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  Access statistics : Table of Contents
   2006| September  | Volume 1 | Issue 2  
    Online since June 30, 2016

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DAS 28 for defining remission in rheumatoid arthritis in Indian patients
R Aneja, R Grover, S Shankar, V Dhir, R Gupta, A Kumar
September 2006, 1(2):48-52
Objectives: To establish DAS 28 and DAS 28-3 scores that best define remission in Indian patients with rheumatoid arthritis (RA). Patients and Methods: All patients diagnosed with RA visiting AIIMS, New Delhi over a period of 3 months were recruited. Clinical assessment included 28 joint counts for swelling and tenderness, duration of early morning stiffness, patient global assessment of disease activity, fatigue, joint pains and ESR. DAS 28 and DAS 28-3 scores were calculated and receiver operating characteristics curve analysis was performed to define cutoff values utilizing 'ACR 5/6' and 'ACR 4/5' remission criteria. Results: Subjects included 207 patients (M: 44; F: 163) with mean age of 47.4 ± 12.6 years, median disease duration of 8 [4.12– 14] years. 'ACR 5/6' and 'ACR 4/5' criteria for remission were satisfied by 34 (16.42%) and 44 patients (21.25%) patients, respectively. DAS 28 score of 2.94 (sensitivity 84.4%, specificity 85.3%) and DAS 28-3 score of 3.02 (sensitivity 82.1%, specificity 82.4) best defined the 'ACR 5/6' remission. Corresponding values using 'ACR 4/5' remission were 3.04 (sensitivity 85.9%, specificity 84.1%) for DAS 28 and 3.05 (sensitivity 82.2%, specificity 81.8%) for DAS 28-3. Conclusions: A cutoff value < 3 for both DAS 28 and DAS 28-3 defines remission in RA in Indian patients.
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  644 101 -
TNF blockers and tuberculosis: an Indian concern
VR Tandon, A Mahajan, V Khajuria
September 2006, 1(2):66-71
Reactivation of latent tuberculosis (TB) with TNF blockers is a cause of concern particularly in developing countries like India, which has a high burden of TB infection. Although etanercept and infliximab are available in India, pub- lished data on Indian experience are scant. Limited data indicate that risk of reactivation of TB is substantially increased. With the growing use of these agents in India inspired by encouraging results in various rheumatic condi- tions a rise in cases of TB is expected. At present, no guidelines exist in India with regard to treatment of latent TB. Indian rheumatologists must adopt a rational approach when treating rheumatic diseases with TNF blockers.
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  552 59 -
A comparative evaluation of MRI, radionucleide bone scan and plain radiographs in Indian patients with spondyloarthropathy
K Shanmuganandan, S Shankar, R Grover, CM Sridhar, MN Sreeram, J Raphael
September 2006, 1(2):53-59
Background: Spondyloarthropaties (SpA) are a diverse group of disorders characterized by inflammatory low backache, genetic predisposition and a variety of articular and extraarticular manifestations. Evidence of acroiliitis in plain radiographs forms the cornerstone for establishing the diagnosis. However, it may take many years for the sacroiliitis to become visible. With the availability of biologics that have the potential to modify the course of SpAs, there is a need for early diagnosis of these disorders. Magnetic resonance imaging (MRI) and nuclear scintigraphy (radionuclide bone scan) appear promising in this context with their ability to pick up structural damage and inflammation before their presence is detected in plain radiographs. Objectives: To assess the role of MRI and bone scan in patients with early SpA. Methods: This was a cross sectional study done at a tertiary care rheumatology center of the armed forces. Patients satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for Spodyloarthropathy and disease duration of less than 8 years were included. All patients underwent conventional radiography, MRI imaging and nuclear scintigraphy of the sacroiliac (SI) joints. The primary outcome assessed was the positivity rate for sacroiliitis of each of the three modalities in this group of patients. The sensitivity of each modality in contributing to the diagnosis over and above that of plain radiographs was assessed. Results: Forty-four patients (predominantly young men, n = 39) with a median disease duration of 5 years were included in the study. Most patients had ankylosing spondylitis (n = 21, 47.7%) closely followed by undifferentiated spondyloarthropathy (n = 14, 31.8%), reactive arthritis (n = 5, 11.1%) and psoriatic arthropathy (n = 4, 9.2%). Evidence of sacroiliitis was seen in 59% (26/44) patients in plain radiographs, in 73% (34/44) with bone Scan