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P16 In-vitro platelet function studies in 20 patients of antiphospholipid syndrome (APS)
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Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl)
groups there was no statistically significant difference in any of the above parameters. Tolerance with both the formulations was similar without any serious side effects. Conclusions: Both of the preparations are effective and safe in treating acute musculoskeletal pain.
P13 A prospective study of correlation between disease activity score (DAS28) and CRP levels in patients with rheumatoid arthritis (RA) S Ostwal Vikas, J Oak Department of Medicine, L.T.M.M.C, SION, Mumbai, India. Introduction: RA is characterized clinically by joint pain, stiffness and swelling due to synovial inflammation and effusion it is reflected by a dramatic increase in acute-phase reactants (APR) which reflects the disease activity. Materials and methods: This study included 60 consecutive patients with RA (of age group 18–60 years, fulfilling the revised ACR criteria, disease duration of ≤ 2 years and ACR class I, II, III) and 30 controls who were healthy hospital personnel. At presentation, the clinical assessment of age, sex, body weight, duration of illness in months was done. If the patient had any concomitant systemic disease were excluded from study. Joint count was calculated as per DAS 28 joint count, DAS28 ESR and DAS28 using CRP were calculated. Results: All the 60 study group patients had high disease activity based on DAS28 ESR value as DAS28 ESR value was > 5.1 for all of them. The mean DAS28 CRP value was 6.22 ± 0.75 range (5–8). 58/60 (96.66%) patients had DAS28 CRP value > 5.1 and categorized into high disease activity and 2/60 (3.33%) had value between 3.2–5.1 and categorized into moderate disease activity. Difference between mean DAS28 ESR and DAS28 CRP was 1.06. Strongly positive correlation is noted between the DAS28 score and serum CRP (r = 0.290, P < 0.05) in RA patients. Conclusion: DAS28 using CRP is superior marker of disease activity as compared to DAS28 ESR. This study shows that DAS28 using ESR significantly correlates with acute phase reactant CRP.
P14 Clinico-pathological study and treatment outcome in 51 patients of lupus nephritis with a follow-up of 2 to 4 year NK Singh, V Kumar, MN Singh, A Agarwal, Usha, RG Singh Department of Medicine and Rheumatology Division, Institute of Medical Sciences. Introduction: Kidney involvement frequently occurs in SLE. It can have varied clinical manifestations, a poor clinico-pathological correlation and variable therapeutic response. Materials and methods: Out of 95 cases of SLE studied from January 2005 to July 2008, 51 (53.68%) had evidence of kidney involvement. Renal biopsy was performed in 23 patients and histopathological grading was done as per WHO, 1995 revised criteria. Patients having stage IV disease received standard protocol of cyclophosphamide followed by Azathioprin and corticosteroid. However, three patients having stage V disease received only corticosteroids. Results: Clinical manifestations of renal involvement in SLE comprised of asymptomatic overt proteinuria in 18 (35.3%), acute nephritic syndrome in 15 (29.4%), nephroto-nephritic syndrome in 10 (19.6%) and nephrotic syndrome in 8 (15.7%) patients. Histopathological changes revealed stage III nephropathy in 4 (17.4%), stage IV in 15 (65.2%), stage V in 3 (13%) and tubulointerstitial lesions in 1 (4.3%) patient. Clinico-pathological correlation revealed that out of 15 patients having stage IV nephropathy, eight had acute nephritic syndrome, three nephrotic syndrome and four nephroto-nephritic syndrome. Out of three patients having stage V nephropathy, two had nephrotic syndrome and one asymptomatic overt proteinuria. None of the patient had ESRD. Eight patients died. Thirty-five (81.39%) patients went into remission average period of remission induction was 2.87 + 1.14 months. During this period nine patients relapsed. Conclusion: Clinical manifestations of renal involvement in SLE were variable. No uniform clinico-pathological correlation could be established. Treatment with cyclophosphamide and corticosteroid was effective in most of the patients.
