No abstract

Background Psoriatic arthritis (PsA) is associated with a higher frequency of abnormal lipids and obesity compared with healthy controls and rheumatoid arthritis. There is also an increased risk of developing PsA in obese individuals, perhaps related to the inflammatory milieu provided by excess adiposity. It is also known that inflammatory cytokines contribute to derangements in lipid metabolism. However, the relationship between disease activity and lipid profiles in PsA is not well studied. Objectives To assess the cross-sectional relationship between PsA disease activity and lipid profiles in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Methods We analyzed PsA patients followed in CORRONA between 6/2008 and 10/2012 with complete data for lipids and disease activity. Moderate to high disease activity was defined as CDAI>10 and/or presence of enthesitis/dactylitis. Abnormal lipids were defined as: total cholesterol (TC)>200 mg/dl (5.17 mmol/L), High Density Lipoprotein (HDL)<40 mg/dl (1.0 mmol/L, men), HDL<50 mg/dl (1.3 mmol/L, women), Low Density Lipoprotein (LDL)>100 mg/dl (2.59 mmol/L), Triglycerides (TG)>150 mg/dl (1.7 mmol/L), and atherogenic ratio (TC/HDL) >5. Models were adjusted for gender, duration of PsA, mHAQ, disease-related medication use, smoking, body mass index (BMI), diabetes (DM), use of cholesterol medications and fish oil. Results Of the 725 PsA patients included in this study, 284 (39%) had moderate to high disease activity. Compared to the low disease activity group, the moderate to high disease activity group had a higher proportion of women (57% vs 46%, p=0.006) and smokers (12.7% vs 7.7%, p=0.029), higher log ESR (2.44 vs 2.13, p=0.003) and log CRP (1.63 vs 1.31, p=0.002), and shorter disease duration (mean 8.7 vs 11.2 years, p=0.001). Those with moderate to high disease activity were more likely to be prescribed prednisone (13% vs 4.5%, p<0.001) and non-biologic DMARDs (63% vs 51%, p=0.002), but were less likely to be prescribed TNF inhibitors (57% vs 66%, p=0.015). Mean BMI in moderate to high and low groups were 31.7kg/m2 and 30.6kg/m2, respectively, p=0.02. There were no differences between age, rate of DM, frequency of cholesterol lowering medications, and fish oil supplementation. Moderate to high disease activity was associated with higher odds of TC>200 mg/dl, OR 1.6 (1.1, 2.2 95%CI), p=0.010, and higher odds of TG>150 mg/dl, OR 1.6 (1.2, 2.3 95% CI), p=0.005. Enthesitis/dactylitis was positively associated with TC>200 mg/dl, OR 1.6 (1.1, 2.5), p=0.02. There was no significant association found between disease activity and other lipid measures in the moderate to high disease vs low disease groups. Conclusions Moderate to high disease activity in PsA is associated with increased levels of total cholesterol and triglycerides, suggesting a commonality between PsA disease mechanisms and lipid metabolism that deserves further exploration. The implications of this association for cardiovascular disease in PsA need to be studied further. Di...

Introduction: Patient interaction is a vital aspect of medical education. Bedside teaching encounters involve clinicians, medical students, and patients, and comprise a formative and focused activity. Patients' willingness to cooperate and contribute to the education and training of medical students provide better teaching opportunities. The study aims to find the patients’ preference to bedside teaching encounters in four major wards in a tertiary care center in Nepal. Methods: This descriptive cross-sectional study was performed in four major wards in a tertary care centre from June 3, 2015 to July 3, 2015 after receiving ethical approval. Convenient sampling was done. Data was collected in Microsoft Excel and analyzed in Statistical Package for Social Sciences 13.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Subgroup analysis was done on the basis of demographic variables. Results: Seventy-eight (77.2%) patients preferred bedside teaching encounters among 101 participants (77.12-77.28 at 95% Confidence Interval). Among which, females, age ranging from 16 to 32 years, education below secondary school and with hospital stay<4 days were most common. Conclusions: The results showed that most of the patients preferred bedside teaching encounters which was congruent with the other national and international studies.

No abstract