Background: CDAI and SDAI have been frequently used to categorize disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Indian population. Objective: To validate CDAI and SDAI in RA, taking DAS-28 as gold standard and to derive new cutoffs for CDAI and SDAI. Methods: Patients fulfilling ACR/EULAR criteria for diagnosis of RA were studied. After complete history, physical examination and biochemical tests, patients were grouped into remission, low, moderate and high activity on the basis of pre-defined cut-offs for DAS-28, CDAI, and SDAI. Spearman's correlation and group wise inter-rater agreement tests were performed. Using DAS-28 as gold standard, the sensitivity and specificity of CDAI and SDAI cut off were determined for predicting levels of disease activity by area under receiver operator characteristics curves. (AUROC) Results: We studied 112 patients with RA, there was excellent correlation between DAS-28 and CDAI (r ¼ 0.96 with 95% C.I. ¼ 0.94-0.97), CDAI and SDAI (r¼0.99, 95% C.I. 0.98-1), and DAS-28 and SDAI (r ¼ 0.96, 95% C.I. ¼ 0.94-0.97). There was a good inter-rater agreement between the various levels of disease activity as defined by DAS-28 and CDAI (weighed k ¼ 0.598) and DAS-28 and SDAI (weighed k ¼ 0.699) with excellent agreement between SDAI and CDAI categories (weighed k ¼ 0.816).There was no statistically significant difference between AUROC of CDAI and SDAI and both performed equally well. Conclusion: CDAI and SDAI are highly correlated with DAS-28 score hence are good markers of disease activity. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Indian scenario.

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Objective: Microalbuminuria is associated with increased risk for renal and cardiovascular mortality and morbidity in diabetes mellitus, hypertension, patients with acute myocardial infarction and elderly patients but the significance of microalbuminuria in rheumatoid arthritis and its correlation with disease activity is not well studied. The present study is therefore aimed to determine the microalbuminuria in rheumatoid arthritis patients and to correlate it with indicators of disease activity like CRP and ESR. Methods: Hundred confirmed cases of Rheumatoid arthritis (2010 ACR-EULAR criteria) and hundred age and sex matched controls were taken. Those suffering from hypertension, diabetes mellitus and renal disease were excluded. Microalbumin was assessed by immunoturbidimetric method on Delta nephelometer. Disease activity was assessed by CRP and ESR. Results: The relative frequency of microalbuminuria in patients with rheumatoid arthritis was 26% as compared to 4% in controls. The median level of microalbuminuria in rheu- matoid arthritis patients was significantly greater than in the controls (17 vs. 3.29, p < 0.01). Microalbuminuria significantly correlated with CRP (p < 0.001, r ¼ 0.457) and ESR (p < 0.001, r ¼ 0.361). A significant correlation was found with duration of disease (p < 0.05, r ¼ 0.231) and number of joints involved (p < 0.05, r ¼ 0.240). Conclusions: We found increased prevalence of microalbuminuria in rheumatoid arthritis patients and it correlated with acute phase reactants.

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Psoriatic arthritis (PsA) is an inflammatory arthritis that usually develops after the onset of cutaneous psoriasis. There is evidence that early diagnosis will lead to better long-term outcomes. Identifying inflammatory arthritis in subjects with psoriasis is the key to early diagnosis of PsA. Screening strategies using questionnaires or biomarkers targeted at subjects with psoriasis may result in early identification of PsA. This article reviews the importance of early diagnosis of PsA and the strategies available for screening psoriasis patients for PsA.

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Backgrounds: In the absence of practical diagnostic criteria for diagnosis of granulomatosis with polyangiitis (GPA), a new diagnostic criteria for GPA is proposed based on literature review for characteristic manifestations of GPA and expert opinion. The sensitivity of the new criteria, Iran criteria for GPA, is assessed in comparison with 1990 American College of Rheumatology (ACR) criteria for Wegener's granulomatosis (WG). Methods: Evaluation of three organs (ear, nose and throat (ENT); lung; kidney) and two laboratory findings (anti-neutrophil cytoplasmic antibody; biopsy), abbreviated mnemon- ically as ELKAB, is suggested in our criteria. A retrospective sensitivity analysis was per- formed based on medical records of 35 patients. Clinical diagnosis of GPA by a single rheumatologist was used as the gold standard. Results: Records of a total of 15 male and 20 female patients with a mean follow-up duration of 21.26 ± 4.13 months were considered. Mean age at diagnosis and mean disease duration were 32.37 ± 2.33 years and 19.06 ± 5.41 months, respectively. The sensitivity for Iran criteria for GPA and 1990 ACR classification criteria for WG were calculated as 100% and 80%, respectively. Conclusions: Iran criteria for GPA is a highly sensitive instrument for detecting GPA patients in comparison with 1990 ACR classification criteria for WG.

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It is well known that there is an increased risk of infections in SLE patients on immuno- suppression. These infections may mimic lupus flares with similar manifestations such as fever, oral ulcers, leukopenia/pancytopenia, renal involvement, pneumonitis, lymphade- nopathy and others. The management of SLE in these two situations becomes contrasting. Viral infections are an important cause of morbidity and mortality in SLE patients but are often not suspected or investigated for. Herein, we present a case of SLE on immunosup- pression who had recurrent herpes simplex infection, mimicking flares of the disease. The case highlights that one should have a high index of suspicion along with appropriate laboratory back up to diagnose these infections.

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