Background: Gray-scale ultrasound and Power Doppler ultrasound (GSUS, PDUS) and contrast Magnetic Resonance Imaging (MRI) are the imaging modalities to detect the disease in this early stage of rheumatoid arthritis (RA). This study was conducted to observe the advantages and disadvantages of USG and MRI of wrist and metacarpophalangeal joints in patients with rheumatoid arthritis. Methods: Clinically diagnosed cases of RA were included. GSUS-PDUS and high field (1.5T) MRI with contrast were used by two assessors. The evaluation and scoring was done using the RAMRIS score. Other assessed parameters included Joint space narrowing, GSUS bone erosions, Gray scale USG synovial hypertrophy, MRI tenosynovitis and tenosynovitis on GSUS. Results: Total 50 patients (44 female, 6 male; age 18-76 years) with 100 joints and 400 Metacarpophalangeal joints (2^nd to 5^th) including 2300 bone areas were evaluated. GSUS, PDUS evaluation was equal to contrast MRI evaluation in detecting joint space narrowing, effusion, flexor tenosynovitis (except for FPL tendon), extensor tenosynovitis. Whereas synovial thickening was better picked up in GSUS, PDUS than on contrast MRI. Contrast MRI picked up more cases of bone erosions, triangular fibro cartilage lesions and active synovitis as compared to GSUS, PDUS. Bone marrow edema which indicates active ostitis could only be directly detected on contrast MRI. Conclusions: GSUS, PDUS can be used as radiological investigative modality for the diagnosis of cases of early rheumatoid arthritis specially for synovial thickening, joint effusion, flexor and extensor tenosynovitis.

Background: In the assessment of primary osteoarthritis (OA) of knees several clinical tool including 6 minutes walk test (6 MWT) are used. The objective of this study was to to analyze the test-retest reliability of 6 MWT and its correlation with various parameters. Methods: Eighty patients (age, 56-79 years) with OA of knees met the inclusion criteria. Demographic and clinical characteristics including radiological severity of OA (by X-ray K/L grading) were recorded. Patients filled in the knee injury and osteoarthritis outcome score (KOOS) questionnaire. All patients performed 6 MWT twice with at least 48 h gap in-between. Results: Test–retest reliability of 6 MWT in primary OA knee patients was excellent with ICC 0.991 (95% confidence interval was 0.986–0.994). 6 MWT had a weak correlation with KOOS-symptom and KOOS-activities of daily living (rho = 0.397 and 0.364 respectively), a strong correlation with KOOS-pain and KOOS-sports (rho = 0.605 and 0.521 respectively), and a very strong correlation with KOOS-quality of life (rho = 0.758). It had a weak correlation with age and height (r = 0.497 and 0.302), a strong correlation with VAS, weight, and BMI (rho = −0.655, r = −0.510, and − 0.691, respectively), and a very strong correlation with disease severity (rho = −0. 849). Conclusion: 6 MWT was a reliable test and positively correlated with all KOOS subscales and negatively correlated with other parameters except height in primary OA knee.

Background: Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disease, which mostly occurs in genetically susceptible individuals. Single-nucleotide polymorphism (SNP), as the major type of genetic variations, is one of the controversial issues discussed in a large portion of autoimmune disorders. BTB domain and CNC homolog 2 (BACH2), encoded by BACH2 gene, is a regulator of the immune system which reduces activation of T cells and suppresses the inflammation. In this study, we surveyed association of rs72928038 Single-nucleotide polymorphism (SNP) located in an intron region of BACH2 gene in Iranian RA population. Methods: Blood samples were collected from 623 RA patients and 412 age-, sex-, and ethnicity-matched healthy controls. In order to genotyping the rs72928038 SNP, amplification refractory mutation system-polymerase chain reaction was employed. Results: None of the alleles and genotypes of rs72928038 SNP had significantly different distributions between RA patients and healthy controls. The GA, GG, and AA genotypes were slightly frequent in patients compared with healthy controls but with no significant differences. Conclusions: This study did not show rs72928038 as a risk factor for RA in the Iranian population, which was strongly associated with other populations. This underscores genetic diversity in RA susceptibility in different populations.

Background: Primary Sjögren's syndrome (pSS) is a systemic disease with a wide array of life-threatening extraglandular manifestations. The main objective of this study was to assess glandular and extraglandular manifestations of pSS. Methods: Eighty-two newly diagnosed pSS patients fulfilling revised American-European Consensus Group criteria of 2002 were included in the study. Twenty patients had predominantly glandular manifestations and 62 had predominant extra-glandular manifestations. Patients underwent baseline hematological, biochemical, immunological investigations, and imaging as needed. All patients underwent Schirmer's Test and lip biopsy irrespective of whether they had sicca symptoms or not. Results: The extraglandular manifestations observed in our patient were arthritis, neurological, renal, respiratory, and vasculitis. Almost 50% of patients with extraglandular manifestations did not have sicca symptoms. Cervical dental caries was seen in 40% of our patients with extraglandular manifestations. Our study had a higher percentage of renal involvement. Age at presentation and duration of illness were lower in the extraglandular group, which were statistically significant. European Sjögren's syndrome disease activity index (ESSDAI) at onset and at 1 year was higher in extraglandular group. Conclusion: The demography of patients with extraglandular manifestations in terms of age, duration of illness, and disease activity is different from those with only glandular manifestations.

Rapid aging of world's population will translate into more elderly patients in the near future. Diagnosis of inflammatory rheumatic diseases in this age group is complicated by atypical clinical features compared to the younger onset group, nonspecific positivity of serological parameters, and confounding radiological signs. Management of these diseases also presents unique challenges in lieu of altered physiology of elderly, cognitive decline, presence of comorbidities, and altered immune system (inflammaging). Hence, this review attempts to synthesize the existing knowledge of the clinical, diagnostic, and therapeutic idiosyncrasies of inflammatory rheumatic diseases in this subgroup of population.

Pain, stiffness of joints, and functional disability of rheumatoid arthritis (RA) are maximum in the morning. Cytokines, especially interleukin (IL)-6, demonstrate a circadian variation in patients with RA and contribute to the severity of aforementioned symptoms. Perturbed cortisol response in patients with RA is not effectively able to negate the effects of interleukin 6 rise in the early morning. Modified-release (MR) prednisone is a polymer-based drug delivery system which releases the drug 4 h after the ingestion of tablet closely simulating the cortisol rise and peak in patients with RA. In this review, we focus on the rationale for chronotherapy, mechanistic considerations, and clinical implications of MR prednisone.

IgG4-related disease (IgG4RD) is a new entry into the field of rheumatology characterized by tumefactive lesions, storiform fibrosis, and involvement of more than one organ. The most common organ involved is the pancreas which often coexist with mass lesions in other organs. We report a case where IgG4RD presented with the involvement of aorta and meninges in the form of periaortitis and hypertrophic pachymeningitis respectively, a rare coexistence in IgG4RD. The patient responded well to rituximab in the initial visit, however during subsequent recurrence, the response was not significant. We also discuss the immunosuppressants used in IgG4 RD and the variability in clinical response during various stages of disease.

The practice of checking and supplementing vitamin D even in situations where it is not warranted has become common practice among physicians. While many do not develop ill effects, some patients may suffer from consequent toxicity. This occurs mostly in patients who are vitamin D sufficient or those who have underlying disorders. We report a case of vitamin D supplementation in an elderly lady which resulted in hypercalcemia and pathological calcification.