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P5 Study of hearing impairment in rheumatoid arthritis
Abstracts of papers presented in IRACON-2007
Poster presentations
S13
Objective: To evaluate the type of pain in patients of severe OA of the knees by use of pain validating instrument ‘Pain Detect’, in order to provide appropriate long term management of the pain. Methods: Two hundred patients with pain due to OA of the knees were requested to fill the pain detect questionnaire. Patients with severe OA knees as per American College of Rheumatology Criteria, between 40 and 70 years of age, with no inflammatory disease or other co-morbid or chronic diseases were included in the study. Results: Out of 200 patients the scores were as follows: 1. 0 to 12.5 (unlikely neuropathic pain [> 15%]) 31. 2. 12.5 to 18.5 (unclear but neuropathic component may be present) 67. 3. 18.5 to 38 (neuropathic pain is certain [< 90%])103 patients.
Conclusion: The patients of OA usually suffer from neuropathic pain, to be managed accordingly and the prolonged use of NSAIDs which is the commonest prescription does not seem to be justified. ‘Pain detect’ could be used to ascertain the appropriate medication for pain relief.
P3
Pulse therapy with solumedrol in ankylosing spondylitis Anish Aggarwal Institute of Rheumatology and Pain, Brij Medical Centre, KK-54, Kavi Nagar, Ghaziabad, India.
Objective: To determine the place of pulse therapy with Solumedrol in ankylosing apondylitis (AS). Methods: Fifty subjects received Inj Solumedrol 25 mg/kg @ 1 g/day. Monitored dose of Paracetamol 650 mg was used as escape medicine. Adequate gastro-protection was used. HLA B27 positive patients, between 20 and 50 years of age with BASDAI > 5 were included, while those with impairment of liver, kidney, cardiac, bone marrow functions, diabetes mellitus or evidence of infection were excluded from the study. BASDAI was recorded at start of the study, after pulse therapy, at 4th and 8th weeks after treatment. The use of Paracetamol was noted. Results: The average BASDAI at start of the study, after pulse therapy, at 4th and 8th weeks was 6.22, 5.13, 4.35, and 3.41, respectively, while the use of Paracetamol at 4th and 8th week was 1014, and 845 mg, respectively. The average percentage change in BASDAI from entry to after therapy, 4th, and 8th weeks was 17.52, 30.06, and 45.18. Conclusion: The significant improvement of BASDAI upto 8 weeks after pulse therapy concludes that Solumedrol has a role in the clinical management of AS as a debulking agent to overcome the inflammatory load and there by reduce disease progression.
P4
Peripheral gangrene in rheumatic diseases R Kirthi, C Panchapakesa Rajendran, J Sasikala, S Rukmangatharajan, P Kanagarani, S Rajeswari, R Ravichandran, N Vasanthy Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamilnadu, India.
Aim: To analyse the patients with peripheral gangrene in systemic connective tissue diseases. Methods: A total of 36 cases of peripheral gangrene who presented to the rheumatic care centre from July 2005 to June 2007 were analysed. Results: Of the 36 patients there were 29 adults and 7 children. In the adult group there were 6 men and 23 women. Among children there were 2 boys and 5 girls. Children of SLE with gangrene were in the age group of 11 to 16 years. Of the 29 adult cases SLE was the commonest in 12 (41.4%) followed by unclassified vasculitis in 5 (17.2%), primary vasculitis, systemic sclerosis 3 each (10.34%). There were 2 cases each in primary Sjogren syndrome and primary APS (6.8%), 1 each in the group of RA and infective vasculitis (3.4%). Conclusion: Females were affected more in children and adults. Gangrene in SLE was common in both the groups. Unclassified vasculitis with gangrene was the next commonest in adults.
P5
Study of hearing impairment in rheumatoid arthritis P Samikrishnan, C Panchapakesa Rajendran, S Ammamuthu, S Rukmangatharajan, S Rajeswari, R Ravichandran, J Sasikala, N Vasanthi Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamilnadu, India.
Objective: To evaluate the pattern of hearing impairment in patients with rheumatoid arthritis and to examine the correlation between hearing impairment with the clinical, laboratory and the disease activity index-DAS 28 and to compare it with normal healthy controls.
