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P20 Complementary role of holistic medicine in rheumatology
Abstracts of papers presented in IRACON-2007
Poster presentations
S19
Results: A total of 29 patients were enrolled. The mean age was 31 ± 6.7 years and the mean disease duration was 3.78 ± 3.59 years. Twelve (40%) of them had depression. A comparison with non-depressed patients revealed that depressed patient had higher DAS28 (5.66 ± 1.21 vs 3.81 ± 1.68; P < 0.005); NPRS (5.73 ± 1.68 vs 3.61 ± 2.12; P < 0.01) and HAQ-D (1.73 ± 1.66 vs 0.36 ± 0.24; P < 0.05). Conclusion: Young women with RA having higher disease activity and greater functional disability were more depressed.
P18
Determinants of sleep quality in patients with systemic lupus erythematosus PKS Chandrasekhara, NV Jayachandran, J Thomas, S Agrawal, L Rajasekhara, G Narsimulu Department of Rheumatology, Nizam’s Institute of Medical Sciences, Hyderabad, India.
Aims: To characterize sleep complaints in patients with systemic lupus erythematosus (SLE) and to identify the correlates of sleep quality. Methods: Fifty patients with SLE (fulfilling ACR1997 criteria) completed the questionnaire assessing sleep quality (Pittsburgh Sleep Quality Index, PSQI), depressed mood (Center for Epidemiological Studies Depression Scale, CES-D), functional disability (Health Assessment Questionnaire, HAQ), and pain severity (HAQ Visual analogue Scale, HAQ-VAS). Clinical examination determined disease activity (SLAM-R) and cumulative damage (SLICC/ACR). Fifty age- and sex-matched healthy controls were included. Results: The mean age of patients were 26.28 ± 9.03 years, disease duration 33.6 ± 29.4 months; HAQ 0.65 ± 0.95; SLAM-R 4.16 ± 2.73; SLICC 0.94 ± 1.15 and HAQ-VAS 1.89 ± 1.21. The global PSQI score was significantly higher in patients than controls (6.36 ± 3.83 vs 2.92 ± 1.61; P < 0.001). Moderate-to-severe sleep impairment was reported by 70% of patients. The disease-related hierarchical linear regression analysis revealed that only HAQ, SLAM-R, CESD scores and pain severity were independent determinants of global sleep quality. Conclusion: Poor sleep quality is common in SLE. It is affected by functional disability, depression, pain and disease activity. Damage has no influence on it.
P19
A clinical study of rheumatoid arthritis with special reference to extra-articular manifestations S Das Gupta, A Chatterjee, RN Halder Rheumatology Clinic, National Medical College, Kolkata, India.
Introduction: Rheumatoid arthritis is a multi-system disorder with world-wide distribution, but variable manifestation. The clinical picture of the disease in India varies significantly from that of the west. Objective: The aim of this study is to evaluate the nature and complications of this disease in our patient population. Methods: This is a hospital based study. It is conducted in Rheumatology Clinic of National Medical College, Kolkata. Sixty consecutive patients were included in this study. American College of Rheumatology criteria was applied for diagnosis of RA. Results: There are 60 patients (40 hindus and 20 muslims), 53 were females and 7 males (M:F ratio 1:7.5). Their age varied between15 and 57 years at presentation and 40% were between 40 and 49 years of age. The duration of illness at presentation varied between 6 months and 35 years. Commonest extra-articular manifestation was anaemia (50%). Hepatomegaly (10%), spenomegly (10%), episcleritis (8%), urinary abnormalities (15%), ECG changes (10%), nerve conduction abnormalities (10%) were found. Only 50% of patients were seropositive. Only 7% of patients have serious deformity of the joints. Serious extra-articular manifestations and gross articular deformities are less common and anaemias more common in our country than in the west.
P20
Complementary role of holistic medicine in rheumatology K Tuli Ravinder Holistic Medicine Founder: “SOHAM” Indraprastha Apollo Hospitals, New Delhi, India.
