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Browsing by Author "Paruk, Farhanah."

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    Cardiovascular disease profile in patients with established rheumatoid arthritis at King Edward VIII Hospital.
    (2018) Govender, Preesha.; Paruk, Farhanah.
    Rheumatoid arthritis (RA) is one of the most common chronic systemic autoimmune inflammatory diseases, which is associated with an increased mortality rate, attributed to premature cardiovascular disease (CVD). Key drivers of mortality from CVD in RA are fuelled by multiple factors. Rheumatoid arthritis disease profiling, particularly seropositivity, presence of extra-articular disease and high disease activity, confer an increased mortality risk. Traditional CVD risk factors (hypertension, diabetes mellitus, dyslipidaemia, obesity) are influenced by both inflammation inherent to RA, and pharmacodynamics of anti-rheumatic drugs. Notwithstanding the above, the current paradigm shift recognises RA as an independent risk factor for CVD. Similar to the rest of Africa, local data on the prevalence of CVD in RA are limited. With an increase in non-communicable diseases and longevity, the RA burden in South Africa (SA) is expected to increase. Local studies are needed to stratify practice in cardio-protective strategies and improved long term outcomes in RA. This study aims to determine the prevalence of CVD in RA, describe the prevalence of CVD risk factors in RA and describe the relationship between RA disease activity and CVD. A retrospective, chart review of all patients with RA according to the American College of Rheumatology 1987/2010 Classification criteria, attending the arthritis clinic in King Edward VIII hospital, a tertiary public healthcare academic teaching hospital in KwaZulu-Natal, SA, during the period August 2017 to March 2018, was undertaken. Patients younger than 18 years of age, or with RA and any other concomitant connective tissue disease or overlap syndrome were excluded. The study group included 150 patients with RA. The demographic details, duration of the RA disease, traditional CVD risk factors, simplified disease activity index (SDAI) and health assessment questionnaire (HAQ) were documented. In addition, results of electrocardiogram, echocardiogram, haemoglobin, glycated haemoglobin, lipid studies and estimated glomerular filtration rate were recorded. Cardiovascular disease was found in 16% of the total study cohort, with an age, gender and ethnic differential. Coronary artery disease was the most common CVD finding in RA patients. The burden of traditional CVD risk factors in RA is high, with hypertension, diabetes mellitus, dyslipidaemia, physical inactivity and chronic kidney disease of particular concern. No significant correlation was observed between RA disease activity, seropositivity and CVD in RA however, extra-articular disease was more common among patients with CVD. Echocardiographic evidence of subclinical cardiac disease in RA is common. Significant disparity was observed between various CVD risk assessment models at different levels of risk, which cautions a comprehensive CVD risk assessment model that stratifies discriminately is needed in patients with RA. The study provides knowledge of CVD burden and risk in RA patients locally, and serves as a foundation for further research in preventative strategies that offer significant survival benefits. The main limitation in this study is that the study cohort consisted mainly of Black and Indian patients and therefore the findings may not be generalised across all ethnic groups. Furthermore as this was a relatively small study conducted in a single public hospital, which is urban based, conclusions from this study may not be applicable to a rural setting or to all socio-economic classes.
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    The profile of rheumatic heart disease at a tertiary hospital, KwaZulu-Natal, South Africa.
    (2021) Shange, Kwenzakwenkosi Siyabonga.; Naidoo, Datshana Prakesh.; Paruk, Farhanah.
    Abstract not available.
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    A retrospective review of the demographic profile, disease activity, co-existent co-morbid disease and treatment in established rheumatoid arthritis at a tertiary center clinic.
    (2016) Singh, Akira.; Paruk, Farhanah.; Magula, Nombulelo Princess.
