Biswadip Ghosh

Comparison between DAS28, CDAI and HAQ-DI as tools to monitor early rheumatoid arthritis patients in eastern India

ABSTRACT Objective To investigate the relationship among DAS28, CDAI and HAQ-DI in early rheumatoid arthritis (RA) patients. Methods It was a prospective study on 61 consecutive DMARD naive early RA patients attending the outpatient department of a tertiary care hospital in eastern India. DAS28, CDAI and HAQ-DI were calculated at the initial visit. They were put on DMARD therapy as per protocol with categorization of disease activity as per the CDAI values. DAS28, CDAI and HAQ-DI were again calculated after 3 months. Statistical analysis was carried out. Results There was a significant correlation among HAQ-DI, DAS28 and CDAI values. HAQ-DI showed significant correlation with the individual variables used in CDAI and DAS28. These observations were noted both in the initial and after 3-month follow-up values. There was significant agreement between the disease activity categories obtained by CDAI and DAS28 cut-off levels. Combination DMARD therapy based on ACR 2008 recommendations resulted in significant improvement in disease activity and functional disability. Conclusion We can assess the disease activity in the patients by recording the HAQ-DI, at least in cases of early RA. Both DAS28 and CDAI are equally useful in assessing the disease activity of RA. These facts become important as it suggests that laboratory values do not remain absolutely essential in the assessment of the patients. These findings are especially important in a fund-stricken health system in developing countries like India.

Early rheumatoid arthritis: clinical and therapeutic evaluation in a tertiary care centre in India

Abstract Background Patients with early rheumatoid arthritis may show a qualitative change in their short-term outcome if they are treated at presentation. We tried to evaluate these patients on disease modifying antirheumatic drugs (DMARDs) commenced at diagnosis. Methods 110 consecutive patients enrolled in this study from our rheumatology clinic, fulfilling American College of Rheumatology (ACR) 1987 revised criteria for classification of RA with disease duration of less than 6 months who had not received any DMARD. Patients were randomized to two groups irrespective of clinical, serological and radiological findings and assigned to treatment with either MTX + HCQ or SSZ + HCQ and were followed for 6 months. Results There were statistically significant differences in clinical and laboratory parameters after 6 months in comparison to baseline within each group but not between the two groups. There was good correlation between DAS28 and CRP when compared at baseline and after 6 months of treatment in both the treatment groups. Conclusions Disease control is the real goal of treatment of early RA irrespective of the DMARD regimen employed. Radiological changes may be found even in early RA and may call for more aggressive management in some patients. Costly estimation of CRP should give way to simple estimation of DAS28.

A study of the prevalence of osteoporosis and hypovitaminosis D in patients with primary knee osteoarthritis

INTRODUCTION Osteoarthritis and Osteoporosis are highly prevalent disease, so is hypovitaminosis D. We tried to find out prevalence of osteoporosis and hypovitaminosis D in patients suffering from primary knee Osteoarthritis. We also compared the prevalence of oseotoporosis between general population and patients of primary osteoarthritis. METHODS Patients suffering from primary knee OA were taken from Rheumatology OPD of Medical College Hospital and SSKM Hospital Kolkata, India. For each patient age and sex matched friend or relative of same locality was taken in the study as controls. Hospital staffs that come from different part of state was taken in the study as controls. The control population was the representative of general population. RESULTS Total number of participants in this study was 206. Out of which there were 98 cases and 108 controls. BMD status correlates significantly with Primary OA. Serum Vitamin D3 status correlates significantly with Osteoarthritis. Age of the patients correlated significantly with both BMD Status and Knee OA but not with the vVitamin D level. There were significant correlation between the Serum Vitamin D3 status and BMD of the subjects. CONCLUSION Osteoporosis is prevalent both in general population and patients suffering from Knee Osteoarthritis and may increase the disability. The matter is complicated by the fact hypovitaminosis D is also prevalent in the population and positively correlated with both Osteoporosis and osteoarthrosis, though we cannot comment on further pathogenesis because of cross sectional design of the study.

Wegener’s granulomatosis with dengue fever: an unusual association

Dear Editor, A 14-year-old unmarried girl was admitted to our hospital with a history of high-grade continuous fever for 15 days, along with mild non-productive cough for 7 days and conjunctival congestion for 4 days. On further interrogation, she revealed that she experienced an episode of epistaxis 3 days prior to onset of fever along with a blood-stained purulent discharge from her right ear which persisted for 2 days. She again had an episode of epistaxis on the day following her admission. On examination, she was found to have fever (38.9 C) and tachycardia (110 beats/min). Systemic examination revealed hemorrhagic spots on right nasal mucosa and tenderness over the right tragus. All other examination findings were normal. Possibilities of viral hemorrhagic fever, sepsis, hematological malignancy or aplastic anemia were kept under consideration and investigations followed. A broad-spectrum antibiotic in the form of cefoperazone + sulbactum (1 g + 500 mg) twice daily was also initiated empirically. The complete hemogram revealed Hemoglobin 8.7 g/dL, total leukocyte count 12 100/mm, neutrophil72, lymphocyte22, platelet count 480 000/mm). The erythrocyte sedimentation rate was 62 mm/1st hour. Liver function tests, blood sugar and serum urea and creatinine values were normal. Tests for human immunodeficiency virus antibodies were found to be non-reactive. Blood culture was found to be negative. Enzyme-linked immunosorbent assay done for detection of Dengue antibodies was found to be positive! There was presence of both immunoglobulin (Ig)M and IgG types of Dengue antibodies in the serum of the patient. A raised platelet count in the background of a seropositivity for Dengue infection was considered an unusual finding. So it was followed up with some more investigations. Urine analysis revealed strong presence of occult blood with 60–80 red blood cells per high power field (RBC/hpf). The albumin/creatinine ratio was 10 mcg/ mg. The urine culture was negative. At this juncture, a chest X-ray done incidentally as a part of routine investigation revealed two thick-walled cavity lesions located in both the right and left lung fields. We followed this up with sputum examination for acid fast bacilli and Gram-staining bacteria. Both microscopy and culture were found to be negative. So we decided to undertake a contrast-enhanced computed tomography (CT) scan of the thorax. This revealed multiple thick-walled lesions in both lung fields and few nodular lesions (Fig. 1). As per the radiologist’s opinion, this was suggestive of Wegener’s granulomatosis. CT-guided fine-needle aspiratory cytology from the lesion confirmed the presence of granulomatous inflammation. Test for detection of antineutrophil cytoplasmic antibody was positive with presence of antiproteinase 3 antibody at a level of 70.27 U/mL (normal < 6 U/mL). With these results, a diagnosis of Wegener’s granulomatosis was established for this patient. The patient was hence put on intravenous methylprednisolone

Cardiovascular evaluation in patients with systemic lupus erythematosus—a cross sectional study

Objectives More than 50% of patients with SLE experience clinical cardiovascular involvement during the course of the illness. We studied the relationship between disease duration, SLE disease activity index (SLEDAI), steroid use and cardiovascular abnormalities, and documented the extent of dyslipidaemia in SLE.