Beta-2 microglobulin as a predictor of peripheral arterial disease in diabetes: The effect of estimated glomerular filtration

Background: Peripheral arterial disease (PAD) is common in patients with type 2 diabetes mellitus. Its definitive diagnosis requires ultrasound or angiography. Beta-2 microglobulin (â2 microglobulin) has been proposed as a diagnostic marker for PAD. The objective of the study was to evaluate the diagnostic value of â2 microglobulin for PAD in patients with diabetes and varying renal function.Design: This was a cross-sectional study.Setting: An academic centre (University of Pretoria and Steve Biko  Academic Hospital Diabetes Clinic).Subjects: One hundred and eight convenience-sampled patients.Outcome measures: Patients completed a questionnaire and had toe and arm blood pressure (toe-arm index), as well as serum â2 microglobulin and creatinine, measured.Results: Beta-2 microglobulin did not differ (p-value = 0.34) between those subjects with PAD (n = 43) and those without PAD (n = 65). In a linear regression model, the interaction term between estimated  glomerular filtration rate categories and the inverse of â2 microglobulin was highly significant (p-value = 0.001).Conclusion: Although the sample size was small, â2 microglobulin did not distinguish between subjects with and without PAD. Renal function and its effects on the association between â2 microglobulin and PAD need furtherstudy

Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis

BACKGROUND: The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early RA were investigated. METHODS: Changes in the Health Assessment Questionnaire-disability index (HAQ) and the Short Form-36 (SF-36) following 12 months of traditional disease modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years. RESULTS: The majority of the 171 patients were female (82%), black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36, but 92 (69%) still had substantial functional disability (HAQ >0.5), and 89 (66%) had suboptimal mental health (SF-36 mental composite score <66.6). Multivariate analysis showed that female sex (p=0.05) and high baseline HAQ (p<0.01) predicted substantial functional disability at 12 months. Unemployment (p=0.03), high baseline pain (p=0.02) and HAQ (p=0.04) predicted suboptimal mental health, with a trend towards low level of schooling being significant (p=0.08). CONCLUSIONS: Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psycho-social support, rehabilitation programmes and biologic therapy to improve physical function and HRQoL in this population.The Connective Tissue Diseases Research Fund, University of the Witwatersrand and the Medical Research Council of South Africa.http://informahealthcare.com/journal/rh