Abstract: The WHO definition of Health, “a state of positive physical, mental and social well being, and not merely absence of disease” guides the healthcare worldwide. But, the experience of WHO–UNICEF program “Health for All by 2000 A.D.”, made the World Health Assembly 1986
S20
Indian Journal of Rheumatology 2007 September; Vol. 2, No. 3 (Suppl)
Poster presentations
recommended ‘spiritual’ well being as the fourth dimension to definition of Health. To enable this, the WHO as well as our National Health Policy formulated integration and indigenization of the health services. The integration of evidence based ‘science’ of modern medicine with the time honored ‘art’ of various traditional systems of health enables the best in healthcare to the society. It enables a ‘synergy’ for much quicker and more complete relief. This integration gives medical profession an opportunity to bring together the strengths and to balance the weaknesses inherent in different systems of healthcare. It, also, adds additional dimension for improved care of an individual, body–mind–spirit, and is thus termed holistic medicine. Because of its tremendous benefits, it is emerging the hope of the people world over. Complementing holistic medicine to patients receiving rheumatology care, without any interference to their conventional treatment, helps to combat stress, restores homoeostasis, initiates immune modulation, promotes healing, accelerates rehabilitation, minimizes residual disabilities, and enhances quality of health and wellness. Thus, it improves the final outcome of every sickness, improves quality of life, and enables higher rate of cure.
P21
Influence of gender and age of onset on the outcome in children with systemic lupus erythematosus Sulaiman M Al-Mayouf, Abdullah Al Sonbul Pediatric Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Objective: To determine the influence of gender and age of onset on the outcome in children with systemic lupus erythematosus (SLE) Methods: Medical records of children with SLE treated at King Faisal Specialist Hospital and Research Center were reviewed. Outcome measures included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SLICC/ACR), renal disease required dialysis or transplant and death related to SLE. Patients were classified based on age at disease onset into early onset (< 5 years) and late onset (> 5 years). Data was analyzed and comparison was made according to the gender and age groups. Results: Eighty nine patients (76 girls and 13 boys), 12 of them had early onset disease. The median disease duration was 5 years. There was no difference in the median of age, age at diagnosis, disease duration and follow up between the different groups. Logistic regression analysis showed significant association of high SLICC/ACR score with early onset disease and male gender. While renal disease required dialysis and renal transplant associated significantly with male gender independently of age of disease onset. In contrast death related to SLE influenced by early onset disease. Conclusion: Male children with early onset disease of this cohort had poorer outcome. This finding indicates that gender and early onset disease influence the long-term outcome of SLE in children. Type of Presentation:
P22
A clinical study of polymyositis/dermatomyositis with special reference to therapeutic response V Marwaha, K Narayanan, OP Garg, SN Bhaduri, R Chengappa, VP Chaturvedi Department of Rheumatology and Department of Physical Medicine Rehabilitation, Army Hospital (Research and Referral) Delhi Cantt, India.
Introduction: Dermatomyositis and polymyositis are immunoinflammatory diseases belonging to the group of idiopathic inflammatory myopathies. The treatment of these diseases requires long -term follow up. Steroids, DMARDs, IVIG are generally used in treating these diseases. Methods: This prospective study was carried out in Army Hospital (Research & Referral) from January 2004 to April 2006. Patients with dermatomyositis/polymyositis were included in the study. Informed concern was taken. They were treated with steroids, DMARDs and IVIG if required. They were followed up every month in our OPD. Clinical examination, CPK was done during every month. Physical rehabilitation was done under specialist in Physical medicine and rehabilitation. Stretching, range of motion exercises and isometric strengthening were done. Results: A total of eight patients were included in the study. Six had dermatomyositis and two had polymyositis. There were five males and three females in the study group. All eight patients responded well to therapy with steroids and DMARDs. However, one patient had associated carcinoma ovary and she succumbed to this. The other patients have recovered well on follow up varying between 12 months to 26 months. One patient relapsed after remission. Two patients required IVIG (1st patient—4 x monthly doses), (2nd patient—3 x monthly doses) and repeated 2 x monthly doses after 6 months of relapse. Duration of treatment has been at least one year or longer. Two patients developed diabetes mellitus requiring insulin therapy. One patient was a known case of familial hyperuricemia and chronic kidney disease. All seven patients are presently on maintenance doses of steroids and DMARDs. Conclusion: Dermatomyositis and polymyositis patient did well on therapy. IVIG should be used in refractory case. Physical rehabilitation plays an important role in recovery. Close follow up improves outcome.
