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P47 Efficacy and safety of mycophenolate in lupus nephritis
S41
Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl) Table 2 Disease prevalence in population
P47 Efficacy and safety of mycophenolate in lupus nephritis
Etiology
AK Surin, RN Benjamin, P Sandhya, G Atul, D Danda Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamilnadu, India. Introduction: Mycophenolate (MMf) is now an established therapy for advanced lupus nephritis. However, data on Indian patients are lacking due to higher cost. Materials and methods: Fifty two patients with lupus nephritis on MMf from 2004 till date were studied for efficacy and safety of the drug. The dose used was 2 g per day. The SLEDAI (SLE disease activity index), C3 and C4 complements, dsDNA antibody, and protienuria were assessed at three different visits, namely the time of initiation of MMf, 3 months later and the last visit. Results: Mean age was 28.12 years and M:F was 4:48. Mean duration of disease prior to starting MMf was MMf treatment led to significant improvement in proteinuria (from 1.7 g to 721 mg and 545 mg, P = 0.01), C4 complement (from14.2 ± 7.78 to 17.7 ± 8.6 and 18.06 ± 8.6, P = 0.01), C3 complement (from 74.8 ± 33.4 to 94.6 ± 30.06 and 93.31 ± 28.7, P = 0.001) and SLEDAI (from 10.91 ± 7.6 to 5.43 ± 6.5 and 4.4 ± 5.8, P = 0.000). However, there was no significant improvement in dsDNA (from 50.17 ± 11.7 to 40.6 ± 13.7 and 43.3 ± 17.4). There was no major side-effects documented necessitating stoppage of the drug. Conclusion: Mycophenolate appears to be a safe and effective, alternative immunosuppressant renal disease in SLE.
P48 Anti-beta 2-glycoprotein as compared with anticardiolipin antibody and lupus anticoagulant in diagnosis of antiphospholipid antibody syndrome P Sandhya, JAJ Prakash, E Saritha, K Singh, P Padhan, D Danda Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamilnadu, India. Introduction: Antibodies to β2-glycoprotein have been reported to have stronger association with clinical antiphospholipid syndrome (APS) than anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC). Methods: IgG, IgM and IgA antibodies to β2-glycoprotein antibodies were determined by ELISA (Aeskulisa) in 46 patients which included 24 patients with SLE and 22 with obstetric complications. Results: There were eight patients of SLE with clinical thrombosis-one each with hemiplegia, seizures, deep vein thrombosis, pulmonary embolism, Budd Chiari syndrome, portal and mesentric vein thrombosis and two with history of abortions. IgG aCL antibodies were positive in all cases. Lupus anticoagulant was positive in 7/8 cases. IgM, IgA, IgG β2-gp was positive in 2/8, 1/8 and 2/8 cases respectively. Majority of these patients (5/8) had haematological manifestations. Nine patients of SLE had only aCL/lupus anticoagulant positive without clinical thrombosis. IgM, IgA, IgG β2-gp was positive in 3/9, 1/9 and 1/9 cases respectively. Sixteen out of 22 patients with bad obstetric history with antiphospholipid syndrome, aCL/ lupus anticoagulant was detected in all cases. IgM, IgA, IgG β2-gp was positive in 6/16, 1/16 and 0/16 cases respectively. Conclusion: β2-gp1 antibody detection does not add any advantage over anticardiolipin antibody/lupus anticoagulant in antiphospholipid antibody syndrome.
