Rheumatology

Electrophysiological Study of Peripheral Nerves in Patients who Rheumatoid Arthritis

R Saigal, RN Yadav, M Bothra, M Mittal, A Kansal, Y Singh
SMS Medical College, Jaipur.

Aim : To study prevalence of peripheral neuropathy in patients of rheumatoid arthritis (RA) using electrophysiological studies and its association with disease duration and activity.

Material and Methods : Twenty five patients of rheumatoid arthritis fulfilling ACR criteria were selected. Clinical data including peripheral performed. All patients were subjected to electrophysiological studies of both upper limbs and lower limbs nerves.

Results : Out of 25 cases, 3 patients (12%) had electrophysiological evidence of neuropathy. All patients with neuropathy were seropositive, had deformities, with longer disease and treatment duration and active disease in comparison to nonneuropathy group.

Conclusion : Peripheral neuropathy is not an uncommon complication of RA.

Dislipidemia and Carotid Intima Medial Thickness in Naïve Patients of Early Rheumatoid Arthritis

S Chatterjee, A Ghosh, PS Karmakar, P Ghosh
IPGMER – Kolkata, West Bengal – 700 0114.

Background and Objectives : Dyslipidemia is an alarming issue in rheumatoid arthritis and its early detection and control can lead to significant reduction in mortality and morbidity due to cardiovascular causes in patients of rheumatoid arthritis.

Materials and Methods : The study is being conducted in Rheumatology outdoor of Institute of Postgraduate Medical Education and Research, Kolkata. Fifty patients of age group 15- 65 years having disease duration less than 2 years (Rheumatoid arthritis being defined by the 1992 ACR criteria) and those who haven’t received any disease modifying anti rheumatic drugs (DMARDS) previously will be enrolled. All the patients would be thoroughly examined including BML. Their baseline Hb% TLC, DLC, ESR, LIPID PROFILE (fasting), CRP and R factor would be assessed including the ultrasound carotid intima medial thickness (CIMT). Then patients will be started on DMARDS based on their DAS28 (disease activity scores) scores. They would be followed up after 6 months and 1 year with assessment of their lipid profile, CRP, ESR and CIMT Doppler. All the patients would be
excluded for other hyperlipidemic states like diabetes, hypertension, hypothyroidism, drugs like estrogens vita. D3, etc. Along with that 50 age sex matched healthy voluntary control will be selected.

Results : Up till now 30 patients have been enrolled in the study. The median age of onset of disease was 40 years with range 18-64 years. Median duration of the disease was 10 months wiwith range 18-64 years. Median duration of the disease was 10 months will range of 1.5 to 24 months. The median total cholesterol, HDL, LDL. TGs with ranges respectively were 155 (107-271), 48 (23-59), 82.5 (24-180), 150.5 (90-290). While the median intima medial thickness was found to 0.6 (0.3-0.8). the median DAS 28 score was found to be 6.79. Male:Female ratio was 1:4. 43% patients were found to have R Factor positive. Till now only 8 patients have been followed up for 6 month which have shown that improvement in lipid profile is not yet significant p=0.066. (Median LDL baseline and after six months). Total cholesterol, HDL, TGs, Mean IMT values, DAS 28 comparisons had similar p values. This may be due to the less number of follow up patients
at present but study is being continued diligently for further results.

Conclusion : Baseline studies have definitely showed that RA is a hyperlipidemic state and results are showing that intervention with DMARDS may be beneficial per se without addition of statins, and study is being continued for definite statistically significant results.

PUO : Is Still the Problem?

R Porkodi, VR Reddy, A Yelsangikar, PR Sowmini
SMC Chennai.

We describe two cases of young male patients who presented with PUO, nocturnal spikes and systemic manifestations of myalgia, arthritis and lymphadenopathy. Labs showed leucocytosis, elevated ASO, CRP and Ferritin levels. Based on Fautral’s criteria, diagnosis of Adult onset Still’s disease (AOSD) was made. This is the first report of AOSD from south India.