- Email: [email protected]
P51 To study the co-relation between the cortical thickness of tibia and bone mineral density
Abstracts of papers presented in IRACON-2010 seizure, internuclear ophthalmoplegia, cranial nerve palsies and stroke. Two patients presented with peripheral nerve involvement like acute demyelinating axonal polyneuropathy and multiple cranial neuropathy involving 10nth and 12th cranial nerve. Vascular complications were documented in 4 patients (7%). Majority of them presented with recurrent deep vein thrombosis and cerebral venous sinus thrombosis. Superficial thrombophlebitis occurred in 2% of patients. There were no documented arterial thrombosis, pulmonary or cardiac involvement in our cohort of patients. Conclusion: Behcet’s disease is mainly seen in young people. The most frequent symptoms are mucocutaneous, musculoskeletal and ocular manifestations. Comparison with large series did not show major differences except nervous system involvement is more common in our study. Positive pathergy test is less common in our cohort of patients, a finding similar to other Indian series.
P48 Intravenous zoledronic acid for osteoporosis in patients with various systemic autoimmune diseases—Jipmer experience VS Negi, P Padhan, T Paul, Antony, CB Mithun Division of Clinical Immunology, Department of Medicine, Jawaharlal Institute of Post Graduate Medical education and Research, Puducherry Introduction: Osteoporosis is a commonly associated various systemic autoimmune diseases either due to disease or steroid therapy or both. Annual zoledronic acid infusion is a safe and effective therapy for post menopausal osteoporosis. There is paucity of data on zoledronic acid therapy in systemic autoimmune diseases with osteoporosis which has additional anti-inflammatory properties. This study was undertaken to know the safety of intravenous zoledronic acid in patients with various systemic autoimmune diseases with osteoporosis. Materials & Methods: Patients with various systemic autoimmune diseases (age > 16 years) attending both outpatient and inpatient departments of Clinical Immunology were screened for osteoporosis. Serum calcium, phosphorous and alkaline phosphatase was done for all patients. Bone densitometry was done for all patients at three sites (femoral neck, lumbar spine, distal radius). Those with T score of less than −2.0 were given zoledronic acid. Intravenous zoledronic acid 4 mg was given in 100 ml of normal saline over 15minutes. Premedication with 1000 mg paracetamol was given to all patients. All of them were receiving daily regular 1000 mg calcium and 400 IU of vitamin D supplementation. Results: A total of 151 patients (25males and 126 females, mean age of 43.6 years) were given zoledronic acid therapy. Out of 151 patients 96 had rheumatoid arthritis, 15 had lupus, 12 had spondyloarthritis. The mean T score at femoral neck, lumbar spine, and distal radius were −2.5 ± 5, −2.61 ± 3.23, −2.89 ± 4.02 respectively. None had history of fracture. All patients had normal calcium, phosphorous and alkaline phosphatase levels. Out of 151 patients, 37 patients (24%) developed flu like symptoms and one had pruritus. None had features of hypocalcemia or jaw osteonecrosis. The mean follow up duration was 6.41 months. Conclusion: Annual intravenous zoledronic acid is a safe and convenient agent for treatment of osteoporosis in patents with systemic autoimmune diseases.
P49 Primary prophylaxis for steroid induced osteoporosis: are we doing enough? An audit from a tertiary care centre Vishnu
Poster presentations
S25
Aims & objectives: To study the association of subclinical LJM in small joints of hands with diabetic peripheral neuropathy (PN). Methods & Materials: A randomised cohort of T2DM patients were required to mark their rheumatic-musculoskeletal pain sites on a maniquin, and evaluated for PN using tuning fork (128 Hz) and monofilaments (4 g, 10 g). PN patients without pain in small joints of hands (cases) were compared with age- and sex-matched controls without PN. Joint mobility at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints was measured using a finger goniometer and Glycosylated haemoglobin (HbA1C) was checked in both groups. Statistical analysis (Independent Samples t test and multiple logistic regression) was done using SPSS 17.0 for Windows. Results: Of the 310 T2DM patients studied, 56 cases and controls were identified. Table 1 shows the association of variables in both groups. Variable HbA1C (%) Mean MCP mobility (°) Mean PIP mobility (°) Mean DIP mobility (°)
Cases (n = 56)
Controls (n = 56)
t value
p value
10.2 ± 1.6 74.2 ± 6.5 83.8 ± 11.9 51.7 ± 8.2
8.4 ± 1.3 81.31 ± 5.3 99.3 ± 10.0 60.9 ± 7.7
6.335 –6.316 –7.420 –6.061
0.001 < 0.001 < 0.001 < 0.001
In logistic regression analysis subclinical LJM at MCP had 2.106 (95% CI: 2.016–2.205) times chance of developing PN. Conclusion: There seems to be a significant association between subclinical LJM and PN in T2DM, which needs to be further corroborated with community-based studies including other micro-vascular complications on a larger population.
