Conclusion: This study shows high prevalence of especially subclinical neuropathy in Indian patients of RA and this may be an important contributor to disability. P70 Burden and etiology of low back pain in West Bengal: report of a community survey Pradyot Sinhamahapatra, Parasar Ghosh, Sanjay Dhar, Arnab Roy, Alakendu Ghosh Department of Rheumatology, Institute of Post Graduate Medical Education & Research (SSKM Hospital) Kolkata, West Bengal Introduction: Approximately 28% of people in the community experience disabling low back pain sometime during their lives 1 . Among developing countries, the lifetime, 12- month period, and point prevalence of LBP were 44.1%, 34.0%, and 19.7% respectively in Turkey 2 . In an outpatient study, from India, 23.09% had low back pain 4 . Occupational and nutritional factors will be important in causation which differs from the western data. In fact, regional variations within India are also likely. Methods and study design: The study was community based cross sectional using stratified multistage random sampling. 450 patients from each district were screened. Of the 450 patients, 360 will be from village areas (rural) and 90 from municipality areas (urban). The individuals were screened and examined by physicians at their houses/workplace using a standard examination protocol. Results: Location: Hooghly, Coochbihar, 24 Pgs, Murshidabad and Birbhum districts, West Bengal. Total population surveyed: 2233 Population Characteristics: Sex distribution: Female:Male = 1341:892 Marital Status: married 1785, unmarried 277, widowed 168, separated 3 Occupational status: Housewife-1028, Manual labour 241, Farmer 222, Business 131, Student 107, Housemaid 52, Service fieldwork 42, Service deskjob 38, Teacher 4, No occupa- tion 9, Others 322. A total of 574 subjects (Female: 417, Male: 157) i.e., 25.7% of the community people suf- fered from low back pain. Diseasewise break up (percentages are given in parenthesis) Disease Female Male Total Degenerative disc 63 (75%) 21 (25%) 84 Facet joint arthritis 21 (80%) 5 (20%) 26 Herniated disc 5 (100%) 0 5 Lumbar strain or sprain 292 (71%) 118 (29%) 410 Osteoporotic compression fracture 9 (69%) 4 (31%) 13 Others 19 (70%) 8 (30%) 27 Pelvic organs 2 (100%) 0 2 Spondylolisthesis 6 (85%) 1 (15%) 7 Total 417 (73%) 157 (27%) 574 Source of Funding: Govt. of West Bengal SHFWS/Release of Fund - 29/2007/1672 and H/TDE/55–22/08/2445 P71 High prevalence of metabolic syndrome in Indian patients with rheumatoid arthritis Sureka R, Kakar A, Byotra SP Department of Medicine, Division of Rheumatology, Sir Ganga Ram Hospital, New Delhi Background: Life expectancy in patients with Rheumatoid Arthritis (RA) is 10 years less as compared to the corresponding age. Among the causes of this premature death, cardiovas- cular disease is an important factor. Metabolic Syndrome (MetS) is defined by presence of 3/5 criterion (NCEP/ATPIII, modified Asian guidelines): obesity (waist circumference: men > 90 cm, women > 80 cm); fasting triglyceride (TG) ≥ 150 mg/dl; low HDL cholesterol (Men < 40 mg/dl, Women < 50 mg/dl); Systolic BP ≥ 130 and/or Diastolic BP > 85 mm Hg; fast- ing glucose ≥ 110 mg/dl. Objectives: To establish the prevalence of MetS in RA using NCEP/ATPIII modified Asian guidelines. To establish correlation between MetS and disease activity score 28 (DAS28). To establish if uric acid was a predictor of MetS. Methods: Consecutive RA patients attending Immunology and Rheumatology Clinic at Sir Ganga Ram Hospital, New Delhi were taken into study. A standard clinical evaluation, including assessment of disease activity was performed. Fasting blood samples for lipid pro- file, glucose, uric acid and ESR levels were taken. The diagnosis of MetS was based on NCEP/ATPIII modified Asian guidelines. Results: 100 RA patients were evaluated (90 male, 10 female). Mean age was 45.98 years, disease duration 8.01 years, DAS28 score 5.46, ESR 42.31, BMI 25.45. Rheumatoid Factor was positive in 92% (84 females, 8 males). Hypothyroid was present in 12%, 20% were diabetics, 26% hypertensive. Mean BMI and waist circumference in patients with MetS was 26.19 Kg/m 2 and 90.09 cm respectively. In patients with MetS Central, obesity defined by waist circumfer- ence was diagnosed in 76 %, raised TG in 56.5% (mean TG = 182.63 mg/dl), low HDL in 91.3 %, hypertension in 91.3%, elevated blood sugars in 43.5%. MetS was present in 46 % (Male = 4, Female = 42) using NCEP/ATPIII modified Asian guidelines. High Disease activity (DAS 28) was seen in RA patients with MetS (P = 0.017). Mean duration of disease correlated with patients with MetS (P = 0.000). Mean uric acid in patients with MetS was 7.1 mg/dl. Uric Acid as a predictor of MetS had high specificity (96.3) but low sensitivity (26.1 %). Conclusion: Prevalence of MetS was high in Indian RA patients (46 %). DAS 28 is higher in patients with MetS. Duration of disease is associated with presence of MetS in RA patients. Uric Acid cannot be used as predictor of MetS in RA patients. P72 A study of mononeuritis multiplex in rheumatology