    Rheumatoid arthritis (RA) is one of the most common forms of chronic inflammatory arthritis and often results in joint damage, physical disability and premature mortality. The incidence of RA is increasing in developing countries, especially in urban areas amongst lower socio-economic groups. There is a dearth of data on non-communicable diseases such as RA in South Africa (SA) as resources and research is concentrated on addressing the high burden of communicable diseases due to human immunodeficiency virus (HIV) and tuberculosis (TB) compounded with addressing high maternal and infant mortality rates. Therefore despite the severity and resultant functional disability, RA remains poorly understood and often mismanaged. This study aims were to understand the natural history of patients with RA treated in a public sector tertiary clinic. The objectives of this retrospective study are to describe the demographic profile, disease activity, drug management and comorbid disease profile in patients with established RA attending a dedicated rheumatic clinic at King Edward VIII Hospital in Durban. A retrospective chart review was conducted of the files of all RA patients attending the arthritis clinic at King Edward VIII Hospital, for a period of at least ten years. The demographic data, serological status, current disease activity, functional class, co-morbid diseases, and treatment were recorded on a structured data collection tool. In this study, Indians comprised the majority (n=81, 58.7%) followed by Blacks (n = 51, 36.9%). All the patients met the clinical criteria for RA on the initial visit, with 73 (63.5%) having a positive rheumatoid factor (RF). Synovitis was still observed in 35.5% of patients at their last visit and in these patients the C-reactive protein remained elevated at ≥ 16 mg/dL (p < 0.0001). Radiographs showed a significant deterioration in terms of erosions between the two time points (p < 0.021). Hypertension was the most frequent co-morbid disease seen in 96 (69.6%) patients. There were several limitations as this was a retrospective study and therefore there were a number of files that had incomplete or missing data. The clinical assessment of disease was performed by several clinicians and inter-observer variability was another shortcoming. Further the study was limited to the public sector only and potentially excluded other ethnicities and therefore may also not be an accurate reflection of natural history of RA in SA. This study highlights the need for better and tighter RA control in the SA public sector and the need for prospective studies with adequate representation of all ethnic groups to evaluate the challenges faced in delivering an effective rheumatology service in SA.
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    Risk factors for morphometric vertebral fractures in subjects aged 60 years and over in the eThekwini Municipality, KwaZulu-Natal, South Africa.
    (2020) Esaadi, Mohidin Amar.; Cassim, Bilkish.; Paruk, Farhanah.
    Abstract available in PDF
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    The clinical profile, serological profile and management of patients diagnosed with systemic sclerosis in South Africa. A single center experience.
    (2023) Shandu, Nokwazi.; Cassim, Bilkish.; Paruk, Farhanah.
    Systemic sclerosis (SSc) is a complex and clinically heterogeneous disease with protean clinical manifestations, a chronic and frequently progressive course, and significant disability and mortality. The disease is characterized by fibrosis of the skin, internal organs and vasculopathy. While it can affect every organ, there is marked variability in patterns of skin and organ involvement, rates of disease progression, response to treatment and survival. The limited studies of SSc in South Africa (SA) have largely described the clinical manifestations and antibody profile in African patients. Since the last study from Durban in 1991 looking at the serological profile of SSc, there have been advances in serological and imaging investigations and therapeutics. Recent studies are predominantly from Johannesburg (JHB), and this study was conducted to look at the demographic profile, clinical characteristics and serological profile of patients with SSc in our local population. Inkosi Albert Luthuli Central Hospital (IALCH), a quaternary hospital, serves as a referral hospital for KwaZulu-Natal and part of the Eastern Cape. The Rheumatology Department provides outpatient and inpatient service for patients with SSc. Given the demography of KZN, the majority of patients attending the clinic are Indian and African Blacks subjects and this study brings the opportunity to document SSc in these populations. A retrospective chart review of the electronic records of all patients with SSc attending the rheumatology clinic IALCH was undertaken for the period January 2010 to December 2020. All patients with confirmed diagnosis of SSc and at least two visits to the clinic were included. Comparisons were made between limited and diffuse SSc and African and Indian patients using two-sided Fisher’s exact tests, Student’s t-tests and the Mann-Whitney U test for normally distributed and skewed numerical variables, respectively. This is the first study to report the differences in presentation of SSc between African and Indian patients in SA, which is reflective of the KZN population. African patients were significantly younger than Indian patients and more likely to have diffuse disease and a shorter disease duration. Interstitial lung disease and PAH, which are associated with poor outcomes, remain common manifestations, especially in diffuse disease. We confirm the absence of ACA in African patients; the mechanism of which requires further research.