Objective: The relationship of Takayasu's arteritis (TA) and Tuberculosis (TB) has been suggested for decades but convincing evidence is lacking. The aim of this study is to assess the published evidence for an association between TA and TB. Method: We performed a systematic search of the MEDLINE database through PubMed using MeSH headings and keywords for "Takayasu's arteritis" and "Tuberculosis". Results: Thirty seven publications were analysed. The sites of TB lesions in these TA cases were mainly found in lymph nodes and lungs and occasionally in the internal organs and skin. One histopathological study did not support the direct role of mycobacterium TB in the pathogenesis of arterial lesions while the other suggested that the arterial damage could occur due to previous TB infection. Regional differences in the prevalence of TB may have influenced the validity of the results. The laboratory studies support the idea of molecular mimicry between mycobacterium heat shock protein (mHSP65) and its human homologue (hHSP60) driving immune response in TA. Based on the epidemiological, immunological and genetic factors, three hypotheses have been proposed to explain the TA and TB link. Conclusions: The mycobacterium theory can neither be confirmed nor excluded with cer- tainty. The proposed hypotheses require future confirmatory studies. Randomised controlled trials are needed to ascertain safety of biologics in TA cases with associated TB infection.

Background: Longer disease duration is believed to be associated with more pronounced bone loss in rheumatoid arthritis (RA). This study was designed to assess bone mineral density (BMD) status in RA compared with age-matched control in relation to disease duration. Methods: This study included 177 RA and 283 age-matched non-RA controls. BMD at the femoral neck and lumbar spine was assessed by Dual Energy X-ray Absorptiometry Oste- oporosis was diagnosed according to WHO criteria. We divided patients with RA into groups based on disease duration of <2, 2-5, 5e10, and >10 years and compared them with controls. The relationship between disease duration and BMD was investigated by chi square and Spearman test. Results: Mean age of patients and control subjects was 51.2 ± 12.5 and 52.2 ± 6.7 years, respectively and mean disease duration was 86.5 ± 73.3 months. Osteoporosis at the femoral neck and lumbar spine in patients with RA was significantly higher than in con- trols. Femoral neck BMD in RA was negatively correlated with disease duration and 4.5% variations of femoral neck BMD was explained by disease duration (r2 Ό 0.045, P Ό 0.005). Odds Ratio (OR) for osteoporosis in RA patients as compared to controls was increased by prolongation of disease duration from 2.38 (0.38-14.7) in patients with disease duration <2 years to 12.56 (2.24e70.2) in patients with disease duration >10 years. For patients treated with methotrexate compared to those who had never received methotrexate the odds ratio for femoral neck osteoporosis reduced by 64% (OR Ό 0.36, 95% CI, 0.15-0.91). Conclusion: There is a significant negative relationship between femoral neck BMD and disease duration in RA. The value of OR increases proportionately with lengthening of disease duration which can be reduced significantly by methotrexate therapy.

Aim of joint surgeries in rheumatoid arthritis is to restore function and quality of life, prevent joint deterioration, relieve pain and correct deformity in patients afflicted with rheumatoid disorders With advent of newer therapeutic modalities, the need for joint surgeries in cases of rheumatoid disorders has drastically reduced over the past two decades. Decision-making and timing for orthopaedic intervention are complex issues because of polyarticular involvement in rheumatoid disorder. Optimal results from the surgery demands close team work between the rheumatologists and the orthopaedic surgeon. However, as studies, have indicated, there appears to be divergent views amongst rheumatologist and the orthopaedic surgeon as regards indications, timing and effectiveness of rheumatoid joint surgery. This is to the detriment of the patient's best interest. Therefore, it is imperative that a multidisci- plinary team approach be adopted towards managing each patient. The need of the hour is evolution of integrated Rheumatology Team comprising of rheumatologist, orthopaedic surgeon, pain care specialist, physiotherapist and nurse, a close synergy of interests to provide holistic care to patients of inflammatory joint disorders.

Caseecontrol studies are a very frequently used restudy design in clinical and epidemio- logical research. They are popular because they are easy, quick and inexpensive to plan and conduct. Despite the risk of several types of biases (selection bias, recall and mea- surement bias, and confounding), their results are often fairly robust. This article explains the basic steps in the design and conduct of caseecontrol studies, and also explains their usual pitfalls, from the perspective of a clinical researcher.