Tab Application Banner
  • Users Online: 1262
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Reader Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2018| June  | Volume 13 | Issue 2  
    Online since May 24, 2018

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
ORIGINAL ARTICLES
Anti-neutrophil cytoplasmic autoantibodies associated vasculitis – Clinical profile and outcomes
Kavya Devi Nunna, Phani Kumar Devarasetti, Rajendra Vara Prasad Irlapati, Liza Rajasekhar
June 2018, 13(2):95-100
DOI:10.4103/injr.injr_80_17  
Background: Studies on antineutrophil cytoplasmic autoantibodies-associated vasculitis (AAV) from India are scarce. The aim of the present study was to characterize the profile of AAV and experience with rituximab in ocular granulomatous with polyangiitis (GPA) in our cohort. Methods: Clinical, laboratory, and treatment details of AAV from January 2010 to May 2017 were noted. Continuous variables were reported as mean and standard deviation (SD). In GPA, clinical variables between survivors and nonsurvivors were compared using independent sample t-test and Fisher's exact test. Cox regression analysis was done to estimate the hazard ratios. Our cohort of GPA was compared with other large single-center cohorts from India, USA, Germany, and France. Results: Thirty-one patients were diagnosed to have AAV. Seventeen were females. GPA was most common phenotype (23/31). Mean (SD) age at onset was 39.8 (15.7) years. Median (IQ) time to diagnosis was 6 (22) months. The most common manifestations in GPA were ocular (n = 20) and lower respiratory tract (n = 13). Mean (SD) Birmingham Vasculitis Activity Score (BVAS) at disease onset was 9.4 (6.9). Pulse methylprednisolone with cyclophosphamide was used as induction regime followed by maintenance with azathioprine. Rituximab was given to four patients with refractory GPA. Six patients succumbed to illness. Remission was achieved in 19/25 survivors. Mean (SD) BVAS at disease onset was significantly higher in nonsurvivors (17.6 ± 10.2) compared to survivors (9.4 ± 4.9) (P = 0.018). Higher proportion of renal involvement was seen in nonsurvivors (P = 0.03). There was three-fold increased mortality with renal and lung involvement. In addition, the risk of death increases by 1.13 fold with each point increase in BVAS score. Conclusion: Ocular involvement was higher in our GPA cohort. Baseline BVAS, renal, and lung involvement predicts poor prognosis in GPA. Sustained remission with rituximab was seen in all patients with refractory ocular disease.
  1,319 197 1
Circulating levels of osteoprotegerin and sRANKL and the effect of methotrexate in patients with rheumatoid arthritis
Aadhaar Dhooria, Narendhiran Pandurangan, Karthik Vinay Mahesh, Suchet Sachdev, Aman Sharma, Shefali Sharma, Nidhi Gupta, Varun Dhir
June 2018, 13(2):90-94
DOI:10.4103/injr.injr_125_17  
Background: Receptor activator of nuclear factor κβ ligand (RANKL) and osteoprotegerin (OPG) are pivotal molecules involved in osteoclast activation and resorption. In RA, their alterations mediated through inflammatory cytokines are responsible for erosions and systemic bone loss. This study planned to look at the effect of methotrexate on circulating levels of OPG and RANKL in RA. Methods: Methotrexate-naive patients with active rheumatoid arthritis (RA) between 18 and 65 years of age were included. Controls were derived from voluntary healthy blood donors after written consent. All patients were started on methotrexate at 15 mg/week, increased by 5 mg every 4 weeks till maximum tolerated dose or 25 mg/week whichever was lower. Circulating plasma levels of OPG and RANKL were measured for cases (at baseline and 24 weeks) and controls (at baseline). Results: Fifty-one consecutive patients with RA and 57 controls were recruited. Circulating OPG (mean ± standard deviation) levels were higher in RA patients as compared to controls, 2879.6 ± 1037.9 and 2214.1 ± 705.3 pg/ml, respectively (P < 0.001). RANKL levels did not differ significantly between cases and controls. After treatment, circulating OPG levels fell significantly, from 2879.6 ± 1037.9 to 2059.8 ± 532.1 pg/ml (P < 0.001), however, no significant change in circulating RANKL levels. No difference was found in OPG and RANKL levels between patients with erosive and nonerosive disease. Conclusions: OPG levels are higher in RA patients and normalize in response to treatment with methotrexate. The initial higher levels of OPG may represent a compensatory mechanism to osteoclast activation; they normalize on reduction of disease activity.
