Bhuvaneswari, R (2017) Evaluation of Otoacoustic Emissions, Brainstem Evoked Response Audiometry and Serum Levels of Anticyclic Citrullinated Protein Antibodies in patients with Active Rheumatoid Arthritis. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Rheumatoid arthritis is a chronic, systemic inflammatory disease whose etiology is not clearly known, probably autoimmune in origin affecting the small, peripheral joints like hand, feet etc. It is characterised by extra-articular manifestations involving the lungs, heart, eyes, ears, etc. Diagnosis of RA is based on 2010 ACR/EULAR classification criteria. Active disease in RA with DAS 28 score >5.1 characterised by early morning stiffness of the affected joints for more than 45 minutes, increased APR like ESR, RF positivity and increased titres of ACPA. In active disease, release of inflammatory cytokines like IL 6, MMP3 increase the expression of citrullinated antigens, thus increasing the autoantibodies like ACPA. Hence, ACPA is taken as the biomarker of active disease. The disease during its active stage affects the cochlear hair cells of the inner ear resulting in SNHL. The hair cell injury is due to the ongoing active inflammation, deposition of immune complexes, expression of antigens by the inner ear, compromised nutrition to the hair cells, oxidant stress, etc. Screening with OAE & BERA is done to identify hair cell damage at a very early stage. AIM OF THE STUDY: 1. To determine the functional integrity of cochlear hair cells in patients with active RA by OAE screening. 2. To determine the site of lesion by Brainstem Evoked Response Audiometry. 3. To assess serum ACPA levels as a biomarker of active RA in these patients. 4. To correlate serum ACPA levels with wave I of BERA in these patients. MATERIALS AND METHODS: 30 patients with active RA of both sexes in the age group 25-45 years without any clinical evidence of hearing impairment ascertained by PTA were included in the study. Controls were age and sex matched healthy population. Both the controls and active RA patients were subjected to OAE, BERA and their serum ACPA levels was measured. RESULTS: Data analysis was done with unpaired student ‘t’ test. Serum ACPA levels were statistically significant in these patients. BERA shows prolonged latency of wave I which was statistically significant. 41 out of 60 ears showed REFER on OAE screening indicating damage to cochlear hair cells. There was a positive correlation between serum ACPA levels & latency of wave l in BERA which was statistically significant. CONCLUSION: Active RA with DAS 28 score >5.1 was assessed by increased serum levels of ACPA. The hair cell abnormalities in active disease were identified with OAE screening tests & BERA in these patients. The positive correlation between latency of wave I of BERA & serum levels of ACPA explains the involvement of hair cells in active RA. Early intervention will protect the hair cells, prevents damage & thus the hearing disability. So periodic & regular ENT examination with OAE screening & BERA may be beneficial to these patients.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No.201415001 |
| Uncontrolled Keywords: | Rheumatoid Arthritis (RA), Sensorineural Hearing Loss (SNHL), Otoacoustic emissions (OAE), Pure tone Audiometry, Anticyclic Citrullinated Protein Antibodies (ACPA), Brainstem Evoked Response Audiometry (BERA). |
| Subjects: | MEDICAL > Physiology |
| Depositing User: | Subramani R |
| Date Deposited: | 18 Jul 2020 18:06 |
| Last Modified: | 19 Jul 2020 08:26 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12559 |
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