European Journal of Molecular & Clinical Medicine

Understanding the etiology and pathogenesis of periodontal diseases and their chronic, inflammatory and infectious nature necessitates recognizing the possibility that these infections may have effects somewhere in the body. The concept that oral diseases and systemic diseases influence each other goes back to the theory of “focal infection”. In 1891, Miller published his theory regarding focal infection in which he indicated that microorganisms and their products are able to access parts of the body that are adjacent to or distant from the mouth. The proponents of this concept assume that microorganisms present in dental plaque and their metabolic products may enter the bloodstream, thereby causing many systemic diseases and sometimes resulting in degenerative conditions. Associations have been reported between periodontal disease and cardiovascular disease (CVD), stroke, diabetes, preterm low birth-weight babies, respiratory infections and rheumatoid arthritis (RA).

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disorder associated with significant proportion of haematological abnormalities. The present study was undertaken for assessing the haematological abnormalities among rheumatoid arthritis patients. The main aim of the study is to study the prevalence of haematological manifestations in patients with seropositive rheumatoid arthritis.

Background: Rheumatoid arthritis (RA) is a chronic multi system disease of unknown cause. The most frequent site of cardiac involvement in RA is the pericardium.  Cardiac disease is clinically silent and is rarely a life-threatening complication in RA. Cardiac failure is the result of either systolic or diastolic dysfunction, or both. Hence this study was conducted to study correlation of electrocardiographic abnormalities and echocardiographic findings in rheumatoid arthritis patients without clinically evident cardiovascular manifestations with the duration of disease.
Methodology: The Hospital based cross sectional observational study was conducted on 50 patients, above 20 years attending the medicine outpatient department of Dr. S.N. Medical College and Mathura Das Mathur Hospital Jodhpur with an established diagnosis of RA, as defined by the ACR/EULAR criteria for Rheumatoid arthritis. A questionnaire was prepared and investigations were performed.
Results: Cardiovascular manifestations are common in Rheumatoid arthritis patients. This study highlights the need for systematic electrocardiogram in patients with rheumatoid arthritis, even in the early stages of the disease when cardiovascular involvement is clinically silent because electrocardiographic abnormalities are real and should alarm the physician and lead to the initiation of appropriate therapy that may help reduce the incidence of cardiovascular death in RA patients. The relation between transmitral flow alteration and disease duration suggests a sub-clinical myocardial involvement with disease progression and may be related to the high incidence of cardiovascular deaths in patients with RA

Background: The present study was undertaken for assessing the haematological disorders among patients presenting with rheumatoid arthritis.
Materials & methods: 100 consecutive rheumatoid arthritis patients were enrolled. Only patients aged 18 years or more willing to participate in the study were included. Also; inclusion criteria included patients having joint pains, signs of inflammation, involving mono or polyarticular joints. A detailed history of the patient was taken and through clinical examination was done according to predesigned and pretested proforma. All patients were subjected to investigations like: Complete Haemogram, ESR, RBS, Blood Urea, Serum Creatinine, Electrocardiogram, Echocardiography and Radiography of Affected Joints. The descriptive and analytical statistics was done
Results: Anaemia was found to be present in 67 percent of the patients. Leucocytosis and thrombocytosis were found to be present in 21 percent and 33 percent of the patients respectively. Raised ESR and raised CRP were found to be present in 94 and 95 percent of the patients.  Anti-CPP was found to be present in 100 percent of the patients.
Conclusion: Specific results may help to target patient education, increase physician awareness of the profile of the disease and suggest the need for social and rehabilitative services, and help monitor responses to therapy.

Background: An excess burden of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is an established paradigm. The present study was conducted to assess the prevalence of acute myocardial infarction in patients with rheumatoid arthritis.
Materials & Methods: From the outpatient department, 150 patients with a confirmed diagnosis of RA were included in this study. Demographic factors including age, past and family history of MI were noted using a self-structured questionnaire.  MI was diagnosed based on symptoms, cardiac enzyme, and ECG. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation, Armonk, New York, USA). p-value of < 0.05 was considered significant.
Results: In the present study, 150 patients with a confirmed diagnosis of RA were included in which 53.33% were females and 46.66% were males. The mean age of patients was 48 years. 4.66% patients had previous history of MI and 6% patients had family history of MI. 14% RA patients had non-fatal MI and 4% RA patients had fatal MI. In 82% RA patients MI was absent.
Conclusion: The present study concluded that 14% RA patients had non-fatal MI and 4% RA patients had fatal MI.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease
characterized by joint swelling, joint tenderness, and destruction of synovial joints,
leading to severe disability and premature mortality. Early rheumatoid arthritis is
defines as “RA with duration of disease/symptoms of disease < 6 month.”
Aim:To study serum vitamin D level in newly onset rheumatoid arthritis patients.
Methodology: It is a Case-control study, all patients fulfilling revised American College
ofRheumatology criteria/EULAR criteria(2010) for Rheumatoid Arthritis being
attended to in therheumatology clinic, Tools like Oral questionnaire, History &
Clinicalexamination,laboratory equipments will be used.Sample size is 45 cases and 45
controls, complying with inclusion and exclusion criteria.
Result: The study suggested that, mean value of Clinical Disease Activity Index (CDAI)
of RA was 12.24±8.05 in cases and 2.89±0.83 in control, DAS28 Score was 4.24 ± 1.07 in
cases and 3.00 ± 0.37 in control, it showed statistically significant association between
serum Vitamin D3 level with CDAI and DAS28 Score in rheumatoid arthritis patients.
Conclusion: The study results suggest that the inverse relationship between serum
Vitamin D levels and RA disease activity.