  1,364 141 -
Poor quality of life in indian ankylosing spondylitis patients
Latika Gupta, Sakir Ahmed, Gautam Dhar Choudhury, Durga Prasanna Misra, Vikas Agarwal
June 2018, 13(2):101-106
DOI:10.4103/injr.injr_108_17  
Background: Ankylosing Spondylitis (AS) is a chronic inflammatory disease that leads to significant disability. We sought to study the impact of the disease activity and functional impairment on QoL in Indian patients with AS. Methods: World Health Organization- Quality of Life-BREF (WHOQoL-BREF) questionnaire was used to measure quality of life (QoL) in 99 adults with AS (modified Rome criteria), 72 healthy individuals, and 20 rheumatoid arthritis patients. Apart from demographic variable such as age, gender, clinical manifestations, and treatment received, disease activity parameters such as duration of early morning stiffness, BASDAI, swollen and tender joint count, Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) were also recorded. Presence of damage was assessed using spinal radiographs. All values are in median (IQR). Results: Out of the 99 patients, 5 were females and 5 had juvenile onset AS. Median age was 32 (26-42) years and median disease duration was 6 (1.25-10) years. Forty-three had peripheral arthritis and 18 had enthesitis. Syndesmophytes were present on spinal radiographs in 54 cases. BASDAI correlated negatively with the physical, psychological and environmental domains (P < 0.05), while BASFI and BASMI did not. In all 4 domains of WHO-BREF, scores for AS were significantly less as compared to healthy controls [P < 0.0001] or even to rheumatoid arthritis [P < 0.01]. Conclusion: Indian AS patients have poorer quality of life than patients with rheumatoid arthritis and healthy individuals, possibly due to poor control of disease activity.
  1,335 134 -
BRIEF REPORTS
Rheumatology training in India compared to the United Kingdom
Parthajit Das, Arumugan Moorthy, Balebail Dharmanand
June 2018, 13(2):113-116
DOI:10.4103/injr.injr_78_17  
Background: Rheumatology is an emerging specialty in India, and there is a huge demand for trained rheumatologist to satiate the overwhelming musculoskeletal disease burden in India. Rheumatology training in the UK is structured and comprehensive. This study was aimed to explore the strengths and weaknesses in the rheumatology training in India as compared to the UK. Methods: This was an observational semiqualitative study. An online questionnaire was circulated electronically to rheumatology trainees across the UK and India. The questionnaire was designed to explore the curriculum content, training and research opportunities, training assessment methodologies, and employability in two countries. Results: A total of 77 respondents participated in this study, 52% (40/77) were from the UK and 48% (37/77) from India. We noted heterogeneity in the structure and delivery of training with multiple incongruous training curricula being prevalent in India. Institutional academic training supervision was comparable in both countries. UK trainees received comparatively more structured supervision for procedural skills. Indian trainees were proficient with laboratory-based rheumatological and immunological tests. Professional research and academic programs were incorporated in UK training. Mandatory training for generic skills was lacking in India. Specialty exit examination was mandatory in both countries. Employment opportunities were better perceived in the Indian subcontinent. Conclusions: In this study comparing rheumatology training between the UK and India,a lack of structured and coherent national curriculum in India was noted. Harmonisation of rheumatology training in India is essential to be at par with the well-established postgraduate rheumatology training curriculum in developed countries.
  1,331 134 -
IMAGES IN RHEUMATOLOGY
Long segment extensive transverse myelitis in a patient of ankylosing spondylitis
Vijay Sardana, Sunil Kumar Sharma, Dilip Maheshwari, Bharat Bhushan
June 2018, 13(2):133-134
DOI:10.4103/injr.injr_118_17  
  1,329 95 -
ORIGINAL ARTICLES
A prospective, randomized, double-blind, comparative clinical study of efficacy and safety of a biosimilar adalimumab with innovator product in patients with active rheumatoid arthritis on a stable dose of methotrexate
Prasad Apsangikar, Sunil Chaudhry, Manoj Naik, Shashank Deoghare, Jamila Joseph
June 2018, 13(2):84-89
DOI:10.4103/injr.injr_107_17  
Objective: The objective of this study was to compare efficacy, safety, and immunogenicity between the biosimilar adalimumab (AdaliRel) and the reference innovator product in moderate-to-severe rheumatoid arthritis (RA) patients on stable dose of methotrexate (MTX). Methods: Patients with moderate-to-severe active RA (n = 106) on a stable dose of MTX were randomized to biosimilar adalimumab (AdaliRel) (study arm) or reference innovator adalimumab (reference arm) 40 mg every 2 weeks. The primary endpoint was proportion of patients who achieve ACR20 response at week 16. The secondary endpoint was proportion of patients who achieve ACR50, ACR70, absolute values, and changes from baseline in the disease activity score 28 joint (DAS28), health assessment questionnaire-disability index (HAQ-DI), C-reactive protein (CRP), and rheumatoid factor (RF) at week 16 and week 24. Safety was assessed through adverse events (AEs) and laboratory evaluations up to week 34. Antidrug antibodies were assessed to determine immunogenicity. Results: Out of 106 randomized, 104 individuals were dosed in the study (one subject from each arm was dropped due to consent withdrawal). The number of patients achieving ACR20 response at week 16 was 90.48% in study arm and 90% in the reference arm. The number of patients ACR70 response at week 16 was 13.1% in the study arm and 15% in the reference arm. There was no statistically significant difference between the two treatment arms in terms of number of responders (P > 0.05). No difference also was observed in DAS28, HAQ-DI scores, RF, and CRP changes from baseline. There were no clinically meaningful differences in AEs. Immunogenicity profile at week 16 did not indicate any clinically significant concerns. Conclusion: Biosimilar adalimumab (AdaliRel) and the reference product showed comparable efficacy and safety in RA patients who were on stable dose of MTX.
