How to cite this Thesis/ Dissertation:

Muhammad Saaiq, Muhammad Asghar Khan,

Muhammad Riaz, Gul Hassan, Muhammad
Qadeem, Musharaf Kamal Khan, Muhammad
Jamshed. ANALYSIS OF RHEUMATOID
ARTHRITIS CASES MANAGED AT HAYAT
SHAHEED TEACHING/ KHYBER TEACHING
HOSPITAL PESHAWAR. (Thesis). Department of
Community Medicine, Khyber Medical College
Peshawar 1998.

TITLE:

ANALYSIS OF RHEUMATOID ARTHRITIS

CASES MANAGED AT HAYAT SHAHEED
TEACHING/ KHYBER TEACHING HOSPITAL
PESHAWAR

CORRESPONDING AUTHOR & EDITOR-IN-

CHIEF:
MUHAMMAD SAAIQ SELJUKI
4th Year MBBS,
Khyber Medical College, Peshawar
muhammadsaaiq5@gmail.com

ABSTRACT

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Background: The rheumatic disorders constitute a

major cause of disability throughout the world.

Rheumatoid arthritis (RA) is on the top of the list of

such disorders. It puts a significant degree of socio-

economic stress and burden on all societies, both

developing and developed. The resulting disabilities

vary according to the severity and progression of

the disease, i.e. the sufferer may become

moderately restricted, incapacitated or fully

dependent on others. His performance is sadly

affected and he can’t add his share to the country’s

economy effectively. If the sufferer is the sole

earner of the family, the whole family may

encounter economic death. For effective

prophylaxis and treatment of RA, there is dire need

of more research and advancement in the areas of

epidemiology, risk factors identification, genetics,

immunology, pharmacology, mass awareness and

education, and rehabilitation of the disabled

sufferers. This need is all the greater owing to

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changing patterns of morbidity and mortality,

resulting from quick urbanization, changes in

lifestyles, increasing life expectancy etc.

Objective: To document the clinical presentation

and outcome of RA in The North West Frontier

Province ( Khyber-PakhtoonKhwa) and

adjoining areas which constitute the catchment

areas of Khyber teaching hospital Peshawar.

Study Design: Clinical Observational study

Place and Duration: Department of Medicine,

Khyber teaching hospital Peshawar from May 01,

1996 to April 30,1997.

Methodology: All adult rheumatoid arthritis

patients of either gender and all ages who were

managed at the Department of Medicine, Khyber

teaching hospital Peshawar during the study period

were included by convenience sampling. Patients

who had rheumatic problems but did not qualify the

ARA Criteria were excluded. Also those patients

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who did not consent to participate in the study were

excluded. The diagnosis of RA was made if the

patient had features of inflammatory arthritis of at

least 6 weeks’ duration, according to the American

Rheumatism Association criteria (ARA Criteria 1988

revision). Diagnosis was made if 4 or more of the

following criteria were present. 1-arthritis of ≥ 3

joints, 2-arthritis of hand joints, 3-symmetrical

arthritis, 4-rheumatoid nodules, 5-rheumatoid factor,

6- radiological changes.

A well designed Proforma was used for data

collection. The data were analysed statistically to

measure the objectives.

Results:

Out of a total of 116 patients, there were 81 females

while 35 males.

Majority (60.5%) patients belonged to the age group

31-60 years. The average age for RA onset was

46.2 years for males while 42 years for females.

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About 6% of the patients had a positive family

history of the disease.

21.55% patients were unmarried while the

remainder were married.

62.07%, 11.21% and 26.72% patients belonged to

urban, suburban and rural areas respectively.

60% patients had hosing of modern style, 1.72%

patients were homeless living under shadows of

tents, the remainder had old fashioned housing.

Factors such as educational status, occupation,

income, diet, addiction, general health, exercise,

racial origin, and religion were found to have no

association with the disease.

Onset and exacerbation of symptoms was seen in

19% of the patients in the month of May ( which

marks the start of summer in the region). Overall

55.2% patients presented for hospitalization in

summer months of May through September.

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The pattern of onset of RA was insidious in 65.52%

cases, oligoarticular in 13.8% cases, polyarticular in

8.62% patients, acute in 8.62% cases, and

palindromic in 3.45% cases.

Presentation with typical form of RA was found

among 45.22% patients. Systemic involvement was

found in 45.7% patients.

66.38%, 25% and 8.62% patients had grade II, III

and IV disability respectively.

25%, 11,2%, 5.17%,1.72%, 1.72%, 0.86% and

0.86% patients had complications of RA in the form

of joint failure, systemic infection, amyloidosis, joint

infection, depression, osteoporosis and spinal cord

compression respectively.

Simple analgesics, antimalarials, NSAIDS,

DMARDS, and steroids were used in various

combinations as the treatment of choice.

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84.5% patients reported symptomatic relief with

treatment, 12.07% reported partial symptomatic

relief, while 3.45% patients reported no relief.

Corrective surgeries were performed in 1.72% of

the patients. There was no in-hospital mortality.

Conclusion: RA is a chronic progressive disorder

affecting small and large synovial joints. Majority of

the patients had insidious onset. Female patients

outnumbered males. Majority of the patients were in

their 3rd ,4th and 5th decades of their life. Only small

percentage of patients had positive family history of

the disease. More patients were from urban than

rural areas. Majority of the patients had onset/

exacerbation of RA in summer season months.

Factors such as educational status, occupation,

income, diet, addiction, general health, exercise,

racial origin, and religion were found to have no

association with the disease. The disability that

resulted from the progressive disease put significant

socio-economic burden on the patients and their

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families. Unfortunately the available treatment

regimens did not provide satisfactory results and

majority of the patients ultimately suffered mutilating

disabilities of hands and feet as a result of the

progressing disease.

Key words: Rheumatoid arthritis. Disabilities from

arthritis, American Rheumatism Association criteria

(ARA Criteria).