The Journal of the Association of Physicians of India, 2017
To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthriti... more To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthritis (OA) in India, where there is widespread Vitamin D deficiency (VDD). 75 postmenopausal women (PMW) fulfilling ACR criteria for Knee OA between 40 - 60 years of age, having OA grade 2 or more as per Kellgren Lawrence grade on anterior- posterior radiograph of the right knee were enrolled. 34 PMW of the same age with normal right knee radiograph were taken as controls. Bone mineral density (BMD) of lumber spine (L1- L4), total hip and left forearm was performed using DXA in all patients and controls. The results were expressed in absolute values (g/cm2) and as per WHO criteria - Osteoporosis: T score < -2.5, Osteopenia: T score between -1 and -2.5. Vitamin D Level was done by ELISA. Body mass index (BMI) of patients was significantly higher than controls (p 0.006). There was no difference in BMD between patients and controls at any site. Forty percent patients and 53% controls had ost...
International journal of rheumatic diseases, Jan 27, 2017
To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow... more To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow. The survey was carried out in a cluster of rural (n = 5118) and urban (n = 5053) communities of Lucknow through a door-to-door survey. Demographic data were collected and subjects with musculoskeletal pain (MSK pain) were identified. A Hindi adapted version of the Community Oriented Program for the Control of Rheumatic Diseases questionnaire was used. Trained community volunteers completed the questionnaire. Present and past MSK pain was the most common self-reported problem in urban areas (34.1%), while it was the third most common self-reported problem in rural areas (15.1%), after abdominal pain and cough. Females (214.9 and 419.5 per 1000) were more affected than males (118.8 and 265.2 per 1000) in rural and urban areas, respectively. Point prevalence of MSK pain (pain in last week) was higher in urban areas (28.2%) compared to rural areas (14.1%). In rural as well as urban areas, ...
To compare the performance of Disease Assessment Score of 28 joints - C-reactive protein (DAS-28-... more To compare the performance of Disease Assessment Score of 28 joints - C-reactive protein (DAS-28-CRP), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) composite measures to assess status of patients with rheumatoid arthritis (RA) on methotrexate, versus DAS-28 CRP as the gold standard. One hundred and thirty-five patients with RA as per the 2010 American College of Rheumatology/European League Against Rheumatism criteria were included in the prospective study. The disease activity was assessed at baseline and at every 6 weeks for 24 weeks, by DAS-28-CRP, CDAI and SDAI. Patients were divided into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28-CRP, CDAI and SDAI. A Spearman correlation between composite measures and inter-group comparison of the measures was performed. There was an excellent positive correlation between DAS-28-CRP and CDAI (linear weighted κ baseline - 0.545), DAS-28 CRP and SDAI (linear weighted κ - 0.689) at baseline. There was moderate agreement between DAS-28-CRP and CDAI (linear weighted κ final visit - 0.458) at final visit. There was moderate correlation between SDAI and DAS-28-CRP at final visit (linear weighted κ - 0.470). However, correlation between CDAI versus SDAI remained excellent at baseline and final visit. Patients in remission as per DAS-28-CRP had significantly more residual disease activity compared to SDAI and CDAI remission criteria. The study shows an excellent strong positive correlation between DAS-28-CRP, CDAI and SDAI at initial evaluation but not at final visit. SDAI- and CDAI-based remission criteria seem to be better than DAS-28-CRP-based remission criteria.
To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patien... more To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patients in split doses at 2-3 days&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; interval, would result in equal or better efficacy, tolerability and compliance, without increasing toxicity compared to single weekly dose given orally or parenterally. One hundred and thirty-five patients fulfilling the American College of Rheumatology (ACR) 2010 criteria for RA, on 7.5 mg of MTX weekly orally, with the Simplified Disease Activity Index (SDAI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 11 were enrolled for a 24-week period. Patients were randomly divided into three groups and were given MTX: Group 1 7.5 mg twice or thrice weekly orally, Group 2 15 mg or 22.5 mg in a single dose weekly orally and Group 3 15 mg or 22.5 mg in a single dose weekly as an intramuscular injection. The primary outcomes were low disease activity (LDA) and mean change in SDAI at week 24, whereas secondary outcomes included remission, adverse events and compliance. At week 24, adherence to treatment was maximum in Group 1, 69% (P = 0.09). In intention-to-treat analysis at 24 weeks, Group 1, 49%, Group 2, 36% and Group 3, 47% achieved LDA (P = 0.4). There was significant difference in mean change in SDAI at week 24 from baseline (P = 0.008) among the groups. Group 3 patients were more uncomfortable with the mode of administration of MTX (P = 0.003). There was no significant difference in adverse events. Oral split doses of MTX are better than an oral single dose and similar to parenteral MTX in terms of efficacy.
