Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune disorder with etiologies including genetic and environmental factors. Protein tyrosine phosphatase non-receptor type22 (PTPN22) 1858C/T polymorphism is widely suspected to be a susceptibility gene for RA in the non-HLA genes group. Aim: This study aimed at determining whether PTPN22 1858C/T polymorphism is associated with RA patients from Western India and to evaluate its possible association with rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) autoantibodies. Methods: A total of 130 Indian RA patients and 100 age and sex matched normal controls were genotyped by polymerase chain reaction restriction fragment length polymorphism (PCReRFLP) for the PTPN22 1858C/T polymorphism. Results: RF positivity was seen among 73.8% RA patients studied and the overall incidence of anti-CCP antibodies was 86.2%. The homozygous genotype (T/T) was absent in both groups. Among RF positives, C/C homozygosity was 90.6% whereas 9.4% patients were C/T heterozygous. Among anti-CCP positives, 89.1% had C/C genotype while the remaining 10.9% have the C/T genotype. Statistically significant association was obtained between the polymorphism and anti-CCP positivity in RA patients (OR: 2.939, 'p' value Ό 0.0595). Conclusion: Our study suggested that a positive autoantibody status may predispose an individual to RA. PTPN22 may act as a susceptibility gene only in certain ethnic groups and there is no direct association between PTPN22 C1858 polymorphism and RA patients from Western India. Still a larger study is needed to understand whether this polymorphism predisposes individual to disease-associated antibodies among Indian RA patients.

Background: Mechanical low back pain (MLBP) is a commonly encountered entity in clinical practice. Pain relief and restoration of functional capacity are management goals. Aims and objectives: To compare the efficacy and tolerability of flupirtine, a selective neuronal potassium channel- opener (SNEPCO), with tramadol, a widely-used opioid analgesic, in MLBP. Methods: This randomized, single-blinded, intention to treat (ITT) trial started with 240 non-steroidal anti-inflam- matory drug (NSAID) intolerant patients who were prescribed either tablet flupirtine (100 mg twice daily) or capsule tramadol (50 mg twice daily), for 4 weeks. Follow-up was done on days 14, 28 and 4 weeks after treatment completion. Assessment of improvements in Indian Health Assessment Questionnaire Disability Index (Indian HAQ- DI), Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and measurement of Pain Relief Rate (PRR) were performed. Adverse events were recorded. Results: One hundred and seven patients receiving flupirtine and 103 receiving tramadol were analyzed on an ITT basis. Scores in Indian HAQ-DI, VAS and NRS improved significantly in both groups in the last visit, but more so with flupirtine. PRR was reasonably higher with flupirtine, [59 (55.14%)] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [41 (39.81%)]. Adverse effects were less with flupirtine [26 (24.30%) versus 41 (39.81%), p < 0.05], minimizing drop-outs. Conclusion: Flupirtine has better sustained efficacy and tolerability than tramadol in

Background: Osteoarthritis (OA) has a major impact on daily life and often leads to avoidance of physical activity. A lack of regular physical activity in people with OA of the hip or knee is an important risk factor for further functional decline. Recently developed and evaluated exercise program called the behavioral graded activity (BGA) program acts as an approach to enhance adherence to exercises that lead to a more physically active lifestyle. The purpose of this systematic review is to identify Randomized Controlled Trials (RCT) on BGA interventions for hip and knee OA and to provide summary of current evidence. Methods: The database searched with the keywords (knee osteoarthritis, hip osteoarthritis, behavior graded activity, behavior physical therapy, physical activity), in Cochrane Library (Cochrane Database of Systematic Reviews), PubMed, MEDLINE Plus, PEDro and CINAHL for studies published from January 2000 to May 2011. The randomized controlled trials included in the study assessed the effect of behavioral graded activity on hip and knee osteoarthritis. Results: Four RCTs meeting the qualitative levels of evidence based on the grading system described by Tugwell and O'Shea (2004) and recommended by the Cochrane Musculoskeletal Group were considered for analysis and the results were projected. Conclusion: There is a silver level evidence that the BGA results in better exercise adherence and more physical activity than usual care in people with OA of the hip and knee, both in the short- and long-term.

Relapsing polychondritis is a rare, progressive and potentially fatal disease affecting the cartilaginous tissues like ears, nose, laryngotracheal tree and joints. Proteoglycan-rich structures like eyes, heart, blood vessels and inner ear are also affected. The common manifestations are auricular and nasal chondritis and nonerosive arthritis. Due to the rarity of the disease, the diagnosis is often delayed due to lack of awareness. Relapsing polychondritis disease activity index has recently been developed and may help in monitoring disease activity thus resulting in better patient outcomes. The treatment depends on the extent and severity of disease, with minor manifestations requiring only NSAIDS and the organ/life-threatening manifestations requiring immunosuppression with corticosteroids ± cytotoxic drugs. Newer biological agents may be helpful in refractory disease.

Assessment of disease activity using clinical instruments like Birmingham Vasculitis Activity Score and Vasculitis Damage index has been extensively used both in trial and clinic setting. It has revolutionised outcome assessment for small size vasculitis as evidenced from studies carried out by the European vasculitis group. There is a need for clinical assessment tools for large vessel disease like Takayasu arteritis, which is seen more frequently in India. An attempt has been made by the Indian Rheumatology Association Vasculitis core group to validate instruments, like Disease Extent Index for Takayasu Arteritis (DEI.Tak), Indian Takayasu Activity Score (ITAS) and Takayasu Arteritis Damage Scores. Both DEI.Tak and ITAS have received interests from international investigators. Widespread usage of these instruments will pave the way to controlled clinical trials for TA.

A case of acute muscle necrosis with multiple bullae and gangrene is described and discussed for a possible etiology.

A young female with known Behcet's disease presented with skin lesions over lower limbs. The lesions were biopsied and found to be pyoderma gangrenosum. The lesions responded to oral steroids for 6 weeks.