  1,121 238 -
LETTERS TO EDITOR
Supplementing pyridoxine and cobalamin in addition to folic acid in patients on methotrexate therapy
Anand Narayan Malaviya, Shubha Bhalla, Shallu Verma, Roopa Rawat
June 2018, 13(2):137-138
DOI:10.4103/injr.injr_29_18  
  1,204 113 -
BRIEF REPORTS
Effectiveness of a 1-day workshop on scientific writing conducted by the Indian journal of rheumatology
Mohit Goyal, Durga Prasanna Misra, Samir Rajadhyaksha, Yogesh Preet Singh, Neha Goyal, Vinod Ravindran
June 2018, 13(2):117-120
DOI:10.4103/injr.injr_36_18  
Background: Writing a scientific manuscript is an important skill to acquire for junior doctors considering the mandatory requirement of research publications during post-graduate training and for career advancement in India. Methods: We conducted a one-day workshop on scientific writing and publication at Udaipur in November 2017, comprising both didactic lectures as well as hands-on evaluation of a dummy manuscript, and evaluated structured questionnaires filled pre- and post-workshop. Results: There were 120 attendees, most of whom were junior doctors with little or no prior experience in writing a scientific paper. A significant baseline knowledge deficit regarding the principles and processes of scientific writing (ranging from 20.9% to 77.3% participants for the different questions asked) could be identified before the workshop. This knowledge deficit was significantly improved in most areas as assessed after the workshop. We identified the need to discuss predatory publishing in greater detail in subsequent workshops, as 20.8% of respondents after the workshop professed that they might consider publishing in a predatory journal. As expressed in participant feedback, longer, more-specialized or advanced level workshops on scientific writing in the future could also consider including more details on appropriate statistical presentation and pictorial representation of data as well as longer time spent on hands-on exercises. Conclusion: There remains a need to conduct more scientific writing workshops by national societies and journals all over the country.
  1,168 98 -
ORIGINAL ARTICLES
Serum Interleukin-6, Interleukin-17A, and transforming growth factor beta are raised in systemic sclerosis with interstitial lung disease
Anupam Wakhlu, Rasmi Ranjan Sahoo, Jyoti Ranjan Parida, Mohit K Rai, Durga P Misra, Vinita Agrawal, Vikas Agarwal
June 2018, 13(2):107-112
DOI:10.4103/injr.injr_106_17  
Background: Dysregulation in cytokines like interleukin-6 (IL-6), interleukin-17A (IL-17A) and transforming growth factor-beta (TGF β1) has been pathogenically implicated in systemic sclerosis (SSc). The present study aimed to assess their serum levels in patients with SSc and correlate with clinical manifestations. Methods: This cross-sectional, observational study included 93 patients fulfilling the 2013 revised ACR/EULAR SSc classification criteria and 33 age-and sex-matched healthy controls. Antinuclear antibody (ANA), extractable nuclear antigen (ENA) profile, chest radiograph, pulmonary function tests and electrocardiography were done. HRCT of thorax and echocardiography were done wherever indicated. Modified Rodnan skin score (MRSS) was calculated. Serum IL-6, IL-17A and TGF β1 levels were assayed using ELISA kit and compared among disease subtypes and clinical parameters. Spearman coefficient was used to test correlation between continuous variables. P value of <0.05 was considered significant. Results: The mean age of patients was 37.8+10.3 years (Female:Male: 30:1) with median duration of disease of 3 years. Serum IL-6, IL-17A and TGF β1 levels were significantly higher in patients as compared to controls (IL-6: 19.4±11 vs 6.7±3.9 pg/ml (P < 0.0001); IL-17A: 39.1±14.8 vs 16.4±2.1 pg/ml (P < 0.0001); TGF β1: 862.2±443 vs 377.2±208.8 pg/ml (P < 0.0001). Higher levels of these cytokines were also observed in patients of diffuse cutaneous SSc, those with lung fibrosis and anti-topoisomerase positivity. Conclusion: Serum IL-6, IL-17A and TGF β1 levels were significantly higher in SSc patients and higher levels were associated with ILD and skin fibrosis.