Background: Aims: The main aim of this study was to investigate whether administrating Methotrexa... more Background: Aims: The main aim of this study was to investigate whether administrating Methotrexate (MTX) more frequently in divided doses would result in equal or better clinical response, tolerability and compliance without increasing toxicity. Method: 66 patients fulfilling ACR 2010 criteria for Rheumatoid arthritis with moderate disease activity were enrolled in the study. Patients were randomly divided into three groups: Group 1- Patients were given MTX in divided doses (7.5 mg twice a week or 7.5 mg thrice a week).Group 2- Patients were given MTX 15 mg or 22.5mg in single dose weekly orally. Group 3- Patients were given MTX 15 mg or 22.5 mg in a single dose weekly parenterally as an intramuscular injection. Patients were followed up every 6 weeks for 24 weeks. At every visit they were assessed for Disease activity by Simplified Disease Activity Index (SDAI), efficacy, side- effects, tolerability and compliance. 50 (76%) patients have completed the study while 16 (24%) patients...
Objective: With increasing longevity of SLE patients, Osteopenia and Osteoporosis are becoming ve... more Objective: With increasing longevity of SLE patients, Osteopenia and Osteoporosis are becoming very important morbidity in patients with SLE. Vitamin D deficiency is believed to be common in India. It is expected that Osteopenia and Osteoporosis will also be very common in Indian patients with SLE. Thus it was aimed to look for the prevalence of osteoporosis in SLE patients in India. Method: In this ongoing study twelve patients of SLE visiting the Rheumatology OPD were evaluated for osteoporosis. Age, duration of disease, weight and height, medication, intake of milk, menopausal status, and cumulative steroid intake was noted for all patients. Disease activity was scored by SELENA SLEDAI. ESR, CRP, Serum calcium, serum alkaline phosphatase tests were done and samples for vitamin D levels have been stored. BMD of Lumbar spine (L2-L4), non dominant hip and the non dominant distal forearm were measured by DXA. Results: Out of the 12 patients 11 were females and 1 male. The mean age wa...
Aim: To study the self reported prevalence of pain in different musculoskeletal sites in geriatri... more Aim: To study the self reported prevalence of pain in different musculoskeletal sites in geriatricAbstract 179 population and comparison with adult population of urban and rural Lucknow. Methods: An epidemiological survey was carried out by door to door visit using a structured questionnaire of community oriented program for control of rheumatic diseases in an urban colony in central Lucknow and villages of Gosaiganj in rural Lucknow. The questionnaire obtained current self reported information of pain in various musculos-keletal sites. 5053 urban dwellers and 5118 villagers were surveyed. Out of which 495 and 361 people were aged more than 60 in urban and rural area respectively and 3280 and 2569 people were between 16 to 59 years in urban and rural area respectively. Results: A significantly high self reported current pain in all musculoskeletal areas was observed in geriatric population (>60 yrs) than adults (16-59 yrs) in urban as well rural population except in toe. The most...
To determine sexual dysfunctions and urinary symptoms in male ankylosing spondylitis (AS) patient... more To determine sexual dysfunctions and urinary symptoms in male ankylosing spondylitis (AS) patients and their association with various disease and patient factors. In this prospective case control study conducted at a tertiary care teaching institution, 100 males with AS were compared to 100 controls using International Index of Erectile Function-15 (IIEF), International Prostate Symptom Score (IPSS), Hospital Anxiety and Depression Scale (HADS) and a global question for overall relationship with their partners. Bath AS Functional Index (BASFI), visual analogue scale pain scores, patient global assessment scale and Bath AS Disease Activity Index were also assessed in the AS group. Chi-square test, unpaired t-test and univariate and multivariate binary logistic regression analyses were used to analyze the data. Anxiety, depression, erectile dysfunction (ED), orgasmic dysfunction, intercourse dissatisfaction, overall sexual dissatisfaction, altered overall relationship with partner and lower urinary tract symptoms (LUTS) were significantly (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) higher in the AS group as compared to controls. Sexual desire, severe LUTS and bothersome LUTS (quality of life score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2) were not different (P = 0.76, 0.82 and 0.30 respectively) between the two groups. ED was associated with anxiety, depression, longer disease duration, higher BASFI and higher age in AS patients (P = 0.02, 0.001, 0.02, 0.003 and 0.001 respectively). AS is associated with higher incidence of sexual dysfunction in male patients. ED is associated with anxiety, depression, longer duration of disease, higher BASFI score and higher age in AS patients.