S14
Indian Journal of Rheumatology 2007 September; Vol. 2, No. 3 (Suppl)
Poster presentations
Methods: This is a prospective case control study from July 2006 to June 2007 from patients (20–60 years) who were attending the Department of Rheumatology, Madras Medical College, Chennai were systematically evaluated for hearing impairment by speech reception threshold test, pure tone audiometry and tympanometry including the static compliance, middle ear pressure, stapedial reflex threshold test, acoustic decay test. In all patients the clinical features, laboratory data, X-rays, disease activity index-DAS 28 were performed and it was compared with normal healthy age and sex matched controls. Results: Out of 150 patients, 116 were females and 34 were males. In 86 controls, 65 were females and 21 were males. Sensorineural hearing loss (SNHL) was found in 34 patients and 5 controls, whereas conductive hearing loss (CHL) was found 7 and 2 patients and controls respectively. Mixed hearing loss was found in 2 patients but none in controls. Conclusion: In patients with RA SNHL was found in 22.7% and 5.8% in controls. Whereas CHL was found in 4.6% of patients versus 2.3% in controls. Speech reception threshold test was not found useful in this study. Hearing loss in RA was directly proportional to the disease duration and disease activity index-DAS 28.
P6
Clinicopathological study and treatment outcome in 31 patients of lupus nephritis MN Singh, NK Singh, A Agrawal, LK Pandey, RG Singh, J Shukla IMS BHU Varanasi, India.
Introduction: Clinical manifestations of lupus are variable of which kidney involvement may be life threatening. However, if timely diagnosed or appropriately treated outcome is rewarding. Methods: Out of 59 cases of SLE studied from 2005 to 2007, 31 (52.54%) patients had evidence of kidney involvement. Renal biopsy was performed in 14 patients and histopathological grading was done as per WHO 1995 revised criteria. All the patients excepting two having stage V disease were given cyclophosphamide 500 mg/m2 along with iv/oral prednisolone. Results: Twelve (38.7%) patients had subclinical non-nephrotic range proteinuria, 4 (12.9%) each had nephrotic syndrome and nephrotonephritic presentation and 11 (35.5%) had acute nephritic syndrome. Histopathological changes under light microscopy revealed stage III nephropathy in 1 (7.4%), stage IV in 10 (71.43%), stage V in 2 (14.29%) patients whereas 1 (7.14%) patient showed tubulointerstitial lesions presenting as proteinuria. Immunofluorescence studies performed over biopsy samples of 3 patients having stage IV nephropathy on light microscopy showed granular peripheral staining with IgG, IgM and C3. Clinico-pathological correlation reveal that (i) out of 10 patients having stage IV nephropathy, 7 had acute nephritic syndrome, 2 had nephrotic syndrome and 1 had nephroto-nephritic syndrome. (ii) Out of 2 patients having stage V nephropathy, 1 each had non-nephrotic range proteinuria and nephritic syndrome. At 6 month, 22 patients went into clinical remission of nephritis and 3 continued to show microscopic hematuria. Five patients expired, 2 because of fluid over load causing heart failure and 3 because of progressive CNS lupus not responding to medications. Conclusion: No uniform clinicopathological correlation could be established. Treatment with cyclophosphamide and corticosteroid was very effective in most of the patients.
P7
Randomised controlled trial of vitamin D in rheumatoid arthritis patients on triple therapy K Gopinath1, D Danda2 1 Department of General Medicine Unit I, 2Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India.
Background: Vitamin D is immunomodulatory and anti osteoporotic. No studies exist to assess its pain relieving action in rheumatoid arthritis. Methods: An open labeled randomized trial comparing triple therapy and 500 IU vitamin D + calcium combo with triple therapy and calcium alone was conducted. The primary outcome was the time to pain relief by patient’s visual analogue scale (VAS). Change in VAS after first achievement of pain relief and after 3 months was noted. Vitamin D levels were correlated with DAS 28 score, adjusting for sun exposure. Comparisons between the groups were done by Mann Whitney test and independent samples test using SPSS software. Results: Patients of the vitamin D group (n = 59) had higher pain relief than the control group (n = 61) {47% vs 40%, P = 0.035}. There was no significant difference in the time taken for initial pain relief between the two groups. Occurrence of hypovitaminosis D in RA patients (68%) is comparable to published normal Indian prevalence. There was no significant correlation between vitamin D levels and DAS 28 scores. Conclusion: Supplementation of vitamin D in patients with rheumatoid arthritis on triple therapy results in a significantly higher pain relief at the end of 3 months.
