Objective:To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups.Methods:During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III (ROCHE). QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score.Results:In this study the mean age of RA group was (45.1±9.5) for Non RA group (43.7±8.2), with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group (14.2±17.1%) and Non RA group was (13.2±19.0%) with (p-value 0.122). The 10-year score with Framingham risk score in RA group was (12.9±10.4%) and Non RA group was (8.9±8.7%) with (p-value 0.001). In RA group QRISK-2 (24.5%) and FRS (31.1%) cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups (Kappa = 0.618 RA Group; Kappa = 0.671 Non RA Group).Conclusion:QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score.

Objective: To determine the frequency and predictors of pulmonary hypertension in patients with Systemic Lupus Erythematosus in a Pakistani population, presenting at a tertiary care hospital Methods: This cross-sectional study was conducted at the Department of Rheumatology, Shiekh Zayed Hospital, Lahore from March to June 2018. A total of 97 patients, who fulfilled the Systemic Lupus Erythematosus (SLE) criteria of American College of Rheumatology (ACR) 1992 were enrolled. Pulmonary Arterial Hypertension (PAH) was measured by calculating pulmonary arterial systolic pressure through echocardiography by a single consultant cardiologist. Disease characteristics and demography was collected in a self-administered proforma. PAH was defined as mean pulmonary arterial pressure of 25mmHg or above by calculating with a formula. SPSS version 20 was used for analysis of data. Results: Out of 97 patients, 89.7% (n=87) were females and 10.3% (n=10) were males, with mean age of 31.29±8.824 years. The mean disease duration was 24.21±30.46 months. PAH was found in 23.3% (n=23) patients, including 19 females and 4 males. On further analysis of data, Raynaud phenomenon, rheumatoid factor and nephritis were assessed as predictors of PAH and all of these showed statistical significance for presence of PAH as per Chi-square test (p<0.05). Conclusion: In this study, 23.3% SLE patients showed evidence of PAH and positive statistical significance was found between predictors like Raynaud phenomenon, rheumatoid factor, nephritis and presence of PAH. So it is imperative to detect PAH early and start prompt treatment to achieve better quality of life. How to cite this:Asif S, Rasheed A, Mahmud TH, Asghar A. Frequency and predictors of pulmonary hypertension in patients with Systemic Lupus Erythematosus. Pak J Med Sci. 2019;35(1):86-89. doi: https://doi.org/10.12669/pjms.35.1.405 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

IntroductionRheumatoid arthritis (RA) is a chronic autoimmune disorder with variable disease course including periods of flares and remissions. High disease activity in terms of disease activity score-28 (DAS-28) results in significant morbidity. Hypothyroidism is found to be associated with higher DAS-28 scores in RA. This study is planned to determine overt and subclinical hypothyroidism and its correlation with the DAS-28 score in patients with RA. MethodologyThis study was conducted from June 2021 to March 2022 at the department of rheumatology and immunology at Shaikh Zayed Hospital, Lahore, Pakistan. Inclusion criteria were any male and female patients aged between 18 and 70 years. The blood samples of diagnosed patients with RA were sent for thyroid function tests (thyroxine [FT4], thyroid-stimulating hormone [TSH]), and erythrocyte sedimentation rate (ESR), and the patients were categorized as overt hypothyroidism, subclinical hypothyroidism, and nonhypothyroid. The collected data were analyzed on Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). ResultsThe mean age of patients was 38.18 ± 9.78 years. The mean duration of symptoms was 14.65 ± 1.04 months. There were 182 (91%) females and 18 (9%) males. The mean number of swollen joints was 2.26 ± 2.8, and the mean number of tender joints was 4.16 ± 5.11. Sixty patients (30%) had high disease activity, i.e., DAS-28 score > 5.1. Fifty-seven patients (28.5%) with RA had subclinical hypothyroidism, and 19 patients (9.5%) had overt hypothyroidism. Pain visual analog scale (VAS) and DAS-28 were significantly higher in hypothyroid patients. ConclusionIt was concluded that patients of RA with concomitant hypothyroidism had increased disease activity with increased tender joints. Thyroid function tests should be included in the clinical evaluation of RA patients. The evaluation of thyroid functional status must be done during screening in RA patients. This will detect thyroid disorders earlier, with early treatment initiation and possibly a better prognosis.

SUMMARYSystemic lupus erythematosus (SLE) is a chronic systemic autoimmune inflammatory disease and early diagnosis is of clinical and therapeutic importance. Melatonin is an endogenous endolamine hormone that plays an important role in the immune system due to its anti-inflammatory action. This study was designed to assess serum melatonin levels in SLE patients and to evaluate the possible correlation between serum melatonin and patients' baseline characteristics. A case-control study was performed on 50 SLE patients (48 females and 2 males), diagnosed according to the revised 1997 ACR Criteria, and 25 healthy controls (24 females and 1 male), matched by age and sex. Daily serum melatonin levels were investigated in all participants using human melatonin enzyme linked immunosorbent assay (ELISA) kit (MYBIOSOURCE (MBS), United States). Serum melatonin concentration was significantly lower in patients with SLE compared to healthy controls (19.17±6.86 pg/mL vs 23.26±6.71 pg/mL, p=0.017). Serum melatonin concentration ≤18.51 pg/mL was the optimum cut off value to differentiate between SLE patients and healthy controls with an accuracy of 69.3%, a sensitivity of 66%, and a specificity of 76%. The positive predictive value (PPV) at pretest 50% was 73.3% and PPV at pretest 90% was 96.1%; the negative predictive value (NPV) at 10% was 95.3%. Patients' characteristics were not significantly correlated with serum melatonin concentrations using multiple logistic regression analysis. Serum melatonin was a valid measure to differentiate between SLE patients and healthy controls with good accuracy, sensitivity and specificity and PPV and NPV. There was no significant correlation between serum melatonin concentrations and patients' baseline characteristics.Key words: Serum melatonin; systemic lupus erythematosus; autoimmune diseases. Reumatismo, 2017; 69 (4): 170-174 n INTRODUCTION S ystemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterized by a multitude of autoantibodies, complement activation and immune-complex deposition, which causes tissue and organ damage (1). The etiology and pathogenetic mechanisms of SLE are still unclear; no single cause for SLE has been identified (2). It is possible that the autoimmune disorder results from the combination of predisposing genetic factors and the disturbed status of stress response mechanisms, including the sympathetic nervous system and various hormones (3). Melatonin, produced by the pineal gland during the night, is the major secretory hormone and a key player in the neuroendocrine-immune pathway (4, 5). Melatonin can stimulate cytokine production, phagocytosis and natural killer cell activity. In vitro studies and animal experiments have provided evidence for a modulatory effect of melatonin in the immune response: melatonin receptors are expressed on the membrane of CD4 T cells, CD8 T cells, and B cells (6, 7), and melatonin treatment in mice showed increasing proliferation of T cells (8). In addition, it can antagonize the increasing levels of I...

Undifferentiated connective tissue diseases usually present with arthralgias, sicca symptoms, Raynaud's phenomenon and leucopenia. This case presents the atypical presentation of an undifferentiated connective tissue disease with extensive cutaneous involvement of fingers and toes leading to gangrene with absence of typical rheumatological symptoms. The autoimmune profile showed positive ANA and anti-Ro/SS-A. Thromboembolism was ruled out on the basis of transthoracic and transesophageal echo. She was treated with I/V corticosteroids and cyclophosphamide that halted the disease progression.