P51 To study the co-relation between the cortical thickness of tibia and bone mineral density Shweta Agarwal, Siddharth Kumar Das, GG Agarwal, Puneet Kumar, Rajesh Yadav Department of Rheumatology, CSM Medical University, Lucknow Background: X-rays of knees are frequently done for diseases like Osteoarthritis. It has been seen that cortical thickness of tibia varies considerably in patients and may co-relate with the BMD of the patient. It is postulated that cortical thickness of Tibia can be used for rough prediction of BMD of a patient as done by DEXA scan. Aim: The study was aimed to evaluate the utility of cortical thickness of tibia for predicting the bone mineral density obtained by DEXA. Method: 48 patients attending the rheumatology OPD, age > 18 yrs were studied in the study after excluding known metabolic bone disease or renal medical disease and pregnancy. All patients underwent a digital X-ray Left Knee PA view in standing posture with an external calibration scale attached to the X-ray plate and BMD by DEXA using GE lunar machine. Cortical thickness measured at 9 levels ranging from 5–9 cm below the tibial plateau on its medial aspect was studied against the BMD at AP spine, left forearm and left femur. Result: The following associations were found to be highly significant—BMD AP spine and cortical thickness 5.5 cm below the tibial plateau (CT-5.5) (r = 0.62, p < 0.0001); BMD Lt femur and CT-5.5 (r = 0.613, p < 0.0001); BMD Lt forearm and CT-5 (r = 0.525, p < 0.0001). Conclusion: Thickness of tibial cortex at 5–6 cm can be used as a rough quick predictor of patients with osteoporosis who need to be subjected to DEXA scan.
Department of Rheumatology. PD Hinduja National Hospital and MRC. Mumbai Background: Glucocorticoid induced osteoporosis (GIOP) has been a well known entity. It is characterized by rapid bone loss and increased fracture risk in the initial months after beginning therapy and is amenable to proper preventive measures. However, recognition, prevention and management of GIOP by health-care professionals in clinical practice have remained suboptimal. Objective: To examine the adequacy of primary prophylaxis for Glucocorticoid induced Osteoporosis in patients on long-tem steroids. Methods: Data of patients receiving oral steroid prescriptions in a six-month period was collected retrospectively. Patients receiving ≥ 7.5 mg/day for a ≥ 3 months were included in the study. Primary preventive measures instituted against GIOP were noted and analyzed. Results: Out of 403 patients who received steroid prescription in six-month period of study, 151 satisfied the inclusion criteria. 44/151 patients did not receive any prophylaxis, 73/151 received inadequate prophylaxis (only Calcium and/or vitamin D) and only 34/151 were given appropriate prophylaxis as per ACR recommendations (which includes anti-resorptive therapy in addition to calcium and vitamin D). Conclusions: The practice of instituting primary preventive measures against GIOP is not satisfactory among prescribing doctors. There is an urgent need to increase awareness and knowledge of GIOP management among doctors to reduce adverse skeletal effects of steroids
P50 Subclinical limited joint mobility (LJM) as a marker for micro-vascular complications in type 2 diabetes mellitus (T2DM)—results of a pilot study
P52 A pilot study to identify C30S and C55S mutations in the TNFRSF1A gene and M680I mutation in the MEFV gene in patients with suspected periodic fever syndrome R Subramanian, A Badika, Aparna, I Aisha, D Sumita, K Sathish, J Mathew, D Danda Department of Rheumatology, Christian Medical College, Vellore Aim: To identify C30S and C55S mutations in the exon 2 and exon 3 of Tumour Necrosis Factor Receptor Superfamily 1A [TNFRSF1A] gene respectively and mutation M680I in exon 10 of MEFV gene in patients with suspected periodic fever syndrome. Materials & Methods: 10 patients fulfilling the inclusion criteria for periodic fever syndrome that is; recurrent fever for more than 5 days along with any one of the following; polyarthritis, recurrent rash, recurrent abdominal pain or patients who had undergone exploratory laprotomy which did not reveal any pathology, focal myalgias, recurrent conjunctivitis, serositis, periorbital edema and family history of undiagnosed recurrent fever were recruited in the study. Patients with lymphadenopathy or proven infection or etiology for the symptoms and patient with deforming arthritis were excluded. DNA was extracted from peripheral blood using Qiagen DNA extraction kit followed by PCR based amplification using specific primers. The products were digested using restriction enzymes specific for the common mutations C30S, C55S of the TNFRSF1A genes and M680I of the MEFV gene to identify the mutations. These were then rechecked by ARMS technique using different sets of mutation specific primers.