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting
the joints with varying severity among patients. The risk factors include age, gender, genetics,
and environmental exposure (cigarette smoking, air pollutants, and occupational). Many
complications can follow, such as permanent joint damage requiring arthroplasty, rheumatoid
vasculitis, and Felty syndrome requiring splenectomy if it remains unaddressed. As there is no
cure for RA, the treatment goals are to reduce the pain and stop/slow further damage. Here, we
present a brief summary of various past and present treatment modalities to address the
complications associated with RA.

Objective
Rheumatoid arthritis (RA) is regarded as the commonest and one of most known
inflammatory arthritis. Our study was to determine the effects of laser therapy and laser
acupuncture therapy on RA elderly patients.
Subjects and Methods
Forty patients with age of 65 to 75 years were being randomly allocated to 2 groups. Group(A)
included twenty participants having RA treated via low level laser therapy. Group(B) included
twenty participants having RA treated via laser acupuncture. All the patients underwent
treatment by methotrexate. Treatments were provided three times each week to the two groups
for twelve weeks.Independent laboratory technician and statistician were blinded to the study
groups.

Introduction: Women with RA have higher grades of disease activity and more declines in health status than men with RA; this recommends a relationship between estrogen and disease activity and severity.
Aim: Our aim was to detect the effect of sex hormone fluctuations and menopause on functional disability and quality of life of postmenopausal RA patients.

Background: The most prevalent form of inflammatory arthritis is rheumatoid arthritis (RA) and it usually involves elbows, feet, wrists, knees, and ankles. The foot is the first region of the body to display RA signs and symptoms for certain patients. This research aimed to assess the prevalence of foot disorders in RA patients, identifying the relationship between the activity of the RA disease and foot disorders, as well as their effect and deformities occurrence.
Patients and methods: A total of 300 RA patients were included in this report. There were 240 women and 60 men, aged between 18 and 74. The following were done to all patients: complete historical review, complete clinical examination, and the evaluation of disease occurrence Complete blood count (CBC), Erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), rheumatoid factor (RF) titer, and anti-cyclic citrullinated peptide (anti-CCP Ab) titer were used and X Ray on foot done to all patients
Results: We found that 31.6% of the study patients had foot deformities. 214 patients (71.3%) had normal gait while 86 patients (28.7.0%) had pathological gait. Hallux valgus was common among old age and obese RA patients. The foot deformities are associated with moderate and high DAS28 activity. Obese RA patients are more susceptible to have foot problems 2.89 times more than normal-weight RA patients. 176 patients (58.6%) had narrowing, 97 patients (32.33%) had osteoporosis 87 patients (29.0%) had erosion, 20 patients (6.67%) had bone cyst, 17 patients (5.6%) had subluxation and 14 patients (4.6%) had amalgamation.

Sjogren’s syndrome (SS) is an autoimmune disorder which is responsible for glandular dysfunction most preferably salivary and lacrimal glands, caused mainly by the lymphocytic infiltration of exocrine glands. It can be classified into two, namely Primary Sjogren’s syndrome and Secondary Sjogren’s syndrome. Primary Sjogren’s syndrome (pSS) occurs in the absence of other autoimmune diseases and is characterised by keratoconjunctiva sicca (dry eyes) and xerostomia (dry mouth), collectively called the sicca syndrome. On the other hand, secondary Sjogren’s syndrome is associated with other autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The prevalence of SS is estimated to be approximately 3% in subjects 50 years or older, with a female to male ratio of 9:1. Conditions associated with SS include rheumatoid arthritis, lupus erythematosus and scleroderma. The clinical manifestations are often vague and mistakenly interpreted and attributed to other medical conditions or iatrogenic disorders. As such, incorrect diagnosis of SS is common and approximately half of all patients are thought to be undiagnosed

