Indian Journal of Rheumatology

Editorial Board

2012-03-01

Drugs don't work if you don't take them: Emerging role of the pharmacist counsellor in patient compliance

Adesh Govind Mathur — 2012-03-01

Alopecia in lupus: Experience from a tertiary referral centre

Alakes Kumar Kole, Rammohan Roy — 2012-03-01

Abstract: Background: Alopecia is a non-specific cutaneous manifestation of lupus and seen in 45–54% of lupus patients at any time during the disease process. Lupus and alopecia often go hand in hand and produce significant psychosocial impact. Objectives: To study the different patterns of alopecia in lupus, relationship to disease activity and its psychosocial impact. Methods: Lupus patients attending the Rheumatology and Dermatology Clinics in the North Bengal Medical College and Hospital were evaluated with special reference to different patterns of alopecia, relationship with disease activity and its impact on lifestyle. Results: A total of 50 lupus patients were studied. Forty patients had alopecia during the study period, whereas 10 patients had alopecia at the time of presentation. Different patterns of alopecia observed were telogen effluvium in 20 cases, ‘lupus hair’ in 10 cases, scarring alopecia (associated with discoid lesions) in seven and alopecia areata in five cases, but alopecia totalis was not detected. ‘Lupus hair’ was associated with high disease activity and 15 patients had impaired quality of life because of recurrent alopecia and scarring. Conclusion: Alopecia is a less serious disease manifestation in lupus, though it can produce a significant psychosocial impact in the quality of life.

Evaluation of clinical pharmacist mediated education and counselling of systemic lupus erythematosus patients in tertiary care hospital

MS Ganachari, Syeda Atiya Almas — 2012-03-01

Abstract: Objectives: To assess the knowledge of systemic lupus erythematosus (SLE) patients before and after clinical pharmacist's education and compare the same with the control group. Methods: In this study done on patients with SLE, the test group patients were provided with education regarding SLE and its management including lifestyle modifications, via the distribution of patient information leaflets (PILs), while the control group were continued with conventional therapy. Validated knowledge assessment questionnaire was administered at baseline, first follow-up and final (second) follow-up to assess the medication knowledge of SLE patients. The Modified Morisky Scale (MMS) was used to assess the adherence at the final follow-up to study the influence of education. Results: Forty-five patients completed the 2 months follow-up study out of 50 enrolled patients. A significant (P < 0.001) improvement in the medication knowledge scores and medication adherence was seen in test group compared to the control group. The reasons for non-compliance included patients forgetfulness, high cost of medications, patients lack of access to hospital/drug store, lack of family support/motivation, fear of side effects, and fear of becoming dependent on treatment. Conclusion: The finding of this study showed that a well-structured SLE patient counselling by clinical pharmacist's intervention will result in improved medication knowledge and better medication adherence.

Biomarkers in systemic lupus erythematosus: Do they make the mark?

Varun Dhir — 2012-03-01

Abstract: Biomarkers are indicators of biological processes. In lupus we especially require activity biomarkers to look at predicting flares, differentiating damage from activity, and assessing response to treatment. There are numerous molecules that have been evaluated for these purposes, but studies suffer from limitations of design, statistical rigor, and outcome measure. The best biomarker remains the oldest one, double-standard deoxyribonucleic acid (dsDNA) and has many longitudinal studies to back it, and shows the ability to predict renal flares. Apart from this anti-C1q, cell-bound complement activation products and urinary molecules-chemokines and neutrophil gelatinase—associated lipocalin (NGAL)—are promising. The interferon signature has not lived up to its promise; however, microRNA (miRNA) signature is newly coming up as a marker of activity. Even if we do come up with better biomarkers, there is lack of clarity on issues of socio-economic impact as well as psychological impact of frequent testing for biomarkers.

Common anti-infective prophylaxis and vaccinations in autoimmune inflammatory rheumatic diseases

Vineeta Shobha — 2012-03-01

Abstract: An exhilarating era for autoimmune inflammatory rheumatic diseases (AIRD) has arrived; new therapeutics are emerging that not only control symptoms, but also may allow a chance for remission. However, enthusiasm must be tempered with judicious caution as gaps in our knowledge remain regarding long-term safety data especially with respect to new onset infections and reactivation of latent infections such as tuberculosis (TB). Chronic vigilance and appropriate anti-infective measures such as trimethoprim/sulphamethaxozole and TB chemoprophylaxis should be instituted whenever indicated to minimise risk. Vaccination is an appropriate choice to prevent substantial number of these infections. In this context, pneumococcal and influenza vaccines are the best evaluated and are recommended by standard vaccination guidelines by most of experts. Some studies have found mildly impaired immune responses to vaccines among patients receiving long-term immunosuppressive therapy and tumour necrosis factor (TNF) antagonists, but post vaccination antibody titres are frequently adequate to provide shield for the majority of immunised individuals. The accumulated data on the safety and effectiveness of vaccines warrant immunisation with the majority of vaccines for patients with AIRD with the exception of live vaccines. In India, however there is a concern about futility of influenza vaccine, as it is feared that the serotypes targeted in this vaccine may not be the prevailing in our geographic area. Vaccination status assessment as soon as diagnosis of any of AIRDs is established and updating to appropriate vaccination status should compulsorily be implemented in daily clinical practice by rheumatologists.

CHOPping the biologics?!

Arun Shrivastava, Dhanita Khanna — 2012-03-01

Rheumatology quiz

Vivek Arya, Varun Dhir — 2012-03-01

International publications of interest from India (December 2011–February 2012)

Vivek Arya — 2012-03-01

What is your diagnosis? A patient with low backache and paraparesis

Rajesh Verma, Puneet Kumar, Mani Gupta — 2012-03-01

What is your diagnosis? Bilateral ankle swelling in a renal-transplant recipient

Prasanta Padhan, Debabrata Padhy, Bikash Agrawala, Ajit Biswal, Samiran Adhikary — 2012-03-01

What is your diagnosis? A rare cause of polyarthritis with myositis

2012-03-01

Subclinical aortitis in a case of polychondritis

2012-03-01

Rheumatology Reviews: January–March 2012

Sukhbir Uppal — 2012-03-01

Nasal polyposis: A rare presenting feature of limited Wegner's granulomatosis

2012-03-01

Idiopathic thrombocytopaenic purpura in a first-degree relative of a patient with multiple sclerosis

S Muthamil Selvan, V Anitha, PN Vinoth, J Julius Xavier Scott — 2012-03-01

A faceless nemesis: Systemic sclerosis sine scleroderma

Dharam Pal Bansal, Dilip Gude, Guruprasad Padsalgi, Saurabh Patle — 2012-03-01

Oral citrullination–A neoteric link in autoimmunity

Lalitha T Arunachalam — 2012-03-01

Behçet's disease presenting as ileal perforation and a thrombosed renal artery aneurysm

2012-03-01