and in 77% (34/44) with MRI. There was significant discordance among the three imaging modalities, documented in 49 of the 132 observations (37%). Amongst patients with a disease duration < 2 years (17/44, 39%), the plain radiographs showed changes in less than half the patients (8/17, 47%) with the MRI scan being positive in 88% of patients and the bone scan being positive in over 80% of patients. Though MRI and bone scan continued to have a higher pickup rate with increasing disease duration, the difference was most striking at 2 years. Amongst patients with differentiated spondyloarthropathies (USpA), (n = 14), none of the patients had evidence of sacroiliitis on plain radiographs. However 10 (71.5%) patients each had evidence of sacroiliitis on MRI and bone scan, with 8 (57.1%) patients having both MRI and bone scan findings suggestive of sacroiliitis. Plain radiographs, MRI and bone scan, when used in combination, are able to detect sacroiliitis in almost all patients with SpA. Conclusions: MRI had the maximum sensitivity (78%) for detecting sacroiliitis closely followed by bone scan (73%). Their utility was most apparent in patients with disease duration lesser than 2 years where plain radiographs have the least sensitivity in detecting sacroiliitis.They were also very useful in the subgroup of patients with uSpA where the radiographs were universally negative. MRI and bone scan individually picked up evidence of sacroiliitis in most of the patients with USpA and in combination picked up all the cases suggesting their usefulness in this group.However, there was a significant discordance rate amongst the three modalities and bone scan seems to lack specificity. MRI may be the preferred modality in patients with USpA and in those with early disease, given the poor specificity of bone scan.
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  558 50 -
B cell therapy in rheumatology: current perspectives
R Grover, R Aneja, V Dhir, V Arya, A Kumar
September 2006, 1(2):72-77
In the recent years there has been a steady increase in the armamentarium of drugs that are available with the rheumatologists. More and more targeted therapies are reaching the clinic. This is a reflection of the improvement in understanding of the immunological basis of autoimmune disorders and availability of technologies to make targeted therapies. The role of B cells in perpetuating and maintaining immune responses is now better understood. This has triggered research into the development of biologics specifically targeting the B Cells. The latest drug that has reached the clinic is rituximab, a chimeric monoclonal antibody to the CD20 molecule on the surface of mature B cells. It has been approved for management of patients with moderate to severe rheumatoid arthritis (RA) in adults who have had inadequate response to one or more biologic therapies. The success of rituximab therapy is a proof of the fundamental role of B cells in autoimmunity. B cell targeted therapies are here to stay and many more agents tar- geting various aspects of B cell biology are under development. This article discusses the current concepts of B cell biology and how the B cells can be targeted. It also reviews the emerging therapeutic agents targeting B cells with special reference to the trials that lead to approval of rituximab for RA.
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  525 48 -
Remission in RA: are we chasing a mirage?
AN Malaviya
September 2006, 1(2):45-47
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  452 66 -
An update on gout
I Pande
September 2006, 1(2):60-65
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  413 86 -
Rheumatology quiz
V Dhir
September 2006, 1(2):82-83
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  358 105 -
Industry sponsored clinical trials in rheumatology: past, present and future
A Aggarwal
September 2006, 1(2):78-81
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  411 45 -
International publications of interest from India (March-August 2006)
V Arya
September 2006, 1(2):85-86
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  400 49 -
What is your diagnosis?
A Sharma, A Wanchu, S Singh, P Bambery
September 2006, 1(2):83-84
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  380 60 -
A Kakar
September 2006, 1(2):87-88
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  376 61 -
RheumaPandit's View from Qutub

September 2006, 1(2):89-90
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  381 45 -
What was new in APLAR 2006 at Kuala Lumpur
Arup Kumar Kundu
September 2006, 1(2):88-88
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  372 52 -
A Kakar
September 2006, 1(2):87-88
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