Aims To determine the prevalence of inflammatory back pain (IBP) and radiographic axial spondyloarthritis (SpA) in a semi‐urban community of Lahore, Pakistan. Methods This cross‐sectional household survey was designed as per the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) model. In Phase 1, the subjects were interviewed for musculoskeletal (MSK) pain in the last 7 days by clinical assistants. In Phase 2, physiotherapists identified subjects with spinal/back pain and interviewed for Assessment in Spondyloarthritis International Working Group (ASAS) criteria for IBP. In Phase 3 subjects having IBP or chronic back pain (CBP) with an age at onset ≤45 years, were assessed and further investigated. Results A total of 4922 subjects with a mean age of 35.3 ± 14.5 years, including 2770 (56%) women were surveyed in Phase 1. MSK pain in last 7 days was reported by 1407 (28.6%) of whom 1034 (21%) had spinal pain. The ASAS criteria for IBP were met in 329 (6.7%, 95% CI 6.0‐7.0). In Phase 3, 222 with IBP and 83 having CBP with age at onset ≤45 years were evaluated. Out of this total of 305, 144 (2.9%) were confirmed to have IBP by rheumatologists as per at least 1 of the 3 criteria. ASAS criteria were met in 107 (2.2%, 95% CI 1.8‐2.6). ASAS criteria for radiographic axial SpA were met in 47 (1%, 95% CI 0.7‐1.3) of the surveyed population. Conclusion Inflammatory back pain was reported in 6.7% by physiotherapists, confirmed in 3% by rheumatologists. The prevalence of radiographic axial SpA was 1%.

Objectives: This study aims to evaluate the clinical and serological characteristics of systemic sclerosis (SSc) in Pakistani population. Patients and methods: This prospective, cross-sectional study included a total of 38 patients (6 males, 32 females; mean age: 34.5±1.5 years; range, 16 to 60 years) with SSc who were admitted to our rheumatology clinic between November 2019 and January 2020. We evaluated the clinical, serological, and radiological features of SSc patients. Results: Thirty-four (89.5%) patients developed Raynaud phenomenon at the time of disease onset, while sclerodactyly was found in 34 (89.5%), digital ulcers in 25 (65.8%), and tendon friction rub in 12 (31.6%) patients. Interstitial lung disease was present in 30 (78.9%) patients with a higher prevalence in diffuse scleroderma (100%) than in limited scleroderma (70%) (p=0.01). Pulmonary hypertension was present in 18 patients with a significantly higher prevalence in diffuse disease (57.1%) than limited disease (11.8%) (p<0.01). Thirty (78.9%) patients had impaired pulmonary function tests. Fibromyalgia was present in seven (18.4%) patients, and depression was present in 10 (26.3%) patients. Antinuclear antibody (ANA) was positive in 30 (78.9%) patients. Anti-Scl-70 antibodies were present in 24 (63.2%) patients with a significant association with diffuse disease (85% vs. 35.3%, respectively; p<0.01). The anti-centromere antibodies (ACA) were present in 20 (52.6%) patients with a significantly higher rate in limited disease (94.2% vs. 19.0%, respectively; p<0.01). Conclusion: Scleroderma has a female preponderance. Raynaud phenomenon is the most initial clinical feature followed by other manifestations of a variable course and disease severity.

Objectives: In our study we evaluate the hyperuricemia levels in patients presenting to us with the chief complaint of chronic lower back pain and determine the associations with age, gender and radiographic findings. Study Design: Cross sectional study. Setting: Dow University of Health Science Civil Hospital Karachi. Period: From April 2017 to September 2017. Material & Methods: Patients with lower back pain of a duration longer than three months and between the ages of 18 and 70 years were included. A complete history and physical examination was done for all the patients including relevant laboratory, radiographic and anthropometric measurements. The neurosurgeon also assessed the patient’s lower back pain and associated findings in the lower limbs. The patients also underwent radiographic evaluations via X-rays and Magnetic resonance imaging. Data were analyzed using IBM SPSS statistical software version 20. We considered a p value of < 0.05 to be statistically significant. Results: The final study population consisted of n= 110 patients of which n= 54 were males and n= 56 were females. Of the total patient population of the study n= 31 (28.18%) had increased serum uric acid and had nearly equal incidence in males and females (27.77% and 28.57% respectively). The highest incidence of hyperuricemia was found patients between 26 and 60 years of age. In our study n= 22 patients did not have any comorbid condition while joint pain was found in n= 24 patients (p-value of <0.05) of these patients they suffered from pain in their knees and tarsal joints. Lumbar disc prolapse was found in n= 21 patients (p-value of <0.05), lumbar disc degeneration was found in n= 16 patients (p-value of <0.0579). Furthermore, disc space narrowing was found in n= 27 patients having a p-value of <0.05. Conclusion: According to the results of our study hyperuricemia is found in one of every four with low back pain. There is a variable association between comorbid conditions and hyperuricemia. While an equal association is found between gender and hyperuricemia. There is also a strong association of hyperuricemia with joint space narrowing and lumbar disc narrowing of the lumbar vertebrae and it augments degenerative spondylolisthesis.