Aims & Objectives: The aim of the study was to test the feasibility of carrying out objectified assessment at each patient visit in a busy rheumatology clinic using a dedicated rheumatology software, adjusting the treatment accord- ingly to achieve predetermined outcome target of disease activity. The objective was to assess the results of tar- geted treatment to see if this method of RA treatment achieved better results than those by routine-care treatment that the patients received in the immediate past before coming to this clinic. Patients and Methods: RA patients presenting from 1-7-07 to 30-6-09 were included. Specialized rheumatology software (Medic-Aid Rheumatology®) was used for data recording, disease assessment and prescription writing. Details of past-health care providers, the type of treatment taken, method used for measuring treatment outcome were recorded at the first clinic visit. A pre-planned treatment protocol was used, guided by the DAS28 or CDAI values. The treatment response was statistically compared with the disease activity status at the first visit. Results: Study included 215 patients; 16% were having low disease activity or were in remission at the first presen- tation. Sixteen patients (7.4%) dropped out before adequate follow-up. The mean follow-up was for 37 (±12) weeks. Among 199 remaining patients, 83.4% had low disease activity or were in remission at the last follow-up visit. This difference was statistically highly significant. Conclusion: Using dedicated rheumatology software, it was feasible to carry out objectified assessment of the disease activity and functional status in every RA patient in real-time at each follow-up visit in a routine OPD setting. Objectified computer-aided assessment and outcome-driven targeted treatment with standard DMARDs achieved low disease activity/remission in a vast majority of patients. This could be a practical and highly effective treatment strategy for patients with RA in a resource-constrained country like ours.

Objective: To study the correlation between bone marrow oedema (BME) on knee magnetic resonance imaging (MRI) and plasma high sensitive-CRP (hs-CRP) levels in patients with symptomatic osteoarthritis (OA) of the knee. Methods: Thirty patients with symptomatic OA of the knee were included and stratified into three equal groups con- sisting of normal alignment, varus or valgus misalignment of symptomatic knee. Radiographic scoring using Kellgren-Lawrence grading (K-L grade) was performed and an MRI of the knee taken. Intensity of pain was evalu- ated using a pain visual analogue scale (VAS) and the functional status determined by Lequesne functional index. In addition, hs-CRP was estimated in all patients and in 20 healthy controls. Results: BME was present in 14 patients (46%) with OA and in none of the controls. Patients with BME had signifi- cantly longer disease duration, a higher lequesne score, suggesting greater functional impairment and more advanced radiological changes. A significantly higher number of patients (12/30, 40%) had an elevated hs-CRP than healthy controls (2/20, 10%, P = 0.02). There was, however, no association between hs-CRP and BME. Patients with varus and valgus deformities harboured BME on the medial and lateral tibiofemoral compartments, respectively. Conclusion: BME is a feature of advanced OA of the knee and is associated with radiographic progression, a greater functional impairment and longer disease duration. It is, however, not associated with raised hs-CRP levels.

Autoimmune rheumatic diseases commonly affect young women with child-bearing potential. It is important to know the impact of these diseases on pregnancy, and conversely the effect of pregnancy on these diseases, which may have important implications for mothers and neonates. Majority of studies suggest that pregnancy aggravates sys- temic lupus erythematosus (SLE) disease activity while ameliorating the symptoms of rheumatoid arthritis (RA). This contrasting finding between RA and SLE in pregnancy is postulated to be due to the differences in autoimmune response. There is a raised Th2 type response during pregnancy in comparison to the non-pregnant state, leading to the over expression of Th2 cytokines, such as IL-4 and IL-10. These cytokines are believed to increase the autoantibody response in SLE but to be immunosuppressive in RA. Studies suggest that patients of systemic scle- rosis and mixed connective tissue disorder (MCTD) also have worsening of their underlying disorder while paucity of data precludes any solid conclusion regarding disease activity in patients of Sjogren's syndrome. Pregnancies in SLE, RA, systemic sclerosis (SSc) and MCTD patients are associated with a greater risk of relatively poor foetal out- come than in the general population, especially with increased disease activity before conception and early in preg- nancy. This review provides an update regarding the effect of pregnancy on autoimmune rheumatic disorders and vice-versa.