P. Prasad, M. Bhargav, Alka Singh, V. Agrawal, Manoj Jain
Background: Nonlupus rheumatic diseases regularly involve solid organs, including the kidney. Renal lesions can be either a manifestation of the same systemic disease, a side effect of drug therapy, or an unrelated renal disease. Our aim was to evaluate the spectrum of renal histopathological lesions found in this group of patients. Methods: Native renal biopsies of patients with systemic rheumatic disorders received between January 2014 and August 2019 were reviewed, along with their immunofluorescence findings. The clinical data were recorded from the Hospital Information System. Patients with systemic lupus erythematosus were excluded. Results: Eighty-one clinically diagnosed cases of nonlupus rheumatic diseases were studied (age range 8–70 years, mean 42.8 years, male: female ratio 1:1.3). The most common systemic autoimmune disease was anti-neutrophil cytoplasmic antibodies -associated vasculitis (n = 21) followed by immunoglobulin-A (IgA) vasculitis (Henoch-schonlein purpura) (n = 12) and rheumatoid arthritis (n = 10). The most common histopathological lesion was pauci-immune crescentic glomerulonephritis (n = 26), followed by IgA nephropathy (n = 12) and amyloidosis (n = 8). All patients were treated as per the standard therapeutic regimens. Conclusion: A diverse group of renal lesions can be found in patients with rheumatic disorders. The diagnosis of such lesions aids the clinician in the decision-making for either intensifying or reducing the drug therapy and in predicting the prognosis.
{"title":"Spectrum of renal histopathologic lesions in patients with nonlupus rheumatologic diseases","authors":"P. Prasad, M. Bhargav, Alka Singh, V. Agrawal, Manoj Jain","doi":"10.4103/injr.injr_93_22","DOIUrl":"https://doi.org/10.4103/injr.injr_93_22","url":null,"abstract":"Background: Nonlupus rheumatic diseases regularly involve solid organs, including the kidney. Renal lesions can be either a manifestation of the same systemic disease, a side effect of drug therapy, or an unrelated renal disease. Our aim was to evaluate the spectrum of renal histopathological lesions found in this group of patients. Methods: Native renal biopsies of patients with systemic rheumatic disorders received between January 2014 and August 2019 were reviewed, along with their immunofluorescence findings. The clinical data were recorded from the Hospital Information System. Patients with systemic lupus erythematosus were excluded. Results: Eighty-one clinically diagnosed cases of nonlupus rheumatic diseases were studied (age range 8–70 years, mean 42.8 years, male: female ratio 1:1.3). The most common systemic autoimmune disease was anti-neutrophil cytoplasmic antibodies -associated vasculitis (n = 21) followed by immunoglobulin-A (IgA) vasculitis (Henoch-schonlein purpura) (n = 12) and rheumatoid arthritis (n = 10). The most common histopathological lesion was pauci-immune crescentic glomerulonephritis (n = 26), followed by IgA nephropathy (n = 12) and amyloidosis (n = 8). All patients were treated as per the standard therapeutic regimens. Conclusion: A diverse group of renal lesions can be found in patients with rheumatic disorders. The diagnosis of such lesions aids the clinician in the decision-making for either intensifying or reducing the drug therapy and in predicting the prognosis.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"147 - 153"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49559582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/injr.injr_278_21
Avinash Jain, V. Shobha, S. Chandrashekara, P. Shenoy, S. Pandya, Prakash Chotalia, Sharath Kumar, S. Malviya, Y. Singh, A. Patil, Vikas Gupta, P. Srivastava, Vijayaraju Parimi, C. Kodishala, R. Janardana, B. Pinto, S. Bhandari, G. Rankawat, P. Jadhav, Damodaram Potugari, Vishnu Sharma, A. Parmar, Sunitha Kayidhi, P. Antony, Ashish Badika, Amit Sharma
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.
