- Email: [email protected]
P23 Observational study on dyslipidaemia in rheumatoid arthritis in a tertiary centre in Eastern India
Abstracts of papers presented in IRACON-2008 Conclusion: Obesity comes out as a prominent risk factor. Also, low vitamin D intake emerged as predisposing factor for decreased calcium absorption consequently leading to knee joint damage. Keywords: Osteoarthritis, obesity, vitamin D.
P19 To study the echocardiographic findings in patients of rheumatoid arthritis H Singh, N Kumar, Jagdish, R Kumar Department of Rheumatology, PT B.D. Sharma University of Health Sciences, Rohtak, Haryana, India. Introduction: Rheumatoid arthritis is a systemic disease in which synovium is main target organ, frequently accompanied by extra-articular involvement particularly cardiovascular system. All layers of the heart can be inflamed and pericarditis is the most common type of involvement. Materials and methods: Fifty patients with RA were included in the study. They were divided into two groups A and B on the basis of duration of disease. Standard 2-D, M-Mode and Doppler echocardiographic examination was carried out on each subject. Mann-Whitney UTest was used for statistical analysis and P < 0.05 was accepted to be statistically significant. Results: Echocardiographic abnormality was detected in 18 of the 50 patients (36%) with pericardial effusion in five cases (10%), diastolic dysfunction in five cases (10%), mitral valve abnormalities (MVP/MR) in three cases (6%), increased LV dimension in two cases (4%) and mitral valve annular calcification in one case (2%). We found no statistically significant difference between two groups of RA patients. Conclusion: Cardiovascular system involvement which is an extra-articular involvement of RA is asymptomatic in most of the patients. Hence a periodical through evaluation of patients and aggressive treatment for identified problem can significantly reduce cardiovascular morbidity and mortality in patients with RA.
P20 Percutaneous vertebroplasty—new treatment for osteoporotic fractures using indiginous instrumentation
Poster presentations
S36
Subtypes: systemic-onset: 15/92 (16.3%; F:M = 3:2); oligoarticular: 16/92 (17.39%; F:M = 3:5; ANA positivity-2); polyarticular RF-negative: 27/92 (29.3%; F:M = 14:13; ANA positivity: 2); polyarticular RF-positive: 13/92 (14.1%; F:M = 8:5); psoriatic arthritis-1/92 (1.08%; F:M = 0:1); enthesis-related arthritis: 11/92 (11.95%; F:M = 2:9; HLAB-27 positive-2); others: 6/92 (6.52%; F:M = 4:2). Knee most commonly affected (68), followed by ankle (46), wrist (38), elbow (32) and hip (27). Four had temporomandibular and 2 sternoclavicular arthritis. Atlantoaxial dislocation in 2, deformities in 28, fever present in 55, 14 had significant weight loss, uveitis 2, episcleritis 2, 1 macrophage activation syndrome. Four developed AVN-femoral head erosions on radiographs in 13. Methotrexate was prescribed to 47 (51.08%), sulphasalazine to 16 (17.39%). Two (2.17%) required infliximab. Intraarticular corticosteroids were given to 12 (13.04%) and systemic to 38 (41.3%) patients. Mean duration of stay 6.78 ± 3.53 days. Conclusion: Commonest indication for admission is active arthritis/flare. Delay in diagnosislate referral to Rheumatologists. Uvetis rare. Lower limb joints most commonly affected.