P15 A comparative study of prevalence and common causes of reproductive tract infections among rheumatoid arthritis (RA) and non-RA women in reproductive ages N Jaleh, R Renu, V Anuradha, A Chopra Department of Rheumatology, Center for Rheumatic Diseases, Renu Nursing Home, School of Health Sciences Pune University, Pune, India. Reproductive tract infection (RTI) are overall neglected both in health and chronic disorders like RA. Aim: To compare the prevalence and common causes of RTI among RA and non-RA women in reproductive ages. Methods and materials: A cross sectional comparative study of 300 (150 RA, 150 non-RA women) sexually active women among 15–49 years, attending Center for Rheumatic Disease (CRD) was carried out. Women underwent an interview followed by gynaecological examination. Lab diagnosis carried out (free of cost) for candidia vaginalis, bacterial vaginosis, trichomona vaginalis and syphilis. Data analyzed (+ multi variable analysis using logistic regression) with SPSS 13.0 (AOR: adjusted odds ratio). Results: The prevalence of RTIs among RA and non-RA women was 37.3% and 20% respectively. Overall, 30% of the RA women had bacterial vaginosis, while 6.7% had candidiasis
Poster presentations and 0.7% was infected with trichomoniasis. For non-RA women, a diagnosis of bacterial vaginosis was made in 8.7% and candidiasis in 11.3%; none suffered from trichomoniasis. None in this study suffered from syphilis. Conclusion: The high prevalence of RTI (37.3%) among RA women, hitherto have not been considered, should be of great concern. This study finding highlights the need to raise awareness of RTI among RA women.
P16 In-vitro platelet function studies in 20 patients of antiphospholipid syndrome (APS) NK Singh, V Kumar, S Srivastava, D Dash Department of Medicine and Rheumatology Division, Institute of Medical Sciences, India. Introduction: Exact pathogenesis of exceedingly high thrombotic events in APS remains obscure and is an open area for intense research. Present study was undertaken in this direction to explore the role of platelets in this disease. Materials and methods: We conducted various in-vitro platelet function tests in blood samples of 20 patients of APS and 20 healthy controls. It included platelet aggregation, total degranulation, degranulation in relation to time under stored condition, degranulation and shape changes in platelets under phase contrast microscope, clot retraction and Western blotting of clot retracted samples. Results: Platelets extracted from APS patients were found to be hyperaggregable, able to secrete more dense granule (ADP/ATP) on activation and were able to sustain its degranulation potential for longer period. Alteration in shape of platelets appeared rapidly, to a greater extent and for longer period when stimulated with thrombin 0.5 units/mL in blood samples of APS patients as compared to that of healthy controls in similar conditions. Clot retraction in APS patients was less. Western blot study of clot retracted samples showed that platelets from APS patients form more active protein (carrying phosphotyrosine moiety) with an extra band at 47 kDa. Conclusion: Platelets separated from APS patients showed hyperactivity which may contribute to hypercoagulable state in APS patients. Additionally, poor clot retraction in APS patients may contribute to sustained blockage of affected vessels.
P17 A prospective study of clinical manifestations of SLE cases at VSGH AP Naveen Kumar, DVN Sharma, MK Tripathy, M Srinivas Department of General Medicine, Visakha Steel General Hospital, Visakhapatnam Steel Plant, Andhra Pradesh, India. Aim of the study: To study the varied clinical manifestations of SLE cases which presented to Visakha Steel General Hospital starting from 2003. Materials and methods: All patients satisfying the American College of Rheumatology criteria were included in the study over a period of 5 years from 2003. Regular follow up of patients included clinical examination and CBP, ESR, RFT, LFT, 24 hour urine protein, lipids, ECG, chest-x-ray. ANA and DsDNA, Smith antibody were done in all and ACA wherever necessary. Results and conclusions: A total number of 26 cases were detected during this period, female 20, male 4. The average age of presentation was 24 years oldest being 46 and the youngest being 12. The major clinical features were arthritis 16, skin manifestations 14, renal 8, haematologic 10, neurologic 3 and other symptoms 6. All the clinical manifestations did not appear at the same time so only the manifestations that occurred at diagnosis were included in the study. All the cases were ANA positive and 14 were DsDNA positive. SLE is a multisystem disease but good clinical history supported by judicious clinical investigations makes a diagnosis of SLE very easy.
