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.

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.