Indian Journal of Rheumatology

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Background: Atherosclerotic cardiovascular disease (CVD) is the major cause for mortality in rheumatoid arthritis (RA). Dyslipidemia is an important risk factor for CVD and is influenced by the disease activity of RA. There is paucity of data on this subject in Indian patients with RA. Objectives: To study the lipid levels in patients with RA and their relation with disease activity. Method: The prospective study was carried out at a tertiary care centre in northern India. Results: The study population included 96 patients with RA. Using the "high" cut-off values of National Cholesterol Education Programme-Adult Treatment Panel (NCEP-ATP III) as many as 38.5% (37/96) of patients exhibited dyslipi- demia. Low high-density lipoprotein cholesterol (HDL-C) was the commonest abnormality seen in 34.3% of (33/96) patients. Disease activity scores (DAS-28) were at baseline and on a follow-up visit after 3 months they were 4.9 (1.02) and 4.4 (0.9), respectively (P = 0.003). With a decline in disease activity, a rising trend was observed for all lipids, statis- tically significant only for HDL. DAS-28 showed significant negative correlation with TC, r = 0.302 (0.003) and LDL-C, r = 0.274 (0.007). For HDL and TG, the correlation was not significant. Conclusion: Lipid abnormalities are common in Indian patients with RA. Low HDL is the commonest abnormality. Disease activity is negatively related with lipids.

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The term panniculitis denotes inflammation of subcutaneous fat. Histologically panniculus is made up of fat cells, bounded by septa which harbour blood vessels. Panniculitis is classified as septal or lobular, with or without vasculi- tis. Surgical biopsy of a fresh lesion is essential for correct histopathological diagnosis. Panniculitis is caused by a variety of processes and conditions such as infection, immune-mediated disorders, malignancy, drugs, enzyme deficiency, trauma, etc. Present article discusses pathogenesis and classification of panniculitides and provides a short description of the common and/or important entities associated with panniculitis.

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Lupus erythematosus (LE) is a heterogeneous connective tissue disease associated with polyclonal B-cell activation and is believed to result from the interplay of genetic, environmental and hormonal factors. The spectrum of disease ranges from limited cutaneous involvement to devastating systemic disease. Skin is the second most common organ involved with varying morbidity. In about 80% of cases skin rash is present at some stages of disease process and in 25% cases it is the presenting sign. Four out eleven classification criteria for systemic lupus erythematosus (ACR criteria- 1982) comprise cutaneous manifestations of the disease. Cutaneous manifestations in LE may be lupus-specific or lupus non-specific but related to the disease process. Cutaneous involvement is responsible for morbidity, which is caused by scarring, dyspigmentation, etc. and types of cutaneous involvement may serve as a good barometer of the pattern of underlying systemic activity. Acute cutaneous LE (lupus-specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity for which patients present to rheumatologists and internists.

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At the stop sign we read the "red flags" and made up our mind and followed one of the road signs pointing to secondary, primary or fake vasculitis. Since then we have steadily followed the road map and passed the first (patient history and physical exam), second and third milestones (laboratory, imaging and pathology studies in the primary care and specialized centres) and have finally reached our destination at the fourth milestone (Part IV) on the road map review to vasculitis. In the management of these syndromes, Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) are not widely used in the routine clinical work, but they are introduced as the idea behind them is really valid. The backbone of the medical therapy is the use of immunosuppressive doses of prednisone (1 mg/kg/day). In some life-threatening and non-responsive vasculitides this is combined with cyclo- phosphamide 2-4 mg/kg/day or 0.5-1.0 g/m2 i.v. every 2-4 weeks (European Vasculitis group uses 15 mg/kg every 2-3 weeks), often at 3-6 months substituted either with methotrexate or azathioprine. In contrast, i.v. immunoglobulins are to be used in Kawasaki's syndrome; cyclosporine, dapsone or colchicine in Behηet's disease; calcium channel blockers in BACNS; and NSAID in small vessel disease; whereas plasmapheresis or immunoadsorption are added to the therapy in Goodpasture's syndrome. Particular attention is drawn to the treatment of the triggers, use of biologicals and new cytostatic drugs and anti-metabolites, prevention of thromboembolic complications with anti-platelet drugs as well as to odd and orphan entities. A short travelogue ends our odyssey as the last sign on our roadmap.

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Online since 29^th June, 2016