Indian Journal of Rheumatology

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Introduction: Nonsteroidal anti-inflammatory drugs are effective in relieving osteoarthritis pain, but because of their side effects, search continues for agents that might provide improvement in symptoms with minimal addition- al risk. Evidence from previous studies suggests that ginger can reduce osteoarthritis pain. The aim of this study is to compare the effects of indomethacin and ginger on relieving osteoarthritis pain. Materials and Methods: A double blind, parallel group clinical trial was designed to evaluate the response of 52 patients with knee osteoarthritis to ginger and indomethacin. Results: Analysis of the mean for pain on standing (based on 100 mm visual analogue scale) showed improve- ment in both groups (22.5 mm in indomethacin group and 23 mm in ginger group, P value = 0.1). Results of improvement in pain after walking 50 feet were similar in both groups (23.5 mm in indomethacin group and 21.4 mm in ginger group, P value = 0.34). Changes in total Western Ontario and MacMaster Universities Osteoarthritis Index score were significant in both groups (4.62 in indomethacin group and 3.39 in ginger group, P value = 0.65). Conclusion: Ginger is as effective as indomethacin in relieving symptoms of osteoarthritis with negligible side effects. Therefore in patients with intolerance to indomethacin, ginger may be substituted.

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Objectives: To study the frequency, demography, clinical features and response to treatment of benign joint hypermobility syndrome (BJHS) in a rheumatology clinic at a tertiary referral centre in India and to ascertain the association of hypermobility with musculoskeletal symptoms. Methods: Consecutive adult patients with Beighton score of 5 or more and conforming to Brighton criteria were recruited from the rheumatology clinic over 18 months. Detailed clinical and laboratory work-up was carried out including ophthalmologic and echocardiographic evaluation. Treatment comprised reassurance, physiotherapy and nonsteroidal anti-inflammatory drugs/analgesics. Pain score and patient global assessment were measured at 0, 2 and 12 weeks. The association of hypermobility with musculoskeletal symptoms was ascertained in a case-control study performed separately. Results: Hypermobility (Beighton score > 5) was observed in about 20% (405/2050) of rheumatology referrals. However, only about half of them (204/2050) met the Brighton criteria for BJHS. One hundred BJHS patients (mean age 30 + 9.4 years, female : male = 2.2 : 1) were recruited for detailed study. All had gross hypermobility and knee was the commonest joint involved. Rheumatoid distribution of painful joints often raised suspicion of rheumatoid arthritis (RA) but objective clinical and laboratory findings of RA were lacking. Sixty-one had received a wrong diag- nosis before referral (RA, ankylosing spondylitis, rheumatic fever) and 22 had been taking long-term penicillin prophylaxis for suspected rheumatic fever. About 40% had negligible symptoms after 12 weeks while others continued to suffer from mild to moderate symptoms with no synovitis or joint damage. Case-control study showed greater likelihood of presence of hypermobility amongst the patients referred to the rheumatology clinic with odds ratio = 3.23 (CI = 1.86-5.63, P = 0.000). Conclusions: BJHS is common in Indians and is often mistaken for other rheumatic disorders. There is 3.2 times more likelihood of finding joint hypermobility amongst patients referred to a rheumatology clinic, thereby confirming its association with musculoskeletal complaints.

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With the development of biological agents our therapeutic approach to rheumatoid arthritis (RA) and inflammatory diseases in general, has dramatically changed in the last few years. Recently, a number of endogenous molecules have been identified that are known to activate CD4+ T cells leading to production of cytokines (IL-1, IL-6 and TNF-α), immunoglobulins like rheumatoid factor and expression of osteoprotegerin ligands that stimulate osteoge- nesis leading to joint destruction. This has led to better insight into the disease mechanisms. As a result, there is a wave of new therapies for RA like infliximab, adalimumab, atlizumab, etanercept, anakinra, prosorba column, abatacept, anti-IL-6 agents, IL-10 and interferon-γ. To date, combination therapy of methotrexate and a single bio- logical has been widely studied with synergistic effect. Etanercept and infliximab are the two biologicals available in India. Present article can prove useful for the physicians to get an insight into these novel therapeutic options for RA.

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Glucocorticoid-induced osteoporosis (GIOP) is a challenging problem. Several rheumatic disorders necessitate long-term glucocorticoid therapy. Therefore, it is a topic of great interest to practicing rheumatologists. During the first 6-12 months of glucocorticoid therapy there is an initial loss of 3-27% of bone mineral density (BMD). It is esti- mated that 50% of chronic glucocorticoid users will develop bone loss leading to fracture, especially of spine and neck of femur. For a given BMD, the risk of fracture is higher in GIOP than in postmenopausal osteoporosis. American College of Rheumatology has laid down guidelines for the prevention and treatment of GIOP. Various facts and current therapies aimed at its prevention and reversal are discussed in this review article.

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Kikuchi Fujimoto disease is a rare disease which must be considered as one of the causes of prolonged fever of unknown cause and lymphadenopathy. Rarely it may antedate, postdate or coincide with the diagnosis of systemic lupus erythematosus. Present case, is an example of this association.

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Online since 29^th June, 2016