The Journal of the Association of Physicians of India, 2017
To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthriti... more To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthritis (OA) in India, where there is widespread Vitamin D deficiency (VDD). 75 postmenopausal women (PMW) fulfilling ACR criteria for Knee OA between 40 - 60 years of age, having OA grade 2 or more as per Kellgren Lawrence grade on anterior- posterior radiograph of the right knee were enrolled. 34 PMW of the same age with normal right knee radiograph were taken as controls. Bone mineral density (BMD) of lumber spine (L1- L4), total hip and left forearm was performed using DXA in all patients and controls. The results were expressed in absolute values (g/cm2) and as per WHO criteria - Osteoporosis: T score < -2.5, Osteopenia: T score between -1 and -2.5. Vitamin D Level was done by ELISA. Body mass index (BMI) of patients was significantly higher than controls (p 0.006). There was no difference in BMD between patients and controls at any site. Forty percent patients and 53% controls had ost...
International journal of rheumatic diseases, Jan 27, 2017
To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow... more To study the prevalence of rheumatic musculoskeletal symptoms in rural and urban areas of Lucknow. The survey was carried out in a cluster of rural (n = 5118) and urban (n = 5053) communities of Lucknow through a door-to-door survey. Demographic data were collected and subjects with musculoskeletal pain (MSK pain) were identified. A Hindi adapted version of the Community Oriented Program for the Control of Rheumatic Diseases questionnaire was used. Trained community volunteers completed the questionnaire. Present and past MSK pain was the most common self-reported problem in urban areas (34.1%), while it was the third most common self-reported problem in rural areas (15.1%), after abdominal pain and cough. Females (214.9 and 419.5 per 1000) were more affected than males (118.8 and 265.2 per 1000) in rural and urban areas, respectively. Point prevalence of MSK pain (pain in last week) was higher in urban areas (28.2%) compared to rural areas (14.1%). In rural as well as urban areas, ...
To compare the performance of Disease Assessment Score of 28 joints - C-reactive protein (DAS-28-... more To compare the performance of Disease Assessment Score of 28 joints - C-reactive protein (DAS-28-CRP), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) composite measures to assess status of patients with rheumatoid arthritis (RA) on methotrexate, versus DAS-28 CRP as the gold standard. One hundred and thirty-five patients with RA as per the 2010 American College of Rheumatology/European League Against Rheumatism criteria were included in the prospective study. The disease activity was assessed at baseline and at every 6 weeks for 24 weeks, by DAS-28-CRP, CDAI and SDAI. Patients were divided into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28-CRP, CDAI and SDAI. A Spearman correlation between composite measures and inter-group comparison of the measures was performed. There was an excellent positive correlation between DAS-28-CRP and CDAI (linear weighted κ baseline - 0.545), DAS-28 CRP and SDAI (linear weighted κ - 0.689) at baseline. There was moderate agreement between DAS-28-CRP and CDAI (linear weighted κ final visit - 0.458) at final visit. There was moderate correlation between SDAI and DAS-28-CRP at final visit (linear weighted κ - 0.470). However, correlation between CDAI versus SDAI remained excellent at baseline and final visit. Patients in remission as per DAS-28-CRP had significantly more residual disease activity compared to SDAI and CDAI remission criteria. The study shows an excellent strong positive correlation between DAS-28-CRP, CDAI and SDAI at initial evaluation but not at final visit. SDAI- and CDAI-based remission criteria seem to be better than DAS-28-CRP-based remission criteria.
To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patien... more To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patients in split doses at 2-3 days&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; interval, would result in equal or better efficacy, tolerability and compliance, without increasing toxicity compared to single weekly dose given orally or parenterally. One hundred and thirty-five patients fulfilling the American College of Rheumatology (ACR) 2010 criteria for RA, on 7.5 mg of MTX weekly orally, with the Simplified Disease Activity Index (SDAI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 11 were enrolled for a 24-week period. Patients were randomly divided into three groups and were given MTX: Group 1 7.5 mg twice or thrice weekly orally, Group 2 15 mg or 22.5 mg in a single dose weekly orally and Group 3 15 mg or 22.5 mg in a single dose weekly as an intramuscular injection. The primary outcomes were low disease activity (LDA) and mean change in SDAI at week 24, whereas secondary outcomes included remission, adverse events and compliance. At week 24, adherence to treatment was maximum in Group 1, 69% (P = 0.09). In intention-to-treat analysis at 24 weeks, Group 1, 49%, Group 2, 36% and Group 3, 47% achieved LDA (P = 0.4). There was significant difference in mean change in SDAI at week 24 from baseline (P = 0.008) among the groups. Group 3 patients were more uncomfortable with the mode of administration of MTX (P = 0.003). There was no significant difference in adverse events. Oral split doses of MTX are better than an oral single dose and similar to parenteral MTX in terms of efficacy.
