Study of APOE Gene and D2S439 Marker in Patients of Rheumatoid Arthritis and their Correlation with Severity of Disease: A Case Control Study

AIM

To delineate the genetic differences in polymorphism of the APOE and D2S439 marker genes for patients with and without rheumatoid arthritis and to study the distribution frequency of the prevalent alleles of these genes in clinically defined sub groups of patients/controls of Indian origin, specifically and their correlation with severity of disease using DAS score.

MATERIAL AND METHODS

This is a case control study where peripheral blood samples 160 cases and 150 controls were collected.

RESULTS

We evaluated the association of the tetra nucleotide repeat microsatellite marker D2S439 lying at 231.27cM position on the q arm of chromosome-2. The alleles of this marker ranged in size from 163bp-203bp in PCR product length corresponding to 5-15 (CTAT)n tetra repeats. The allele frequencies for this marker in the North Indian population are different from the CEPH populations. The longer alleles, >199bp (=14 or 15 CTAT repeats) were not observed. The genotypes after bimodal distribution differ significantly among cases and controls (p=0.003). Statistically significant difference was seen between cases and controls for ≥(CTAT) 10 longer allele which was more prevalent in the adult RA cases than in controls. Severity of RA was defined by a DAS28 score of >6 on a scale of ten. No significant association was seen with the APOE polymorphism and disease severity.

CONCLUSION

The long allele of D2S439 marker representing an expansion of the CTAT, tetranucleotide repeat doubles an individual's the risk for developing RA.

Study of Carotid Artery Intimomedial Thickness in Patients with Rheumatoid Arthritis and its Co-relation with Severity of the Disease

INTRODUCTION

RA is a chronic inflammatory state, predisposing for atherosclerosis as it is an immunoinflammatory process. This study focuses on use of Carotid artery intimomedial thickness (CIMT) as a marker for subclinical atherosclerosis.

OBJECTIVE

To study the assessment of atherosclerosis by Carotid Intimo-Medial Thickness (CIMT) in patients with rheumatoid arthritis and Correlation of ultrasonographic findings with severity of disease (using DAS-28 score).

MATERIAL AND METHODS

A prospective, case-control study involving 50 cases of diagnosed RA cases, and 50 healthy control. Sonological examination of the carotid and the vertebral arteries was done using a L&T SEQUINA color Doppler scanner with a linear band probe of frequency 6.6 to 14 MHz's.

RESULTS

This case control study was carried out in 100 subjects (50 cases and 50 controls). Cases comprised of 41 rheumatic women (Mean age 42.08+12.13 yrs) and 9 (mean age 48.4+12.8 years) rheumatic men. Mean CIMT of the study group (0.5996+0.109mm) was significantly greater (p<0.001) than that of control group (0.5290+0.006mm). We observed carotid plaques in 18% subjects of study group compared to 2% in controls (p<0.001). Mean age in the study group was 46.56+12.82 years and that of controls was 46.38+11.69 years (p>0.05). In the study group mean CIMT was significantly increased in RA factor positive patients than in RA factor negative patients. We also calculated the DAS-28 score of the study group subjects and found that 8, 27 and 15 were having Mild, Moderate & severe disease activity respectively.

CONCLUSIONS

CIMT has significant correlation with the age, and CIMT increases with age. Mean CIMT was found to be more with RF+(ve) patients indicating acute inflammation also has a role. When compared, the mean CIMT in each DAS sub group the result was found to be statistically insignificant.

Clinical Spectrum of Chikungunya in Bikaner (North Western India) in 2006 and Follow up of Patients for Five Years

OBJECTIVE

To find out clinical and laboratory profile of patients of chikungunya outbreak in 2006 in Bikaner (North-West Rajasthan) and follow up of chikungunya patients for 5 years.

METHODS

Study was conducted among 50 chikungunya patients. For this study the inclusion criteria was clinical presentation consistent with chikungunya virus infection (e.g. abrupt onset of fever and/or polyarthralgia) and laboratory confirmation of chikungunya virus infection by IgM-capture ELISA. All patients were subjected for thorough clinical and general physical examination, investigations like CBC, ESR, CRP, rheumatoid factor, ECG, LFT, RFT, anti-CCP antibody were done in all patients and their follow up was done for 5 years.

RESULTS

Among the 50 patients of chikungunya arthritis 34 (68%) patients developed persistent arthritis. Among the patients with persistent arthritis 70.58% were shown positive for anti-ccp antibody. CRP (95.24%) and ESR level were raised (68%) in patient with persistent arthralgia. Level of CRP and ESR was proportionally related to number of partially recovered joints, higher the CRP positivity and raised ESR levels severe were the persistent arthralgias.

CONCLUSIONS

Our study shows that chikungunya patients who had persistent arthralgia on 5 year follow up mimicked rheumatological disorder like rheumatoid arthritis in 70.58%. Therefore DMARD can be effective.

Post chikungunya brain stem encephalitis

Chikungunya is an arthropod born acute febrile arbo viral illness characterized by acute severe polyarthralgia. During last few years there has been scattered out breaks with associated neurological complications in India. Here we report a case of post chikungunya reversible demyelinating encephalitis who presented with vertigo, dysarthria and ataxia. There was complete clinical as well as radiological improvement with steroids.