P49 Burden and etiology of low back pain in West Bengal: interim report of a community survey A Ghosh, P Sinhamahapatra, S Dhar, P Ghosh, A Roy Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. Aims and objectives: This study was undertaken to look at the prevalence of low back pain in West Bengal and its etiology. Introduction: It is estimated that 28% experience disabling low back pain sometime during their lives.1 Among developing countries, prevalence of LBP were 44.1% to 64%.2,3 In India 23.09% had low back pain.4 Occupational and nutritional factors will be important in causation.5 Methods and study design: Community based cross-sectional study using stratified multistage random sampling. 450 patients from each district were screened. Of the 450 patients, 360 will be from village areas (rural) and 90 from municipality areas (urban). Results: Total population surveyed: 886 Sex distribution: Male 359; Female 527 Number of ‘patients’ (who had low back pain symptoms): 278 (Male 69; Female 209) Table 1 Characteristics of the population
Age (yr) Monthly income (Rs) Height (cm) Weight (kg)
Poster presentations
Minimum
Maximum
Mean ± SD
18.00 .00 110.00 26.00
95.00 200,000.00 195.00 144.00
41.7 ± 16.5 4808.1 ± 12816.5 155.0 ± 10.0 51.5 ± 11.9
Degenerative disc dis Facet joint dis Herniated disc Lumbar strain Osteopotic compression fracture Spondylolisthesis Spinal stenosis Pelvic organ Psychosomatioc Others Total
Female
Male
Total
38 11 2 132 3 4 0 1 2 16 209
11 4 0 40 2 1 1 0 0 10 69
49 15 2 172 5 5 1 1 2 26 278
References 1. Manchikanti L. Epidemiology of low back pain. Pain Physician 2000; 3(2): 167–92. 2. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine 2006; 31(25): E968–72. 3. Barrero LH, Hsu YH, Terwedow H, Perry MJ, Dennerlein JT, Brain JD, Xu X. Prevalence and physical determinants of low back pain in a rural Chinese population. Spine 2006; 31(23): 2728–34. 4. Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in workage adults in rural North India. Indian J Med Sci 2003; 57(4): 145–7. 5. Kumar A, Varghese M, Mohan D, Mahajan P, Gulati P, Kale S. Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India. Spine 1999; 24(23): 2506–15.
P50 Using arthritis camps to recruit patients into osteoarthritis knee drug trials—an innovative tool M Saluja, J Patil, VL Joshi, A Chopra Department of Rheumatology, Center for Rheumatic Diseases (CRD), Pune, India. We have used arthritis camps, probably for the first time, to enroll patients in drug trial (Chopra et al. J Rheumatol 2000;27:1365–72). Under a CSIR ‘New Millennium Indian Technology Leadership Initiative’ project 2002–2007, we carried out five controlled drug trials (total sample 593 patients, duration 12–48 weeks) to validate Ayurvedic drugs. An aggressive strategy systematically identified consenting eligible patients in routine free of cost camps (held in a community setting). Post camp screening success, patients were meticulously evaluated for trial eligibility. The enrollment success rate was 90.2% over 203 days (cumulative period). Post camp, several patients failed protocol eligibility (40%) or withdrew consent (20%). The varying camp based enrollment success (see Table) reflects possible community perceptions regarding drug trials. Table Knee pain camps to enroll patients in OA Knee Ayurvedic Drug Trials (target = 593 patients)
1 2 3 4 5 6 7 8 9 10 11 12 13
*Location
Attendees number
Found eligible
Entered trial
Enroll success % (I)
Enroll success % (II)
Clinic Clinic Clinic Clinic Clinic Clinic Clinic School School School Hall Hall Hall Total
229 146 182 107 182 256 222 262 116 353 144 86 283 2568
148 78 110 52 81 153 146 141 55 168 59 34 134 1359
63 20 43 13 33 61 87 53 15 49 35 10 54 536 (90.2%)
27.5 13.69 23.62 12.14 18.13 23.82 39.18 20.22 12.93 13.88 24.30 11.62 19.08 20.8
42.6 25.64 39.09 25.0 40.74 39.86 59.58 37.58 27.27 29.16 59.32 29.41 40.29 39.4
I = Percent enrolled/attendees; II = Percent enrolled/eligible.
Conclusion: Camps are an effective tool for speedy enrollment into drug trials. They provide patients from real life situation who are often naïve for drug trials. Acknowledgement: Sponsorship & funding by the CSIR, Government of India.