{"title":"Impact of COVID-19 on rheumatic diseases in india: Determinants of mortality and adverse outcome: A retrospective, cross-sectional cohort study","authors":"Avinash Jain, V. Shobha, S. Chandrashekara, P. Shenoy, S. Pandya, Prakash Chotalia, Sharath Kumar, S. Malviya, Y. Singh, A. Patil, Vikas Gupta, P. Srivastava, Vijayaraju Parimi, C. Kodishala, R. Janardana, B. Pinto, S. Bhandari, G. Rankawat, P. Jadhav, Damodaram Potugari, Vishnu Sharma, A. Parmar, Sunitha Kayidhi, P. Antony, Ashish Badika, Amit Sharma","doi":"10.4103/injr.injr_278_21","DOIUrl":"https://doi.org/10.4103/injr.injr_278_21","url":null,"abstract":"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.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"134 - 140"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49061695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/injr.injr_160_22
S. Acharya, A. Hegde, G. Subramaniam, Krishna Adhikari
{"title":"Park-Harris growth arrest lines associated with majeed syndrome – A case report","authors":"S. Acharya, A. Hegde, G. Subramaniam, Krishna Adhikari","doi":"10.4103/injr.injr_160_22","DOIUrl":"https://doi.org/10.4103/injr.injr_160_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"180 - 181"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44589643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Statin-naïve immune-mediated necrotizing myopathy (IMNM) is a rare disease entity, the diagnosis of which is complicated in the absence of a reliable biomarker. In this context, this case, which is the first one reported from a tertiary care center in South India, is unique. The presence of hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody supplements the clinical diagnosis, specifically in the serological absence of myositis-specific antibodies. A comprehensive diagnostic approach including HMGCR antibody positivity is advisable in IMNM.
{"title":"Immune-mediated necrotizing myositis with hydroxy-3-methyl-glutaryl-coenzyme A reductase antibody positivity in MSA-negative and statin-naive profile","authors":"K. Nagamounika, Josna Joseph, R. Kumar, J. Mathew","doi":"10.4103/injr.injr_82_22","DOIUrl":"https://doi.org/10.4103/injr.injr_82_22","url":null,"abstract":"Statin-naïve immune-mediated necrotizing myopathy (IMNM) is a rare disease entity, the diagnosis of which is complicated in the absence of a reliable biomarker. In this context, this case, which is the first one reported from a tertiary care center in South India, is unique. The presence of hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody supplements the clinical diagnosis, specifically in the serological absence of myositis-specific antibodies. A comprehensive diagnostic approach including HMGCR antibody positivity is advisable in IMNM.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"166 - 169"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46095156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/injr.injr_231_21
P. Padhan, D. Maikap
{"title":"Successful use of tofacitinib in reactive arthritis following COVID-19 infection","authors":"P. Padhan, D. Maikap","doi":"10.4103/injr.injr_231_21","DOIUrl":"https://doi.org/10.4103/injr.injr_231_21","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"96 - 97"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/injr.injr_280_21
K. Chandwar, P. Dogga, J. Dixit, K. Kishor, R. Sahoo, A. Wakhlu
{"title":"Primary sjögren's presenting with glomerulonephritis, pure motor neuropathy, pancreatitis, and hypogammaglobulinemia","authors":"K. Chandwar, P. Dogga, J. Dixit, K. Kishor, R. Sahoo, A. Wakhlu","doi":"10.4103/injr.injr_280_21","DOIUrl":"https://doi.org/10.4103/injr.injr_280_21","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"103 - 105"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48725309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/injr.injr_173_22
F. Sofi, M. Sheikh, Shaariq Naqati, Mushtaq Ahmad, MohammadYonus Soharwardy, BilalAhmad Rather, S. Qayoom
