RELATIONSHIP BETWEEN DISABILITY AND RADIOGRAPHIC FINDINGS OF LUMBAR DISK DEGENERATION IN SAMPLE OF IRAQI PATIENTS WITH MECHANICAL LOW BACKACHE

Objectives: Disability related to chronic low back pain (LBP) is a complex and multidimensional phenomenon all over the world. The prevalence of backache in middle age and elderly is up to 84%. This study aims to evaluate the associations of X-ray features of lumbar disk degeneration with severity of disability among patients with mechanical LBP. Methods: A cross-sectional study was conducted on a total of 300 patients with chronic mechanical LBP. Severity of disability was measured using Modified Oswestry Disability Index and intensity of backache was assessed using numeric rating scale (0–10). X-ray features of lumbar disc degeneration according to Lane classification and spondylolisthesis were assessed in lateral recumbent lumbar X-rays. Results: The mean age of our sample was 52.45±7.87 and 71.7% of involved patients were women. Most patients were recorded as overweight or obese. The findings of disk space narrowing were mild in 65.7%, moderate in 28.7%, and severe in 5.6%, where the presence of osteophytes were small in 76.9%, moderate in 20.5%, and large in 2.6%. Regarding disability, two-third of cases were focused on minimal disability, followed by moderate, severe, and crippled as (26%), (6%), and (2%), respectively. There was highly significant association between women and pain radiation to legs (p=0.004). Obesity and overweight had meaningless effects on all markers. Conclusions: The severity of disability was significantly more in women, high intensity of lower back pain, presence of pain radiating to legs, moderate/severe disk space narrowing on X-ray, and disk degenerative disease score on X-ray, while age, presence of osteophytes and spondylolisthesis, body mass index, and pain duration were not associated with severity of disability

ASSOCIATION OF ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN A SAMPLE OF ADULT PATIENTS WITH PSORIASIS AND PSORIATIC ARTHROPATHY

Objective: Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy commonly associated with psoriasis, a large number of patients with PsA that has persistent inflammation may develop progressive joint damage and disability and have reduced life expectancy. This study aims to determine the associations of anti-cyclic citrullinated peptide (CCP) antibodies in adult patients with psoriasis and PsA.Methods: A case–control study was conducted at Baghdad teaching hospital, Units of Rheumatology and Dermatology, during the period from December 2016 to April 2017 including three groups; 40 patients with psoriasis, 40 patients with PsA fulfilling the CASPAR classification criteria, and 40 healthy control persons.Results: Two patients with psoriasis (5%) and 10 patients with PsA (25%) were seropositive for anti-CCP antibodies (ACPA). Healthy controls were negative for anti-CCPA. Regarding ACPA positivity, a significant difference was found between those three studied groups (p<0.001) and there was a significant difference between positive and negative ACPA in PsA patients regarding disease activity score (p=0.044).Conclusion: Positive ACPA were found more significant with PsA than in patients with psoriasis as well as associated with higher disease activity

An Observational Descriptive Cross-Sectional Study of 200 Iraqi Adult Patients with Ankylosing Spondylitis: Analysis of Ocular Manifestations

Objective: To analyze the ocular findings in adult patients with ankylosing spondylitis.Patients and methods: A cross sectional study was conducted on (200) ankylosing spondylitis (AS) patients diagnosed according to the modified New York criteria for ankylosing spondylitis. Demographic and clinical data were collected and all patients were examined by same ophthalmologist for ocular findings.Results: The mean age of patients was (35.2 ± 8.6) years with male to female ratio (13.3:1), and mean disease duration was (10.9 ± 6.7) years. Family history of AS was positive in (26%) of patients. HLA-B27 was obtained in (69.5%) of the total number of the patients. Among those patients in whom HLA-B27 test was obtained, (43.2%) had positive HLA-B27. Enthesitis was found in (48%) of patients, and (63.5%) had peripheral arthritis. Ocular manifestations were found in (21.5%) of the patients in the form of anterior uveitis (14.5%), conjunctivitis (3%), ocular dryness (2%), and cataract (2%). Ocular manifestations had significant association with enthesitis, peripheral arthritis, HLA-B27 positivity and positive family history of AS (p<0.05), but not with age, sex, disease duration and disease activity (p > 0.05).Conclusions: Prevalence of ocular manifestations in adult Iraqi patients with AS was (21.5%). The commonest form was anterior uveitis. Other forms included conjunctivitis, ocular dryness, and cataract. Ocular manifestations had significant association only with enthesitis, peripheral arthritis, HLA-B27 positivity and positive family history of AS. This may suggest that early screening for ocular features in AS is important for early diagnosis and treatment. Keywords: Ankylosing spondylitis, Ocular manifestations, Anterior Uveitis, Conjunctivitis, Ocular dryness, Cataract

Ocular Manifestations in Rheumatoid Arthritis: A Descriptive Cross-Sectional Study from Iraq

Background: Ocular involvement.is one of the most important extra articular manifestation of rheumatoid arthritis (RA) Objective: To evaluate the ocular manifestations in patients with RA. Patients and Methods: A cross sectional study was conducted on (103) patients with RA diagnosed according to either 1987 revised American College of Rheumatology (ACR) criteria or the 2010 ACR /European League Against Rheumatism (EULAR) criteria for diagnosis of RA. Baseline demographic and clinical characteristics of patients were recorded. Ocular manifestations were assessed in all patients. Results: A total of 103 patients with RA enrolled in this study, the mean age was 41.5 years with a female to male ratio of 7.6: 1. A positive serum for rheumatoid factor was obtained in 72.8% of patients, and a positive anti-cyclic citrullinated peptide antibody (ACPA) was obtained in 69.9% of patients. Dry eyes were the most frequently identifiable ocular manifestation (27.2%), followed by drug induced ocular disease (12.6%), in this category, posterior subcapsular cataract ranked first (8.7%), followed by blepharitis (3.9%). The occurrence of ocular inflammatory diseases was 8.7%, among this category of ocular diseases, conjunctivitis was at the top of the list (5.8%). A significant correlation was found between ocular dryness with RF, ACPA, high disease activity and treatment with biological drugs. Conclusions: The prevalence of ocular findings in patients with RA was 57.2%. The commonest was ocular dryness followed by posterior subcapsular cataract, other types of cataract, conjunctivitis, blepharitis, uveitis, episcleritis, keratitis and scleromalacia. Ocular dryness had a significant correlation with RF, ACPA, high disease activity and treatment with biological drugs but there was no correlation of these predictors with drug induce ocular disease or inflammatory ocular disease. There was no significant correlation between ocular manifestation with age, gender, functional class and disease duration. Keywords: Rheumatoid arthritis, Ocular manifestations, Dry eyes, Drug induced ocular manifestations, Ocular inflammatory diseases