A retrospective analysis over 30 years

Publisher Copyright: © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Objective. To review the likelihood of very long-term remission in patients with biopsy-proven LN attempting to identify good prognostic features. Methods. We reviewed patients with LN whose renal biopsies showed World Health Organization (WHO) classes III, IV and V and who had a follow-up of at least 5 years between 1973 and 2008. We analysed demographic, clinical, laboratory and therapeutic parameters comparing those patients with (group A) and without (group B) 5 year remission. Results. Of 191 LN patients followed, 105 patients met the strict inclusion criteria. Ninety-five patients were female. Mean age at diagnosis of lupus was 24.1 years (s.d. 10.7). ean age at diagnosis of LN was 28.4 years (s.d. 11.3). The mean duration of follow-up was 13.7 years (s.d. 14.1). Forty (38%) patients achieved 5 year remission, of whom 17 (16.2%) had remission for ≥15 years. The incidence of flares per year from 5 to 15 years was 7.9%; however, no flares were observed after 15 years of remission. The only distinguishing feature found in this study was the association of WHO class IV on kidney biopsy with LN progression (P = 0.03).Conclusion. Renal histology with WHO class IV predicted a poor long-term remission rate. Age, sex, ethnicity, serological parameters and treatment received did not predict long-term remission. Renal flares can occur up to 15 years after a patient has gone into remission.publishersversionpublishe

Anti-neutrophil cytoplasmic autoantibodies associated vasculitis – Clinical profile and outcomes

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

Long-Term Effects of Organic Amendments on Carbon Stability in Clay–Organic Complex and Its Role in Soil Aggregation

Clay–organic complexes (COC) impart chemical and physical protection to soil carbon (C). In the present study, the aim was to assess the long-term effects of different organic amendments on C stability in COC, distribution of the aggregates, C concentration in the aggregates and labile organic C fractions in the inceptisols located at the research farm situated in the semi-arid sub-tropical climate of India. The results showed that the COC, the percentage of large macroaggregates (LMA) (>2 mm) and the C associated with the aggregates decreased through the soil depths, whereas the other size fractions of soil aggregates (min), glomalin-related soil protein (GRSP), macroaggregate (MA)-associated C and rice equivalent yield (REY). Overall, the data suggest that the combined application of FYM + GM + BF promotes soil quality under rice–wheat rotation in inceptisols in semi-arid sub-tropical India