Background: Aims: The main aim of this study was to investigate whether administrating Methotrexa... more Background: Aims: The main aim of this study was to investigate whether administrating Methotrexate (MTX) more frequently in divided doses would result in equal or better clinical response, tolerability and compliance without increasing toxicity. Method: 66 patients fulfilling ACR 2010 criteria for Rheumatoid arthritis with moderate disease activity were enrolled in the study. Patients were randomly divided into three groups: Group 1- Patients were given MTX in divided doses (7.5 mg twice a week or 7.5 mg thrice a week).Group 2- Patients were given MTX 15 mg or 22.5mg in single dose weekly orally. Group 3- Patients were given MTX 15 mg or 22.5 mg in a single dose weekly parenterally as an intramuscular injection. Patients were followed up every 6 weeks for 24 weeks. At every visit they were assessed for Disease activity by Simplified Disease Activity Index (SDAI), efficacy, side- effects, tolerability and compliance. 50 (76%) patients have completed the study while 16 (24%) patients...
Objective: With increasing longevity of SLE patients, Osteopenia and Osteoporosis are becoming ve... more Objective: With increasing longevity of SLE patients, Osteopenia and Osteoporosis are becoming very important morbidity in patients with SLE. Vitamin D deficiency is believed to be common in India. It is expected that Osteopenia and Osteoporosis will also be very common in Indian patients with SLE. Thus it was aimed to look for the prevalence of osteoporosis in SLE patients in India. Method: In this ongoing study twelve patients of SLE visiting the Rheumatology OPD were evaluated for osteoporosis. Age, duration of disease, weight and height, medication, intake of milk, menopausal status, and cumulative steroid intake was noted for all patients. Disease activity was scored by SELENA SLEDAI. ESR, CRP, Serum calcium, serum alkaline phosphatase tests were done and samples for vitamin D levels have been stored. BMD of Lumbar spine (L2-L4), non dominant hip and the non dominant distal forearm were measured by DXA. Results: Out of the 12 patients 11 were females and 1 male. The mean age wa...
Aim: To study the self reported prevalence of pain in different musculoskeletal sites in geriatri... more Aim: To study the self reported prevalence of pain in different musculoskeletal sites in geriatricAbstract 179 population and comparison with adult population of urban and rural Lucknow. Methods: An epidemiological survey was carried out by door to door visit using a structured questionnaire of community oriented program for control of rheumatic diseases in an urban colony in central Lucknow and villages of Gosaiganj in rural Lucknow. The questionnaire obtained current self reported information of pain in various musculos-keletal sites. 5053 urban dwellers and 5118 villagers were surveyed. Out of which 495 and 361 people were aged more than 60 in urban and rural area respectively and 3280 and 2569 people were between 16 to 59 years in urban and rural area respectively. Results: A significantly high self reported current pain in all musculoskeletal areas was observed in geriatric population (>60 yrs) than adults (16-59 yrs) in urban as well rural population except in toe. The most...
To determine sexual dysfunctions and urinary symptoms in male ankylosing spondylitis (AS) patient... more To determine sexual dysfunctions and urinary symptoms in male ankylosing spondylitis (AS) patients and their association with various disease and patient factors. In this prospective case control study conducted at a tertiary care teaching institution, 100 males with AS were compared to 100 controls using International Index of Erectile Function-15 (IIEF), International Prostate Symptom Score (IPSS), Hospital Anxiety and Depression Scale (HADS) and a global question for overall relationship with their partners. Bath AS Functional Index (BASFI), visual analogue scale pain scores, patient global assessment scale and Bath AS Disease Activity Index were also assessed in the AS group. Chi-square test, unpaired t-test and univariate and multivariate binary logistic regression analyses were used to analyze the data. Anxiety, depression, erectile dysfunction (ED), orgasmic dysfunction, intercourse dissatisfaction, overall sexual dissatisfaction, altered overall relationship with partner and lower urinary tract symptoms (LUTS) were significantly (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) higher in the AS group as compared to controls. Sexual desire, severe LUTS and bothersome LUTS (quality of life score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2) were not different (P = 0.76, 0.82 and 0.30 respectively) between the two groups. ED was associated with anxiety, depression, longer disease duration, higher BASFI and higher age in AS patients (P = 0.02, 0.001, 0.02, 0.003 and 0.001 respectively). AS is associated with higher incidence of sexual dysfunction in male patients. ED is associated with anxiety, depression, longer duration of disease, higher BASFI score and higher age in AS patients.
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