Validity of Remission Criteria in Rheumatoid Arthritis Compared to Ultrasound-Defined Remission

Objectives: Remission is the ultimate purpose of treatment in Rheumatoid Arthritis (RA). However, even when the most stringent composite scores were used, structural damages can occur. For that purpose ultrasonography (US) appears to be the best way to assess real remission. Our principal aim was to investigate the validity of different RA remission scores using the US as the reference. Methods: An analytic diagnostic study of 30 RA patients in remission according to DAS28 and a control group with active RA was conducted between January and October of 2018. Among them, we identified patients in remission according to the SDAI, the CDAI, and the ACR/EULAR remission score. The validity of each activity score for remission was calculated using as a gold standard the absence of PD signal. Results: All patients were in remission according to DAS28 with an average score of 2.03 [1.13-2.6]. US examination showed PD signals in 57% of all patients. Twenty-six patients were in remission according to CDAI, a Doppler signal was detected in 58% of those cases. SDAI remission was accomplished in 19 patients with PD activity in 53% of cases. For the 14 patients in remission according to ACR/EULAR criteria, synovial hyper-vascularization was found in 64%. Considering true remission as the absence of PD signals, the most sensitive and specific score was DAS28 (93% and 68% respectively). Conclusion: Considering remission in RA as the absence of vascularized synovitis, the DAS28 was the most sensitive and the most specific score. Keywords: Rheumatoid Arthritis, remission, ultrasonography, validity

Pemenuhan Kebutuhan Aktivitas Pada Lansia Dengan Rheumatoid Arthritis (RA) Di UPT Pelayanan Lanjut Usia Binjai

ABSTRACT: FULFILLMENT OF AN ELDERLY ACTIVITY NEED WITH RHEUMATOID ARTHRITIS (RA) AT UPT PELAYANAN SOCIAL LANJUT USIA BINJAI Introduction: Musculoskeletal system disorders are often experienced by the elderly that consist of rheumatoid arthritis, osteoarthritis, and gout. Rheumatoid arthritis is an autoimmune disease with the main target is the joints, usually occurs in the joints of the hand, elbows, feet, and knees. Pain, swelling, and stiffness in the joints can take place continuously, it could cause the elderly to experience the impaired physical mobility. Purpose: The study aimed to fulfill the physical mobility needs in rheumatoid arthritis at UPT Social Services for Elderly Binjai.Methods: The study used a descriptive case study design on two elderly with the same disease which includes five stages of the nursing process; assessment, diagnosis, intervention, implementation, and evaluation. The study was conducted at UPT Social Services for Elderly Binjai with inclusion criteria, specifically the patients who suffer from rheumatoid arthritis, having impaired physical mobility, and the elderly aged 60-74 years.Result: The result after being given nursing care for four days of visits with nursing intervention by performing Range Of Motion (ROM), showed that patients 1 and 2 had a significant increase in extremity movement, and a decrease of pain, joint stiffness, and physical weakness. Conclusion: It is suggested to the patients and families to continue providing ROM to reduce the pain, recover the patient's ability to move the muscles, improve blood circulation, and increase physical mobility. Keywords: Rheumatoid Arthritis, Physical Mobility, Elderly. INTISARI: PEMENUHAN KEBUTUHAN AKTIVITAS PADA LANSIA DENGAN RHEUMATOID ARTHRITIS (RA) DI UPT PELAYANAN LANJUT USIA BINJAI Latar Belakang: Gangguan system muskuloskletal yang sering dialami oleh lansia diantaranya adalah Rheumatoid Arthritis, osteoarthritis, dan gout, Rheumatoid Arthritis adalah suatu penyakit autoimun. Dengan target utama adalah sendi, biasanya terjadi di sendi tangan, siku, kaki, dan lutut. Nyeri, Bengkak, dan kaku pada persendian dapat berlangsung secara terus menerus hal tersebut dapat menyebabkan lansia mengalami gangguan mobilitas fisik.Tujuan: Penelitian ini bertujuan untuk memenuhi kebutuhan mobilitas fisik pada Rheumatoid Arthritis Di UPT Pelayanan Lanjut Usia Binjai.Metode: Jenis penelitian ini Adalah deskriptif dengan rancangan studi kasus pada dua orang lansia dengan penyakit yang sama yang meliputi lima tahapan proses keperawatan yaitu pengkajian, diangnosa keperawatan, intervensi keperawatan, implementasi keperawatan, dan evaluasi. Penelitian ini dilakukan di UPT Pelayanan Sosial Lanjut Usia Binjai dengan Kriteria inklusi yaitu pasien yang menderita Rheumatoid Arthritis, klien yang mengalami gangguan mobilitas fisik, lansia yang berumur 60-74 Tahun.Hasil: Hasil studi kasus setelah diberikan asuhan keperawatan selama empat hari kunjungan dengan intervensi keperawatan berupa diberikan Asuhan keperawatan gerakan Range Of Motion (ROM) di dapatkan hasil pada klien 1 dan 2 menunjukkan pergerakan ekstermitas Meningkat, Nyeri menurun, Kaku sendi menurun, Kelemahan fisik menurun.Kesimpulan: untuk klien dan keluarga agar klien mampu melanjutkan pemberian tindakan gerakan Range Of Motion (ROM) Untuk mengurangi rasa nyeri, mengembalikan kemampuan klien menggerakan otot, melancarkan peredaran darah, dan meningkatkan mobilitas fisik. Kata Kunci: Rheumatoid Arthritis, Mobilitas Fisik, lansia.

