We present a case of a 29-year-old female from Sudan, who was diagnosed with rheumatoid arthritis (RA) in 2005 and with immune thrombocytopenic purpura (ITP) in 2009. The ITP immediately followed using, for four weeks...We present a case of a 29-year-old female from Sudan, who was diagnosed with rheumatoid arthritis (RA) in 2005 and with immune thrombocytopenic purpura (ITP) in 2009. The ITP immediately followed using, for four weeks, a combination of medications that included rifampicin. The platelets count continued to be low thereafter. During the year following her diagnosis with ITP, she reported gradual improvement in her joints symptoms, which continued during her pregnancy in 2011. Following puerperium, her chronic ITP resolved completely;however, her joint disease flared up few months later. To our knowledge, there are no reported cases of chronic ITP, which were drug induced at first in a patient of RA except with gold therapy. Similarly, there are no reports on cases that recovered from chronic ITP after delivery. Finally, this case highlights the impact different coexisting autoimmune diseases may have on each other regarding course and prognosis.展开更多
Background: Glucocorticoids (GC) are considered a mainstay as well as symptomatic and disease-modifying therapy for rheumatic diseases. They are generally used to quickly dampen inflammation, reduce duration of diseas...Background: Glucocorticoids (GC) are considered a mainstay as well as symptomatic and disease-modifying therapy for rheumatic diseases. They are generally used to quickly dampen inflammation, reduce duration of disease flares and as a maintenance therapy. Conventionally, oral GC are to be prescribed for short periods when possible;mainly, because of their side effects when used for long periods. One of the most important drawbacks of prolonged GC therapy is the risk of bone loss (osteoporosis (OP)) and osteoporotic fragility fracture (OFF). Objective: The aim of this audit was to assess counselling, prevention and management of OP in patients with rheumatic conditions who are or were receiving high doses of oral GC for three months or more against standard international guidelines. Method: The audit was carried out in March/April 2018 for a period of four weeks in a busy rheumatology service in Khartoum, Sudan. A Performa was used to collect data manually from eligible patients and their outpatient medical cards retrospectively. Then, data were audited against standard guidelines. Result: Overall, the selected Centre failed to meet the audit standard of 50% of eligible patients being appropriately managed for OP/OFF according to NICE and ACR guidelines. Conclusion: Huge areas of deficiency in the practice were identified. Acknowledging socioeconomic difficulties in the area of study, simple measures, such as carrying out a fracture risk assessment, optimizing calcium and vitamin D supplements with life style modification and patient education, would have a great impact on patients treated with steroids for rheumatic diseases.展开更多
文摘We present a case of a 29-year-old female from Sudan, who was diagnosed with rheumatoid arthritis (RA) in 2005 and with immune thrombocytopenic purpura (ITP) in 2009. The ITP immediately followed using, for four weeks, a combination of medications that included rifampicin. The platelets count continued to be low thereafter. During the year following her diagnosis with ITP, she reported gradual improvement in her joints symptoms, which continued during her pregnancy in 2011. Following puerperium, her chronic ITP resolved completely;however, her joint disease flared up few months later. To our knowledge, there are no reported cases of chronic ITP, which were drug induced at first in a patient of RA except with gold therapy. Similarly, there are no reports on cases that recovered from chronic ITP after delivery. Finally, this case highlights the impact different coexisting autoimmune diseases may have on each other regarding course and prognosis.
文摘Background: Glucocorticoids (GC) are considered a mainstay as well as symptomatic and disease-modifying therapy for rheumatic diseases. They are generally used to quickly dampen inflammation, reduce duration of disease flares and as a maintenance therapy. Conventionally, oral GC are to be prescribed for short periods when possible;mainly, because of their side effects when used for long periods. One of the most important drawbacks of prolonged GC therapy is the risk of bone loss (osteoporosis (OP)) and osteoporotic fragility fracture (OFF). Objective: The aim of this audit was to assess counselling, prevention and management of OP in patients with rheumatic conditions who are or were receiving high doses of oral GC for three months or more against standard international guidelines. Method: The audit was carried out in March/April 2018 for a period of four weeks in a busy rheumatology service in Khartoum, Sudan. A Performa was used to collect data manually from eligible patients and their outpatient medical cards retrospectively. Then, data were audited against standard guidelines. Result: Overall, the selected Centre failed to meet the audit standard of 50% of eligible patients being appropriately managed for OP/OFF according to NICE and ACR guidelines. Conclusion: Huge areas of deficiency in the practice were identified. Acknowledging socioeconomic difficulties in the area of study, simple measures, such as carrying out a fracture risk assessment, optimizing calcium and vitamin D supplements with life style modification and patient education, would have a great impact on patients treated with steroids for rheumatic diseases.
