Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department

Background: Rheumatoid arthritis (RA) is a chronic, progressive, debilitating, systemic, autoimmune disease that mainly affects the diarthrodial joints. It is the most common form of inflammatory arthritis that occurs in approximately 1% of adults. The main objective is to study the characteristics of patients with Rheumatoid Arthritis (RA) at first presentation to a specialized rheumatology department.Methods: The study included 122 consecutive patients with RA, fulfilling 1987 American College of Rheumatology (ACR) criteria for RA at ‘Joint Disease Clinic’ of rheumatology department, at ISIC, New Delhi.Results: The mean age was 45.3 ± 12.4 years, F:M ratio, 8.4:1; maximum patients (31.1%) belonging to age group 30-40 years. Mean age at onset of symptoms was 38.1 ± 12.9 years and disease duration mode 5 years. 88% patients were literate and 59% referred by other patients. 14.8% patients had family history of RA, 7.38% (all males) were smokers. 16.4% female patients developed symptoms of arthritis within one year after delivery. 44.3% patients had severe, 50.8% moderate, 3.3% mild and 1.6% inactive disease (DAS 28[ESR] scoring system). 28.7% patients were taking treatment from alternative systems, 25.4% from orthopaedicians, 15.6% from internists and 8.2% from rheumatologists. Methotrexate and glucocorticoids were the most prescribed drugs (50.8% each) but in inappropriate doses. 23.8% patients had co-morbidities, hypothyroidism (9%) being the commonest.Conclusions: RA affects middle aged women. Hypothyroidism is the mostly associated autoimmune disease. The majority receive suboptimal / inappropriate treatment before visiting a rheumatologist. Most patients consult a rheumatologist at late stage in the disease often with deformities. Hence, increased awareness is needed about this disease among patients and doctors so that patients get timely referral to a rheumatologist for the proper management of this disease.

Nonspecific interstitial pneumonia presenting with high grade fever: a case report

Nonspecific interstitial pneumonia (NSIP), one subtype of idiopathic interstitial pneumonias is an autoimmune disease presenting usually at a younger age, most commonly in women. It can be distinguished clinically and pathologically from other subgroups of idiopathic interstitial pneumonias. Many cases of this entity occur in the context of an underlying disorder, such as a connective tissue disease, drug induced interstitial lung disease, or chronic hypersensitivity pneumonitis. Symptoms are non-specific and include insidious onset of dyspnoea and dry cough with restrictive pattern of decreased lung function and reduced gas exchange capacity. Fever or a flu-like syndrome can occur in up to one third of patients with NSIP. We report a case of 50 years old female who presented with breathlessness, cough and high grade fever. She did not have any features suggestive of connective tissue disease. On computed tomography of chest, diagnosis of NSIP was made and she responded to steroids

Pattern of dyslipidemia in Type 2 Diabetes Mellitus in Punjab

Background: India leads the world with the largest number of diabetic patients. The risk of mortality is high with cardiovascular disease in patients of diabetes mellitus which in turn is well associated with dyslipidemia. Patients of type 2 diabetes mellitus are usually dyslipidemic, even when under relatively good glycaemic control. Diabetic dyslipidemia usually includes elevated plasma triglycerides (TG), elevated low density lipoprotein cholesterol (LDL-C) and decreased high density lipoprotein cholesterol (HDL-C) levels but its pattern is also influenced by patient ethnicity. The objective of the study was to investigate the pattern of dyslipidemia in patients of type 2 diabetes mellitus attending a tertiary care hospital of Punjab.Methods: A cross sectional study was performed on the consecutive patients of type 2 diabetes mellitus attending the Medicine OPD of Punjab Institute of Medical Sciences, Jalandhar over 6 months period (March 2015 to August 2015). The study included 285 patients of type 2 diabetes mellitus and the variables recorded were demographic characteristics, weight, height and fasting lipid profile parameters i.e. total cholesterol (TC), TG, LDL-C and HDL-C. The collected data was analyzed statistically using SPSS version 20 software.Results: There were 55.1% male and 44.9% female with mean age 52.7 ± 11.43; 42.8% patients were urban and 57.2% rural. The mean body mass index (BMI) was 26.8 ± 5.48 (male: 25.4 ± 4.62 and female: 28 ± 5.31). Dyslipidemia was found in 81.8% patients. The most commonly elevated lipid was LDL-C (59.3%) followed by TG (57.2%) and TC (36.5%). The HDL-C was decreased in 34.4% patients. The distribution of dyslipidemia among the different age groups was almost similar: 82.6% in < 45 years, 82.9% in 45-60 years and 83.7% in > 60 years, the difference was not statistically significant (p = 0.998).Conclusions: Dyslipidemia is highly prevalent in type 2 diabetes mellitus patients in Punjab. The patients of all age groups are affected similarly. The patients of type 2 diabetes mellitus should be made aware of dyslipidemia and the consequent increased risk for cardiovascular diseases. The complete lipid profile should be evaluated and dyslipidemia should be treated. This would significantly reduce cardiovascular morbidity and mortality among the type 2 diabetes mellitus patients.

Community Acquired Pneumonia with High Grade Fever: A Rare Presentation of Pulmonary Tuberculosis

Pulmonary tuberculosis usually has a smouldering onset and progression, and patients typically present with the symptoms of cough, weight loss, anorexia, night sweats and malaise that is usually present for a few weeks before presentation. Up to 80% of cases of pulmonary tuberculosis have fever which is often low-grade and intermittent. We report a 26-year old man who was admitted with community acquired pneumonia having high grade fever. He did not respond to intravenous antibiotics for one week. Then, the sputum was induced by saline nebulisation and sputum examination revealed acid-fast bacilli. Anti-tubercular treatment was started and the fever resolved. This is unusual presentation of pulmonary tuberculosis. Hence, pulmonary tuberculosis must be considered in the differential diagnosis of a patient presenting with community acquired pneumonia