The maiden WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan (1996e2014) demonstrated that musculoskeletal (MSK) pain was the commonest self-reported ailment in the community, soft tissue rheumatism, ill-defined MSK symptoms and osteoarthritis (OA) were the predominant disorders and about 10% cases suffered from inflammatory arthritis. The burden of rheumatoid arthritis (RA) was high with point prevalence of 0.7%. Bone and joint decade (BJD) India conducted several standardized and uniform surveys (2004e2010) all over India and collected data from over 55,000 persons at 12 sites. The pooled age sex adjusted (India census population 2001) prevalence reported by the recent surveys was e RA (0.34), OA knees (3.34), undifferenti- ated inflammatory arthritis (0.22), Spondyloarthritis (0.23), ankylosing spondylitis (0.03), psoriatic arthritis (0.01) soft tissue rheumatism (1.39), gout (0.05) lupus (0.01); prevalence percent in parenthesis. Several forms of collagen vascular disorders and vasculitis are described in hospital based case series. Musculoskeletal infections including tuberculosis remain an important clinical burden. The 2006 India Chikungunya epidemic has put an additional burden of chronic MSK pain and arthritis. The recently launched national health programs pertaining to non-communicable diseases, rural and women health does not even mention rheumatic diseases thus there is urgent need to study the burden of rheu- matic diseases and its impact on society.

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Systematic reviews and meta-analysis both form essential research in today's scientific world with plethora of primary research in every filed. A systematic review is an overview of primary studies which contains an explicit statement of objectives, materials, and methods and is conducted according to the explicit and reproducible methodology. When systematic reviews provide a quantitative (statistical) estimate of net benefit aggregated over all the included studies, it is termed meta-analysis. In this review important indi- vidual components of systematic review and meta-analysis have been discussed for the benefit of our readers.

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Aim: We tested the utility of topical application of Chloroquine-Solid Lipid Nanoparticle loaded gel against rheumatoid arthritis using Complete Freund's adjuvant (CFA) induced arthritic model. Methods: Chloroquine loaded solid lipid nanoparticle (SLN) was prepared using probe sonication method. Briefly, the drug was solubilized into melted compritol which was further emulsified using aqueous medium followed by subjection to ultra-sonication to reduce the globule size. Further cooling the nano sized emulsion rendered SLN which was incorporated into a gel matrix. Ex vivo permeability study of the same was also performed using Franz diffusion cell, taking chloroquine phosphate gel as standard. Pharmacody- namics study (Radiographic & histopathology analysis) was performed to evaluate the ef- ficacy of the formulation in arthritis induced rats. Results: SLN with a particle size of 113.75 nm and entrapment efficiency of 97.23% were obtained. It was found from ex-vivo permeation study that chloroquine-SLN loaded gel shows maximum retention in skin as compared to chloroquine phosphate gel. Radiographic and histopathology studies of the arthritic rats treated with Chloroquine SLN gel revealed lesser extent of bone and cartilage degradation as compared to those treated with chloroquine phosphate gel. Conclusion: The chloroquine-SLN loaded gel had greater protective potential over chloro- quine phosphate gel. It may be possible to target the affected site locally and overcome the problems of gastrointestinal as well as dose dependent systemic side effects associated with oral administration of chloroquine.

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Objectives: The increased risk of atherosclerosis in inflammatory rheumatic diseases like rheumatoid arthritis and systemic lupus erythematosus has been established in various studies. However, similar studies in ankylosing spondylitis (AS) have yielded conflicting results. We studied subclinical atherosclerosis and endothelial dysfunction sono- graphically in AS patients and compared the results with matched healthy controls. Methods: Fifty AS patients and 50 age and sex matched controls were recruited. However, 45 AS patients (28.6 ± 8.2 years; 42 males and 3 females) and 42 healthy controls (29.6 ± 8.6 years; 38 males and 4 females) were studied, as the others were excluded because of dyslipidemia. Height, weight, and waist circumference measurements were taken. Flow- mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery (CIMT) and ankle-brachial index (ABI) were measured sonographically. Results: AS patients had significantly higher CIMT compared to controls (0.56 ± 0.1 mm in AS patients and 0.51 ± 0.08 mm in controls; p = 0.03). FMD was lower in AS patients (14.1 ± 9.7%) as compared to controls (18.1 ± 8.7%; p = 0.04) and ABI was higher in patients (1.16 ± 0.1) as compared to controls (1.1 ± 0.1; p = 0.05) 20% of AS cases had impaired FMD (defined as a FMD <4.5%) compared to none among the controls (p = 0.03). Conclusions: This study revealed an increased prevalence of subclinical atherosclerosis in AS patients.

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Objectives: To evaluate clinical and radiographic patterns of cervical spine affection in patients with psoriatic arthritis (PsA). Methods: This cross sectional study included 30 PsA patients, who were examined clinically and had radiographics of the cervical spine, sacroiliac joints and both hands and feet. Results: Cervical spine disease was evident clinically in 46.7% and radiographically in 20% of PsA patients, with no significant correlation between radiological and laboratory abnor- malities. Also, there was no significant correlation between peripheral arthritis and cer- vical spine affection. Conclusion: Cervical spine disease is not an uncommon clinical and radiographic finding in patients with PsA.

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Early detection of rheumatological diseases is an important step in prevention of perma- nent damage and deformities. Conventional radiography has traditionally been used as a diagnostic tool in rheumatology but is incapable to detect early changes in the periarticular tissues and bones. MRI has gained undoubted superiority for detection of soft tissue pa- thologies and early bony inflammatory changes but its widespread use is restricted by multiple factors. Ultrasonography (USG) is a promising tool for bridging this gap. Though the use of USG in the field of Rheumatology is almost three decades old, recent advance- ment in technology has made it an attractive imaging tool for early detection various musculoskeletal disorders. The utility of USG is not only limited to the detection of sy- novitis but has expanded to detect various extra skeletal manifestations of rheumato- logical diseases. Absence of radiation hazards, reasonable cost, and widespread availability are the added advantages of USG. In this article the promising role of USG in musculo- skeletal diseases has been reviewed.

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