Indian Journal of Rheumatology

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Not many years ago achieving remission in rheumatoid arthritis (RA) was difficult due to lack of effective treatment. With the advent of biologics, remission is very much within reach. But biologics are expensive. And not all patients respond adequately to biologics. Hence it will be useful if we have a marker which predicts response to any disease modifying anti-rheumatic drug (DMARD), whether conventional or biologic. Expansion of CD28-ve T cells is characteristically seen in RA. Both CD28-ve T Cells and RA are believed to be linked to immunosenescence. The available evidence is suggestive of an intimate relationship between RA and clonal expansion of CD28-ve T cells. Newer biomarkers are constantly being looked at and CD28-ve T cells is one of them. In this review the rela- tionship between immune disorders like RA and immunosenescence and significance of CD28-ve T cells in RA is discussed.

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The young researcher today is confronted with a choice of hundreds of statistical tests, both while reading research works or while planning own research. The principles guiding the choice of statistical tests are simple and this article, aimed at the young researcher, aims to demystify the same.

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Objectives: Nocardia infections have been described in immunosuppressed patient including patients with systemic lupus erythematosus (SLE). There are only a few case series in patients with SLE. Thus we studied the clinical presentations, organ involvement, treatment and outcome of cases of nocardial infection in the SLE patients. Methods: Records of SLE patients who attended our rheumatology clinic in the last 25 years were reviewed and cases of nocardial infection were identified and data was collected from case records. Results: Three cases of nocardiosis were found in our lupus series, giving a prevalence of 0.2%. Brain involvement was seen in all 3, whereas pulmonary and subcutaneous abscess was found in two patients each. All patients were managed with antibiotics and one pa- tient required surgical drainage. All recovered without any morbidity. Conclusion: Nocardial infection, though rare in SLE has a good outcome. Involvement of brain, skin and lung together in a patient with background of immunosuppression should raise a suspicion of nocardial infection.

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Disease activity and quality of life (QOL) including functional status in rheumatoid arthritis (RA) is influenced by several ethnic, cultural and other factors. Standard of care manage- ment should cater for country specific needs. Objectives: To assess and compare clinical disease characteristics and health status in pa- tients with RA from two countries, India and Iran. Material and methods: A cross-sectional survey of 140 RA patients (Indian70 and Iranian70) was chosen from rheumatology outpatients (Bandar Abbas, Iran and Pune, India) in random manner. One of the authors evaluated all patients under Rheumatologist super- vision. Standard evaluation was as per current American College of Rheumatology guide- lines and included a 68/66 joint count and laboratory tests. Health assessment questionnaire (CRD Pune version HAQ) and SF36v2 was utilized to assess functional and health status. While Iranian patients were all Muslims, the Indian patients were pre- dominantly Hindu. Results: The groups matched well for age, gender, duration of disease and rheumatoid factor. Patients in Iran had less years of education as compared to patients from India (p < 0.001), Pains and SF 36 domains (barring vitality, social function and mental health) and sedimentation rate (ESR) scored significantly higher in the Iranian group. Swollen joint counts, global disease assessment and blood hemoglobin were higher in the Indian group. The overall DAS 28 (disease activity score) index, general health (VAS), HAQ and SF 36 Mental health domain scores did not differ significantly in two groups. Conclusions: Though there were some important differences in pain perception, joint counts and QOL, the study cohorts of RA belonging to the Iranian and Indian ethnicity were similar for disease activity (DAS) and functional status (HAQ).

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Online since 29^th June, 2016