P18 A comparative analysis to study dietary habits in persons with osteoarthritis knee compared to those without osteoarthritis of knee in Lucknow M Tandon, R Srivastava, P Tiwari, SK Das, P Kumar Introduction: This study has been conducted to assess the relationship between the dietary habits in the persons of non-osteoarthritis and osteoarthritis of knee. Materials and methods: Total 94 persons (OA = 53, non-OA = 41) were enrolled. Non-OA controls were enrolled from the same population. All OA patients fulfilled the ACR (American College of Rheumatology) clinico-radiological criteria 1986 for OA. Diet related information was collected with the help of structured questionnaire. Dietary information was based on the 24-hour dietary recall intake of the persons. Result: The mean age of OA patients was 54.8 ± 9.8 and of non-OA persons was 48.7 ± 13.8. The mean weight of the OA persons were 68.3 ± 14.3 and of non-OA persons was 57.9 ± 11.7. The observed mean BMI of the OA persons was 27.2 ± 5.5 and in non-OA was 23.3 ± 4.7. It was observed that 64.2% of the OA patients and 29.3% of the non-OA persons were of pre obese/obese weight status. The energy, fat, calcium and vitamin D intake of the persons in OA persons and non-OA persons were 2162 Kcal, 36.91 g, 1437.26 mg, 225.98 IU and 2138.46 Kcal, 56.90 g, 1499.33 mg, 298.42 IU, respectively. Also, the main observations includes that dairy products have been emerged as the main source of calcium in both OA as well as in non-OA persons. And OA patients had low vitamin D intake as compare to non-OA persons.
Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl)
groups there was no statistically significant difference in any of the above parameters. Tolerance with both the formulations was similar without any serious side effects. Conclusions: Both of the preparations are effective and safe in treating acute musculoskeletal pain.
P13 A prospective study of correlation between disease activity score (DAS28) and CRP levels in patients with rheumatoid arthritis (RA) S Ostwal Vikas, J Oak Department of Medicine, L.T.M.M.C, SION, Mumbai, India. Introduction: RA is characterized clinically by joint pain, stiffness and swelling due to synovial inflammation and effusion it is reflected by a dramatic increase in acute-phase reactants (APR) which reflects the disease activity. Materials and methods: This study included 60 consecutive patients with RA (of age group 18–60 years, fulfilling the revised ACR criteria, disease duration of ≤ 2 years and ACR class I, II, III) and 30 controls who were healthy hospital personnel. At presentation, the clinical assessment of age, sex, body weight, duration of illness in months was done. If the patient had any concomitant systemic disease were excluded from study. Joint count was calculated as per DAS 28 joint count, DAS28 ESR and DAS28 using CRP were calculated. Results: All the 60 study group patients had high disease activity based on DAS28 ESR value as DAS28 ESR value was > 5.1 for all of them. The mean DAS28 CRP value was 6.22 ± 0.75 range (5–8). 58/60 (96.66%) patients had DAS28 CRP value > 5.1 and categorized into high disease activity and 2/60 (3.33%) had value between 3.2–5.1 and categorized into moderate disease activity. Difference between mean DAS28 ESR and DAS28 CRP was 1.06. Strongly positive correlation is noted between the DAS28 score and serum CRP (r = 0.290, P < 0.05) in RA patients. Conclusion: DAS28 using CRP is superior marker of disease activity as compared to DAS28 ESR. This study shows that DAS28 using ESR significantly correlates with acute phase reactant CRP.