P51 Anti-cyclic citrullinated peptide (CCP) antibodies are uncommon in juvenile inflammatory arthritis (JIA): observations from a referral rheumatology clinic V Kunjir, V Anuradha, A Chopra Department of Rheumatology, Center for Rheumatic Diseases (CRD), Pune, India. Anti-CCP antibodies have a proven role in adult RA. JIA is riddled with low seropositivity of RF. Few studies report a low frequency of anti-CCP in JIA. Indian data is sparse. We maintain
Indian Journal of Rheumatology 2008 November; Vol. 3, No. 3 (Suppl) Table 2 Disease prevalence in population
P47 Efficacy and safety of mycophenolate in lupus nephritis
Etiology
AK Surin, RN Benjamin, P Sandhya, G Atul, D Danda Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamilnadu, India. Introduction: Mycophenolate (MMf) is now an established therapy for advanced lupus nephritis. However, data on Indian patients are lacking due to higher cost. Materials and methods: Fifty two patients with lupus nephritis on MMf from 2004 till date were studied for efficacy and safety of the drug. The dose used was 2 g per day. The SLEDAI (SLE disease activity index), C3 and C4 complements, dsDNA antibody, and protienuria were assessed at three different visits, namely the time of initiation of MMf, 3 months later and the last visit. Results: Mean age was 28.12 years and M:F was 4:48. Mean duration of disease prior to starting MMf was MMf treatment led to significant improvement in proteinuria (from 1.7 g to 721 mg and 545 mg, P = 0.01), C4 complement (from14.2 ± 7.78 to 17.7 ± 8.6 and 18.06 ± 8.6, P = 0.01), C3 complement (from 74.8 ± 33.4 to 94.6 ± 30.06 and 93.31 ± 28.7, P = 0.001) and SLEDAI (from 10.91 ± 7.6 to 5.43 ± 6.5 and 4.4 ± 5.8, P = 0.000). However, there was no significant improvement in dsDNA (from 50.17 ± 11.7 to 40.6 ± 13.7 and 43.3 ± 17.4). There was no major side-effects documented necessitating stoppage of the drug. Conclusion: Mycophenolate appears to be a safe and effective, alternative immunosuppressant renal disease in SLE.
P48 Anti-beta 2-glycoprotein as compared with anticardiolipin antibody and lupus anticoagulant in diagnosis of antiphospholipid antibody syndrome P Sandhya, JAJ Prakash, E Saritha, K Singh, P Padhan, D Danda Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamilnadu, India. Introduction: Antibodies to β2-glycoprotein have been reported to have stronger association with clinical antiphospholipid syndrome (APS) than anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC). Methods: IgG, IgM and IgA antibodies to β2-glycoprotein antibodies were determined by ELISA (Aeskulisa) in 46 patients which included 24 patients with SLE and 22 with obstetric complications. Results: There were eight patients of SLE with clinical thrombosis-one each with hemiplegia, seizures, deep vein thrombosis, pulmonary embolism, Budd Chiari syndrome, portal and mesentric vein thrombosis and two with history of abortions. IgG aCL antibodies were positive in all cases. Lupus anticoagulant was positive in 7/8 cases. IgM, IgA, IgG β2-gp was positive in 2/8, 1/8 and 2/8 cases respectively. Majority of these patients (5/8) had haematological manifestations. Nine patients of SLE had only aCL/lupus anticoagulant positive without clinical thrombosis. IgM, IgA, IgG β2-gp was positive in 3/9, 1/9 and 1/9 cases respectively. Sixteen out of 22 patients with bad obstetric history with antiphospholipid syndrome, aCL/ lupus anticoagulant was detected in all cases. IgM, IgA, IgG β2-gp was positive in 6/16, 1/16 and 0/16 cases respectively. Conclusion: β2-gp1 antibody detection does not add any advantage over anticardiolipin antibody/lupus anticoagulant in antiphospholipid antibody syndrome.