Musculoskeletal manifestations of diabetes mellitus

The musculoskeletal conditions most commonly associated with diabetes are discussed below. One or more pathogenic mechanisms may be implicated in an association of a musculoskeletal condition with diabetes. Some rheumatological conditions are exclusive to diabetes whilst others occur more frequently in the diabetic population compared with non-diabetics. Whilst some musculoskeletal conditions may be managed conventionally when associated with diabetes, others may require special considerations. There is a preponderance of rheumatological manifestations of diabetes in the upper limb, although some conditions occur throughout the skeletal system.

Pulmonary manifestations in brucellosis: a report on seven cases from Bikaner (north-west India)

OBJECTIVES

Pulmonary manifestations of Brucellosis are rare. We came across seven patients with predominant symptomatology of pulmonary involvement amongst 98 patients of active brucellosis seen in last four years.

MATERIAL AND METHODS

The study is related to patients of brucellosis whose principal presenting features were related to respiratory symptom (cough, expectoration, pain in chest and breathlessness) along with fever and other constitutional symptoms. It included seven patients amongst 98 patients of active brucellosis seen during June 1996 to Feb. 2000 at PBM Hospital Bikaner. Diagnosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum. All patients were treated with rifampicin 900 mg daily and doxycyclin 100 mg twice daily for six week. The treatment was extended for another four weeks in two patients because of persistence of skiagram abnormalities.

RESULT

Three patients had abnormality in skiagram chest in the form of pleural effusion, multiple paranchymal opacities and pneumonia. The skiagram chest was normal in remaining four patients. The response of treatment started with 10-15 days and all the patients became symptom-free at the end of six weeks except one patient. Skiagram chest at this time was normal in patients of pleural effusion but there was persistence of haziness and few opacities in other two patients. Follow up skiagram chest at the end of six months and twelve months was normal in all patients except calcified opacity in one patient. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed.

CONCLUSION

Pulmonary manifestations of brucellosis are rare. Treatment with rifampicin and doxycylin showed marked clinical and radiological improvement. All patients were completely disease-free at the end of one year follow up.

Scorpion envenomation causing hemiparesis

We report a case of scorpion sting who presented with right hemiparesis and deranged level of consciousness. Prolonged BT/CT, decreased platelet counts, prolongation of PT and APTT with positive fibrinogen degradation products (FDP) D-dimer and CT scan findings of multiple cerebral haemorrhagic infarct indicating the presence of disseminated intravascular coagulation (DIC) as a cause of hemiparesis. Patient was managed with fresh blood transfusion and conventional treatment with favourable outcome.

A preliminary study of glycosylation of hair in diabetes mellitus

Glycosylation of hair was studied in 30 diabetic (15 IDDM and 15 NIDDM) patients and in 30 age and sex matched healthy non-diabetic subjects. A positive correlation occurs between glycosylation of proximal portion of hair and the simultaneously measured glycosylated haemoglobin. The hair glycosylation remains stable along the length of hair from scalp to tip in normal subjects and suggests that a sufficiently long hair sample may offer a long term record of degree of hyperglycaemia. This may be useful in the investigation of hyperglycaemia and microvascular complications of diabetes mellitus. The level of glycosylation of hair is independent of duration of the disease, age, sex and race of the patient and colour of the hair, thus providing a universal index of hyperglycaemia in the control of diabetic state. Glycosylation of hair is perhaps the most non-invasive technique readily acceptable to the patients and yet provides a fairly accurate and reliable information regarding hyperglycaemia in the preceding duration in which the hair has been grown.

Incidence of coronary artery disease in asymptomatic uncomplicated essential hypertensive patients--evaluation by treadmill exercise test

Treadmill exercise test was performed in 100 patients, 50 were hypertensive who were not having any clinical or electrocardiographic manifestation of coronary artery disease and 50 were controls. The test was positive in 28% of hypertensive patients as compared to 6% in controls. This study therefore suggests that hypertension is frequently associated with asymptomatic coronary artery disease as compared to normotension and it is concluded that exercise electrocardiography test is a definite diagnostic tool in diagnosis of coronary artery disease not only in symptomatic but also in asymptomatic patients with one or more risk factors.

An epidemiologic study of acute intermittent porphyria in Maheshwari community of Sri-Dungargarh municipal area

Fifteen patients of acute intermittent porphyria (AIP) were detected out of 2500 persons of Maheshwari community surveyed. These 15 patients belonged to 11 families. The prevalence of AIP in Maheshwari population came out to be 1:640 which is considerably higher than the figures reported from many other areas of our country. AIP was more common in females than males, the ratio being 9:6. Maximum number of cases (6) were encountered in the age group of 11-20 years. AIP was observed to be inherited as an autosomal dominant disease in 3 families. Spontaneous mutation of gene may be considered to be the mode of inheritance in the remaining 8 families. The disease was found to be more common in Daga and Tapadia subcastes. There were 5 cases belonging to Daga subcaste and 3 belonging to Tapadia subcaste.

Prognostic significance of exercise testing three weeks after myocardial infarction

Treadmill exercise test was performed in 50 patients aged 35-60 years, 3 weeks after myocardial infarction. Thirty-two had anterior and 18 had inferior wall transmural myocardial infarction. Cardiac events like angina, reinfarction and sudden death were more common in patients with positive stress test. Thus treadmill testing in the early postinfarction period is of great prognostic value.