Objectives: Glucocorticoids are important and frequently used class of anti-inflammatory drugs. Deflazacort (DFZ) is a glucocorticoid and an oxazolone derivative of prednisolone. As it has high anti-inflammatory and immunosuppressive potency, we studied inhibitory effect of DFZ on mediators regulating the pro-inflammatory response and oxidative stress induced in arthritis. Methods: Female Wistar rats were immunized intradermally by collagen type II to induce collagen induced arthritis. Arthritic rats were treated with DFZ orally (6 mg kg-1 body weight) until 28 days after the onset of clinical symptoms of disease. The effect of DFZ treatment in the rats was monitored by clinical scoring, biochemical parameters, immu- nohistochemistry and histopathological evaluation. Results: Deflazacort significantly decreased the level of articular elastase, nitric oxide and lipid peroxidation whereas significantly increased the activity of catalase, superoxide dismutase and glutathione. Deflazacort down-regulated expression of pro-inflammatory molecules like TNF-a and COX-2. Histopathological evaluation revealed significant reduc- tion of synovial hyperplasia and cellular infiltration in synovial membrane in DFZ treated group as compared to the diseased group. Conclusions: This suggests that DFZ significantly down-regulates the expression of pro-in- flammatory molecules such as TNF-a and COX-2 and alleviates the oxidative stress which make it a viable therapeutic option for treatment of arthritis.

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Introduction: Hand osteoarthritis (OA) is a highly prevalent disease with a significant physical and social burden. Thus we decided to find out prevalence of hand OA in the patients above 40 year of age who presented to us with either hand symptoms or knee OA. Methods: Postero-anterior hand radiographs were taken of both hands to confirm the diagnosis of hand OA. Fifteen joints were evaluated for the presence of osteophytes, joint space narrowing, sclerosis, and cysts. 358 patients attending Rheumatology OPD of two tertiary care centers in Eastern India in one year participated in study. Results: Ninety nine (27.65%) of 358 subjects had radiological hand OA. Among the 222 patients with knee OA 90 (40.5%) patients had hand OA. Nine (6.6%) of 136 patients with hand symptoms alone had hand OA. Overall 212 (59.21%) of 358 patients had symptoms in hand joints and of them 49 (23.2%) patients had hand OA positive. Female sex, older age, BMI >25, family history of OA or diabetes mellitus increased the risk of radiological hand OA. Knee OA increased the risk of hand OA both symptomatic and asymptomatic. Conclusion: Hand OA is common and a good quality X ray of hand is an initial investigation to diagnose hand OA. Presence of Knee OA increases risk of hand OA.

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Objectives: Non-classical HLA-E molecules may influence the disease susceptibility and phenotype including treatment response in chronic inflammatory disorders such as Rheumatoid Arthritis (RA) by virtue of their capacity to modulate innate immune pro- cesses. This study was carried out to investigate the role of HLA-E polymorphism in RA susceptibility, clinical and serological phenotype as well as treatment response. Methods: Genomic DNA from 221 RA patients and 200 healthy controls (HC) were typed for HLA-E rs2844724 (C/T) and rs1264457 (HLA-E*01:01/*01:03) single nucleotide polymorphisms (SNPs) using the TaqMan 5'nuclease assay consisting of allele-specific fluorogenic oligo- nucleotide probes. Results: Our study did not find any association between HLA-E polymorphism and RA susceptibility or disease phenotype. However, it was observed that the frequency of HLA- E*01:03 allele was higher in all RA cases (Pc ¼ 0.03,OR ¼ 3.02, 95% CI ¼ 1.06e9.39), young onset RA (YORA) (Pc ¼ 0.03, OR ¼ 3.20, 95% CI ¼ 1.11e9.98) and female RA (Pc ¼ 0.04, OR ¼ 3.04, 95% CI ¼ 1.06e9.46) patients who responded well (good responders) to a com- bination of non-biological disease modifying anti rheumatic drugs (DMARDs), metho- trexate (MTX) and hydroxychloroquine (HCQ) as compared to non-responders. Moreover, the frequency of rs2844724 T allele and TT genotype was observed to be higher in patients with low titers of rheumatoid factor (RF) than those with high titers (90% vs. 77% and 79% vs. 59% respectively), although the difference did not reach statistical significance. Conclusion: The results of our study suggest that HLA-E rs1264457 may influence the patient response to treatment with methotrexate-based DMARD therapy. Thus, it may be a useful genetic marker for treatment response in patients with RA.

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Behcet's syndrome (BS) is a multisystem vasculitis with an unknown etiology and an unique geographic distribution. The pathogenesis of BS is complex and currently not fully understood. Since the 1970's there have been different attempts to classify BS within the specific group of diseases such as spondyloarthritis, autoimmune and more recently autoinflammatory disease. However current evidence suggests that BS does not easily fit into any one of these diseases and we propose the possibility that the construct we take as BS might represent more than one disease. The management of BS usually depends on clinical presentation and organ involve- ment. Traditional immunosuppressives and concomitant use of corticosteroids have been the main therapeutic choice for many years. There is growing experience with biologic therapeutics especially with tumor necrosis factor-alpha (TNF-alpha) antagonists in the management of refractory eye, gastrointestinal and neurologic involvement in BS. In this review we have proposed a different perspective about the disease mechanisms of BS and have summarized the current management strategies in BS in the light of available evidence.

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Randomised controlled trials (RCTs) have become the workhorse for evaluating efficacy of various healthcare interventions. The basic plan is to compare the outcome experience of two or more prognostically similar groups of patients with study intervention being the only difference between them. It involves key elements such as random allocation, concealment of allocation, and blinding to guard against design-related biases. This article explains these key features and the steps involved in designing an RCT in the context of rheumatological diseases.

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