P14 Clinico-pathological study and treatment outcome in 51 patients of lupus nephritis with a follow-up of 2 to 4 year NK Singh, V Kumar, MN Singh, A Agarwal, Usha, RG Singh Department of Medicine and Rheumatology Division, Institute of Medical Sciences. Introduction: Kidney involvement frequently occurs in SLE. It can have varied clinical manifestations, a poor clinico-pathological correlation and variable therapeutic response. Materials and methods: Out of 95 cases of SLE studied from January 2005 to July 2008, 51 (53.68%) had evidence of kidney involvement. Renal biopsy was performed in 23 patients and histopathological grading was done as per WHO, 1995 revised criteria. Patients having stage IV disease received standard protocol of cyclophosphamide followed by Azathioprin and corticosteroid. However, three patients having stage V disease received only corticosteroids. Results: Clinical manifestations of renal involvement in SLE comprised of asymptomatic overt proteinuria in 18 (35.3%), acute nephritic syndrome in 15 (29.4%), nephroto-nephritic syndrome in 10 (19.6%) and nephrotic syndrome in 8 (15.7%) patients. Histopathological changes revealed stage III nephropathy in 4 (17.4%), stage IV in 15 (65.2%), stage V in 3 (13%) and tubulointerstitial lesions in 1 (4.3%) patient. Clinico-pathological correlation revealed that out of 15 patients having stage IV nephropathy, eight had acute nephritic syndrome, three nephrotic syndrome and four nephroto-nephritic syndrome. Out of three patients having stage V nephropathy, two had nephrotic syndrome and one asymptomatic overt proteinuria. None of the patient had ESRD. Eight patients died. Thirty-five (81.39%) patients went into remission average period of remission induction was 2.87 + 1.14 months. During this period nine patients relapsed. Conclusion: Clinical manifestations of renal involvement in SLE were variable. No uniform clinico-pathological correlation could be established. Treatment with cyclophosphamide and corticosteroid was effective in most of the patients.
P15 A comparative study of prevalence and common causes of reproductive tract infections among rheumatoid arthritis (RA) and non-RA women in reproductive ages N Jaleh, R Renu, V Anuradha, A Chopra Department of Rheumatology, Center for Rheumatic Diseases, Renu Nursing Home, School of Health Sciences Pune University, Pune, India. Reproductive tract infection (RTI) are overall neglected both in health and chronic disorders like RA. Aim: To compare the prevalence and common causes of RTI among RA and non-RA women in reproductive ages. Methods and materials: A cross sectional comparative study of 300 (150 RA, 150 non-RA women) sexually active women among 15–49 years, attending Center for Rheumatic Disease (CRD) was carried out. Women underwent an interview followed by gynaecological examination. Lab diagnosis carried out (free of cost) for candidia vaginalis, bacterial vaginosis, trichomona vaginalis and syphilis. Data analyzed (+ multi variable analysis using logistic regression) with SPSS 13.0 (AOR: adjusted odds ratio). Results: The prevalence of RTIs among RA and non-RA women was 37.3% and 20% respectively. Overall, 30% of the RA women had bacterial vaginosis, while 6.7% had candidiasis
Poster presentations and 0.7% was infected with trichomoniasis. For non-RA women, a diagnosis of bacterial vaginosis was made in 8.7% and candidiasis in 11.3%; none suffered from trichomoniasis. None in this study suffered from syphilis. Conclusion: The high prevalence of RTI (37.3%) among RA women, hitherto have not been considered, should be of great concern. This study finding highlights the need to raise awareness of RTI among RA women.