patients under 30. The control group consisted of 110 healthy middle-aged
individuals. In the surveyed population, those with 1 to 5 years of age were the largest group
(38.3%), followed by those with 5 to 10 years of age (34%). In 66.3% of the patients of RA MT
was used as a base preparation. The average dose (median) of MT over the study period was
10 mg per week. 80% of patients took prednisolone in an average dose of 10 mg/day. The
content of lipids in venous blood was determined by photocolometry on Vitros SYSTEM
Chemistry DT 60 biochemical analyzer (Austria). Results: RA patients who took MT showed a
significant increase in the level of triglycerides (TG). Also, it is characterised by an increase
in TG levels and a decrease in the concentration of high-density lipoprotein cholesterol
(HDL) and an increase in the atherogenicity factor. A more pronounced decrease in HDL
levels. Significantly high indicators of the atherogenicity coefficient, which to a lesser extent
depended on the duration of MT use. Low-density lipoprotein cholesterol (LDL) and
triglyceridemia are also proved to be serious risk factors for atherosclerosis and
cardiovascular heart diseases (CHD). Also according to the results of the research, special
attention is paid to the use of hypolipidemic drugs, which is promising in improving the
prognosis and reducing cardiovascular injuries in RA patients. In the group of patients who
received additional lipidex SR, there was a decrease in the level of OHS by 17.1%, an
important shift was observed on the part of TG, this indicator decreased by 29.7% and
practically did not differ from the control indicators. HDL cholesterol in the SR lipidex group
increased significantly by 37.7%. These fibrates have a stimulating effect on all components of

Arthritis is a type of joint dysfunction that includes one or more joint inflammation like rheumatoid or psoriatic arthritis, and associated autoimmune disorders. The biggest concern about arthritis is that the discomfort is always persistent and may be confined to the injured joint due to swelling that happens throughout the joint, trauma to the joint induced by illness, regular wear and tear, muscle strains triggered by vigorous action toward hard sore joints and exhaustion, which in effect contributes to inflexibility, immobility and muscle weakening. Carbon nanotubes with unusual physicochemical properties (cell membrane penetration, large surface area and drug payload, biocompatibility, simple surface alteration, photoluminescence properties and non-immunogenicity) are employed to conquer the challenges of inflammation.

Smoking leads to disease and disability and harms nearly every organ of the body. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. It increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. Secondhand smokers are also at great risk of developing certain disease conditions like stroke, lung cancer, and coronary heart disease in adults.

Health assessment questionnaire (HAQ) is increasingly being used for assessing health outcome in the Rheumatoid Arthritis (RA) patients. The present study aims to determine the relationship between the functional status and disease activity of South Indian patients with RA at initial presentation using HAQ and tools such as disease activity score (DAS -28 ESR) and Clinical Disease Activity Index (CDAI).
Methods
This was a cross sectional observational study on relationship between DAS-28 ESR, CDAI and HAQ tools in 100 consecutive newly diagnosed patients with RA in Southern India. Patients were stratified based on HAQ score and their association was studied using chi square test and Mann Whitney U test.
Results
The patients were classified as Group I with HAQ score <1 (n=73) and Group II with HAQ score>1 (n=27). The median TJC (22 vs 12; p<0.01) and SJC (7 vs 5; p=0.04) scores were significantly higher in patients with HAQ>1 group. Also, patients in HAQ>1 group had significantly higher median DAS-28 ESR (7.5 vs 6.5; p<0.01) and CDAI (43 vs 29.5; p<0.01).
Conclusion
There was a very high positive correlation between HAQ with DAS 28 ESR and CDAI score at initial presentation in RA patients. Hence HAQ score can be used earlier in the disease course to assess functional limitations and monitor disease activity in RA patients.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease, causing joint damage and functional impairment. Worldwide prevalence of RA is around 0.5 to 1 percent. Disease severity assessment in Rheumatoid Arthritis patients is done routinely using Disease Activity Score in 28 joints with ESR (DAS-28 ESR) and Clinical Disease Activity Index (CDAI). The present study sought to evaluate and correlate disease activity in RA patients from Southern India using DAS-28 ESR and CDAI.
Material and methods: First 100 newly diagnosed Rheumatoid Arthritis patients satisfying American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA who attended Rheumatology clinic in a tertiary care hospital in Southern India from April 2017 to September 2017 were studied. Based on previous established values, the patients were divided into low, moderate, and high disease activity groups. Chi-square test and Mann-Whitney U test were used to study association between the disease severity score and clinical factors. Spearman rank correlation was performed to assess the correlation between DAS-28 and CDAI scores.
Results: Median age of patients was 47.5 years, predominantly female. Elevated CRP was observed in 85% patients. All patients were classified having high disease severity for DAS 28 ESR score with mean score 6.8 (±0.8). Nine patients had moderate severity, while 91 patients had high disease severity CDAI score with mean score of 34.8 (±11.3). There was strong correlation between DAS 28 ESR score and CDAI score (r=0.94).
Conclusions: All patients enrolled had high disease severity using DAS 28 ESR score, while 91 patients were classified having high disease severity using CDAI in the present study. There was strong correlation between the DAS 28 ESR score and CDAI score. From an outpatient setting from Southern India, CDAI may be a preferred disease assessment tool in day-to-day clinical practice in assessing RA patients because it does not include laboratory tests and complex mathematical calculations.