Poster presentations
S19
Results: A total of 29 patients were enrolled. The mean age was 31 ± 6.7 years and the mean disease duration was 3.78 ± 3.59 years. Twelve (40%) of them had depression. A comparison with non-depressed patients revealed that depressed patient had higher DAS28 (5.66 ± 1.21 vs 3.81 ± 1.68; P < 0.005); NPRS (5.73 ± 1.68 vs 3.61 ± 2.12; P < 0.01) and HAQ-D (1.73 ± 1.66 vs 0.36 ± 0.24; P < 0.05). Conclusion: Young women with RA having higher disease activity and greater functional disability were more depressed.
P18
Determinants of sleep quality in patients with systemic lupus erythematosus PKS Chandrasekhara, NV Jayachandran, J Thomas, S Agrawal, L Rajasekhara, G Narsimulu Department of Rheumatology, Nizam’s Institute of Medical Sciences, Hyderabad, India.
Aims: To characterize sleep complaints in patients with systemic lupus erythematosus (SLE) and to identify the correlates of sleep quality. Methods: Fifty patients with SLE (fulfilling ACR1997 criteria) completed the questionnaire assessing sleep quality (Pittsburgh Sleep Quality Index, PSQI), depressed mood (Center for Epidemiological Studies Depression Scale, CES-D), functional disability (Health Assessment Questionnaire, HAQ), and pain severity (HAQ Visual analogue Scale, HAQ-VAS). Clinical examination determined disease activity (SLAM-R) and cumulative damage (SLICC/ACR). Fifty age- and sex-matched healthy controls were included. Results: The mean age of patients were 26.28 ± 9.03 years, disease duration 33.6 ± 29.4 months; HAQ 0.65 ± 0.95; SLAM-R 4.16 ± 2.73; SLICC 0.94 ± 1.15 and HAQ-VAS 1.89 ± 1.21. The global PSQI score was significantly higher in patients than controls (6.36 ± 3.83 vs 2.92 ± 1.61; P < 0.001). Moderate-to-severe sleep impairment was reported by 70% of patients. The disease-related hierarchical linear regression analysis revealed that only HAQ, SLAM-R, CESD scores and pain severity were independent determinants of global sleep quality. Conclusion: Poor sleep quality is common in SLE. It is affected by functional disability, depression, pain and disease activity. Damage has no influence on it.
P19
A clinical study of rheumatoid arthritis with special reference to extra-articular manifestations S Das Gupta, A Chatterjee, RN Halder Rheumatology Clinic, National Medical College, Kolkata, India.
Introduction: Rheumatoid arthritis is a multi-system disorder with world-wide distribution, but variable manifestation. The clinical picture of the disease in India varies significantly from that of the west. Objective: The aim of this study is to evaluate the nature and complications of this disease in our patient population. Methods: This is a hospital based study. It is conducted in Rheumatology Clinic of National Medical College, Kolkata. Sixty consecutive patients were included in this study. American College of Rheumatology criteria was applied for diagnosis of RA. Results: There are 60 patients (40 hindus and 20 muslims), 53 were females and 7 males (M:F ratio 1:7.5). Their age varied between15 and 57 years at presentation and 40% were between 40 and 49 years of age. The duration of illness at presentation varied between 6 months and 35 years. Commonest extra-articular manifestation was anaemia (50%). Hepatomegaly (10%), spenomegly (10%), episcleritis (8%), urinary abnormalities (15%), ECG changes (10%), nerve conduction abnormalities (10%) were found. Only 50% of patients were seropositive. Only 7% of patients have serious deformity of the joints. Serious extra-articular manifestations and gross articular deformities are less common and anaemias more common in our country than in the west.
P20
Complementary role of holistic medicine in rheumatology K Tuli Ravinder Holistic Medicine Founder: “SOHAM” Indraprastha Apollo Hospitals, New Delhi, India.