P22 Ochronosis presenting as paraparesis AP Naveen Kumar, Lalitha, M Srinivas, A Patnaik Department of General Medicine, Visakhapatnam Steel Plant, Visakhapatnam, Andhra Pradesh, India. Aim of the presentation: To present this rare case of ochronosis which presented to us with paraparesis. Results: A 37 year old patient presented with an h/o low backache and weakness of both lower limbs of 5 months duration and inability to walk since 1 month. He gave a history of polyarthralgia since the age of 15 years. On examination he was having fixed flexion deformities in both knees, weakness at the hip and restricted mobility at multiple levels in the spine s/o a degenerative disease. On further analysis the patient’s mother revealed h/o passing urine which darkened upon standing. So a total workup was done and a diagnosis of Alkaptonuria made. He had all the features of ochronosis making the diagnosis complete. Alkaptonuria is a rare disorder of tyrosine metabolism with deficiency of homogentisic acid oxidase leading to excretion of homogentisic acid in urine and accumulation of the same pigment in connective tissues (ochronosis). This patient was managed with a protein restricted diet with vitamin C supplementation high doses. Conclusions: This case is being presented because of its rarity and mode of presentation.
B Arvind Department of Spine/Orthopaedics, Bharati Vidyapeeth Medical College, India. Summary of the background data: The vertebral compression fractures are diagnosed in large numbers because of increasing incidence of osteoporosis. They are treated conservatively with variable outcomes causing high morbidity due to deformities and pain. Minimally invasive spine surgery, by the way of vertebroplasty is good modality to stabilize the vertebral body to reduce pain and prevent long term deformity is getting acceptable, particularly in geriatric age group where major open surgeries are high risk. Materials and methods: Forty patients (27 females and 13 males) in the age group of 60 to 90 years of age who had osteoporotic compression fractures were treated by ‘percutaneous vertebroplasty’ studied for 2 years postoperatively. Study analysed from the period of January 2003 to December 2003. Locally made vertebroplasty needle device was used for all these cases. This device has been patented recently. These 40 patients who had painful osteoporotic fractures, who did not do well with conservative treatment, were high risk due to medical illnesses underwent percutaneous vertebroplasty using indigenously developed instruments. The history of the fractures was from 3 weeks to 2 years and had progressive pain and deformity. The assessment was done as follows: (1) Subjective: pain relief and ability to do activities of daily living [ADL]. (2) Objective: VAS score [Visual Analogue Score for pain], healing of the fractures on x-rays. Patients were followed up 24 hours, 4 weeks, 12 weeks, 6 and 12 months and 24 months postoperatively. Results: All patients had significant improvement of VAS by 50% or more within 24 hours and ADL started by next day. Conclusions: The results of this series are comparable to the one-presented by 2MAC, Kwok & Wong (2002). Distinct advantages being: (1) All patients had excellent pain relief and all the fractures united. (2) Single day hospitalization, local anaesthesia, less morbidity. (3) Reduction of cost by indigenous instrumentation. Vertebroplasty is an excellent minimally invasive procedure for osteoporotic fractures of the geriatric patients. Keywords: Vertebroplasty, osteoperotic vertebral fracture.
P21 Clinical profile of juvenile idiopathic arthritis at a tertiary referral centre in South India S Habibi, S Agrawal, JK Kishore, L Rajasekhara, G Narsimulu Department of Rheumatology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. Aim: A study of in-patients with juvenile idiopathic arthritis (JIA). Patients and methods: Records of in-patients with JIA (2004–2008) were retrieved. Details on demography, clinical characteristics, indications for admission and management were collected. Results: Ninety two patients (girls 38; boys 54; mean age 12.01 ± 2.12 years). Reasons for admission: arthritis/flare: 68 (81.5%); anaemia: 8 (8.6%); infections: 7 (7.6%); infliximab infusion: 2 (2.1%). Mean duration of disease before diagnosis 1.5 ± 4.75 years.