  1,106 131 1
REVIEW ARTICLE
Vascular cytoprotection, autoimmune disease, and premature atherosclerosis
Justin C Mason
June 2018, 13(2):121-128
DOI:10.4103/injr.injr_6_18  
A healthy vascular endothelium is critical to health, and interference with endothelial homeostasis disrupts hemostasis, regulation of vascular tone and blood pressure, leukocyte trafficking, angiogenesis and tissue repair. Endothelial injury and apoptosis leads to endothelial dysfunction, which is closely associated with increased generation of reactive oxygen species, reduced endothelial nitric oxide (NO) synthase, increased consumption, and impaired synthesis of NO. Systemic inflammatory diseases including rheumatoid arthritis and systemic lupus erythematosus are associated with endothelial dysfunction, increased aortic stiffness, and accelerated atherogenesis. Premature cardiovascular disease is well-recognized feature of many rheumatic diseases. The cell and molecular mechanisms related to this remain poorly understood. Specific diseases display individual and common attributes that likely influence cardiovascular risk. A key challenge is the development of the means by which those at highest risk can be identified. Likewise, the ability of current therapies to mitigate risk and the identification of novel vasculoprotective therapies represent important areas of research focus. Similarly, close liaison between rheumatologists and cardiologists is essential to minimize the cardiovascular impact on patients and to ensure that patients with rheumatic disease and coexistent coronary heart disease receive appropriate therapy. Identification of safe therapeutic approaches that combine the targeted immunosuppression required, along with comprehensive vascular protection to control the primary disease and prevent secondary complications over the longer term, remains the ultimate challenge.
  1,075 111 -
IMAGES IN RHEUMATOLOGY
Palmar fasciitis and polyarthritis as a paraneoplastic syndrome
Prasanta Padhan, Swati Mishra
June 2018, 13(2):129-130
DOI:10.4103/injr.injr_138_17  
  1,075 99 -
Ulcerative colitis and systemic sclerosis
Mayank Jain
June 2018, 13(2):131-132
DOI:10.4103/injr.injr_141_17  
  1,092 77 -
LETTERS TO EDITOR
Tolosa–Hunt syndrome in a patient of lupus
Jeet Patel, Lalit Duggal, Neeraj Jain, Bhandari Gurbir Singh, Amal Basnet, Anjal Bisht
June 2018, 13(2):141-142
DOI:10.4103/injr.injr_2_18  
  1,005 90 -
EDITORIALS
Rheumatology training in India and the UK: Time for a unified and bespoke approach
Nilesh Nolkha, Kaushik Chaudhuri, Srinivasan Venkatachalam
June 2018, 13(2):82-83
DOI:10.4103/0973-3698.233163  
  916 120 -
LETTERS TO EDITOR
Comments on: Vitamin D and autoimmune diseases
Ankur Dalal
June 2018, 13(2):143-144
DOI:10.4103/injr.injr_144_17  
  930 96 -
IMAGES IN RHEUMATOLOGY
Calcinosis cutis in connective tissue diseases
Gianfranco Vitiello, Boaz Palterer, Paola Parronchi, Daniele Cammelli
June 2018, 13(2):135-136
DOI:10.4103/injr.injr_21_18  
  918 84 -
EDITORIALS
Rheumatology training in India: Pragmatism needed
Durga Prasanna Misra, Vikas Agarwal
June 2018, 13(2):80-81
DOI:10.4103/injr.injr_16_18  
  816 141 -
FROM THE EDITORS DESK
From the editor's desk
Vinod Ravindran
June 2018, 13(2):79-79
DOI:10.4103/0973-3698.233116  
  739 129 -
LETTERS TO EDITOR
Aseptic meningitis as the first manifestation in a young male with systemic lupus erythematosus
Shamsudeen Moideen, NA Uvais
June 2018, 13(2):139-140
DOI:10.4103/injr.injr_143_17  
  758 59 -
BOOK REVIEW
Handbook on research methodology
Anupam Wakhlu, Durga Prasanna Misra
June 2018, 13(2):145-145
DOI:10.4103/injr.injr_73_18  
  551 114 -