State Nodal Office. Indian Institute of Diabetes, Trivandrum
Results: Age ranged from 6 to 43 years, out of which 6 were males. Polyarthritis was present in 6 and abdominal pain was present in 4 patients. None of the patients suspected to be having periodic fever syndrome showed the above commonly described mutations in TNFRSF1A and MEFV genes.
Background: Although the association of LJM and micro-vascular complications in T2DM is described, there is no data on subclinical LJM.
Conclusion: The common mutations described in the European population with TRAPS syndrome and FMF were not detected in these patients. The absence of these mutations may
Ashish Jacob Mathew, B Jayakumar, Saran Soman
P48 Intravenous zoledronic acid for osteoporosis in patients with various systemic autoimmune diseases—Jipmer experience VS Negi, P Padhan, T Paul, Antony, CB Mithun Division of Clinical Immunology, Department of Medicine, Jawaharlal Institute of Post Graduate Medical education and Research, Puducherry Introduction: Osteoporosis is a commonly associated various systemic autoimmune diseases either due to disease or steroid therapy or both. Annual zoledronic acid infusion is a safe and effective therapy for post menopausal osteoporosis. There is paucity of data on zoledronic acid therapy in systemic autoimmune diseases with osteoporosis which has additional anti-inflammatory properties. This study was undertaken to know the safety of intravenous zoledronic acid in patients with various systemic autoimmune diseases with osteoporosis. Materials & Methods: Patients with various systemic autoimmune diseases (age > 16 years) attending both outpatient and inpatient departments of Clinical Immunology were screened for osteoporosis. Serum calcium, phosphorous and alkaline phosphatase was done for all patients. Bone densitometry was done for all patients at three sites (femoral neck, lumbar spine, distal radius). Those with T score of less than −2.0 were given zoledronic acid. Intravenous zoledronic acid 4 mg was given in 100 ml of normal saline over 15minutes. Premedication with 1000 mg paracetamol was given to all patients. All of them were receiving daily regular 1000 mg calcium and 400 IU of vitamin D supplementation. Results: A total of 151 patients (25males and 126 females, mean age of 43.6 years) were given zoledronic acid therapy. Out of 151 patients 96 had rheumatoid arthritis, 15 had lupus, 12 had spondyloarthritis. The mean T score at femoral neck, lumbar spine, and distal radius were −2.5 ± 5, −2.61 ± 3.23, −2.89 ± 4.02 respectively. None had history of fracture. All patients had normal calcium, phosphorous and alkaline phosphatase levels. Out of 151 patients, 37 patients (24%) developed flu like symptoms and one had pruritus. None had features of hypocalcemia or jaw osteonecrosis. The mean follow up duration was 6.41 months. Conclusion: Annual intravenous zoledronic acid is a safe and convenient agent for treatment of osteoporosis in patents with systemic autoimmune diseases.
P49 Primary prophylaxis for steroid induced osteoporosis: are we doing enough? An audit from a tertiary care centre Vishnu
Poster presentations
S25
Aims & objectives: To study the association of subclinical LJM in small joints of hands with diabetic peripheral neuropathy (PN). Methods & Materials: A randomised cohort of T2DM patients were required to mark their rheumatic-musculoskeletal pain sites on a maniquin, and evaluated for PN using tuning fork (128 Hz) and monofilaments (4 g, 10 g). PN patients without pain in small joints of hands (cases) were compared with age- and sex-matched controls without PN. Joint mobility at metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints was measured using a finger goniometer and Glycosylated haemoglobin (HbA1C) was checked in both groups. Statistical analysis (Independent Samples t test and multiple logistic regression) was done using SPSS 17.0 for Windows. Results: Of the 310 T2DM patients studied, 56 cases and controls were identified. Table 1 shows the association of variables in both groups. Variable HbA1C (%) Mean MCP mobility (°) Mean PIP mobility (°) Mean DIP mobility (°)
Cases (n = 56)
Controls (n = 56)
t value
p value
10.2 ± 1.6 74.2 ± 6.5 83.8 ± 11.9 51.7 ± 8.2
8.4 ± 1.3 81.31 ± 5.3 99.3 ± 10.0 60.9 ± 7.7
6.335 –6.316 –7.420 –6.061
0.001 < 0.001 < 0.001 < 0.001
In logistic regression analysis subclinical LJM at MCP had 2.106 (95% CI: 2.016–2.205) times chance of developing PN. Conclusion: There seems to be a significant association between subclinical LJM and PN in T2DM, which needs to be further corroborated with community-based studies including other micro-vascular complications on a larger population.