P23 Observational study on dyslipidaemia in rheumatoid arthritis in a tertiary centre in Eastern India U Ghosh, AK Kundu, A Roy, A Biswas, K Sen Department of Rheumatology Unit, Department of Medicine, R.G.KAR Medical College and Hospital, Kolkata, India. Introduction: Dyslipidaemia, an important risk factor for cardio-vascular disease, in rheumatoid arthritis (RA) is associated with accelerated atherosclerosis. Evidence of dyslipidaemia in RA was not studied much in Eastern India before. A study on the lipid levels in patients of RA and its relation with disease activity were done. Materials and methods: An observational study was done on lipid levels in 82 diagnosed patients of RA (fulfilling the ACR criteria) from inpatient, outpatient and Rheumatology clinic of a tertiary centre of Eastern India (Kolkata) from April’06 to July’08. Lipids estimations were done enzymatically by semi-autoanalyser and dyslipidaemia was defined by taking the cut-off value of National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) guidelines. Patients with other co-morbid illness and on statins were excluded. Disease Activity Score 28 (DAS-28) was employed for evaluating disease activity. Patients were followed up 10–12 weeks for repeat lipid levels estimation. Results: Using the high cut-off values of NCEP-ATP III, 37.8% (31/82) of our patients showed dyslipidaemia. Low HDL-C was the commonest abnormality seen in 34% (28/82). TC/HDL-C ratio was more than 5 in approximately 25% (20/82) and 2/82 had shown LDL-C of greater than 150 mg%. In the follow-up study after getting DMARD (MTX, SSZ, HCQ) therapy, there were increase in TC, LDL-C, HDL-C but TG was reduced; rise in HDL-C was statistically significant. DAS-28 showed significant correlation with HDL-C. Conclusion: Lipid abnormalities are common in Indian patients with RA. This is also observed in Eastern India. Low HDL-C being the commonest abnormality. Disease activity in RA is inversely related to the lipid levels.
P24 Suboptimal utilization of the services of the allied health professionals (AHPS) in rheumatology clinics in India R Rawat, RK Issac, RR Raja, IA Wani, AN Malaviya, S Garg, S Kapoor, DP Prashant Department of Rheumatology, Indian Spinal Injury Centre, Joint Disease Clinic, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India. Aims and objective: Due to acute shortage of trained rheumatologists in India, clinical load on them is extremely high. This study was conducted to ascertain the extent to which the services of AHPs are being utilized by the rheumatologists in India. Method: A pre-designed pre-paid questionnaire was mailed to 183 randomly selected rheumatologists listed in IRA directory. Simple calculations were done.
P19 To study the echocardiographic findings in patients of rheumatoid arthritis H Singh, N Kumar, Jagdish, R Kumar Department of Rheumatology, PT B.D. Sharma University of Health Sciences, Rohtak, Haryana, India. Introduction: Rheumatoid arthritis is a systemic disease in which synovium is main target organ, frequently accompanied by extra-articular involvement particularly cardiovascular system. All layers of the heart can be inflamed and pericarditis is the most common type of involvement. Materials and methods: Fifty patients with RA were included in the study. They were divided into two groups A and B on the basis of duration of disease. Standard 2-D, M-Mode and Doppler echocardiographic examination was carried out on each subject. Mann-Whitney UTest was used for statistical analysis and P < 0.05 was accepted to be statistically significant. Results: Echocardiographic abnormality was detected in 18 of the 50 patients (36%) with pericardial effusion in five cases (10%), diastolic dysfunction in five cases (10%), mitral valve abnormalities (MVP/MR) in three cases (6%), increased LV dimension in two cases (4%) and mitral valve annular calcification in one case (2%). We found no statistically significant difference between two groups of RA patients. Conclusion: Cardiovascular system involvement which is an extra-articular involvement of RA is asymptomatic in most of the patients. Hence a periodical through evaluation of patients and aggressive treatment for identified problem can significantly reduce cardiovascular morbidity and mortality in patients with RA.