practice Thachil EJ, Thomas J, Habibi S, Agrawal S, Rajasekhar L, Narsimulu G Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad Background: Study of mononeuritis multiplex (MNM) in Rheumatology practice Patients and methods: Records of in-patients with MNM between January 2004 and June 2009 were retrieved. Data on demography, diagnosis, clinical features, evaluation and treat- ment received were collected and analyzed. Results: Seventy one patients- 43 females (60.6%). Mean age 38.6 ± 15.5 years). Etiologies were SLE in 29 (40.8%), primary systemic vasculitis 18 (25.4%), Rheumatoid arthritis 11 (15.5%) and Hansen’s Disease 7 (9.9%). Sensory abnormalities were present in 64 (90%): paresthesia 58 (82%); motor abnormality in 48 (67%): Foot drop 16 (22%). Sensory and motor abnormalities occurred more frequently in lower limbs (81% and 51%). Associated features included arthralgia/arthritis (65%), fever (49%), rashes (43%) and gangrene (31%). Digital gangrene was seen most frequently in SLE (41%) and primary systemic vasculitis (36%). MNM was a presenting manifestation in 16 (55 %) patients with SLE. The duration of the underly- ing disease before onset of MNM was lowest for vasculitis (6.2 ± 8.6 months) and highest for Rheumatoid arthritis (99.9 ± 55.3). Mean duration of SLE before onset of MNM was 12.2 ± 10.6 months. In these patients: mean ANA 4.8 ± 2.5; anti-ds DNA 173.6 ± 114.7. In RA subset: 9 (91%) seropositive; mean IgM RF 178.8 ± 94.2; mean DAS-28 5.1 ± 1.1. In Hansen’s disease subset: 4 slit skin smear and 2 skin biopsy positive for Leprae bacilli. Mean ESR 60.3 ± 36.4. Nerve biopsy was available for 7 (9.8%) patients. All had biopsy proven vasculitic neuropathy. 44 (62%) had received methyl prednisolone, 43 (61%) Cyclophosphamide. Conclusion: In rheumatology practice, MNM is seen most commonly in SLE and is a present- ing manifestation in a significant proportion. Sensory abnormalities and lower limb involvement were most common. P73 Rare case of acute polyarthritis V Vasdev Department of Rheumatology, Army Hospital (Research & Referral), New Delhi 110010 Background: Acute Polyarthritis can occur in non rheumatic systemic illnesses presenting as a diagnostic dilemma. We present an extremely rare case presenting as acute polyarthritis, panniculitis and medullary fat necrosis with underlying pancreatic pathology. Case report: A 20 years old female patient was admitted in a tertiary care centre ICU with acute onset joint pains and severe breathlessness of 2 days duration. On admission, she was hypoxemic and initially required ventilatory support. She also had polyarthritis involving large and small joints of upper and lower limbs. She had past history of recurrent episodes of short lasting and self limiting epigastric pain abdomen since the age of 7 years. Later, she developed epigastric pain abdomen and further evaluation revealed raised pancreatic enzymes and pancreatic mass on imaging with histopathological diagnosis of Guber Frantz tumor. Subsequently, she developed panniculitis, severe pain in long bones of upper and lower limbs and joint effusions. Joint aspiration revealed sterile pus like material with few inflammatory cells. MRI of lower limbs and bone scan showed features of medullary fat necrosis of long bones of upper and lower limbs. Discussion: Polyarthritis and panniculitis may rarely complicate a pancreatic disease; this association is defined PPP-syndrome and in very few cases it may be associated with medullary fat necrosis of long bones. Panniculitis is related to subcutaneous fat necrosis with secondary skin changes due to the local activity of pancreatic enzymes released during different pancreatic diseases (inflammatory, acute and chronic, and neoplastic). The exact pathogenesis of pancreatic-disseminated fat necrosis remains obscure, but it might be related to the release of lipase and other enzymes from the diseased pancreas into the bloodstream through venous or lymphatic channels. Radiographic findings of intramedullary fat necrosis include osteolytic lesions with moth-eaten bone destruction, periostitis of the tubular bones of the extremities. P74 Effect of disease modifying anti-rheumatic drugs (DMARDs) on lipid profile in treatment naive Indian rheumatoid arthritis patients Binit vaidya, Rajiva Gupta, Vinay Gulati, Rohini Handa, R Lakshmy Nepal Medical College and Teaching Hospital (NMCTH), Jorpati, Kathmandu, Nepal Background: To study the effect of DMARDs on lipid profile (Total cholesterol, LDL cholesterol, HDL cholesterol, Triglycerides), Lipoprotein a (Lp (a)), Oxidized LDL (ox-LDL), in treatment naïve RA patients and to compare the levels of ox-LDL and Lp (a) with normal Indian subjects. Methods: This is a prospective case-control study. 30 newly diagnosed treatment naive RA patients were recruited. Patients with various confounding factors for dyslipidemia were excluded. Baseline demographic data, clinical findings, DAS28 score and lipid levels were S22 Indian Journal of Rheumatology 2009 November; Vol. 4, No. 3 (Suppl) Poster presentations