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Assessment of Disease Activity in Rheumatoid Arthritis: A Comparative Study of Clinical Evaluation with Ultrasonography

Authors: Ali Abdul-Rahman Younis --- Nizar Abdul Lateef Jassim --- Abdullateef Aliasghar*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 202-210
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: In patients with rheumatoid arthritis (RA) a poor relation on an individual joint basis, has been observed between clinical signs of synovitis and ultrasound measures of synovial disease. OBJECTIVE:To compare the traditional clinical measures of disease activity with the ultrasound (US) features of synovitis, and investigate the relationship between composite US measures and disease activity score in 28 joints (DAS28), clinical disease activity index (CDAI), their components and other variables of disease activity in RA.METHODS:Fifty patients with RA were enrolled in this study. The following 28 joints including bilateral glenohumeral, elbow, wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) of the hands, and knee joints were assessed for tenderness and swelling. DAS28 and CDAI were determined for each patient. A systematic US examination was carried out by a radiologist for the 28 clinically examined joints. Each joint was evaluated for the presence of synovial hypertrophy (SH), power Doppler (PD) signals, and effusion. The following composite US measures of synovial disease were made: SH joint count (SHJC), effusion joint count (EJC), PD joint count (PDJC), SH index (SHI), and PD index (PDI).RESULTS: Joints with tenderness only showed significantly less PD scores than other groups. SH and PD signals were detected in 32.1% and 27.8% of the Nil group respectively. SHJC and SHI showed moderate correlation with TJC and high correlation with SJC, evaluator global assessment (EGA), patient global assessment (PGA), DAS28, CDAI, and erythrocyte sedimentation rate (ESR). PDJC and PDI showed moderate correlations with tender joint count (TJC), and high correlation with swollen joint count (SJC), EGA, DAS28, and ESR. PDI showed high correlation with PGA, and CDAI. CONCLUSION:Traditional clinical signs used in the evaluation for disease activity may bear different relation to the US features of synovitis (SH, PD signals). Composite US count and indices for SH and PD relate significantly to the DAS28-ESR, CDAI, and their components..


Article
Fibromyalgia Syndrome in 104 Iraqi Patients with Inflammatory Bowel Disease

Authors: Nizar Abdul lateef Jassim --- *,Faiq Isho Gorial --- Bassim.A.Asker --- Akram Ajeel Najeeb --- et al.
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 352-357
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Fibromyalgia syndrome (FMS) is a common rheumatologic syndrome with multiple systemic manifestations & associated with many diseases. OBJECTIVE: To assess fibromyalgia syndrome in inflammatory bowel disease. PATIENTS AND METHODS: One hundred four Iraqi patients with inflammatory bowel disease were studied and compared with another (112) healthy individuals matched for age and sex as a control group. Full history was taken and complete clinical examination was done for all individuals in both groups. Fibromyalgia syndrome was diagnosed in all patients on base of the American College of Rheumatology (ACR) 1990 Criteria for the classification of FMS. Inflammatory bowel disease was detected by colonoscopy & tissue biopsy. RESULTS: There was a significant increase in the frequency of FMS among individuals with IBD (24 %) compared to healthy control group (5.4%) ((P-value =0.0001, Odd ratio=0.18, 95% CI=0.07-0.46). CONCLUSION: FMS occurs with increased frequency in IBD.


Article
Carotid Intima-Media Thickness in Rheumatoid Arthritis Detected by Doppler Ultrasound

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Abstract

Background: The excess mortality associated with rheumatoid arthritis is largely due to cardiovascular disease. Rheumatoid arthritis is of primary importance in atherogenesis. The intima-media thickness of extracranial carotid arteries is a measurable index of the presence of atherosclerosis.Objective: To assess carotid intima-media thickness in rheumatoid arthritis by Doppler ultrasound.Methods: Fifty two Iraqi patients with rheumatoid arthritis were studied and compared with another fifty two, healthy individuals matched for age and sex as a control group. Full history was taken and complete clinical examination was done for all individuals in both groups. Rheumatoid arthritis diagnosis was based on The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Carotid intima-media thickness was measured by Doppler ultrasound.Results: There was a significant increase in the frequency of increased carotid intima-media thickness among individuals with rheumatoid arthritis (44.2%) compared to healthy control group (3.8%) (P=0.000001).Conclusion: Increased carotid intima-media thickness occurs in high frequency in rheumatoid arthritis.

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