The Incidence of Peripheral Artery Disease in Patients with Rheumatoid Arthritis

Objectives: The basic aim of this study was to find the expression of PAD in a group of Rheumatoid arthritis participants but with no record of any cardiovascular diseases. Methods: On Ninety subjects with no record of considerable CVD but with RA a prospective observational non-experimental studywas performed. Doppler spectral waveform analysis and Ankle Brachial Pressure Index for vascular judgment was performed. Place and Duration: In the Medicine Department of Aziz Fatima Medical and Dental College Faisalabad for one-year duration from April 2020 to April 2021. Results: In this study total 90 of participants were selected out of which 18 were males and 72 were females. The mean age for this study and time period of RA was 62 ±9.01 and 11.8±11.2 years respectively. It was noticed that seventy five percent of the subjects had triphasic waveforms in the Right foot while sixty percent had in the Left foot when examined the posterior tibial or PT artery. In sixty-eight percent of the total participants triphasic waveforms of the Dorsalis Pedis Arteries were found. Biphasic right was present in thirty percent subjects while biphasic left was present in thirty five percent subjects. Biphasic Dorsalis Pedis was found in forty percent participants of both feet. Only one subject was found with discontinuous monophasic PT of both feet. Conclusions: Results show that ABPI index was discovered normal in majority of patients but waveform analysis was found suboptimal or biphasic in total of one-third of the participants. These results indicatethat to find patients with early PAD the judgment of peripheral arterial perfusion should use both modes. Keywords: Rheumatoid arthritis, ankle brachial pressure value, CVD risks hazards, screening.

Recurrent Methotrexate-related Lymphoproliferative Disorder of the Lumbar Spine Origin: A Case Report

Introduction: Previously, we reported a relatively rare case of methotrexate-related lymphoproliferative disorder (MTX-LPD) that developed in the lumbar spine. At present, we report the follow-up of that case, presenting with relapse of MTX-LPD. Case Report: The participant was a 75-year-old woman who was diagnosed with MTX-LPD of the lumbar spine and in whom remission was obtained 6 months after discontinuing methotrexate (MTX). At 12 months after remission, elevated levels of soluble interleukin-2 receptor, lymph node swelling on plain computed tomography (CT), and fluorodeoxyglucose uptake on positron emission tomography CT were observed, and recurrent MTX-LPD was diagnosed. Doxorubicin, bleomycin, vinblastine, and dacarbazine therapy was initiated, and partial remission was obtained 6 months later. Conclusion: In MTX-LPD, remission is often achieved following discontinuation of MTX alone; however, some patients do not improve, and some patients relapse, as seen in the present case. Such cases are treated using the standard regimen for the observed histologic subtype. Even after remission has been achieved, strict follow-up observation is needed for MTX-LPD. Furthermore, when signs of recurrence are observed during follow-up, practitioners should endeavor to cooperate with other specialists and act without delay. Keywords: Rheumatoid arthritis, methotrexate, lymphoproliferative disorder, lumbar spine, oncology.

Rheumatoid Arthritis: Etiology, Treatment and Animal Models

Rheumatoid arthritis is an autoimmune disease that can cause joint pain and damage throughout your body. About 75% of Rheumatoid arthritis patients are women. In fact, 1 – 3% of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the ages of 30 and 50. Rheumatoid arthritis occurs when your immune system attacks the synovium, the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment. It also affects other organs of body like: skin, eyes, heart, kidneys, and lungs. The main risk factors that cause Rheumatoid arthritis are Age, Gender, Genetics, weight, smoking, diet, etc. Three main ways to treat rheumatoid arthritis are Drugs, physical therapies and surgery. There are four main groups of drugs that are used to treat rheumatoid arthritis are non-steroidal anti-inflammatory drugs , disease-modifying anti-rheumatic drugs and steroids (also known as corticosteroids). Collagen induced arthritis and Adjuvant arthritis are the most commonly used standard animal models in Rheumatoid arthritis. This literature review assessed the sign & symptoms, risk factors, etiology, treatment and standard animal models for Rheumatoid arthritis. Keywords: Rheumatoid arthritis, Inflammation, Antirheumatic drugs, Adjuvants, Rat, Mice.

