Pub Date : 2023-04-01DOI: 10.4103/injr.injr_136_22
A. Nair, A. Chandhu, M. Zafar, G. Vinodini, B. Yadav, Shivraj Padiyar, A. Ganapati, J. Mathew
Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.
{"title":"Rituximab and COVID-19 infection in patients with autoimmune rheumatic diseases – A real-world study from India","authors":"A. Nair, A. Chandhu, M. Zafar, G. Vinodini, B. Yadav, Shivraj Padiyar, A. Ganapati, J. Mathew","doi":"10.4103/injr.injr_136_22","DOIUrl":"https://doi.org/10.4103/injr.injr_136_22","url":null,"abstract":"Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41477202","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":null,"pages":null},"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}
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":null,"pages":null},"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 : 2023-04-01DOI: 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":null,"pages":null},"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}
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":null,"pages":null},"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}
{"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":null,"pages":null},"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_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":null,"pages":null},"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_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":null,"pages":null},"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}
Pub Date : 2023-01-01DOI: 10.4103/injr.injr_247_21
S. Sandip, S. Chandarashekhara
Chronic recurrent multifocal osteomyelitis (CRMO) is a noninfective auto-inflammatory bone disease; characterized by multifocal involvement of bone. This condition is primarily seen in children and adolescents though sometimes can be found in adults. It is primarily diagnosis of exclusion which is made in conjunction with radiological finding with clinical details with/or histopathology and at present no single test or modality is available to make the diagnosis. Magnetic resonance (MR) imaging can give clue to the diagnosis by demonstration of the involvement of bone in a specific distribution pattern. We report a case of an 11-year-old girl with MR features of CRMO.
{"title":"Chronic recurrent multifocal osteomyelitis on magnetic resonance imaging","authors":"S. Sandip, S. Chandarashekhara","doi":"10.4103/injr.injr_247_21","DOIUrl":"https://doi.org/10.4103/injr.injr_247_21","url":null,"abstract":"Chronic recurrent multifocal osteomyelitis (CRMO) is a noninfective auto-inflammatory bone disease; characterized by multifocal involvement of bone. This condition is primarily seen in children and adolescents though sometimes can be found in adults. It is primarily diagnosis of exclusion which is made in conjunction with radiological finding with clinical details with/or histopathology and at present no single test or modality is available to make the diagnosis. Magnetic resonance (MR) imaging can give clue to the diagnosis by demonstration of the involvement of bone in a specific distribution pattern. We report a case of an 11-year-old girl with MR features of CRMO.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47491731","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":null,"pages":null},"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}
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