Abstract: The WHO definition of Health, “a state of positive physical, mental and social well being, and not merely absence of disease” guides the healthcare worldwide. But, the experience of WHO–UNICEF program “Health for All by 2000 A.D.”, made the World Health Assembly 1986
S20
Indian Journal of Rheumatology 2007 September; Vol. 2, No. 3 (Suppl)
Poster presentations
recommended ‘spiritual’ well being as the fourth dimension to definition of Health. To enable this, the WHO as well as our National Health Policy formulated integration and indigenization of the health services. The integration of evidence based ‘science’ of modern medicine with the time honored ‘art’ of various traditional systems of health enables the best in healthcare to the society. It enables a ‘synergy’ for much quicker and more complete relief. This integration gives medical profession an opportunity to bring together the strengths and to balance the weaknesses inherent in different systems of healthcare. It, also, adds additional dimension for improved care of an individual, body–mind–spirit, and is thus termed holistic medicine. Because of its tremendous benefits, it is emerging the hope of the people world over. Complementing holistic medicine to patients receiving rheumatology care, without any interference to their conventional treatment, helps to combat stress, restores homoeostasis, initiates immune modulation, promotes healing, accelerates rehabilitation, minimizes residual disabilities, and enhances quality of health and wellness. Thus, it improves the final outcome of every sickness, improves quality of life, and enables higher rate of cure.
P21
Influence of gender and age of onset on the outcome in children with systemic lupus erythematosus Sulaiman M Al-Mayouf, Abdullah Al Sonbul Pediatric Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Objective: To determine the influence of gender and age of onset on the outcome in children with systemic lupus erythematosus (SLE) Methods: Medical records of children with SLE treated at King Faisal Specialist Hospital and Research Center were reviewed. Outcome measures included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SLICC/ACR), renal disease required dialysis or transplant and death related to SLE. Patients were classified based on age at disease onset into early onset (< 5 years) and late onset (> 5 years). Data was analyzed and comparison was made according to the gender and age groups. Results: Eighty nine patients (76 girls and 13 boys), 12 of them had early onset disease. The median disease duration was 5 years. There was no difference in the median of age, age at diagnosis, disease duration and follow up between the different groups. Logistic regression analysis showed significant association of high SLICC/ACR score with early onset disease and male gender. While renal disease required dialysis and renal transplant associated significantly with male gender independently of age of disease onset. In contrast death related to SLE influenced by early onset disease. Conclusion: Male children with early onset disease of this cohort had poorer outcome. This finding indicates that gender and early onset disease influence the long-term outcome of SLE in children. Type of Presentation:
P22
A clinical study of polymyositis/dermatomyositis with special reference to therapeutic response V Marwaha, K Narayanan, OP Garg, SN Bhaduri, R Chengappa, VP Chaturvedi Department of Rheumatology and Department of Physical Medicine Rehabilitation, Army Hospital (Research and Referral) Delhi Cantt, India.
Introduction: Dermatomyositis and polymyositis are immunoinflammatory diseases belonging to the group of idiopathic inflammatory myopathies. The treatment of these diseases requires long -term follow up. Steroids, DMARDs, IVIG are generally used in treating these diseases. Methods: This prospective study was carried out in Army Hospital (Research & Referral) from January 2004 to April 2006. Patients with dermatomyositis/polymyositis were included in the study. Informed concern was taken. They were treated with steroids, DMARDs and IVIG if required. They were followed up every month in our OPD. Clinical examination, CPK was done during every month. Physical rehabilitation was done under specialist in Physical medicine and rehabilitation. Stretching, range of motion exercises and isometric strengthening were done. Results: A total of eight patients were included in the study. Six had dermatomyositis and two had polymyositis. There were five males and three females in the study group. All eight patients responded well to therapy with steroids and DMARDs. However, one patient had associated carcinoma ovary and she succumbed to this. The other patients have recovered well on follow up varying between 12 months to 26 months. One patient relapsed after remission. Two patients required IVIG (1st patient—4 x monthly doses), (2nd patient—3 x monthly doses) and repeated 2 x monthly doses after 6 months of relapse. Duration of treatment has been at least one year or longer. Two patients developed diabetes mellitus requiring insulin therapy. One patient was a known case of familial hyperuricemia and chronic kidney disease. All seven patients are presently on maintenance doses of steroids and DMARDs. Conclusion: Dermatomyositis and polymyositis patient did well on therapy. IVIG should be used in refractory case. Physical rehabilitation plays an important role in recovery. Close follow up improves outcome.