The maiden WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan (1996e2014) demonstrated that musculoskeletal (MSK) pain was the commonest self-reported ailment in the community, soft tissue rheumatism, ill-defined MSK symptoms and osteoarthritis (OA) were the predominant disorders and about 10% cases suffered from inflammatory arthritis. The burden of rheumatoid arthritis (RA) was high with point prevalence of 0.7%. Bone and joint decade (BJD) India conducted several standardized and uniform surveys (2004e2010) all over India and collected data from over 55,000 persons at 12 sites. The pooled age sex adjusted (India census population 2001) prevalence reported by the recent surveys was e RA (0.34), OA knees (3.34), undifferenti- ated inflammatory arthritis (0.22), Spondyloarthritis (0.23), ankylosing spondylitis (0.03), psoriatic arthritis (0.01) soft tissue rheumatism (1.39), gout (0.05) lupus (0.01); prevalence percent in parenthesis. Several forms of collagen vascular disorders and vasculitis are described in hospital based case series. Musculoskeletal infections including tuberculosis remain an important clinical burden. The 2006 India Chikungunya epidemic has put an additional burden of chronic MSK pain and arthritis. The recently launched national health programs pertaining to non-communicable diseases, rural and women health does not even mention rheumatic diseases thus there is urgent need to study the burden of rheu- matic diseases and its impact on society.

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Rheumatology in India, albeit old, has lagged behind in research on epidemiology and outcomes of chronic rheumatic diseases. The realization about paucity of Indian data has created the felt need for cohort-building and sustainable research. With this comes the dawn of collaborative research. Myositis is one such rare disease with considerable morbidity and mortality, where little is known about the behavior of the disease and treatment practices in the Indian setting. In recent years with the availability of myositis-specific autoantibodies, newer clinic-serologic associations have been described. Collaborative efforts in rare diseases from the Western world have yielded exemplary results. Hence, a pan-India collaborative network called MyoIN (Myositis India Collaborative Effort) was formed to collect data on patients with inflammatory myositis in a standardized format including clinical and investigational parameters both at presentation and follow up to build up a large series prospectively. This report describes the activities since the inception of this group.

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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.

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Background: Stanford HAQ (S-HAQ) and several versions are used worldwide to measure physical function. Based on traditions and life style, a maiden Indian version (CRD Pune) was developed and used extensively (1996e2011). We report clinimetric properties and long term use. Methods: The Indian version was finalized in a step wise consensus building process between doctors, community and patients. It remained similar to S-HAQ in basic structure (categories) and score/disability index. Current data was selected from controlled drug trials in active RA, referral community patients (clinic and camps) and WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan. Standard statistics were used; significant p < 0.05. Results: Testeretest and correlation statistics confirmed face and content (Cronbach's index >0.8) and construct validity and reliability at several time points. There was fair to good (0.2e0.6) correlation between Indian HAQ and pain visual analog scale, joint counts for pain/tenderness and swelling, sedimentation rate and radiological score (joint damage). The efficacy variables explained up to 70% variation in HAQ (dependent) regression models. The Indian HAQ scored significantly higher than the S-HAQ but the difference was not clinically relevant. The Indian HAQ was sensitive to change (effect size 0.7) over 24 week treatment with hydroxychloroquin. Generic use in COPCORD survey showed moderately severe HAQ disability in all patient groups including 'ill-defined aches' and soft tissue rheumatism. HAQ improved patient satisfaction. Conclusion: The Indian HAQ (CRD Pune) was a valid and useful patient outcome measure and improved compliance (long term follow up).