Poster presentations
S13
Objective: To evaluate the type of pain in patients of severe OA of the knees by use of pain validating instrument ‘Pain Detect’, in order to provide appropriate long term management of the pain. Methods: Two hundred patients with pain due to OA of the knees were requested to fill the pain detect questionnaire. Patients with severe OA knees as per American College of Rheumatology Criteria, between 40 and 70 years of age, with no inflammatory disease or other co-morbid or chronic diseases were included in the study. Results: Out of 200 patients the scores were as follows: 1. 0 to 12.5 (unlikely neuropathic pain [> 15%]) 31. 2. 12.5 to 18.5 (unclear but neuropathic component may be present) 67. 3. 18.5 to 38 (neuropathic pain is certain [< 90%])103 patients.
Conclusion: The patients of OA usually suffer from neuropathic pain, to be managed accordingly and the prolonged use of NSAIDs which is the commonest prescription does not seem to be justified. ‘Pain detect’ could be used to ascertain the appropriate medication for pain relief.
P3
Pulse therapy with solumedrol in ankylosing spondylitis Anish Aggarwal Institute of Rheumatology and Pain, Brij Medical Centre, KK-54, Kavi Nagar, Ghaziabad, India.
Objective: To determine the place of pulse therapy with Solumedrol in ankylosing apondylitis (AS). Methods: Fifty subjects received Inj Solumedrol 25 mg/kg @ 1 g/day. Monitored dose of Paracetamol 650 mg was used as escape medicine. Adequate gastro-protection was used. HLA B27 positive patients, between 20 and 50 years of age with BASDAI > 5 were included, while those with impairment of liver, kidney, cardiac, bone marrow functions, diabetes mellitus or evidence of infection were excluded from the study. BASDAI was recorded at start of the study, after pulse therapy, at 4th and 8th weeks after treatment. The use of Paracetamol was noted. Results: The average BASDAI at start of the study, after pulse therapy, at 4th and 8th weeks was 6.22, 5.13, 4.35, and 3.41, respectively, while the use of Paracetamol at 4th and 8th week was 1014, and 845 mg, respectively. The average percentage change in BASDAI from entry to after therapy, 4th, and 8th weeks was 17.52, 30.06, and 45.18. Conclusion: The significant improvement of BASDAI upto 8 weeks after pulse therapy concludes that Solumedrol has a role in the clinical management of AS as a debulking agent to overcome the inflammatory load and there by reduce disease progression.
P4
Peripheral gangrene in rheumatic diseases R Kirthi, C Panchapakesa Rajendran, J Sasikala, S Rukmangatharajan, P Kanagarani, S Rajeswari, R Ravichandran, N Vasanthy Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamilnadu, India.
Aim: To analyse the patients with peripheral gangrene in systemic connective tissue diseases. Methods: A total of 36 cases of peripheral gangrene who presented to the rheumatic care centre from July 2005 to June 2007 were analysed. Results: Of the 36 patients there were 29 adults and 7 children. In the adult group there were 6 men and 23 women. Among children there were 2 boys and 5 girls. Children of SLE with gangrene were in the age group of 11 to 16 years. Of the 29 adult cases SLE was the commonest in 12 (41.4%) followed by unclassified vasculitis in 5 (17.2%), primary vasculitis, systemic sclerosis 3 each (10.34%). There were 2 cases each in primary Sjogren syndrome and primary APS (6.8%), 1 each in the group of RA and infective vasculitis (3.4%). Conclusion: Females were affected more in children and adults. Gangrene in SLE was common in both the groups. Unclassified vasculitis with gangrene was the next commonest in adults.
P5
Study of hearing impairment in rheumatoid arthritis P Samikrishnan, C Panchapakesa Rajendran, S Ammamuthu, S Rukmangatharajan, S Rajeswari, R Ravichandran, J Sasikala, N Vasanthi Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamilnadu, India.
Objective: To evaluate the pattern of hearing impairment in patients with rheumatoid arthritis and to examine the correlation between hearing impairment with the clinical, laboratory and the disease activity index-DAS 28 and to compare it with normal healthy controls.
