Objectives: More than 50% of patients with SLE experience clinical cardiovascular involvement during the course of the illness. We studied the relationship between disease duration, SLE disease activity index (SLEDAI), steroid use and cardiovascular abnormalities, and documented the extent of dyslipidaemia in SLE. Methods: Eighty-two consecutive patients suffering from SLE were recruited in this cross sectional study. Lipid parameters, SLEDAI, ECG and echocardiography were obtained in all patients, and treadmill test (TMT) and coro- nary angiogram (CAG) were performed in selected patients. Chi-square test and Fisher's exact test was applied to determine the relation between cardiovascular status and steroid dose. Mann-Whitney U test and unpaired T test were applied in other cases. Results: We did not find any influence of disease duration (P = 0.129), SLEDAI (P = 0.429) or steroid use (P = 0.287) on the cardiovascular abnormalities observed in ECG, echocardiogram, CAG or TMT. Steroid doses influenced the serum triglycerides (P = 0.000029) and HDL-C (P = 0.00826) but not LDL-C (P = 0.3720) or total cholesterol (P = 0.2488) levels. There was high prevalence of dyslipidaemia (60%) and cardiovascular abnormalities (58.5%) in patients with SLE. Conclusions: Proper clinical evaluation and investigations can unveil cardiac abnormalities in most patients with SLE who do not have symptoms at early stage of disease. Further studies are needed to determine the risk factors.

Objective: To study the profile of patients with rheumatoid arthritis (RA) attending a private hospital. Methods: Prospectively collected data (at the first visit to clinic) of first 400 patients with RA attending our rheumatology clinic, from January 2002 to December 2005 was analyzed for age at onset, sex, education, occupation, marital status, smoking, alcohol ingestion, diet, prior treatment with DMARDs and steroids, alternative therapy, co-morbidities such as hypertension, diabetes mellitus, family history of RA, past history of tuberculosis (TB) and jaundice. In females, additionally age at menarche, relationship of pregnancy to onset of RA and age at menopause were noted. Results: 400 patient data was analyzed. Female patients accounted for 88.5%; median age at onset of RA was 36 years. Only 3% had not received formal education. 4% gave history of smoking. Mean age at menarche was 13.4 years, 3% had developed RA within 1 year, post-delivery; 39% were menopausal when first seen with mean age at menopause of 45.7 years. 72% had received alternative therapy and 38% gave history of steroid intake. Family history of RA was present in 10%. About 47% had been treated with DMARDs before referral. At least one co-morbidity was present in 44%: hypertension (23%) and diabetes (9%) being the most common. Past history of TB and hepatitis was present in 11.5% and 13% patients respectively. Conclusion: Our RA patient population consisted predominantly of females with disease onset between 3rd and 5th decades; were married, educated, and non-smokers. Majority had received alternative therapy and steroids. Hypertension, diabetes, and TB were important co-morbidities. Family history was positive in 10% and 39% were menopausal at presentation.

Osteoporotic fractures are an important public health problem leading to substantial mortality and morbidity in the ageing population. The estimated Indian population, who would be affected by osteoporosis by 2015, would be 25 million. This would be associated with enormous costs and considerable consumption of health resources. Hence prevention and treatment of osteoporosis is of paramount importance. The existing drugs for treatment of osteoporosis are limited in scope, tolerability and antifracture efficacy. Considerable efforts have been made to optimize the existing drugs and to develop newer ones. Long acting bisphosphonates, SERMs with less non-skeletal adverse effects and PTH are definitely milestone developments. Newer osteoclast targeted agents like inhibitors of RANK pathway; cathepsin K; c-src kinase; and integrins are under clinical development. Osteoblast targeted therapies include the agents acting through the Wnt-beta catenin signaling pathway like sclerostin antagonists and Dkk-1 inhibitors. The molecular targets and the emerging drugs for treatment of osteoporosis are discussed.

Hepatitis C virus (HCV) is the major cause of post transfusion viral hepatitis and affects > 180 million people world wide. Besides being hepatotropic, HCV is lymphotropic as well and predominantly affects the B cells leading to non- neoplastic clonal proliferation with potential to induce B-cell malignancies. Rheumatic manifestations are being increasingly recognized and appreciated as part of spectrum of chronic HCV infection. Mixed cryoglobulinemia (MC) is the most common and prototype disorder induced. Besides MC, sicca syndrome, HCV associated arthritis, systemic vasculitis, cytopenias, fatigue and fibromyalgia have been documented. Moreover, chronic HCV infection induces a number of autoantibodies and may mimic various autoimmune disorders. Recognition and distinction of these features may help in choosing correct therapeutic approach as immunosuppressive therapy may be detrimental in HCV infection. Antiviral regimen, ribavirin and interferon-α, remains the cornerstone for the treatment of MC, however other rheu- matic manifestations may not respond similarly. There is a great need for better understanding of the pathophysiology of these manifestations.