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Aim: We tested the utility of topical application of Chloroquine-Solid Lipid Nanoparticle loaded gel against rheumatoid arthritis using Complete Freund's adjuvant (CFA) induced arthritic model. Methods: Chloroquine loaded solid lipid nanoparticle (SLN) was prepared using probe sonication method. Briefly, the drug was solubilized into melted compritol which was further emulsified using aqueous medium followed by subjection to ultra-sonication to reduce the globule size. Further cooling the nano sized emulsion rendered SLN which was incorporated into a gel matrix. Ex vivo permeability study of the same was also performed using Franz diffusion cell, taking chloroquine phosphate gel as standard. Pharmacody- namics study (Radiographic & histopathology analysis) was performed to evaluate the ef- ficacy of the formulation in arthritis induced rats. Results: SLN with a particle size of 113.75 nm and entrapment efficiency of 97.23% were obtained. It was found from ex-vivo permeation study that chloroquine-SLN loaded gel shows maximum retention in skin as compared to chloroquine phosphate gel. Radiographic and histopathology studies of the arthritic rats treated with Chloroquine SLN gel revealed lesser extent of bone and cartilage degradation as compared to those treated with chloroquine phosphate gel. Conclusion: The chloroquine-SLN loaded gel had greater protective potential over chloro- quine phosphate gel. It may be possible to target the affected site locally and overcome the problems of gastrointestinal as well as dose dependent systemic side effects associated with oral administration of chloroquine.

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Background: Biobanking refers to the cryopreservation of the various biologic samples for future research. In the era of omics, biobanking has emerged as a vital process to aid research, more so for rare diseases. Aims and Methods: We describe herein the development of a biobank for idiopathic inflammatory myopathies (IIMs), a rheumatic illness with low prevalence. This study addresses the sample collection, transport, storage, maintenance, retrieval, and disposal of samples with a focus on cost-effectiveness, limitations, ethics, and legal aspects involved. Discussion: Financial constraints are juxtaposed next to a wealth of clinical data in the developing countries with a large population size and consequently high burden of rare diseases. Fine-tuning efforts toward the development of bio-archival facilities can maximize outcomes from research units in these countries. A time and cost-efficient model can be the first step toward such initiatives in the appropriate setting. Unique ethical, executive, and scientific challenges were encountered by the authors while establishing the MyoCite biobank in a resource-poor setting. The various efforts to foreclose these obstacles are discussed. Conclusion: This brief summarizes the unmet need, unique challenges, and potential solutions based on the authors' experiences gathered while setting up the MyoCite biobank for research in IIM. It also outlines the means and directions for national and global collaborations in the times ahead.

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Takayasu's arteritis (TA) is a large vessel vasculitis of unknown etiology, more common among Asians. Since it is a smoldering, chronic disease, assessment of disease activity is a challenge. Acute phase reactants, erythrocyte sedimentation rate and CRP, imperfectly correlate with disease activity on histopathology. The earliest clinical criteria to assess disease activity were the NIH criteria, taking a composite of clinical features, inflammatory markers, and imaging to assess disease activity in TA. Of late, clinical scoring systems like DEI.Tak (Disease Extent Index in TA), derived from the BVAS scoring for small vessel vasculitis, and the ITAS2010 and ITAS-A, derived from DEI.Tak, have been validated. Serum biomarkers like matrix metalloproteinases 2, 3, and 9, pentraxin-3 and soluble receptor for advanced glycation end products hold promise in assessing disease activity. Recently, endothelial microparticles have been shown to correlate with active TA. Evidence suggests wall edema, and contrast uptake in the vessel wall on angiography may suggest active TA. Scoring systems assessing angiographic extent of TA are a work in progress, validation of which shall help quantify extent of vascular involvement in TA, and serial follow-up might prove valuable for assessment of disease activity. PET-CT is useful to diagnose prepulseless TA; however, its utility in patients on immunosuppression is debatable. Analysis of serum metabolites using nuclear magnetic resonance spectroscopy is a promising exploratory approach towards identifying new biomarkers in TA. There remains an unmet need for a composite index, taking into account clinical features, serial radiography, and circulating biomarkers, to assess disease activity in TA.

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Background: Rheumatology journals are exploring social media presence, though currently less than a third have dedicated social media editors. Methods: A survey was conducted among the attendees of the Indian Rheumatology Association annual meet 2019 held at Puducherry, to assess the attitudes and perceptions of a target audience. Results: There were 111 respondents, 90 practicing rheumatology and 21 from allied fields. Around threequarters (76.6%) have never subscribed to hard copies of any journal and 65% followed at least one medical journal on at least one social media platform; 87% preferred visual cues for learning and 95% felt the need for visual abstracts to promote articles on social media. Two-thirds (64%) felt that Altmetrics® might reflect the impact of an article better than the number of times it is cited. Conclusion: Thus, the survey strengthened the felt need of rheumatology journals to have a presence on the social media. This presence ought to be supported by a strategy, including the active use of visual abstracts.