P49 Burden and etiology of low back pain in West Bengal: interim report of a community survey A Ghosh, P Sinhamahapatra, S Dhar, P Ghosh, A Roy Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. Aims and objectives: This study was undertaken to look at the prevalence of low back pain in West Bengal and its etiology. Introduction: It is estimated that 28% experience disabling low back pain sometime during their lives.1 Among developing countries, prevalence of LBP were 44.1% to 64%.2,3 In India 23.09% had low back pain.4 Occupational and nutritional factors will be important in causation.5 Methods and study design: Community based cross-sectional study using stratified multistage random sampling. 450 patients from each district were screened. Of the 450 patients, 360 will be from village areas (rural) and 90 from municipality areas (urban). Results: Total population surveyed: 886 Sex distribution: Male 359; Female 527 Number of ‘patients’ (who had low back pain symptoms): 278 (Male 69; Female 209) Table 1 Characteristics of the population
Age (yr) Monthly income (Rs) Height (cm) Weight (kg)
Poster presentations
Minimum
Maximum
Mean ± SD
18.00 .00 110.00 26.00
95.00 200,000.00 195.00 144.00
41.7 ± 16.5 4808.1 ± 12816.5 155.0 ± 10.0 51.5 ± 11.9
Degenerative disc dis Facet joint dis Herniated disc Lumbar strain Osteopotic compression fracture Spondylolisthesis Spinal stenosis Pelvic organ Psychosomatioc Others Total
Female
Male
Total
38 11 2 132 3 4 0 1 2 16 209
11 4 0 40 2 1 1 0 0 10 69
49 15 2 172 5 5 1 1 2 26 278
References 1. Manchikanti L. Epidemiology of low back pain. Pain Physician 2000; 3(2): 167–92. 2. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine 2006; 31(25): E968–72. 3. Barrero LH, Hsu YH, Terwedow H, Perry MJ, Dennerlein JT, Brain JD, Xu X. Prevalence and physical determinants of low back pain in a rural Chinese population. Spine 2006; 31(23): 2728–34. 4. Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in workage adults in rural North India. Indian J Med Sci 2003; 57(4): 145–7. 5. Kumar A, Varghese M, Mohan D, Mahajan P, Gulati P, Kale S. Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India. Spine 1999; 24(23): 2506–15.
P50 Using arthritis camps to recruit patients into osteoarthritis knee drug trials—an innovative tool M Saluja, J Patil, VL Joshi, A Chopra Department of Rheumatology, Center for Rheumatic Diseases (CRD), Pune, India. We have used arthritis camps, probably for the first time, to enroll patients in drug trial (Chopra et al. J Rheumatol 2000;27:1365–72). Under a CSIR ‘New Millennium Indian Technology Leadership Initiative’ project 2002–2007, we carried out five controlled drug trials (total sample 593 patients, duration 12–48 weeks) to validate Ayurvedic drugs. An aggressive strategy systematically identified consenting eligible patients in routine free of cost camps (held in a community setting). Post camp screening success, patients were meticulously evaluated for trial eligibility. The enrollment success rate was 90.2% over 203 days (cumulative period). Post camp, several patients failed protocol eligibility (40%) or withdrew consent (20%). The varying camp based enrollment success (see Table) reflects possible community perceptions regarding drug trials. Table Knee pain camps to enroll patients in OA Knee Ayurvedic Drug Trials (target = 593 patients)
1 2 3 4 5 6 7 8 9 10 11 12 13
*Location
Attendees number
Found eligible
Entered trial
Enroll success % (I)
Enroll success % (II)
Clinic Clinic Clinic Clinic Clinic Clinic Clinic School School School Hall Hall Hall Total
229 146 182 107 182 256 222 262 116 353 144 86 283 2568
148 78 110 52 81 153 146 141 55 168 59 34 134 1359
63 20 43 13 33 61 87 53 15 49 35 10 54 536 (90.2%)
27.5 13.69 23.62 12.14 18.13 23.82 39.18 20.22 12.93 13.88 24.30 11.62 19.08 20.8
42.6 25.64 39.09 25.0 40.74 39.86 59.58 37.58 27.27 29.16 59.32 29.41 40.29 39.4
I = Percent enrolled/attendees; II = Percent enrolled/eligible.
Conclusion: Camps are an effective tool for speedy enrollment into drug trials. They provide patients from real life situation who are often naïve for drug trials. Acknowledgement: Sponsorship & funding by the CSIR, Government of India.
P51 Anti-cyclic citrullinated peptide (CCP) antibodies are uncommon in juvenile inflammatory arthritis (JIA): observations from a referral rheumatology clinic V Kunjir, V Anuradha, A Chopra Department of Rheumatology, Center for Rheumatic Diseases (CRD), Pune, India. Anti-CCP antibodies have a proven role in adult RA. JIA is riddled with low seropositivity of RF. Few studies report a low frequency of anti-CCP in JIA. Indian data is sparse. We maintain