Introduction: Human immunodeficiency virus (HIV) infection which is a global pandemic affecting millions of people shares many similarities with autoimmune diseases. In this study we share our experience in a HIV referral service hospital. Objectives: To study the rheumatologic disorders encountered in HIV infected patients. Methods: The study was carried out between July 2002 and December 2005 in an armed forces referral centre for HIV cases. All HIV cases reporting to the centre were screened for rheumatic disorders six monthly during the study period. CD4 count was done in all cases from 2004 onwards once a year. Results: About 704 HIV cases were studied during this period. Of these 469 cases were newly detected. Mean duration of the disease among the remaining 235 old cases was 3.6 years (range 1-11 years). 126 patients were on highly active retroviral therapy (HAART). About 30% of the newly detected patients were asymptomatic and were diagnosed during blood donation or voluntary HIV testing. Twenty-eight patients expired during study period. Rheumatic disorders were diagnosed in 14 cases (2%). Two patients presented with inflammatory arthritis. Seronegative spondyloarthropathy was the commonest presentation. There were no cases of vasculitis or polymyositis in our study. Non-specific systemic symptoms of fatigue, myalgia and polyarthralgia seen in HIV infection or opportunistic infections were not considered rheumatic disorder after relevant investigations. Conclusion: Though there are many reports of increased incidence of reactive arthritis and other rheumatic disorders in HIV infection, our series consisting mainly adult males, showed only 2% prevalence of rheumatic disorders in HIV infection.

Introduction: Rheumatoid arthritis (RA) has long been categorized as a connective tissue disease and an autoimmune disease, but was not generally recognized, until recently, as a disease of oxidative stress. The present study attempted to gain an insight into the overall status of oxidative stress parameters in RA patients. Objective: To assess the free radical and antioxidant status in RA patients. Methods: Patients with RA satisfying the revised 1987 ACR classification criteria were included into group I (n = 60). Group II (n = 60) consisted of age and sex matched normal healthy controls. The free radical and antioxidant status of both groups were determined by a set of 5 parameters viz. serum nitrite, serum nitrate, plasma malondialdehyde, serum protein carbonyl and plasma superoxide dismutase. Results: A total of 60 RA patients (M : 21; F : 39) with a mean ΁ SD age of 47.28 ΁ 11.72 years were included in the present study. The aforementioned parameters of free radical and antioxidant status were assayed and the results compared with those from 60 age and sex matched controls. All parameters were found to be significantly elevated in RA patients compared to the controls. Conclusion: The findings suggest that oxidative stress generated in an inflamed joint can contribute to autoimmune phenomenon and connective tissue destruction in RA. New therapeutic protocols based on correcting oxidative stress levels may prove effective in restricting disease progression and limiting deformities.

Disease of the gastrointestinal tract (GIT) occurs in approximately 90% of patients with scleroderma (systemic sclero- sis) and has a major impact on their quality of life. Every part of the GIT can be involved in scleroderma and may include the mouth (xerostomia), esophagus (dysmotility, acid reflux), stomach (vascular ectasia, gastroparesis), intestines (vascular lesions, hypomotility, bacterial overgrowth, intestinal pseudo-obstruction) and anorectal system (fecal incontinence). This review provides practical guidance in the diagnosis and treatment of systemic sclerosis- associated GIT involvement.

The role of glucocorticoids (GC's) in the management of Rheumatoid arthritis (RA) has been controversial ever since their initial discovery and therapeutic application in RA, in the late 1940s. On the one hand, they are indispensable for the treatment of RA and other autoimmune inflammatory conditions; on the other they have significant toxicity. The use of low dose GCs in the management of RA has been re-evaluated since the mid 1990s in a number of trials and there has been a couple of Cochrane reviews on the subject in the past 5 years. The mechanisms of action of these drugs are now better understood. Their toxicity in the context of RA has also been looked at more critically. There are exciting new GC's in the pipeline, which may have fewer side effects than the ones we currently use. This review summarises some of the key, current evidence we have for the rational use of GCs in RA.