Association of Gout with Rheumatoid Arthritis and Pulmonary Toxicity of Methotrexate: A Case Report about Algerian Women

Coexistence of rheumatoid arthritis and gout is considered as rare however some patients may gather both diseases. Long-term treatment with Methotrexate may cause pulmonary pathology. We report a case of a 48-year-old Algerian woman with medical history (swelling of knee and joint pain in the shoulders and hands) diagnosed with Rheumatoid Arthritis (RA), after 3 years of self-medication with Methotrexate; she returned with hyperurecimia that confirmed the co-presence of the gout and RA as well as a pneumonia confirmed with clinical sign and chest X-Ray. Methotrexate dose compliance can reduce adverse effects. Keywords: Rheumatoid arthritis; Gout; Pneumonia; Methotrexate; Toxicity.

CLINICAL EVALUATION OF PATIENTS SUFFERING FROM RHEUMATOID ARTHRITIS WITH RESPECT TO IRON DEFICIENCY

Iron deficiency results in the decreased synthesis of important molecules including iron containing enzymes thereby inducing cellular organic functional disturbances. If not corrected in a timely manner, iron deficiency anemia (IDA) will ensue. The consequences of iron deficiency anemia (IDA) range from impaired psychological and physical well-being and decreased occupational abilities to developmental troubles in children and increased morbidity and mortality in some patient populations. Moreover, iron deficiency is a risk factor in various medical settings because it impedes erythropoietic response to acute and chronic anemia. Hence based on above findings the present study was planned to evaluate the levels of iron in rheumatoid The present study was planned in Department of General Medicine, All India Institute of Medical Sciences, Patna from jan 2018 to june 2018. Group A consist of 30 informed male and female consented patients diagnosed with Rheumatoid arthritis were enrolled for the study. The group B consist of 30 control patients for comparative evaluation. Hence from present study it can be concluded that, there is no known prevention for iron deficiency anaemia in rheumatoid arthritis (RA) patients other than the reduction of contributory factors. Therapy goals are to reduce pain and inflammation and improve quality of life. Surgery to repair, replace or fuse joints may help in serious conditions. Keywords: Rheumatoid Arthritis, Iron Deficiency, Heamoglobon, Iron, etc.

Proportion and Factors that Associate with Incidence of Hepatotoxicity in Rheumatoid Arthritis Patients Treated with Methotrexate in RSCM Year 2013−2015

Background Rheumatoid arhtirtis (RA) is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate (MTX) which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients' medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60%. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity (p>0.05).Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX. Keywords: Rheumatoid Arthritis, Methotrexate, Hepatotoxicity

Proportion and Factors that Associate with Incidence of Hepatotoxicity in Rheumatoid Arthritis Patients Treated with Methotrexate in RSCM Year 2013−2015

Background Rheumatoid arhtirtis (RA) is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate (MTX) which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients' medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60%. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity (p>0.05).Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX. Keywords: Rheumatoid Arthritis, Methotrexate, Hepatotoxicity

Is Male Rheumatoid Arthritis an Occupational Disease? A Review

Background:Rheumatoid arthritis (RA) is a systemic, inflammatory disease with an estimated global prevalence of 0.3–1.0%. An unexplained association exists between low formal education and the development of RA independent of smoking. It is established that RA is initiated in the lungs and that various occupations associated with dust, fume and metal inhalation can increase the risk of RA development.Objective:The objective of this review is to evaluate published clinical reports related to occupations associated with RA development. We highlight the concept of a “double-hit” phenomenon involving adsorption of toxic metals from cigarette smoke by dust residing in the lung as a result of various work exposures. We discuss the relevant pathophysiological consequences of these inhalational exposures in relation to RA associated autoantibody production.Method:A thorough literature search was performed using available databases including Pubmed, Embase, and Cochrane database to cover all relative reports, using combinations of keywords: rheumatoid arthritis, rheumatoid factor, anti-citrullinated peptide antibody silica, dust, fumes, metals, cadmium, cigarette smoking, asbestos, mining, bronchial associated lymphoid tissue, heat shock protein 70, and adsorption.Conclusion:We postulate that the inhalation of dust, metals and fumes is a significant trigger factor for RA development in male patients and that male RA should be considered an occupational disease. To the best of our knowledge, this is the first review of occupations as a risk factor for RA in relation to the potential underlying pathophysiology.