake ratio between SI joint and sacrum (SI/S). A level of > 2 SD above mean uptake in controls was considered to be suggestive of sacroiliitis. A ROC curve was plotted between SI/S ratio and MRI evidence of sacroiliitis. Results: A total of 118 SI joints in 31 patients (age 34 + 10 years, M:F 27:4) and 28 controls (age 36 + 9.7 years, M:F 22:5) were analysed. On bone scan, SI/S uptake was significantly higher in the patient group. A cut off value of > 1.49 (mean + 2 SD) had 95% specificity in diagnosing sacroiliitis. Conclusions: Bone scan is a specific investigation to diagnose sacroiliitis in patients with low backache.
Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl)
O31 The prevalence and impact of fibromyalgia in rheumatoid arthritis
O33 Time lag before institution of DMARDs and radiological outcome in patients with RA
V Dhir, A Aggarwal, R Misra, A Lawrence
S Jayaprakash1, Ashok Kumar1, Atin Kumar2, R Gupta1, Uma Kumar1
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India.
1
Background: Fibromyalgia is a pain disorder characterized by widespread pain and tender points. It may coexist with rheumatic diseases leading to worse outcomes. We looked at the prevalence of fibromyalgia in rheumatoid arthritis and its impact on pain, function, quality of life and mood. Methods: Out patients with RA fulfilling ACR 1987 criteria and healthy individuals (controls) not having renal failure or metabolic bone disease were included. Age, sex, overall pain and fatigue (Likert scale of 1–10), disease duration, current treatment, disease activity (DAS28–3) and functional status (mHAQ) were noted. Quality of life was assessed using WHOQol Bref, depression using BPHQ (brief patient health questionnaire) and HADS (hospital anxiety and depression scale). All have Hindi and English versions. Tender point examination was done and fibromyalgia was defined using ACR 1990 criteria. Statistical analysis was done using the t test and chi square test for univariate and linear regression for multivariate analysis. Results: Two hundred patients with RA and 100 controls were included with female to male ratio 5.6:1, 2.1:1; age 46.7 years (± 10.8), 40.4 years (± 9.6); College educated 52%, 92% (all P < 0.01) respectively. In RA disease duration was 8.7 years (± 6.3) and 78% were RF +. RA patients had higher prevalence of fibromyalgia, depression and anxiety (Table 1). RA patients with and without fibromyalgia show differences in the disease activity, function, pain and fatigue (Table 2); there is no difference in age, sex ratio, DMARDs, steroid dose, quality of life or depression. In a linear regression model, number of tender points and DAS 28 are independent predictors of pain and fatigue. Table 1
RA controls Depression BPHQ Anxiety HADS Depression HADS
F
M
P
16% 30% 25% 17.9%
2% 5% 8% 14.8%
.001 .05 .05 NS
Table 2
DAS28-3 HAQ Pain Fatigue
Oral presentations
RA with FM
RA without FM
P
5.4 ± 1.2 1.1 ± 0.7 5.4 ± 2.1 5.9 ± 2.4
4.3 ± 1.2 0.7 ± 1.3 3.5 ± 2.6 3.5 ± 2.6
< 0.01 0.05 < 0.001 < 0.001
Clinical Immunology and Rheumatology Service, Department of Medicine and Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
2
Introduction: Early DMARD therapy is believed to retard the radiological progression of disease. This retrospective study analyzed the relationship between ‘time lag’ before institution of DMARDs in the first 5 years of rheumatoid arthritis and its radiological outcome. Materials and methods: Two hundred adults with RA of > 5 years duration and taking DMARDs for at least one year were recruited. Patients who had received no DMARDs in the first 5 years of disease, discontinued DMARDs for > 6 months, undergone hand surgery or had overlap with other rheumatic disease were excluded. Work up included detailed clinical evaluation, X-rays of both hands and feet AP view, Van Der Heijde-modified sharp score, RF, HAQ-DI and deformity score. Radiological score was correlated with time lag before starting DMARDs. Results: The mean age was 43.7 years and 92% were females. Median duration of disease was 7 years (IQR 5, 10) and 83% were RF positive. Time lag before starting DMARDs was divided into < 3 months, 3 to 12 months, > 1–3 years and > 3–5 years and the number of patients in these subgroups was 16, 86, 63 and 35, respectively. The corresponding median radiological scores were 5 (IQR 0, 30), 9.5 (IQR 0, 27), 22 (IQR 16, 36) and 36 (IQR 26, 56), respectively. There was a significant rise in radiological score with increasing time lag but the difference between < 3 months and 3–12 months categories was not statistically significant. Conclusion: Crucial therapeutic window in rheumatoid arthritis appears to be the first year, after which the radiological score tends to rise significantly.