S14
Indian Journal of Rheumatology 2007 September; Vol. 2, No. 3 (Suppl)
Poster presentations
Methods: This is a prospective case control study from July 2006 to June 2007 from patients (20–60 years) who were attending the Department of Rheumatology, Madras Medical College, Chennai were systematically evaluated for hearing impairment by speech reception threshold test, pure tone audiometry and tympanometry including the static compliance, middle ear pressure, stapedial reflex threshold test, acoustic decay test. In all patients the clinical features, laboratory data, X-rays, disease activity index-DAS 28 were performed and it was compared with normal healthy age and sex matched controls. Results: Out of 150 patients, 116 were females and 34 were males. In 86 controls, 65 were females and 21 were males. Sensorineural hearing loss (SNHL) was found in 34 patients and 5 controls, whereas conductive hearing loss (CHL) was found 7 and 2 patients and controls respectively. Mixed hearing loss was found in 2 patients but none in controls. Conclusion: In patients with RA SNHL was found in 22.7% and 5.8% in controls. Whereas CHL was found in 4.6% of patients versus 2.3% in controls. Speech reception threshold test was not found useful in this study. Hearing loss in RA was directly proportional to the disease duration and disease activity index-DAS 28.
P6
Clinicopathological study and treatment outcome in 31 patients of lupus nephritis MN Singh, NK Singh, A Agrawal, LK Pandey, RG Singh, J Shukla IMS BHU Varanasi, India.
Introduction: Clinical manifestations of lupus are variable of which kidney involvement may be life threatening. However, if timely diagnosed or appropriately treated outcome is rewarding. Methods: Out of 59 cases of SLE studied from 2005 to 2007, 31 (52.54%) patients had evidence of kidney involvement. Renal biopsy was performed in 14 patients and histopathological grading was done as per WHO 1995 revised criteria. All the patients excepting two having stage V disease were given cyclophosphamide 500 mg/m2 along with iv/oral prednisolone. Results: Twelve (38.7%) patients had subclinical non-nephrotic range proteinuria, 4 (12.9%) each had nephrotic syndrome and nephrotonephritic presentation and 11 (35.5%) had acute nephritic syndrome. Histopathological changes under light microscopy revealed stage III nephropathy in 1 (7.4%), stage IV in 10 (71.43%), stage V in 2 (14.29%) patients whereas 1 (7.14%) patient showed tubulointerstitial lesions presenting as proteinuria. Immunofluorescence studies performed over biopsy samples of 3 patients having stage IV nephropathy on light microscopy showed granular peripheral staining with IgG, IgM and C3. Clinico-pathological correlation reveal that (i) out of 10 patients having stage IV nephropathy, 7 had acute nephritic syndrome, 2 had nephrotic syndrome and 1 had nephroto-nephritic syndrome. (ii) Out of 2 patients having stage V nephropathy, 1 each had non-nephrotic range proteinuria and nephritic syndrome. At 6 month, 22 patients went into clinical remission of nephritis and 3 continued to show microscopic hematuria. Five patients expired, 2 because of fluid over load causing heart failure and 3 because of progressive CNS lupus not responding to medications. Conclusion: No uniform clinicopathological correlation could be established. Treatment with cyclophosphamide and corticosteroid was very effective in most of the patients.
P7
Randomised controlled trial of vitamin D in rheumatoid arthritis patients on triple therapy K Gopinath1, D Danda2 1 Department of General Medicine Unit I, 2Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India.
Background: Vitamin D is immunomodulatory and anti osteoporotic. No studies exist to assess its pain relieving action in rheumatoid arthritis. Methods: An open labeled randomized trial comparing triple therapy and 500 IU vitamin D + calcium combo with triple therapy and calcium alone was conducted. The primary outcome was the time to pain relief by patient’s visual analogue scale (VAS). Change in VAS after first achievement of pain relief and after 3 months was noted. Vitamin D levels were correlated with DAS 28 score, adjusting for sun exposure. Comparisons between the groups were done by Mann Whitney test and independent samples test using SPSS software. Results: Patients of the vitamin D group (n = 59) had higher pain relief than the control group (n = 61) {47% vs 40%, P = 0.035}. There was no significant difference in the time taken for initial pain relief between the two groups. Occurrence of hypovitaminosis D in RA patients (68%) is comparable to published normal Indian prevalence. There was no significant correlation between vitamin D levels and DAS 28 scores. Conclusion: Supplementation of vitamin D in patients with rheumatoid arthritis on triple therapy results in a significantly higher pain relief at the end of 3 months.