Soluble Receptor for Advanced Glycation End Products (sRAGE) is decreased in patients with Juvenile Idiopathic Arthritis (ERA category) and inversely correlates with disease activity and S100A12 levels

Objectives: Membrane bound receptor for advanced glycation end products (RAGE) is over-expressed in response to increasing concentrations of its ligand (eg S100A12) and triggers an inflammatory immune response. Its truncated form sRAGE acts as decoy receptor and competes for ligands thus down-modulating inflammation. Decreased sRAGE levels are associated with rheumatoid arthritis, Sjogren syndrome and Kawasaki disease, however limited data is available in JIA thus we studied its levels in JIA-ERA patients. Methods: sRAGE levels were estimated in serum of patients with ERA (n=101), SoJIA and polyJIA (n=10 each) and healthy controls (n=45). Synovial fluid (SF) sRAGE was measured in ERA, RA, ReA and OA patients (n=10). S100A12 levels were also measured. 24 ERA patients were followed up for 4 months. Disease activity was assessed by swollen joint count (SJC), tender joint count (TJC) and ESR. Results: Serum sRAGE (pg/ml) level was significantly lower in patients compared to healthy controls [515 (64-1887) vs 1542 (627-3159); p<0.0001]. In paired samples, SF had lower levels compared to corresponding plasma level [102 (51-799) vs 481 (134-1006); p<0.0001]. S100A12 (ng/ml) was higher in SF (1042; 573-1415) than sera (638; 208-779). Serum sRAGE negatively correlated with S100A12 levels (r= -0.474; p<0.01.), ESR (r= -0.306; p<0.01), SJC(r= -0.237; p<0.05) but not with TJC (r= -0.134; p=ns). The levels of sRAGE remained stable over time in patients with stable disease. Conclusion: sRAGE levels are reduced in patients with ERA and negatively correlate with disease activity and S100A12 levels. sRAGE may be a modulator of inflammation in these patients

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

Evidence of cellular immune response to outer membrane protein of salmonella typhimurium in patients with enthesitis-related arthritis subtype of juvenile idiopathic arthritis

Objective: Enthesitis-related arthritis subtype of juvenile idiopathic arthritis (JIA-ERA) clinically resembles reactive arthritis (ReA). In patients with ReA the immune response is targeted at the outer membrane protein (OMP) of Salmonella typhimurium. We studied the immune response in JIA-ERA to S. typhimurium OMP. Methods: Synovial fluid mononuclear cells (SFMC) and peripheral blood mononuclear cells (PBMC) were isolated from blood and SF of patients with JIA-ERA. Lymphocyte transformation test was done with S. typhimurium OMP and crude bacterial lysates of Yersinia enterocolitica, Shigella flexneri, and S. typhimurium. IgG and IgA ELISA were performed in serum and SF using S. typhimurium OMP as antigen and compared with sera from healthy controls. Results: In PBMC samples (n = 25) an antigen-specific proliferative response was seen in 13 patients and a cross-reactive response in 6. Among these 19 patients, 12 showed response to OMP. In SFMC (n = 15) antigen-specific responses were seen in 3 patients and cross-reactive responses in 9. Among these 12 patients, 11 showed response to OMP. The IgG and IgA anti-OMP antibody concentrations in serum and SF were similar in patients and controls. Conclusion: In JIA-ERA, OMP is the major antigenic target recognized by both SFMC and PBMC. Response to OMP is independent of specific bacterial response, suggesting that OMP is the immunodominant antigen. In these patients, absence of significant humoral response suggests response to OMP is mainly T cell mediated

Low-dose methotrexate-induced pancytopenia

Methotrexate (MTX) has gained wide acceptance among both patients and rheumatologists due to its efficacy and safe therapeutic window in a variety of inflammatory rheumatological disorders. However, it has the potential to cause serious, life-threatening complications and even mortality. In the present series, we have reviewed our data of five patients who developed serious pancytopenia after the use of MTX, including one who died. Two of these resulted from prescription errors by primary care physicians. The clinical, laboratory, and outcome profile of all five cases are discussed with a brief review of the literature about MTX-induced pancytopenia. There is an urgent need to increase awareness in primary care physicians, patients, and pharmacists toward informed prescribing, dispensing, and monitoring of MTX to prevent such mishaps in the future

Central nervous system tuberculosis: mimicking neuropsychiatric systemic lupus erythematosus

This article does not have an abstract

Feasibility and Efficacy of Craniosacral Therapy on Sleep Quality in Fibromyalgia Syndrome: a Pre-Post Pilot Trial

