Background/Aim: In the present study, the protective effect of rutin in ameliorating the disease process via markedly reducing the reactive oxygen species in joint destruction was demonstrated in collagen induced arthritis (CIA) model. Methods: Arthritis was induced in male Wistar rats by CIA method. Rutin was administered at a dose of 25 mg kg-1 body weight once daily for 21 days. The effects of treatment in the rats were assessed by biochemical and histological evaluation in joints. Results: There was a steep elevation in the activity of neutrophils elastase following by the induction of disease. The depletion of the cellular defence in the CIA rats was significant decrease in the enzymatic as well as non-enzymatic antioxidants. The study revealed that the treatment with rutin was due to the significant changes on all the parameters studied in CIA rats as compared to control. Conclusions: These data confirm that erosive destruction of the joint cartilage in CIA is due to free radicals released by activated neutrophils. The beneficial effect of rutin may be due to its antioxidant and anti-inflammatory activity. This study indicates that the administration of rutin might have potential value in the treatment of rheumatoid arthritis.

Objective: To study vitamin D deficiency as the primary cause of musculoskeletal complaints in rheumatology clinic. Methods: Adult patients presenting with 'non-inflammatory' musculoskeletal pain to our rheumatology clinic between May 2009 and April 2011 underwent estimation of serum 25-hydroxyvitamin D [25(OH)D] and those with level < 20 ng/ml were recruited. Hypothyroidism, painful neuropathies, chronic kidney disease, malignancies, chi- kungunya, HIV, HCV and HBV were excluded. All study patients underwent complete physical examination and baseline estimation of serum calcium, phosphorus, alkaline phosphatase and PTH besides routine tests. Study patients received treatment with oral cholecalciferol and calcium and were re-assessed clinically and biochemically after 8 weeks. Serum 25(OH)D levels were also estimated in 92 asymptomatic controls. Results: Thirty patients were found eligible for the study after screening a total of 95 (Male/Female: 12/18; mean age: 42.3 ± 13.2 years). Polyarthralgia was the commonest presenting complaint (46.6%). Other symptoms included myalgia, bone pains and chronic widespread pain. Physical examination showed joint and muscle tenderness in 10 patients each and joint swelling in one. Paired biochemical results at baseline and 8 weeks were: 25(OH)D (ng/ml) Ό 5.84 ± 2.71 and 34.45 ± 12.98, calcium (mg/dL) Ό 9.06 ± 0.58 and 9.16 ± 0.63, phosphorus (mg/dL) Ό 3.65 ± 0.95 and 3.84 ± 0.70. Paired median [IQR] values for alkaline phosphatase and PTH were 89 [66e181] and 68 [55e138] units/L, and 69.2 [47.6e106] and 38.8 [25e60] pg/ml respectively. Treatment was successful in all except 4. Improvement was found to be sustained in all cases at 6 months follow up. Although 75% of controls also had biochemical evidence of vitamin D deficiency, their vitamin D levels were significantly higher. Conclusions: Vitamin D deficiency is frequently the sole cause of polyarthralgia, myalgia, bone pain and chronic widespread pain in patients referred to rheumatology clinic. Referring physicians ought to have a lower threshold for this eminently curable condition.

Introduction: Systemic Lupus Erythematosus (SLE), a prototype autoimmune disease can have bizarre clinical presentation. Male SLE patients are believed to suffer more from renal, neurological and cardiovascular manifes- tations as compared with women SLE patients. A proper and early diagnosis is needed especially in male sex in order to minimize mortality associated with the disease. Aim: This study was designed to determine whether the gender plays any role in severity among Indian SLE patients. Material & methods: The clinical and laboratory features of 28 males in comparison with 222 female SLE patients from Mumbai, Western India were analyzed. SLE disease activity was evaluated by SLE Disease Activity Index (SLEDAI) score at the time of evaluation. Results: Age of disease onset and age at evaluation was comparatively lower among male SLE patients as compared to females whereas mean disease duration was higher among females (1.8 years vs 3.5 years). SLEDAI was more among females than in males. Renal histopathological findings revealed that mesangial proliferative glomerulonephritis (MPGN) was more prevalent in males. Oral ulcers, renal disorders and hematological disorders such as leucopenia, lymphopenia, thrombocytopenia and autoimmune hemolytic anemia (AIHA) were more prevalent in male patients. Hepatosplenomegaly was also seen more frequently in male patients (32% vs 21%) (p < 0.05). There was no statistically significant difference noted among autoantibody profile when two genders were compared. Conclusion: Indian SLE patients showed differences in clinical manifestations between male and female patients supporting the hypothesis that gender biases exist in clinical expression of the disease.

Objectives: Antineutrophil cytoplasmic antibodies (ANCAs) are serological hallmark of ANCA associated vasculitides (AAV); Wegener's granulomatosis (WG), Microscopic polyangiitis (MPA) and ChurgeStrauss Syndrome. Conven- tionally, ANCA test is carried out on human neutrophils by indirect immunofluorescence (IIF) and antigenic determinant is confirmed with specific ELISA. Since most of the ELISA kits are manufactured outside India and cut-offs provided by the manufacturers are based on different ethnic population, their diagnostic performance may vary. Therefore, we aimed to define the optimum cut-off values that distinguish between the patient and healthy individual in Indian population. Methods: Sera of patients with AAV, and healthy individuals were tested for anti-Proteinase 3 (PR3) and -Myelo- peroxidase (MPO) using commercially available ELISA kits. Receiver operator characteristics (ROCs) curve was constructed to define the optimum cut-off value between the patients and healthy individuals. Results: ANCA was performed on 280 sera from healthy individuals, and 22 patients with active WG and 11 with active MPA. In healthy individuals, ANCA at dilutions 1:40, 1:80, 1:160, and 1:320 was positive in 7.14, 3.9, 1, and 0.3% respectively. ROC curves analysis showed that for PR3-ANCA antibody the best cut-off was 19 RU/ml at which the sensitivity was 81.8% and specificity was 100%. Similarly, for MPO-ANCA antibody, the best cut-off was 14.95 RU/ml at which sensitivity was 90.9% while specificity was 100%. Both of these cut-off values were different than the manufacturer's cut-off values. Conclusion: Optimization of imported kits as per the local healthy population should be carried out to improve its diagnostic performance.

Undifferentiated arthritis progresses to RA in one third of cases and spontaneously remits in up to half of patients, with disease persistence and the development of RA more likely in those with the greater clinical burden of synovitis. Clinical and laboratory characteristics can be utilized within algorithms to more accurately predict disease progression and a need for disease modifying therapy. Biological agents are not required as first line therapy with excellent results from traditional DMARDs if a treat to target approach is used and early intense escalation of therapy undertaken when outcome targets are not achieved.

Glucocorticoids (GCs) are used in the management of inflammatory disorders such as allergies, asthma, sepsis and several autoimmune diseases including of skin, bowel and joints. Recently the concerns regarding the safety of GCs have resulted in their renewed appraisal. Recognition of GC resistance has also contributed to the drive of the development of new technologies to utilise the GCs better. Use of the knowledge about mechanisms of action of GCs to overcome the undesirable effects has resulted in newer GC molecules, novel drug delivery systems and novel drug combinations which hold promise for the optimum use of GCs in future.