O34 Population based survey at village Mirza, Gauhati Assam for rheumatic and other musculoskeletal disorders based on WHO-ILAR COPCORD Bhigwan model B Thakuria, BP Chakravarty, MP Das, JD Phukan, B Kakoty, A Nag Department of Medicine, Gauhati Medical College and Hospital, India. Introduction: Under the aegis of WHO bone and joint decade; a COPCORD project is being undertaken at Mirza. As no well structured data is available on the prevalence pattern of rheumatic and other musculoskeletal disorders from this part of the country; it is expected to form the base for planning of preventive and therapeutic strategies in future. Materials and methods: The project has been undertaken according to the prescribed methodologies of WHO-ILAR COPCORD. An adult population of 4500 has been targeted. In phase I, eight volunteers went house to house and fill up the questionnaire. Positive respondents in phase I were identified and clinical rheumatologic evaluation were done by doctors of Gauhati Medical College and Hospital; phase II and III of the COPCORD Questionnaire filled up for each of them. Diagnosis was made as per the standard categories laid down.
Discussion: Fibromyalgia is present in a high number of patients with rheumatoid arthritis and is associated with worse overall patient pain and fatigue. High disease activity is associated with the presence of fibromyalgia in RA.
Results: The project is yet to be completed. The phase I survey has finished. Out of the total 4500 population; a positive response was found in 428 subjects. Of these 292 subjects have been evaluated and were entered into diagnostic categories. Most common diagnosis encountered is symptom related problems.
O32 Simplified disease activity index as an index of disease activity in rheumatoid arthritis
Conclusion: This population based survey is sure to be a milestone in the development of rheumatologic database of North-East India.
R Sharma, J Thomas, M Thakare, S Agrawal, L Rajasekhar, G Narsimulu
O35 Radionuclide bone scan to detect sacroiliitis in early spondyloarthropathy
Department of Rheumatology, Nizam’s Institute of Medical Sciences, Hyderabad, India. Introduction: Various factors are known to determine the disease activity in patients of rheumatoid arthritis. The main objective of this study was to establish the validity of the new tool of measurement of disease activity, Simplified Disease Activity Index (SDAI), in patients of RA. Patients and methods: All patients of rheumatoid arthritis fulfilling the ACR criteria attending the rheumatology clinic at Nizam’s Institute of Medical Sciences, Hyderabad over a period of 3months were included in the study. A detailed assessment of each patient including their demographic characteristics, duration of the disease, number of tender and swollen joint counts, westergren’s ESR (mm/FHR) and C-reactive protein (mg/dL), patient’s and physician’s global assessment by VAS (0-10) were recorded. DAS28 and SDAI were calculated for each patient. Statistical analysis was done. Results: Two hundred and sixteen patients were included in the study of these 184 were women and 32 men. Mean age of the patients and duration of disease were 42.94 ± 11.23 and 4.10 ± 4.02 years respectively. Mean DAS28 and SDAI were 5.19 ± 1.48 and 24.2 ± 16.06 respectively. ROC curve revealed that DAS28 had sensitivity and specificity of 92% and 90% respectively and SDAI was found to have sensitivity of 95% and a specificity of 87.5%. Conclusion: SDAI is a valid tool for measurement of disease activity in RA and is as good as DAS28 in its ability to assess the patient’s status.
S Subramanian, A Shankar, A Chaturvedi, K Abhisheka, PG Kumar, RK Ganjoo Rheumatology Division, Department of Medicine, Command Hospital (Air Force), Bangalore, Karnataka, India. Background: Nuclear scintigraphy (radionuclide bone scan) is a promising modality to pick up inflammation of sacroiliitis in early spondyloarthropathy before their presence is detected in plain radiographs. Objectives: To assess the role of Tc-99m MDP bone scan in patients with early SpA of < 2 years. Methods: Patients with inflammatory low backache of less than 2 years duration were included. Controls had mechanical low backache. Evidence of sacroiliitis on radioisotope (Tc 99 MDP) bone scan was determined by the uptake ratio between SI joint and sacrum (SI/S). A level of > 2 SD above mean uptake in controls was considered to be suggestive of sacroiliitis. A ROC curve was plotted between SI/S ratio and MRI evidence of sacroiliitis. Results: A total of 118 SI joints in 31 patients (age 34 + 10 years, M:F 27:4) and 28 controls (age 36 + 9.7 years, M:F 22:5) were analysed. On bone scan, SI/S uptake was significantly higher in the patient group. A cut off value of > 1.49 (mean + 2 SD) had 95% specificity in diagnosing sacroiliitis. Conclusions: Bone scan is a specific investigation to diagnose sacroiliitis in patients with low backache.