Background: Sleep disturbance is one of the key symptoms of fibromyalgia syndrome (FMS), which negatively affects the participants’ quality of life. Craniosacral therapy (CST) is a gentle manual technique found to have significant effects on pain and function in chronic pain participants. However, limited evidence exists on its effectiveness on sleep quality in FMS participants. Purpose: To evaluate the feasibility and effectiveness of CST on sleep quality in FMS participants. Setting: Outpatient physiotherapy department of a hospital in Bangalore. Participants: Participants diagnosed with FMS. Research Design: A pre/post pilot trial. Intervention: Once weekly, 45-minute sessions of CST for 12 weeks. The participants continued the standard medical care prescribed by the physician. Main Outcome Measure: The sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) at baseline and 12 weeks. The data analysis was carried out using paired t test. Results: 9 out of 10 included par-ticipants completed the treatment and were included for analysis. The results of the paired t test showed significant improvement in the global PSQI score (p = .001, mean difference = 5.44±3.28, 95% CI = 2.92-7.97), as well as the 5 components of PSQI (p < .05). Conclusion: CST was feasible to deliver with high retention, acceptability, and minimal adverse events. It significantly improved sleep quality in FMS participants along with standard medical care. However, future studies with larger sample sizes and appropriate control groups are required to confirm the findings

Effectiveness of a 1-day workshop on scientific writing conducted by the Indian journal of rheumatology

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

Primary central nervous system lymphoma in rheumatoid arthritis

This article does not have an abstract

Impaired mobility drives disability in psoriatic arthritis – An observational study from Karnataka Psoriatic Arthritis Cohort (KPsAC)

Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease with significant functional impairment. Health Assessment Questionnaire-Disability Index (HAQ-DI) is a reliable and validated outcome measure for a variety of arthritides including PsA. Objective: The objective of this study was to assess the disability as an outcome measure in PsA using the Indian version of HAQ (I-HAQ). Methods: The I-HAQ was administered to PsA patients diagnosed as per the Classification Criteria for PsA. The I-HAQ comprises 12 questions (nine basic and three advanced activities of daily living (ADLs), on the standard HAQ format) relevant to the Indian population. Results: In the 549 participants, the mean I-HAQ was 0.31 (0.45) and 48.2% had mild-to-moderate disability (I-HAQ>0–1). Female gender, older age, higher skin, joint scores, and Disease Activity Index for PsA were associated with some disability (I-HAQ>0). Symmetric polyarthritis (0.34) and spondyloarthritis (0.32) had a significantly higher disability compared to other subsets. Analyzing the individual questions of I-HAQ, squatting in the toilet or sitting cross-legged on the floor (r = 0.78), walking 3 km (r = 0.77), and climbing a flight of stairs (r = 0.74) correlated maximally to the total I-HAQ. ADL which was affected most frequently was “climbing a flight of stairs.” I-HAQ was significantly lower in patients who had been on disease-modifying antirheumatic drugs for 6 months or more (P = 0.0001). Conclusions: The Indian version of HAQ-DI could be efficiently employed to assess outcomes in our cohort. Nearly half of the cohort had mild-to-moderate disability suggesting a high burden of inflammation. Higher joint activity scores are strongly associated with disability

Impact of COVID-19 on rheumatic diseases in india: Determinants of mortality and adverse outcome: A retrospective, cross-sectional cohort study

Introduction: There is varying impact of COVID19 on world population depending on ethnicity, age and underlying co-morbidities. However, the lack of data regarding the effect of COVID on patients with rheumatological disorders (RDs) from different nations adds to uncertainty on disease outcome. Across the world, many rheumatology associations have joined hands to collate-related information. A national database under Indian Rheumatology Associations (IRAs) was developed to understand the impact of underlying RD and immunosuppressants during the COVID pandemic on its severity and outcome in our country. Methods: All registered members of IRA were invited to participate in this registry and provide information of reverse transcription–polymerase chain reaction confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-infected RD patients using an online platform https://iradatabaseard.in/iracovid/index.php. The results of the data were analyzed using the appropriate statistics. Multivariate logistic regression was used to analyze the impact of different variables on mortality. Odds ratio and 95% confidence interval were used to define risk of death. Results: In this retrospective cross-sectional study, data for 447 RD patients who were infected with SARS-CoV2 data were available as of December 1, 2020. The mean age was 47.9 ± 14.4 years, including two children and 93 (20.8%) geriatric age group patients, male: female ratio was 0.4:1 and mean disease duration was 79.3 ± 77.1 months. Rheumatoid arthritis was the most common RD. Underlying disease was quiescent in 54.7% and active in 18.4% patients. Most common medications at the time of COVID diagnosis were steroids (57.76%) and hydroxychloroquine (67.34%). Fever and cough were the most common symptoms. More than half of the patients (54.4%) needed hospitalization. Oxygen requirement was noted in 18.8%, intensive care unit admission, and invasive ventilation was needed in 6.0%, and 2.9% patients, respectively. Complete recovery was seen in 95.5% of patients and 4.47% (n = 20) expired due to COVID. The presence of comorbidity, dyspnea, and a higher neutrophil count was statistically significantly associated with death (P < 0.05). None of the other factors affected COVID-19 outcome. Conclusion: This is the largest cohort from a single nation looking at the interface between RD and COVID. The results indicate that patients with RD do not show increased mortality despite current use of disease-modifying anti-rheumatic drugs/immunosuppressants