P51 To study the co-relation between the cortical thickness of tibia and bone mineral density Shweta Agarwal, Siddharth Kumar Das, GG Agarwal, Puneet Kumar, Rajesh Yadav Department of Rheumatology, CSM Medical University, Lucknow Background: X-rays of knees are frequently done for diseases like Osteoarthritis. It has been seen that cortical thickness of tibia varies considerably in patients and may co-relate with the BMD of the patient. It is postulated that cortical thickness of Tibia can be used for rough prediction of BMD of a patient as done by DEXA scan. Aim: The study was aimed to evaluate the utility of cortical thickness of tibia for predicting the bone mineral density obtained by DEXA. Method: 48 patients attending the rheumatology OPD, age > 18 yrs were studied in the study after excluding known metabolic bone disease or renal medical disease and pregnancy. All patients underwent a digital X-ray Left Knee PA view in standing posture with an external calibration scale attached to the X-ray plate and BMD by DEXA using GE lunar machine. Cortical thickness measured at 9 levels ranging from 5–9 cm below the tibial plateau on its medial aspect was studied against the BMD at AP spine, left forearm and left femur. Result: The following associations were found to be highly significant—BMD AP spine and cortical thickness 5.5 cm below the tibial plateau (CT-5.5) (r = 0.62, p < 0.0001); BMD Lt femur and CT-5.5 (r = 0.613, p < 0.0001); BMD Lt forearm and CT-5 (r = 0.525, p < 0.0001). Conclusion: Thickness of tibial cortex at 5–6 cm can be used as a rough quick predictor of patients with osteoporosis who need to be subjected to DEXA scan.
Department of Rheumatology. PD Hinduja National Hospital and MRC. Mumbai Background: Glucocorticoid induced osteoporosis (GIOP) has been a well known entity. It is characterized by rapid bone loss and increased fracture risk in the initial months after beginning therapy and is amenable to proper preventive measures. However, recognition, prevention and management of GIOP by health-care professionals in clinical practice have remained suboptimal. Objective: To examine the adequacy of primary prophylaxis for Glucocorticoid induced Osteoporosis in patients on long-tem steroids. Methods: Data of patients receiving oral steroid prescriptions in a six-month period was collected retrospectively. Patients receiving ≥ 7.5 mg/day for a ≥ 3 months were included in the study. Primary preventive measures instituted against GIOP were noted and analyzed. Results: Out of 403 patients who received steroid prescription in six-month period of study, 151 satisfied the inclusion criteria. 44/151 patients did not receive any prophylaxis, 73/151 received inadequate prophylaxis (only Calcium and/or vitamin D) and only 34/151 were given appropriate prophylaxis as per ACR recommendations (which includes anti-resorptive therapy in addition to calcium and vitamin D). Conclusions: The practice of instituting primary preventive measures against GIOP is not satisfactory among prescribing doctors. There is an urgent need to increase awareness and knowledge of GIOP management among doctors to reduce adverse skeletal effects of steroids
P50 Subclinical limited joint mobility (LJM) as a marker for micro-vascular complications in type 2 diabetes mellitus (T2DM)—results of a pilot study
P52 A pilot study to identify C30S and C55S mutations in the TNFRSF1A gene and M680I mutation in the MEFV gene in patients with suspected periodic fever syndrome R Subramanian, A Badika, Aparna, I Aisha, D Sumita, K Sathish, J Mathew, D Danda Department of Rheumatology, Christian Medical College, Vellore Aim: To identify C30S and C55S mutations in the exon 2 and exon 3 of Tumour Necrosis Factor Receptor Superfamily 1A [TNFRSF1A] gene respectively and mutation M680I in exon 10 of MEFV gene in patients with suspected periodic fever syndrome. Materials & Methods: 10 patients fulfilling the inclusion criteria for periodic fever syndrome that is; recurrent fever for more than 5 days along with any one of the following; polyarthritis, recurrent rash, recurrent abdominal pain or patients who had undergone exploratory laprotomy which did not reveal any pathology, focal myalgias, recurrent conjunctivitis, serositis, periorbital edema and family history of undiagnosed recurrent fever were recruited in the study. Patients with lymphadenopathy or proven infection or etiology for the symptoms and patient with deforming arthritis were excluded. DNA was extracted from peripheral blood using Qiagen DNA extraction kit followed by PCR based amplification using specific primers. The products were digested using restriction enzymes specific for the common mutations C30S, C55S of the TNFRSF1A genes and M680I of the MEFV gene to identify the mutations. These were then rechecked by ARMS technique using different sets of mutation specific primers.
State Nodal Office. Indian Institute of Diabetes, Trivandrum
Results: Age ranged from 6 to 43 years, out of which 6 were males. Polyarthritis was present in 6 and abdominal pain was present in 4 patients. None of the patients suspected to be having periodic fever syndrome showed the above commonly described mutations in TNFRSF1A and MEFV genes.
Background: Although the association of LJM and micro-vascular complications in T2DM is described, there is no data on subclinical LJM.
Conclusion: The common mutations described in the European population with TRAPS syndrome and FMF were not detected in these patients. The absence of these mutations may
Ashish Jacob Mathew, B Jayakumar, Saran Soman