P20 Percutaneous vertebroplasty—new treatment for osteoporotic fractures using indiginous instrumentation
Poster presentations
S36
Subtypes: systemic-onset: 15/92 (16.3%; F:M = 3:2); oligoarticular: 16/92 (17.39%; F:M = 3:5; ANA positivity-2); polyarticular RF-negative: 27/92 (29.3%; F:M = 14:13; ANA positivity: 2); polyarticular RF-positive: 13/92 (14.1%; F:M = 8:5); psoriatic arthritis-1/92 (1.08%; F:M = 0:1); enthesis-related arthritis: 11/92 (11.95%; F:M = 2:9; HLAB-27 positive-2); others: 6/92 (6.52%; F:M = 4:2). Knee most commonly affected (68), followed by ankle (46), wrist (38), elbow (32) and hip (27). Four had temporomandibular and 2 sternoclavicular arthritis. Atlantoaxial dislocation in 2, deformities in 28, fever present in 55, 14 had significant weight loss, uveitis 2, episcleritis 2, 1 macrophage activation syndrome. Four developed AVN-femoral head erosions on radiographs in 13. Methotrexate was prescribed to 47 (51.08%), sulphasalazine to 16 (17.39%). Two (2.17%) required infliximab. Intraarticular corticosteroids were given to 12 (13.04%) and systemic to 38 (41.3%) patients. Mean duration of stay 6.78 ± 3.53 days. Conclusion: Commonest indication for admission is active arthritis/flare. Delay in diagnosislate referral to Rheumatologists. Uvetis rare. Lower limb joints most commonly affected.
P22 Ochronosis presenting as paraparesis AP Naveen Kumar, Lalitha, M Srinivas, A Patnaik Department of General Medicine, Visakhapatnam Steel Plant, Visakhapatnam, Andhra Pradesh, India. Aim of the presentation: To present this rare case of ochronosis which presented to us with paraparesis. Results: A 37 year old patient presented with an h/o low backache and weakness of both lower limbs of 5 months duration and inability to walk since 1 month. He gave a history of polyarthralgia since the age of 15 years. On examination he was having fixed flexion deformities in both knees, weakness at the hip and restricted mobility at multiple levels in the spine s/o a degenerative disease. On further analysis the patient’s mother revealed h/o passing urine which darkened upon standing. So a total workup was done and a diagnosis of Alkaptonuria made. He had all the features of ochronosis making the diagnosis complete. Alkaptonuria is a rare disorder of tyrosine metabolism with deficiency of homogentisic acid oxidase leading to excretion of homogentisic acid in urine and accumulation of the same pigment in connective tissues (ochronosis). This patient was managed with a protein restricted diet with vitamin C supplementation high doses. Conclusions: This case is being presented because of its rarity and mode of presentation.
B Arvind Department of Spine/Orthopaedics, Bharati Vidyapeeth Medical College, India. Summary of the background data: The vertebral compression fractures are diagnosed in large numbers because of increasing incidence of osteoporosis. They are treated conservatively with variable outcomes causing high morbidity due to deformities and pain. Minimally invasive spine surgery, by the way of vertebroplasty is good modality to stabilize the vertebral body to reduce pain and prevent long term deformity is getting acceptable, particularly in geriatric age group where major open surgeries are high risk. Materials and methods: Forty patients (27 females and 13 males) in the age group of 60 to 90 years of age who had osteoporotic compression fractures were treated by ‘percutaneous vertebroplasty’ studied for 2 years postoperatively. Study analysed from the period of January 2003 to December 2003. Locally made vertebroplasty needle device was used for all these cases. This device has been patented recently. These 40 patients who had painful osteoporotic fractures, who did not do well with conservative treatment, were high risk due to medical illnesses underwent percutaneous vertebroplasty using indigenously developed instruments. The history of the fractures was from 3 weeks to 2 years and had progressive pain and deformity. The assessment was done as follows: (1) Subjective: pain relief and ability to do activities of daily living [ADL]. (2) Objective: VAS score [Visual Analogue Score for pain], healing of the fractures on x-rays. Patients were followed up 24 hours, 4 weeks, 12 weeks, 6 and 12 months and 24 months postoperatively. Results: All patients had significant improvement of VAS by 50% or more within 24 hours and ADL started by next day. Conclusions: The results of this series are comparable to the one-presented by 2MAC, Kwok & Wong (2002). Distinct advantages being: (1) All patients had excellent pain relief and all the fractures united. (2) Single day hospitalization, local anaesthesia, less morbidity. (3) Reduction of cost by indigenous instrumentation. Vertebroplasty is an excellent minimally invasive procedure for osteoporotic fractures of the geriatric patients. Keywords: Vertebroplasty, osteoperotic vertebral fracture.