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Background: The aim is to study the clinical features and diagnosis of primary extra-spinal musculoskeletal manifestations of tuberculosis (TB) in otherwise healthy individuals. Methods: In this retrospective study of 10 years duration electronic database and case records of patients with musculoskeletal TB were analyzed. Patient's positive for HIV and rheumatic diseases with or without immunosuppressive drugs or biological agents were excluded from the study. Results: Fifty-one patients were identified with the mean age at presentation of 33.35 years (range 4–72), male: female ratio of 1.1:1 and mean duration of disease was 14.65 months (range, 0.25–120). The most frequent manifestation was articular (arthritis/arthralgia n = 40, monoarthritis n = 28, oligoarthritis n = 10, polyarthralgia n = 2) followed by tenosynovitis (n = 6), tuberculous osteomyelitis (n = 5), isolated bursitis (n = 1), and pyomyositis (n = 1). Poncet's disease was diagnosed in five patients. Disseminated TB was detected in four patients. Pain (n = 50) followed by swelling of the involved site (n = 37) were the most common presenting symptoms. Fever was present in 15 (29.4%) patients. Nine patients had a previous history of TB. Concurrent pulmonary TB was present in two patients. Lymph node enlargement was present in 12 (23.5%) patients. A definite diagnosis of musculoskeletal TB was made in 31 (61%) patients and probable TB in 20 (39%) patients. Conclusion: Musculoskeletal manifestations of TB can occur at any age. Chronic monoarthritis is the most common presentation; however, oligoarthritis and/or tenosynovitis may be a presenting manifestation. The absence of fever should not discourage the diagnosis of musculoskeletal TB.

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Objectives: To assess the knowledge of systemic lupus erythematosus (SLE) patients before and after clinical pharmacist's education and compare the same with the control group. Methods: In this study done on patients with SLE, the test group patients were provided with education regarding SLE and its management including lifestyle modifications, via the distribution of patient information leaflets (PILs), while the control group were continued with conventional therapy. Validated knowledge assessment questionnaire was administered at baseline, first follow-up and final (second) follow-up to assess the medication knowledge of SLE patients. The Modified Morisky Scale (MMS) was used to assess the adherence at the final follow-up to study the influence of education. Results: Forty-five patients completed the 2 months follow-up study out of 50 enrolled patients. A significant (P < 0.001) improvement in the medication knowledge scores and medication adherence was seen in test group compared to the control group. The reasons for non-compliance included patients forgetfulness, high cost of medi- cations, patients lack of access to hospital/drug store, lack of family support/motivation, fear of side effects, and fear of becoming dependent on treatment. Conclusion: The finding of this study showed that a well-structured SLE patient counselling by clinical pharmacist's intervention will result in improved medication knowledge and better medication adherence.

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Introduction: Hansen's disease (leprosy) most commonly presents with cutaneous and nerve involvement. Rheumatological manifestations occur commonly but are often under-recognized. Physicians and rheumatologists alike are often perplexed with the rheumatological manifestations, given that these may precede the diagnosis of leprosy or may suggest another disease, in addition to leprosy. We present our experience with patients of leprosy presenting with rheumatological manifestations. Methods: This was a retrospective study carried out in the Departments of Rheumatology and Medicine, King George's Medical University, Lucknow, a tertiary care hospital in North India. Those patients who had a confirmed diagnosis of leprosy were subsequently included. Demographic details and clinical presentations were documented. Results: Twenty-nine cases (19 males, mean age 38 ± 17.2 years) were included in the study. The mean duration of disease was 20.2 ± 18.4 months. Rheumatological manifestations seen included arthritis (n = 17), tenosynovitis (n = 5), swollen hands and feet syndrome (n = 6), painful swollen feet (n = 2), arthralgias (n = 3), and vasculitis (n = 1). The rheumatological diseases mimicked were rheumatoid arthritis (n = 10) and spondyloarthritis (n = 3), sarcoidosis (n = 2), relapsing polychondritis (n = 1), and vasculitis (n = 1). At some point in time, lepra reactions manifesting with arthritis, nodules, tenosynovitis and/or dactylitis were observed in 15 cases. Other classical clinical manifestations detected were paresthesia (n = 13) and anesthetic patches (n = 15). Thickened great auricular, ulnar and lateral popliteal nerve were seen in 20 cases. Five patients had pure neuritic leprosy with no cutaneous manifestations and had arthritis or tenosynovitis. Conclusion: Leprosy may mimic a number of common and uncommon rheumatological diseases, and these may be the presenting manifestation. Awareness and a high index of suspicion are required to arrive at a timely and accurate diagnosis.