{"title":"Clinical and serological profile of systemic sclerosis patients in a tertiary care center in Kashmir, North India","authors":"F. Sofi, M. Sheikh, Shaariq Naqati, Mushtaq Ahmad, MohammadYonus Soharwardy, BilalAhmad Rather, S. Qayoom","doi":"10.4103/injr.injr_173_22","DOIUrl":"https://doi.org/10.4103/injr.injr_173_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"6 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70775700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ultrasonography in rheumatology: Beyond the joints and the vessels!","authors":"A. Chattopadhyay, D. Misra","doi":"10.4103/injr.injr_32_23","DOIUrl":"https://doi.org/10.4103/injr.injr_32_23","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"2 - 3"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43922943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/injr.injr_251_21
K. Chandwar, Chandani Shah, P. Srivastava
{"title":"Tumor necrosis factor inhibitors versus janus kinase inhibitors in patients with incomplete response to methotrexate in rheumatoid arthritis","authors":"K. Chandwar, Chandani Shah, P. Srivastava","doi":"10.4103/injr.injr_251_21","DOIUrl":"https://doi.org/10.4103/injr.injr_251_21","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"108 - 110"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47585055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Latika Gupta, A. Anuja, K. Thomas, M. Singh, A. Mathew, V. Agarwal
Introduction: Reactive arthritis (ReA) is a postinfectious, nonseptic arthritis that is characterized by an acute lower limb predominant oligoarthritis. Inflammasome activation and its contribution to autoinflammatory loop are described in spondyloarthritis (SpA). ReA may present a forme fruste of diseases with autoinflammation as in familial Mediterranean fever. Therefore, we investigated the presence of gene polymorphisms of the Mediterranean fever (MEFV) gene in patients with ReA. Methods: Patients of ReA presenting to a Tertiary Hospital in North India were enrolled and evaluated for MEFV gene polymorphism by restriction fragment length polymorphism analysis. Results: Forty-nine patients (male:female – 37:12), including five juvenile ReA were included during the study. The median age was 25 (±11) years and disease duration was 0.76 (±1.33) months. Twenty-six cases were triggered by preceding enteritis and 23 by urethritis. Ten healthy controls of age 27 (male:female – 7:3, interquartile range ± 1.5) were included for comparison. All 49 patients of adult and juvenile ReA were negative for the M694V mutation. Conclusions: This is the first study assessing the prevalence of MEFV gene mutation in SpA in India. It is difficult to ascertain if the lack of association is limited to the Indian subcontinent.
{"title":"M694V gene polymorphism may not contribute to the pathogenesis of reactive arthritis in the North Indian population","authors":"Latika Gupta, A. Anuja, K. Thomas, M. Singh, A. Mathew, V. Agarwal","doi":"10.4103/injr.injr_64_22","DOIUrl":"https://doi.org/10.4103/injr.injr_64_22","url":null,"abstract":"Introduction: Reactive arthritis (ReA) is a postinfectious, nonseptic arthritis that is characterized by an acute lower limb predominant oligoarthritis. Inflammasome activation and its contribution to autoinflammatory loop are described in spondyloarthritis (SpA). ReA may present a forme fruste of diseases with autoinflammation as in familial Mediterranean fever. Therefore, we investigated the presence of gene polymorphisms of the Mediterranean fever (MEFV) gene in patients with ReA. Methods: Patients of ReA presenting to a Tertiary Hospital in North India were enrolled and evaluated for MEFV gene polymorphism by restriction fragment length polymorphism analysis. Results: Forty-nine patients (male:female – 37:12), including five juvenile ReA were included during the study. The median age was 25 (±11) years and disease duration was 0.76 (±1.33) months. Twenty-six cases were triggered by preceding enteritis and 23 by urethritis. Ten healthy controls of age 27 (male:female – 7:3, interquartile range ± 1.5) were included for comparison. All 49 patients of adult and juvenile ReA were negative for the M694V mutation. Conclusions: This is the first study assessing the prevalence of MEFV gene mutation in SpA in India. It is difficult to ascertain if the lack of association is limited to the Indian subcontinent.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"11 - 15"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46302390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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