P21 Clinical profile of juvenile idiopathic arthritis at a tertiary referral centre in South India S Habibi, S Agrawal, JK Kishore, L Rajasekhara, G Narsimulu Department of Rheumatology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. Aim: A study of in-patients with juvenile idiopathic arthritis (JIA). Patients and methods: Records of in-patients with JIA (2004–2008) were retrieved. Details on demography, clinical characteristics, indications for admission and management were collected. Results: Ninety two patients (girls 38; boys 54; mean age 12.01 ± 2.12 years). Reasons for admission: arthritis/flare: 68 (81.5%); anaemia: 8 (8.6%); infections: 7 (7.6%); infliximab infusion: 2 (2.1%). Mean duration of disease before diagnosis 1.5 ± 4.75 years.
P23 Observational study on dyslipidaemia in rheumatoid arthritis in a tertiary centre in Eastern India U Ghosh, AK Kundu, A Roy, A Biswas, K Sen Department of Rheumatology Unit, Department of Medicine, R.G.KAR Medical College and Hospital, Kolkata, India. Introduction: Dyslipidaemia, an important risk factor for cardio-vascular disease, in rheumatoid arthritis (RA) is associated with accelerated atherosclerosis. Evidence of dyslipidaemia in RA was not studied much in Eastern India before. A study on the lipid levels in patients of RA and its relation with disease activity were done. Materials and methods: An observational study was done on lipid levels in 82 diagnosed patients of RA (fulfilling the ACR criteria) from inpatient, outpatient and Rheumatology clinic of a tertiary centre of Eastern India (Kolkata) from April’06 to July’08. Lipids estimations were done enzymatically by semi-autoanalyser and dyslipidaemia was defined by taking the cut-off value of National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) guidelines. Patients with other co-morbid illness and on statins were excluded. Disease Activity Score 28 (DAS-28) was employed for evaluating disease activity. Patients were followed up 10–12 weeks for repeat lipid levels estimation. Results: Using the high cut-off values of NCEP-ATP III, 37.8% (31/82) of our patients showed dyslipidaemia. Low HDL-C was the commonest abnormality seen in 34% (28/82). TC/HDL-C ratio was more than 5 in approximately 25% (20/82) and 2/82 had shown LDL-C of greater than 150 mg%. In the follow-up study after getting DMARD (MTX, SSZ, HCQ) therapy, there were increase in TC, LDL-C, HDL-C but TG was reduced; rise in HDL-C was statistically significant. DAS-28 showed significant correlation with HDL-C. Conclusion: Lipid abnormalities are common in Indian patients with RA. This is also observed in Eastern India. Low HDL-C being the commonest abnormality. Disease activity in RA is inversely related to the lipid levels.
P24 Suboptimal utilization of the services of the allied health professionals (AHPS) in rheumatology clinics in India R Rawat, RK Issac, RR Raja, IA Wani, AN Malaviya, S Garg, S Kapoor, DP Prashant Department of Rheumatology, Indian Spinal Injury Centre, Joint Disease Clinic, ISIC Superspeciality Hospital, Vasant Kunj, New Delhi, India. Aims and objective: Due to acute shortage of trained rheumatologists in India, clinical load on them is extremely high. This study was conducted to ascertain the extent to which the services of AHPs are being utilized by the rheumatologists in India. Method: A pre-designed pre-paid questionnaire was mailed to 183 randomly selected rheumatologists listed in IRA directory. Simple calculations were done.