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Takayasu's arteritis (TA) is a systemic large vessel chronic inflammatory disease affecting the aorta and its branches. Epidemiological data on the prevalence of TA are limited to the hospital-based studies. The prevalence, clinical features and outcomes of TA vary across the globe. Although TA is reported from all parts of the world, the prevalence of the disease appears to be high in oriental countries especially in Japan, India, Korea, and Thailand. The exact pathogenesis of the disease is unknown but an ongoing research is being carried out in the immunological and genetic aspects of the disease. HLA Bw52, cytotoxic T cells, and antiendothelial cell antibodies are significant highlights in the pathogenesis of TA. The exact antigenic targets of the immune system are still unknown. We attempt a review of the available literature on epidemiology and etiopathogenesis of TA.

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Objectives: To investigate the differences in clinical presentation, disease activity, HLA-B27 positivity in nr-axSpA and AS. Methods: Prospective observational study conducted in tertiary care centre from India. Total 125 consecutive patients with chronic low backache were screened,96 fulfilling ASAS criteria for axial SpA were included and grouped into radiographic (AS) (n = 55) and non- radiographic (n = 41) axial SpA. Demographic, clinical, disease activity and functional indices, ESR were noted from study group. HLA B27 testing was performed in study group by using an in-house PCR method. Results: Patients with AS compared with nr-axSpA were older at presentation (mean 33.7 ± 11.9 vs 26.5 ± 9, p < 0.001), longer mean time to disease diagnosis (4.4 ± 4 vs 1.3 ± 1.7,p < 0.0001) and had higher proportion of positive family history of SpA(29% vs 9.7%,p = 0.02). No statistical significant differences were found in male to female ratio, peripheral arthritis, dactylitis, enthesitis, ESR, HLA B27 positivity, disease activity and functional indices (BASDAI,BAS-G&BASFI) Conclusion: Though the clinical features and HLA B27 frequency is similar in nr-axSpA and AS, Patients with AS were older and had longer disease duration.

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Objectives: Chronic osteoarthritis of knee is very commonly encountered in clinical practice. Pain relief and restoration of physical function are the targets of therapy. This study aims to compare the efficacy and safety of tapentadol with etoricoxib in the management of osteoarthritis of knee. Methods: This is a randomised, open labelled, controlled study in which patients received either tablet tapentadol (100 mg twice daily) or etoricoxib (30 mg twice daily) for 12 weeks. Follow-up was done after 2nd, 4th, 8th and 12th weeks of initiation of treatment and also after 2 weeks of treatment completion. Assessment of improvement in pain perception on Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) sub-score for stiffness and physical function were performed. Results: 108 patients receiving tapentadol and 110 patients receiving etoricoixb were ana- lysed on Intention to Treat basis. Steady improvement was seen in VAS and WOMAC scores in both the groups, though there was no significant difference between the groups. Clinical Global Impression measured by physician showed significant difference between groups with greater number of patients experiencing at least satisfactory response at the end of the study in the tapentadol group ( p = 0.036). The total number of adverse events was less with tapentadol than etoricoxib. Conclusions: Tapentadol is as effective as etoricoxib in the management of mild to moderate grades of chronic osteoarthritis of knee with lower incidences of adverse effects.

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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.

