Behavioral management of the pediatric dental patient among clinical dental students and interns

Abstract

Anaemic syndrome is a common manifestation of rheumatoid arthritis. Both anaemia of chronic disease and iron deficiency anaemia are present in patients with rheumatoid arthritis. Patients with active rheumatoid arthritis are more like to be anaemic with a high impact on the quality of life. The diagnosis of anaemia of chronic disease is made by exclusion. Treatment of the anaemia consists merely of anti-rheumatic treatment. This was a retrospective study of 34 patients diagnosed of rheumatoid arthritis between July 2013 and June 2016. These were the patients that satisfied the 1987 revised diagnostic criteria of the American College of Rheumatology for the diagnosis of rheumatoid arthritis. Anaemia was diagnosed based on the packed cell level and laboratory analysis of red blood cell morphology. Patients with rheumatoid arthritis were divided into 3 groups; rheumatoid arthritis patients without anaemia, rheumatoid arthritis patients with anaemia of chronic disease, and rheumatoid arthritis patients with iron deficiency anaemia. The laboratory results for packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were noted and analyzed. Erythrocyte sedimentation rate and rheumatoid factor results were documented. Five hundred and two rheumatology patients were seen over a period of three years (July 2013 –June 2016). Thirty-four rheumatoid arthritis patients were diagnosed (F-26, M-8) with a female to male ratio of 3.3:1. The age range was 18 to 65 years with a mean age of 45 ± 6yrs. The mean duration of onset at presentation was 5 ±2.6 years, and the mean early morning joint stiffness was 3 ±1.2 hours. The mean swollen and tender joint count was 14 ± 2. Erythrocyte sedimentation rate was uniformly elevated with a mean value of 78 ± 5mm/hr. Rheumatoid factor was positive in 27 patients. Anaemia was predominant in age group 41 to 50 years. The prevalence of anaemia was 70.6%, and anaemia of chronic disease was predominantly seen (70.8%). Among patients with rheumatoid arthritis, the prevalence of anaemia was found to be relatively high. Anaemia of chronic disease was the leading cause of anaemia. The degree of anaemia was closely related to the age and duration of the disease.Keywords: Haemoglobin, iron deficiency, mean corpuscular haemoglobin, anti-rheumatic drugs, rheumatoid arthritis