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  Access statistics : Table of Contents
   2008| September  | Volume 3 | Issue 3  
    Online since July 22, 2016

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Methotrexate and hydroxychloroquine combination therapy in chronic chikungunya arthritis: a 16 week study
s Pandya
September 2008, 3(3):93-97
Objective: To study the clinical profile of patients of chronic chikungunya arthritis presenting to a rheumatology OPD in the Western part of India and to judge the treatment response to the disease modifying drugs (methotrexate and hydroxychloroquine) used to treat them. Materials and methods: The diagnosis of chronic chikungunya arthritis was based on clinical criteria only. All patients giving a history of fever with arthritis starting during the epidemic of chikungunya in the Western part of India (August-September 2006) and having had the arthritis for > 3 months since then were included in the study. Baseline clinical characteristics were calculated. Most patients received methotrexate (15 to 20 mg weekly) and hydroxychloroquine for their chronic arthritis and their ACR 20, 50 and 70 responses and EULAR remission and EULAR good response based on DAS 28 ESR were calculated. Results: A total of 305 patients presented to the OPD till March 2008. Mean age of the patients was 49 years. Female to male ratio was 2.8:1 (223:82). The other mean baseline values were: patients global 6 (0 to 10, 0 best), physician's global 5.8 (0 to 10, 0 best), HAQ score 1.6 (0 to 3), swollen joint count 8.8 (28 joint count), tender joint count 14 (28 joint count), ESR 52 mm first hour (Westergren). About one-third of the patients had parasthesias in the carpal tunnel distribution. Rheumatoid factor was positive in 76 out of 256 when it was done (29.7%) and anti-CCP was positive in 6/73 when it was done. Data needed for judging treatment response was available in 149 patients at a mean follow up of 16 weeks period and they received combination of methotrexate and hydroxychloroquine. ACR 20 was achieved in 73/149 (48.9%), ACR 50 in 28/149 (18.8%) and ACR 70 in 6/149 (4%). Only one of the patients achieved EULAR remission (DAS 28 ESR < 2.6) and four others achieved EULAR good response (DAS 28 ESR < 3.2) at the end of 16 weeks. None of the patients had any adverse effect to the DMARDs used. Conclusion: Chronic chikungunya arthritis is a significant cause of morbidity in this part of the world. In this analysis most patients were middle aged and female to male ratio was 3:1. About one-third of the patients reported carpal tunnel symptoms. About half of the patients who received the combination of methotrexate and hydroxychloroquine achieved an ACR 20 response at 16 weeks.
[ABSTRACT]   Full text not available  [PDF]
  666 188 -
Juvenile idiopathic arthritis: an update
S Singh, KR Jat
September 2008, 3(3):110-119
Juvenile idiopathic arthritis (JIA) is the commonest rheumatologic disease in children and is a significant cause of short- and long-term functional disability. The term JIA refers to a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. It encompasses several clinical conditions with relatively distinct patterns of presentation. Although none of the currently available drugs can be said to be curative, with the advent of methotrexate in early 1990s and biological agents in late 1990s, the long-term prognosis of the condition has improved considerably. In the present review we have discussed the different classifications, clinical features of different categories of JIA and recent advances in the management.
[ABSTRACT]   Full text not available  [PDF]
  510 98 -
Comparison of MRI and X-ray in detection of erosions in RA
R Saigal, M Mittal, A Kansal, Y Singh, H Ram
September 2008, 3(3):98-100
Objective: To compare magnetic resonance imaging (MRI) of hands with conventional radiographs in detection of erosions in rheumatoid arthritis (RA) patients. Methods: The study was conducted on 42 RA patients. X-ray and MRI of both hands were done and findings were compared. Results: Out of 42 patients, MRI detected erosions in 41 patients (97.6%). However, X-ray detected erosions only in 19 patients (45.2%). No patient had erosion detected on X-ray, which was not visualized by MRI. Mean numbers of erosions detected by X-rays were 2.09 ± 2.97 and by MRI were 11.30 ± 10.03 (P < 0.0001). In early RA (disease duration less than 3 months), MRI could detect erosions in some patients, whereas X-rays were unable to detect erosions in any. Conclusions: In RA, MRI is superior to conventional radiographs in detecting erosions, especially in patients with early disease.
[ABSTRACT]   Full text not available  [PDF]
  499 90 -
Haematopoietic stem cell transplantation in autoimmune diseases
Velu Nair
September 2008, 3(3):101-109
Haematopoietic stem cell transplantation (HSCT) comprises the elimination of nonfunctioning, dysfunctional or malignant cells using high-dose chemotherapy with or without radiation therapy. This is followed by stem cell rescue sourced from bone marrow or peripheral blood. In autoimmune disease (AID) the main target is to achieve lym- phoablation. The newly generated lymphoid cells will have a new immunological repertoire which hopefully is not auto-reactive. HSCT aims to 'reset' the dysregulated immune system of AID patients. Most clinical studies reported for HSCT in AID have involved autologous HSCT and have been carried out in patients who have failed to respond to conventional therapies. Many of these patients had advanced active disease, often with organ dysfunction which explains the wide range of transplant-related mortality (TRM) from 1 to 12%. Conditions in which autologous HSCT has been performed with variable degree of success include systemic sclerosis, SLE, RA, JIA, multiple sclerosis and a number of other disorders. Because transplant physicians do not have expertise in AIDs it is vital to actively engage clinical immunologists and rheumatologists in protocol conception for conditioning and post-transplant main- tenance therapy. National and international co-ordination would be helpful in developing guidelines regarding patient selection and defining clinical and scientific endpoints. Hence, all treating teams should comprise of both disease and transplant experts working towards a common goal of achieving maximal benefit with minimal TRM using HSCT in the treatment of AID.
[ABSTRACT]   Full text not available  [PDF]
  491 88 -
Chikungunya arthritis
v Krishnamurthy
September 2008, 3(3):91-92
Full text not available  [PDF]
  339 124 -
Rheumatology quiz
V Arya, V Dhir
September 2008, 3(3):124-124
Full text not available  [PDF]
  301 157 -
Sweet's syndrome with life-threatening manifestations
VS Ostwal, JL Oak
September 2008, 3(3):130-133
Full text not available  [PDF]
  286 88 -
Do we need paediatric rheumatologists in India?
Sujata Sawhney
September 2008, 3(3):120-123
Full text not available  [PDF]
  282 72 -
International publications of interest from India (June-August 2008)
v Arya
September 2008, 3(3):128-129
Full text not available  [PDF]
  250 104 -
What is your diagnosis?: A 16-year old girl with venous thrombosis at an unusual site of 5 months duration
R Sharma, J Kishore, S Agrawal, L Rajasekhar, GG Narsimulu
September 2008, 3(3):125-127
Full text not available  [PDF]
  254 88 -
RheumaPandit's View from Qutub

September 2008, 3(3):134-135
Full text not available  [PDF]
  247 86 -