P16 In-vitro platelet function studies in 20 patients of antiphospholipid syndrome (APS) NK Singh, V Kumar, S Srivastava, D Dash Department of Medicine and Rheumatology Division, Institute of Medical Sciences, India. Introduction: Exact pathogenesis of exceedingly high thrombotic events in APS remains obscure and is an open area for intense research. Present study was undertaken in this direction to explore the role of platelets in this disease. Materials and methods: We conducted various in-vitro platelet function tests in blood samples of 20 patients of APS and 20 healthy controls. It included platelet aggregation, total degranulation, degranulation in relation to time under stored condition, degranulation and shape changes in platelets under phase contrast microscope, clot retraction and Western blotting of clot retracted samples. Results: Platelets extracted from APS patients were found to be hyperaggregable, able to secrete more dense granule (ADP/ATP) on activation and were able to sustain its degranulation potential for longer period. Alteration in shape of platelets appeared rapidly, to a greater extent and for longer period when stimulated with thrombin 0.5 units/mL in blood samples of APS patients as compared to that of healthy controls in similar conditions. Clot retraction in APS patients was less. Western blot study of clot retracted samples showed that platelets from APS patients form more active protein (carrying phosphotyrosine moiety) with an extra band at 47 kDa. Conclusion: Platelets separated from APS patients showed hyperactivity which may contribute to hypercoagulable state in APS patients. Additionally, poor clot retraction in APS patients may contribute to sustained blockage of affected vessels.
P17 A prospective study of clinical manifestations of SLE cases at VSGH AP Naveen Kumar, DVN Sharma, MK Tripathy, M Srinivas Department of General Medicine, Visakha Steel General Hospital, Visakhapatnam Steel Plant, Andhra Pradesh, India. Aim of the study: To study the varied clinical manifestations of SLE cases which presented to Visakha Steel General Hospital starting from 2003. Materials and methods: All patients satisfying the American College of Rheumatology criteria were included in the study over a period of 5 years from 2003. Regular follow up of patients included clinical examination and CBP, ESR, RFT, LFT, 24 hour urine protein, lipids, ECG, chest-x-ray. ANA and DsDNA, Smith antibody were done in all and ACA wherever necessary. Results and conclusions: A total number of 26 cases were detected during this period, female 20, male 4. The average age of presentation was 24 years oldest being 46 and the youngest being 12. The major clinical features were arthritis 16, skin manifestations 14, renal 8, haematologic 10, neurologic 3 and other symptoms 6. All the clinical manifestations did not appear at the same time so only the manifestations that occurred at diagnosis were included in the study. All the cases were ANA positive and 14 were DsDNA positive. SLE is a multisystem disease but good clinical history supported by judicious clinical investigations makes a diagnosis of SLE very easy.
P18 A comparative analysis to study dietary habits in persons with osteoarthritis knee compared to those without osteoarthritis of knee in Lucknow M Tandon, R Srivastava, P Tiwari, SK Das, P Kumar Introduction: This study has been conducted to assess the relationship between the dietary habits in the persons of non-osteoarthritis and osteoarthritis of knee. Materials and methods: Total 94 persons (OA = 53, non-OA = 41) were enrolled. Non-OA controls were enrolled from the same population. All OA patients fulfilled the ACR (American College of Rheumatology) clinico-radiological criteria 1986 for OA. Diet related information was collected with the help of structured questionnaire. Dietary information was based on the 24-hour dietary recall intake of the persons. Result: The mean age of OA patients was 54.8 ± 9.8 and of non-OA persons was 48.7 ± 13.8. The mean weight of the OA persons were 68.3 ± 14.3 and of non-OA persons was 57.9 ± 11.7. The observed mean BMI of the OA persons was 27.2 ± 5.5 and in non-OA was 23.3 ± 4.7. It was observed that 64.2% of the OA patients and 29.3% of the non-OA persons were of pre obese/obese weight status. The energy, fat, calcium and vitamin D intake of the persons in OA persons and non-OA persons were 2162 Kcal, 36.91 g, 1437.26 mg, 225.98 IU and 2138.46 Kcal, 56.90 g, 1499.33 mg, 298.42 IU, respectively. Also, the main observations includes that dairy products have been emerged as the main source of calcium in both OA as well as in non-OA persons. And OA patients had low vitamin D intake as compare to non-OA persons.