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Background: Ankylosing Spondylitis (AS) is a chronic inflammatory disease that leads to significant disability. We sought to study the impact of the disease activity and functional impairment on QoL in Indian patients with AS. Methods: World Health Organization- Quality of Life-BREF (WHOQoL-BREF) questionnaire was used to measure quality of life (QoL) in 99 adults with AS (modified Rome criteria), 72 healthy individuals, and 20 rheumatoid arthritis patients. Apart from demographic variable such as age, gender, clinical manifestations, and treatment received, disease activity parameters such as duration of early morning stiffness, BASDAI, swollen and tender joint count, Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) were also recorded. Presence of damage was assessed using spinal radiographs. All values are in median (IQR). Results: Out of the 99 patients, 5 were females and 5 had juvenile onset AS. Median age was 32 (26-42) years and median disease duration was 6 (1.25-10) years. Forty-three had peripheral arthritis and 18 had enthesitis. Syndesmophytes were present on spinal radiographs in 54 cases. BASDAI correlated negatively with the physical, psychological and environmental domains (P < 0.05), while BASFI and BASMI did not. In all 4 domains of WHO-BREF, scores for AS were significantly less as compared to healthy controls [P < 0.0001] or even to rheumatoid arthritis [P < 0.01]. Conclusion: Indian AS patients have poorer quality of life than patients with rheumatoid arthritis and healthy individuals, possibly due to poor control of disease activity.

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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.

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Background: The revised Japanese criteria, the International study group (ISG), the International criteria for Behcet's disease (ICBD) 2006, and the revised ICBD 2010 are frequently used for the classification of Behcet's Disease (BD). In this study we evaluated the performance of these criteria sets in Egyptians. Methods: A total of of 461 Egyptian patients over 5 years were studied. It included 256 patients classified as BD based on expert opinion and 205 patients with other autoimmune and/or autoinflammatory diseases with symptoms similar to BD. Performance of the revised Japanese criteria, ISG, ICBD 2006, and the revised ICBD 2010 was evaluated evaluated in terms of sensitivity, specificity, negative predictive value (NPV), negative likelihood ratio (NLR), positive predictive value (PPV), positive likelihood ratio (PLR), diagnostic odd ratio (DOR), and Youden's index (YI). Results: ICBD 2010 carried the highest sensitivity (98.83%), NPV (98.48%), DOR (1645), and YI (0.94) with lowest NLR (0.01). On the other hand, ICBD 2006 and ISG were very specific (99.51%, 99.41%, respectively) with PPV (99.49%, 99.40%) and PLR (155.35, 126.33), respectively. Conclusions: ICBD 2010 is a very good criteria set to be used in Egyptian BD patients based on its very high sensitivity, accepted specificity, and power of discrimination that enables early patients classification, management, and prognosis.

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Introduction: Biologics are widely used in Autoimmune rheumatologic diseases (AIRDs), however the need to capture real life data which monitors indications, adverse reactions cannot be over emphasized. Methods: This is a cross-sectional ambidirectional multi-center study conducted over 8 months from January 2016 to August 2016, across 12 tertiary care rheumatology centers in Karnataka, India conducted by members of the Karnataka Rheumatology Association. Results: The most common biologic prescribed is tumour necrosis factor antagonist etanercept. Commonest indication for biologics being Spondyloarthropathy group of disorders. The most common cause for stopping biologics is clinical improvement. Only 4.8% of patents discontinued biologics due to ADRs. Conclusion: The prescribing patterns, mode of use, prebiologics screening methods, and adverse event profile are similar across centres. Pre-screening for latent tuberculosis (TB) is consistent across centres, and TB prophylaxis appears to be effective in preventing its reactivation.

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We describe the process of patient involvement and the impact of including the patient perspective in OMERACT conferences. OMERACT has taken on a leading role in including patients as research partners in conferences and scientific projects, and this has lead to a formal assessment of the patient perspective over the last 10 years. The role of patients has evolved from a single focus group in 2002 to full integration in all parts of the conference in 2012. Long-term engagement of patient partners has made a significant change in the scope and conduct of rheumatology research. It has enriched the research agenda by identifying previously neglected outcome domains such as fatigue, sleep disturbances and flares, and it has contributed to more patient relevant outcomes in clinical trials. Facili- tating factors toward patient involvement have been the strong commitment of the lead- ership; an adequate selection procedure; an inclusive conference design; an interactive and encouraging moderation style, and self-organized support. However, challenges for the future include where to set the limits for patient partnership, and the representativeness of the patient research partners in particular in terms of country of origin and culture.

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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

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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.

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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.

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