Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic

OBJECTIVES

This study evaluated the prevalence of fibromyalgia (FM), anxiety and depression in patients with rheumatoid arthritis (RA) and their effects on the clinical parameters of RA during the COVID-19 pandemic.

DESIGN

Cross-sectional, outpatient clinic, observational, non-interventional.

SETTING

Single-centre, tertiary care, multispecialty, service and research hospital, north-central India.

PARTICIPANTS

Adult patients with RA, controls.

RESULTS

This cross-sectional study included 200 patients with RA diagnosed with the American College of Rheumatology/European League Against Rheumatism 2010 (ACR) criteria and 200 controls. FM was diagnosed using the revised 2016 ACR FM Criteria. Disease activity, quality of life and functional disability in patients with RA were assessed using multiple Disease Activity Scores. The presence of depression and anxiety was determined using the Hospital Anxiety and Depression Scale. FM was present in 31% of patients with RA compared with 4% of controls in our study. Patients with RA with FM were older, predominantly females with longer disease duration, and more likely to be on steroids. Patients with RA with FM had a higher disease activity, and none of our RA with FM patients were in remission. The multivariable analysis found FM to be an independent predictor of the Simplified Disease Activity Index for RA. Patients with RA with FM had worse functional ability and poorer quality of life. The prevalence of anxiety and depression was 12.5% and 30%, significantly higher in RA with FM patients.

CONCLUSION

During the COVID-19 pandemic, around one-third of our study patients had FM and depression, significantly higher than pre-COVID-19 times. Thus, mental health assessment should be incorporated into the routine management of patients with RA.

Validation of Hindi version of the Pittsburg Sleep Quality Index

BACKGROUND

Sleep quality is poorly understood in the Indian population. Lack of a suitable tool to assess sleep quality in Hindi language is the main reason behind this. Pittsburg sleep quality index (PSQI) is widely used in different population groups to assess subjective sleep quality over last one month.

OBJECTIVES

To assess the reliability and validity of the Hindi translated version of Pittsburgh Sleep Quality Index (PSQI-H). gt;Methods: The PSQI-H was developed from PSQI according to following steps: (a) translation, (b) back-translation, (c) comparison between translation and back-translation performed by a group of experts, and (d) pre-pilot test in intended population. The PSQI-H was applied to 105 bilingual individuals knowing Hindi and English. The internal consistency of PSQI-H was assessed by Cronbach's alpha. For test-retest reliability assessment intraclass correlation coefficient (ICC) was measured between PSQI-H at baseline and PSQI after 4 weeks. The Pearson's coefficient was used to assess the correlation between the score of the questions and the PSQI-H scores.

RESULTS

The seven components of PSQI-H shows acceptable level of internal consistency with Cronbach's alpha of 0.776. There is good test-retest reliability between PSQI-H and PSQI as measured by ICC of 0.979. The score of individual items and global scores of PSQI-H were highly correlated with each other (p< 0.001). The mean of the seven individual components score and global scores of PSQI-H at baseline and original PSQI after 4 weeks did not differ significantly.

CONCLUSION

This study results demonstrate that the PSQI-H is a valid and reliable instrument for the assessment of sleep quality. PSQI-H can be used for the assessment of sleep quality in the predominantly Hindi speaking population.

Modelling the effect of race surface and racehorse limb parameters on in silico fetlock motion and propensity for injury

BACKGROUND

The metacarpophalangeal joint (fetlock) is the most commonly affected site of racehorse injury, with multiple observed pathologies consistent with extreme fetlock dorsiflexion. Race surface mechanics affect musculoskeletal structure loading and injury risk because surface forces applied to the hoof affect limb motions. Race surface mechanics are a function of controllable factors. Thus, race surface design has the potential to reduce the incidence of musculoskeletal injury through modulation of limb motions. However, the relationship between race surface mechanics and racehorse limb motions is unknown.

OBJECTIVE

To determine the effect of changing race surface and racehorse limb model parameters on distal limb motions.

STUDY DESIGN

Sensitivity analysis of in silico fetlock motion to changes in race surface and racehorse limb parameters using a validated, integrated racehorse and race surface computational model.

METHODS

Fetlock motions were determined during gallop stance from simulations on virtual surfaces with differing average vertical stiffness, upper layer (e.g. cushion) depth and linear stiffness, horizontal friction, tendon and ligament mechanics, as well as fetlock position at heel strike.

RESULTS

Upper layer depth produced the greatest change in fetlock motion, with lesser depths yielding greater fetlock dorsiflexion. Lesser fetlock changes were observed for changes in lower layer (e.g. base or pad) mechanics (nonlinear), as well as palmar ligament and tendon stiffness. Horizontal friction and fetlock position contributed less than 1° change in fetlock motion.

MAIN LIMITATIONS

Simulated fetlock motions are specific to one horse's anatomy reflected in the computational model. Anatomical differences among horses may affect the magnitude of limb flexion, but will likely have similar limb motion responses to varied surface mechanics.

CONCLUSIONS

Race surface parameters affected by maintenance produced greater changes in fetlock motion than other parameters studied. Simulations can provide evidence to inform race surface design and management to reduce the incidence of injury.

Lack of clinical association with antibodies to ribosomal P proteins in Indian patients with systemic lupus erythematosus

OBJECTIVE

We examined the prevalence and clinical association of the antiribosomal antibodies in our cohort of patients with systemic lupus erythematosus (SLE).

METHODS

IgG antiribosomal P protein (anti-P) antibodies were detected in 202 consecutive patients with SLE and 212 age and sex matched healthy subjects by an in-house ELISA, using the 22-mer C-terminal peptide. In 13 patients, IgG anti-P antibodies were also tested in paired cerebrospinal fluid (CSF) and sera samples. Clinical variables were compared in the antibody-positive and negative groups using appropriate statistical tests.

RESULTS

Of the 202 patients, 15 were male. Their median age was 30 years and the median disease duration was 36 months. Thirty-one patients (15.35%) were positive for IgG anti-P antibodies, of which 24 were also positive by Western blot. No association with SLE Disease Activity Index, nervous system disease, nephritis, hepatitis, skin disease, arthritis, and juvenile onset disease could be demonstrated. Levels of IgG anti-P antibodies in CSF were 100-fold less compared to levels in serum, and correlated well with the latter (r = 0.86; p < 0.01).

CONCLUSION

The prevalence of IgG anti-P antibodies is similar in Indian and Caucasian patients with SLE. No association with specific organ involvement or age at onset could be demonstrated.

Biochemical and molecular markers in renal cell carcinoma: an update and future prospects

Cancer is a big problem in the developed world as well as in developing countries. Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. RCC is more common in men than in women (2:1), and it most often occurs in patients between the ages of 50-70 years. In all cancers the cancerous cells release particular kind of proteins (called tumour markers) and blood tests are used to detect the presence of these markers. These tumour markers nowadays are an area of interest for oncologists who search for a possible solution in the detection and treatment of RCC. Different kinds of biochemical and molecular markers such as ferritin, MN/CA9, apoptotic index, p53, IL-2, gamma-enolase, CD44, CD95, chromosome instability and loss of heterozygosity have been tested in RCC, but so far no marker fulfils one or the other criteria to be considered as an ideal marker for RCC. This review gives basic and updated information about the different kinds of biomarkers studied in RCC and about the role implementation of genomics and proteomics in RCC.