Objective: To analyze the clinical manifestation of patients with Behcet’s disease, and performance of different classification criteria of Behcet’s disease in our population. Methods: It was a retrospective analysis of all Behcet’s disease patients attending Department of Rheumatology at Fatima Memorial Hospital, Lahore, Pakistan from April 2019 to July 2019. We performed a comprehensive clinical evaluation of patients with Behcet’s disease, with focus on patients’ age, gender and different clinical manifestations. Results: A consecutive cohort of 20 patients was studied. All patients met the International Criteria of Behcet’s Disease criteria, and 18 out of 20 patients also met International Study Group criteria. Mean age of the cohort was 33.5±10.4 years and 45% was female (male to female ratio of 1:1.2). Around 90% of cohort had recurrent oral and genital ulcers. Ocular involvement was present in 80% patients, while Joint manifestations were present in 75% of patients. Cutaneous, neurological (both central and peripheral nervous system involvement), and GIT symptoms were present in 50%, 30%, and 15% of patients, consecutively. Joint pain and eye symptoms were major initial symptoms in males, while eye symptoms and neurological symptoms were more common in female patients at disease onset. Reaching border line significance, Cutaneous (p-value=0.479), ocular (p-value=0.61), and GIT involvement (p-value=0.59) were more prevalent in males while neurological involvement (p-value=0.336) in females. Conclusion: Behcet’s disease occurs commonly in middle age population with equal male to female ratio, with mucocutaneus aphthosis, ocular disease and joint pains being common manifestation. Gastrointestinal symptoms are more common in males while neurological symptoms in females. doi: https://doi.org/10.12669/pjms.36.5.1916 How to cite this:Khan A, Haroon M, Bashir F, Zia-ud-Din. Behcet’s Disease: Pakistani Experience. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1916 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Hydroxychloroquine (HCQ) an anti-inflammatory drug used in treatment of rheumatic diseases causes retinal toxicity in a minority of patients which are both time and dose dependent. The aim of this study was to assess the compliance with guidelines of American Association of Ophthalmology for screening and dosage of this drug. Patients and methods: In this cross-sectional analysis, the medical records of patients who were on HCQ, attending Rheumatology Outpatient Department of Fatima Memorial Hospital Shadman, Lahore from 25-05-2019 to 30-05-2019 were reviewed. The dosage and, duration of HCQ were collected, files were reviewed for physician recommendation of screening tests for retinal toxicity. HCQ dose of 5mg/kg/day was labeled as adequate dose; dose below 4.5mg/kg/day under dosed, while dose of 6mg/kg/day and above was considered overdose. Results: Data was collected from 81 patients during the study period, 74 (91.4%) of them being female, with mean age 35.15 ± 12.6 years. Based on total body weight, 23 patients (28.4%) were receiving the correct dosage of the drug around 5mg/kg/day whereas 39 (48.1%) patients were under-dosed below 4.5mg/kg/day, and 19 patients (23.5%) were over dosed, out of which 5 (6.17%) were receiving doses above 6.5mg/kg. Baseline eye screening examination by ophthalmologist was performed within 1 year of commencing treatment in 54 (66%) patients. Of the 27 patients receiving HCQ more than 5 years, 6 patients underwent Spectral coherence Ocular CT scan (SD-OCT) evaluation at 5 years. There was minimal compliance (less than 70% of Patients) to optimum drug dosage, partial compliance (70-89% patients) to preventing over-dosage of the drug, and full compliance (more than 90% patients) was achieved in baseline screening exam recommendation. Follow-up screening documentation and 5-years screening examination had minimal compliance. Conclusion: A significant proportion of patients are underdosed, especially the obese population where the recommended dosage is not prescribed.
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