Tehran University Medical Journal

Background: Pulmonary involvement is a common and serious complication of rheumatoid arthritis. This cross sectional study sought to determine the prevalence of pulmonary disease in patients with rheumatoid arthritis on the basis of history, physical examination, chest X-ray and PFT.

Materials and Methods: 103 patients (81 Women, 22 Men) fulfilling the ACR (American College of Rheumatology) criteria for RA (Rheumatoid arthritis) were consecutively included in a cross sectional study. Detailed medical (including respiratory symptoms and the disease activity symptoms) and drug and occupational histories and smoking were obtained. All patients underwent a complete pulmonary and rheumatologic examination and conventional chest radiography. All patients underwent PFT that comprised spirometry and body plethysmography.Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height.

Results: On the basis of history: Their mean age was 43.3 ± 2.6 years (range: 17-74) and the mean duration of the disease was 69.3 ± 15.6 months. Rheumatoid factor was positive in% 61.2. No patients were 0.5Pack/Year smoker in whole life. Prevalence of pulmonary involvement based on radiographic and pulmonary function test detected in 41 patients (39/7%). The most frequent respiratory clinical finding was dyspnea (33%), (NYHA grade I in 17.5% and NYHA grade II in 15.5%), Cough (with or without sputum) in 13.6 %, Crackle was the most sign in pulmonary examination (5.8%). Chest X-ray was abnormal in 13.3 % that the most common finding in this study was reticulonodular pattern in 20 patients (19.4 %), and pleural effusion detected in 7 patients (6.7%). PFT was abnormal in 30 patients (29.1 %). A significant decrease of FEF 25%-75% below 1.64 SD. Small airway involvements was the most abnormal finding of PFT. No relation between rheumatoid arthritis disease activity (ESR>30, Morning stiffness>30', Anemia, thrombocytosis) with pulmonary disease was seen.

Conclusion: This study suggests a high prevalence of lung involvement in patients with rheumatoid arthritis.Therefore we recommend a complete investigation in patients with RA with any respiratory symptom.

Background: Recent studies have raised the issue of an increased incidence of polycystic ovaries (PCO) and menstrual disturbances in women with epilepsy treated with valproate (VPA). It seems that antiepileptic drugs, especially valproate, may have a functional role in altering the endocrine system of child-bearing women with epilepsy. We conducted this study to investigate the association of VPA and ovarian structural/menstrual disorders in epileptic women.

Methods: In this cross-sectional study, we compared a total of 64 epileptic patients, aged 16-45 years, 32 of whom had been taking VPA alone and 32 were on other antiepileptic drugs for a minimum duration of six months. Ovarian sonography was performed and body mass index (BMI) calculated for all subjects. We also recorded the presence of menstrual disturbances in both groups.

Results: Fifteen (46%) of the VPA subjects had PCO compared to 7 (21.9%) of the other group. In the VPA group, four (12.5%) had oligomenorrhea, one (3.1%) amenorrhea and 13 (40.6%) had irregular menstrual cycles. However, from the other group, two (6.3%) subjects had oligomenorrhea and seven (21.9%) had irregular menstrual cycles amenorrhea was not present in the non-VPA treated patients. Mean BMI was 22.5 kg/m² among the VPA subjects and 20.1 kg/m² in the non-VPA subjects.

Conclusions: This study supports the association of PCO and high BMI with VPA treatment. The frequency of menstrual disturbances did not differ significantly between the two groups.