Objective: To assess the frequency of methotrexate intolerance in patients with rheumatoid arthritis by using methotrexate intolerance severity scale. Study Design: Cross Sectional study. Setting: DHQ Teaching Hospital Sahiwal. Period: November 2021 – April 2022. Material & Methods: Sample of 178 cases were selected through non-probability consecutive sampling. Patients of age 20-80 years, either gender, diagnosed with rheumatoid arthritis were enrolled. The MISS questionnaire was used to note the information and in tolerance was noted. Data analysis was done in SPSS version 25.0. Results: In this study, the mean age of patients was 35.12 ± 11.16 years. Out of 178 patients, 24 (13.5%) were males and 154 (86.5%) were females. The mean duration of disease was 31.22 ± 23.94 months. Mean duration of using methotrexate was 12.03 ± 12.61 months. About 33.7% patients had mild to moderate complaint of abdominal pain after taking methotrexate, abdominal pain anticipatory was absent in 98.9% patients and abdominal pain associative was also absent in 96.6% cases. Restlessness was mild in 20 (11.2%) cases, moderate in 22 (12.4%) and severe in 4 (2.2%) cases. Irritability was mild in 22 (12.4%) cases, moderate in 20 (11.2%) and severe in 4 (2.2%) cases. Overall refusal of methotrexate was noted in 38 (21.3%) cases. The mean MISS score attained by patients was 2.93 ± 3.82. Out of 178 patients, 44 (24.7%) had intolerance against methotrexate use for rheumatoid arthritis. Conclusion: The frequency of intolerance against methotrexate in patients of rheumatoid arthritis is high and cannot be ignored. Further trials should be done at adjust dose and alterations must be done to improve the tolerance and outcome of treatment.
Systemic lupus erythematosus (SLE) is an autoimmune disease that is frequently treated with high doses of corticosteroids and other immunosuppressive drugs. Thus patients with SLE are at increased risk for infections with several pathogens including Mycobacterium tuberculosis. There are no established guidelines available for treatment of tuberculosis in SLE patients with high disease activity due to lack of relevant studies and management based more on physician expertise. We report a case of a young SLE patient with high disease activity index (SLEDAI19) as evidenced by the presence of a vasculitic rash, non-healing ulcer on forearm and proteinuria of >1 g/d along with miliary tuberculosis. She was treated with intravenous methylprednisolone pulse up to 3 g and antituberculous therapy, but the result was a fatal outcome. This case report emphasizes the need for formal guidelines for co-management of active tuberculosis and SLE with high disease activity.
Objective: To know the gender difference in the autoimmune profile that is anti TPO antibodies and thyroid profile in patients with hypothyroidism and in euthyroid controls. Study Design: Case Control study. Settings: Medical Out Door Department of Bahawal Victoria Hospital, Bahawalpur. Period: 01/09/2018 to 31/08/2019. Material & Methods: Case control study that was conducted after taking ethical approval from hospital ethical committee. After taking informed consent data was entered on a predesigned questionnaire and 5 ml of venous blood was taken for thyroid profile and anti TPO antibodies. Study population was selected by nonprobability sampling. A total 128 patients in which 69 in the hypothyroid group A and 69 in euthyroid control group were added. Results: Most of the anti TPO positive hypothyroid participants were females but TSH value was more in males. All euthyroid anti TPO participants were females. Female hypothyroid patients were young compared to males. Conclusion: Autoimmune thyroid disorders are more common in females, autoimmunity appears before biochemical failure of thyroid.
Objective: To determine the frequency of extra articular manifestations in Ankylosing spondylitis patients at Independent University Hospital Faisalabad. Study Design: Cross-sectional study. Setting: Rheumatology Division of Internal Medicine Independent University Hospital, Faisalabad. Period: June 2020 to June 2021. Material & Methods: Consecutive one hundred and thirty-nine adult patients with baseline Ankylosing Spondylitis fulfilling the Assessment of spondyloarthropathy society criteria at early stage and Modified New York criteria in chronic form of disease, and fulfilling the selection criteria, were selected through Non-Probability Convenient Sampling technique for this study. Chi square test was used to compare the frequency of extra articular manifestations among disease duration, age groups and treatment group. A p-value ≤ 0.05 was considered statistically significant. Results: In this study, 139 number of patients were selected with confirmed diagnosis of ankylosing spondylitis. Mean age of patients was 32.60 ± 8.5 years with age range of 18 to 50 years. Extra articular manifestations were assessed in all selected patients of ankylosing spondylitis. Enthesitis and dactylitis were found in 8.6% (12) of patients. Uveitis was found in 5% (7) of patients. Similarly, psoriasis was found in 4.3% (6) of patients. Lung fibrosis was found in 3.6% (5) of patients. Inflammatory bowel disease was found in 2.9% (4) of patients. Conclusion: Assessment of extraarticular manifestations in AS was very important. Timely intervention with specific therapy decreases morbidity and mortality related to disease.
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