Ahsan Tasnim, Erum Uzma, Khowaja Danish, Dahani Assadullah
Prof. Tasnim Ahsan, MRCP, FRCP, FRCP, FRCP. Jinnah Postgraduate Medical Centre, Medical Unit-II, Rafiqee Shaheed Road, Karachi, Pakistan.
Dr. Uzma Erum, MBBS, FCPS Trainee. Jinnah Postgraduate Medical Centre, Medical Unit-II, Rafiqee Shaheed Road, Karachi, Pakistan.
Pak J Med Sci. 2017 Jul-Aug;33(4):840-843. doi: 10.12669/pjms.334.12704.
To determine the disease severity in patients with Rheumatoid Arthritis (RA), at baseline and the impact of treatment on disease activity (DA) after six months of disease modifying anti-rheumatic drugs (DMARDs) therapy.
This prospective study was conducted at the 'Rheumatology Clinic' of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2014 to May 2015. A total of 111 patients, with the diagnosis of RA were included in the study. DA was calculated using 'Clinical Disease Activity Index' (CDAI) score at base line and after 6 months of DMARDs therapy.
Out of 111 patients, 17 (15.3%) were male and 94 (84.7%) were female. The mean age was 37.16±11.3 years and the mean duration of joint pain was 3.8±3.6 years (median 2.5 years). The mean Hb was 10.8±1.8 g/dl and the mean ESR at baseline was 59.63±30.9 mm/Hr. The mean initial CDAI score was 18.14±11.69; reflecting moderate to severe disease. Of all of these patients, 32 (28.8%) patients received monotherapy, 78 (70.3%) received dual therapy and 1(0.9%) was given triple DMARDs therapy. The mean ESR was 39.5±27.31 mm/Hr, and mean CDAI was 7.36±7.8 with a median of 6.0 after 6 months of DMARDs treatment.
The CDAI score and the ESR reflected that majority of our patients were in remission or at low disease activity, after six months of DMARDs therapy. It is possible to control DA in RA, in a low resource health care facility with conventional DMARDs therapy. Continuity of treatment was ensured through motivation, regular supply of drugs and regular follow-up.
确定类风湿关节炎（RA）患者在基线时的疾病严重程度，以及疾病改善抗风湿药物（DMARDs）治疗6个月后治疗对疾病活动度（DA）的影响。
这项前瞻性研究于2014年6月至2015年5月在卡拉奇真纳研究生医学中心（JPMC）的“风湿病诊所”进行。共有111例诊断为RA的患者纳入研究。在基线时以及DMARDs治疗6个月后，使用“临床疾病活动指数”（CDAI）评分计算疾病活动度。
111例患者中，17例（15.3%）为男性，94例（84.7%）为女性。平均年龄为37.16±11.3岁，关节疼痛的平均病程为3.8±3.6年（中位数为2.5年）。平均血红蛋白为10.8±1.8 g/dl，基线时平均红细胞沉降率为59.63±30.9 mm/Hr。初始CDAI评分的平均值为18.14±11.69；反映为中度至重度疾病。在所有这些患者中，32例（28.8%）患者接受单药治疗，78例（�0.3%）接受联合治疗，1例（0.9%）接受三联DMARDs治疗。DMARDs治疗6个月后，平均红细胞沉降率为39.5±27.31 mm/Hr，平均CDAI为7.36±7.8，中位数为6.0。
CDAI评分和红细胞沉降率反映出，在接受DMARDs治疗6个月后，我们的大多数患者处于缓解期或疾病活动度较低。在资源匮乏的医疗机构中，使用传统的DMARDs治疗可以控制RA的疾病活动度。通过激励、定期供应药物和定期随访确保了治疗的连续性。
