PSR’s 22nd Annual International Rheumatology Conference proceedings-III


 PSR’s 22nd Annual International Rheumatology 

Conference proceedings-III

LAHORE: The first speaker in the second session of Rheumatology Conference organized by Pakistan Society for Rheumatology here on April 6th 2018 chaired by Prof. Sajid Nisar was Dr. Javaid Malik from Rawalpindi. His presentation was based on case studies of scleroderma and trying to solve the problems. His first patient was a thirty three years old women suffering from scleroderma who developed gangrene of left third finger. He then discussed the management plan for this patient. He pointed out that all such patients should be advised to avoid cold exposure, avoid smoking, rapidly changing temperature and also avoid the drugs used for migraine. They should also be advised to avoid repetitive trauma, control their stress and anxiety. Calcium Channel Blockers are used in such conditions which are quite effective. Nifidipine is recommended by EULAR in 2016 Guidelines. One can switch to Amlodipine 5-10mg and if there is no response the dose can be increased up to 20mg. In the next step one can try Sildenafil which leads to significant reduction in RCS. However, it is not cost effective. IV prostaglandins analogue is the next step. Other options include Prazocin, topical nitrates and Losartan.

The next patient he presented was forty three years old women who suffered from scleroderma for the last ten years. She had digital ulcers and presented with new ulcers. With the use of PDE5 inhibitors there was significant improvement in healing and it also prevented new ulcers. Bosentan also prevented ulcers. His third patient was twenty eight years old women who had limited scleroderma five years ago. After two years she developed ILD. This patient had pulmonary arterial hypertension. Endothelium receptor antagonists were used besides PDE 5 Inhibitors to manage this patient.

Members of the organizing committing of International Rheumatology Conference organized by PSR at
Lahore during April 2018 photographed along with Prof. Nighat Mir, Prof. Sumaria Farman Raja
(President PSR) and Dr. Ahmed Saeed convener of the conference.

Prof. Kamran Chima was the next speaker who talked about Pulmonary Hypertension in CTD. PAH, he stated is a progressive disease. Despite treatment, pressure does not come down. In this multi systemic disease, survival of the patient is very poor even after improvement. Disease severity is based on clinical features, functional class and a patients can be divided into low, intermediate and high risk group. She then discussed the proposed treatment protocol and mentioned about DLCO, if there is relapse, opt for HRCT chest, echocardiography and integrated CPET.

Dr. SargunanSockalingam from Malaysia spoke on Sjogren’s Syndrome- a multi-system disease. He discussed in detail its epidemiology, pathogenesis, clinical spectrum of multisystem aspects and finally discussed its management. He also mentioned about serology, dry eye and dry mouth besides positive ANA. It was first described in 1933 by Dr. Henrick Sjogren. It is seen at its peak in 4-5th decade of life. In this genetic and non-genetic factors are involved. Pulmonary involvement is evident with cases of interstitial lung diseases, primarily of the non-specific interstitial lung diseases. The most significant manifestation include hematological. In this condition, renal disease has a number of varied pathological lesions. All cases of Sjogren’s in women of child bearing age present a special challenge due to the possibility of congenital fetal heart block and neonatal lupus. Its varied clinical picture poses a challenge once the patient is diagnosed. A biopsy is almost always required and pathological analysis can reveal the diagnosis. He pointed out that currently a number of novel therapies are in the pipeline to compliment the already extensive range of medications which are available including glucocorticoids, cyclophosphamide, mycophenolate and monoclonal antibodies against CD20 cells. About 5% of these patients do develop lymphoma. Musculo skeletal, lungs, skin, joint are also involved. If these patients are picked up and diagnosed early, they can be helped. These patients also have vasculitis and they may also suffer from neurological, psychiatric disease. Their central nervous system may also be involved. He concluded his presentation by stating that early diagnosis is essential and neurological system needs screening.

Prof. Jamshaid Nasir (Principle, Fatima Memorial Medical College extreme left) along with others
chairing one of the sessions during the International Rheumatology Conference held at Lahore recently.

Dr. Shafaq Abbas from Karachi spoke on difficult systemic Lupus Erythematous. She was of the view that it was hard to apprehend the complexity of lupus disease due to its various different manifestations. Response to treatment is also unpredictable. One organ involved may get better but the other may become worse thereby affecting the target treatment goal. However due to increased recognition of its vague presentations and use of emerging new therapies, lupus patients can live longer and healthier life. She also discussed a few case histories and their management which included refractory nephritis, lupus nephritis. Preventing the flare up of the disease remains the main goal. She then discussed the three, six, and twelve month follow up the cases and DNA was negative after twelve months. One of her cases was twenty one years old women which was later diagnosed as Nocardia related brain abscess. SLE and Nocardosis, she said, are not uncommon. The next case she discussed was forty nine years old women suffering from lupus psychosis.

Summing up the discussion Prof. Sajid Nisar said that for doctors, every day in the hospital is a great learning experience. The family physicians should be educated and they must learn what to do, how to do and what they should avoid while managing these patients.

In the next session Prof. Sami Salman from Iraq discussed vasculitis mimics. Vasculitis, he said, is a blood vessel inflammation which may lead to tissue injury from vascular stenosis, aneurysm or rupture. Vasculitis can be classified as primary or secondary to identifiable causes like infectious agents, systemic autoimmune diseases or malignancy. There are many disorders which may closely resemble the clinical and radiologic pathological features of the primary vasculitis. It is categorized based upon the predominant size of vessel involvement. Awareness about this is essential to avoid un-necessary and potentially harmful treatment with immunosuppressive agents, he added.

Dr. BetinaRogalski from Germany made a presentation on Polyarticular Juvenile Idiopathic Arthritis. Its treatment, it was pointed out is with NSAIDs. Methotrexate is the most important drug. One can start as subcutaneous injections and the drug needs twelve weeks to show its effect. Avoid using high doses of steroids. Some biologicals are also licensed for Polyarticular JIA. Start treatment with methotrexate. It was also pointed out that one has to suspect it to diagnose this condition and one can suspect only if one knows about it.

Dr. Tajvur Saber from Pakistan talked about Osteoporosis which was a case based review. It was pointed out that nutritional Vitamin D deficiency is quite common. Causes of Vitamin D deficiencies were also highlighted. One can use Calcium 1000mg, Calcium plus Vitamin D and Bisphosphonates. All bisphosphonates are released through kidney. She also discussed the Bisphosphonate drug holiday.