Phototherapy induces an improvement in clinical and biochemical scores in rheumatoid arthritis

Objective: Rheumatoid arthritis is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy improves changes in functional scales in patients with rheumatoid arthritis. Methods: Seven women with rheumatoid arthritis were enrolled for this study and submitted to phototherapy sessions with a 425 to 650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the RaQol questionnaire decreased abruptly from 29 to zero points (p = 0.018), the Steinbrocker Functional Capacity Rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042), erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in rheumatoid arthritis patients. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms in rheumatoid arthritis

Correlation of HbA1c with a basic math test in gestational diabetes

Background: A good metabolic control in Gestational Diabetes Mellitus (GDM) is crucial to avoid complications in the mother and the offspring. A limitation to reach a desired HbA1c in GDM is the education level of the mothers. Aims: The aim of this study was to determine the correlation between the HbA1c and the points obtained in a basic mathematical test. Study Design: cross-sectional study. Methods: This was a pilot study, prospective and cross-sectional. Pregnant women, older than 18 years old, diagnosed with GDM were invited to participate resolving a mathematical test of ten questions. HbA1c was done in the first consultation. Spearman correlation test was used between HbA1c and the punctuation of the mathematical test. Results: 31 patients with a mean age of 29 ± 6.7 years old accepted to participate. The education level was as follows: 5 (16.12%) with Primary School, 20 (64.51%) with High School, 2 (6.45%) with Preparatory School, 2 (6.45%) with technical studies and 1 (3.22%) that finished the University. The Spearman test showed a negative correlation between the mathematical test and the HbA1c (r2 = -0.395, P ≤ 0.001). Conclusion: A low mathematics knowledge limits the expectation to get an optimal metabolic control in GDM

Complications in pregnant women with autoimmune diseases

BACKGROUND: Autoimmune diseases complicate pregnancy in several manners. This study aimed at describing the most common complications in pregnant women with autoimmune diseases. METHODS: This was a descriptive and retrospective study. Two groups of pregnant women with autoimmune diseases were included: 1) Those who since the beginning of gestation received obstetrical care at a tertiary-level hospital and 2) Women who were treated first in a medical unit not specialized in rheumatological diseases. Odds ratio, logistic regression and multinomial logistic regression were used to determine risk of complicated pregnancy. RESULTS: The distribution of autoimmune diseases in our sample is as follows: systemic lupus erythematosus (SLE): 6, rheumatoid arthritis (RA): 4, primary anti-phospholipid syndrome (APS): 4, systemic sclerosis (SS): 2, mixed connective tissue disease (MCTD): 1. Eight patients were seen throughout their gestation at a tertiary-level hospital and nine were referred from other non-specialized hospitals. Patients in the first group had four complications, and those of the second group, 28. The Odds Ratio (OR) of having a complication in the hospitals of reference compared to the “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital (HMPMPS) was of 29.8 (95% CI: 1.29-692.46; Z statistic 2.11, p = 0.03). In relation to the logistic regression, this test was not significant neither for the group nor the treatment scheme for the presence of at least one complication. The multinomial logistic regression did not show significant predictive probabilities of the different possible outcomes for the group and drug treatment scheme. CONCLUSION: Pregnant women with autoimmune diseases can have an OR up to 29.8 to develop complications when they are not cared for by specialized personnel

Trends of inflammatory markers and cytokines after one month of phototherapy in patients with rheumatoid arthritis

Objective. to evaluate changes in the expression of tumor necrosis factor-α in patients with rheumatoid arthritis submitted to phototherapy. Materials and methods. This was an open label study, enrolling ten patients. The phototherapy scheme within a range of 425 to 650 nm, 11.33 Joules/cm2, 30 cm above the chest was as follows: a) 45-min daily sessions from Monday to Friday for 2 to 3 months; b) three, 45-min weekly sessions for 1 to 2 months; c) twice weekly 45-min sessions for 1 to 2 months, and d) one weekly session for 1 to 2 months until completion. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were measured in peripheral blood and tumor necrosis factor-α, interleukin-1β, and interleukin-10 in leukocytes by quantitative real-time Reverse transcriptase-Polymerase chain reaction. In all the patients the next indexes: Karnofsky scale, Rheumatoid Arthritis-specific quality of life instrument, Steinbrocker Functional Capacity Rating and the Visual Analog Scale were evaluated. Results. Erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor declined notoriously after the indicated sessions. In gene expression, there was a tendency in tumor necrosis factor-α to decrease after 1 month, from 24.5±11.4 to 18±9.2 relative units, without reaching a significant statistical difference. The four tested indexes showed improvement. Conclusion. Phototherapy appears to be a plausible complementary option to reduce the inflammatory component in rheumatoid arthritis