The Effects of Different Drugs Regimens in the Disease Activity Index and Uric Acid Levels of Sudanese Patients with Rheumatoid Arthritis
Abstract
Background: In Sudan, rheumatoid arthritis is treated with steroids and disease-modifying anti-rheumatic drugs (DMARDs). The typically used DMARDs include methotrexate, hydroxychloroquine (HCQ), sulfasalazine, and leflunomide.
Objective: In this study, authors assess the different drug regimens used in Sudan and their role in affecting the clinical disease activity index (CDAI) and serum uric acid (UA) of the patients.
Methodology: This was a comparative analytical case-control study enrolling 192 participants, (96) rheumatoid patients as cases and (96) non- rheumatoid as controls. Clinical disease activity index (CDAI) was performed on the patients, and venous blood samples, analyzed by automated spectrometry, were taken to measure the two groups of uric acid. Results were analyzed using Microsoft Excel 2013. A T-test was performed to assess the difference between two numerical means, and Analysis of variance (ANOVA) was used to assess the difference between three means or more. For categorical data, the Chi-square test was used.
Results: Only four patients were males (5%0) and the remaining 95% were females. The mean UA in males was 5.6 while in females it was 4.45, and the difference was significant (P=0.047). The difference between genders concerning the CDAI grading was insignificant (P=0.51). Lefulonodmide gave the highest rate of CDAI remission (67%) and the lowest serum UA mean (4.26.), while HCQ gave the least per cent of severe-high CDAI score (20%). The last-mentioned results were all statistically insignificant (P>0.05).
Conclusion: CDAI score was not correlated to specific drug regimens in Sudan. Further studies are needed to assess the drug regimens' effect in CDAI levels in Sudan.
References
- Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract. 2018;27(6):501-507. doi: 10.1159/000493390. Epub 2018 Sep 2. PMID: 30173215; PMCID: PMC6422329.
- Cross M, Smith E, Hoy D, Carmona L, Wolfe F, Vos T, Williams B, Gabriel S, Lassere M, Johns N, Buchbinder R, Woolf A, March L. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1316-22. doi: 10.1136/annrheumdis-2013-204627. Epub 2014 Feb 18. PMID: 24550173.
- Choe JY, Kim SK. Association between serum uric acid and inflammation in rheumatoid arthritis: perspective on lowering serum uric acid of leflunomide. Clin Chim Acta. 2015 Jan 1;438:29-34. doi: 10.1016/j.cca.2014.07.039. Epub 2014 Aug 7. PMID: 25108207.
- Arya V, Malaviya AN, Raja RR. CDAI (clinical disease activity index) in rheumatoid arthritis: cut-off values for classification into different grades of disease activity. In J Rheum. 2007;2( 3): 91-94. https://doi.org/10.1016/S0973-3698(10)60091-X
- Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S100-8. PMID: 16273793.
- England BR, Tiong BK, Bergman MJ, Curtis JR, Kazi S, Mikuls TR, O'Dell JR, Ranganath VK, Limanni A, Suter LG, Michaud K. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care Res (Hoboken). 2019 Dec;71(12):1540-1555. doi: 10.1002/acr.24042. Epub 2019 Nov 11. PMID: 31709779; PMCID: PMC6884664.
- Kirwan JR, Bijlsma JW, Boers M, Shea BJ. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD006356. doi: 10.1002/14651858.CD006356. PMID: 17253590; PMCID: PMC6465045.
- Gotzsche PC, Johansen HK. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database Syst Rev. 2002;(2):CD000189. doi: 10.1002/14651858.CD000189. Update in: Cochrane Database Syst Rev. 2003;(1):CD000189. PMID: 12076385.
- Smolen JS, van der Heijde D, Machold KP, Aletaha D, Landewé R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014 Jan;73(1):3–5. doi:10.1136/annrheumdis-2013-204317
- "Rheumatoid arthritis in adults: management: recommendations: Guidance and guidelines". NICE. December 2015. Archived from the original on 2017-04-16. https://web.archive.org/web/20170416130024/https://www.nice.org.uk/guidance/CG79/chapter/Recommendations#
- Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, McNaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O'Dell J, King C, Leong A, Matteson EL, Schousboe JT, Drevlow B, Ginsberg S, Grober J, St Clair EW, Tindall E, Miller AS, McAlindon T. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016 Jan;68(1):1-26. doi: 10.1002/art.39480. Epub 2015 Nov 6. PMID: 26545940.
- Schapink L, van den Ende CHM, Gevers LAHA, van Ede AE, den Broeder AA. The effects of methotrexate and hydroxychloroquine combination therapy vs methotrexate monotherapy in early rheumatoid arthritis patients. Rheumatology. 2019: 58(1): 131–134. https://doi.org/10.1093/rheumatology/key275
- Costa NT, Scavuzzi BM, Iriyoda TMV, Lozovoy MAB, Alfieri DF, de Medeiros FA, de Sá MC, Micheletti PL, Sekiguchi BA, Reiche EMV, Maes M, Simão ANC, Dichi I. Metabolic syndrome and the decreased levels of uric acid by leflunomide favor redox imbalance in patients with rheumatoid arthritis. Clin Exp Med. 2018 Aug;18(3):363-372. doi: 10.1007/s10238-018-0500-y. Epub 2018 Apr 11. PMID: 29644482.
