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   2022| June  | Volume 17 | Issue 2  
    Online since June 13, 2022

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Effectiveness of colchicine among patients with COVID-19 infection: A randomized, open-labeled, clinical trial
Aryan Mohamadfatih Jalal, Sheelan Faroz Aref, Dashty Abbas Albustany
June 2022, 17(2):136-141
Background and Objective: In November 2019, there were abundant cases of COVID-19 which first case was reported in Wuhan, China. Colchicine has an important role in inhibiting activation of NLRP3 inflammasome that predispose to decrease cytokine production. This study aimed to evaluate whether colchicine is effective in treatment of corona virus disease of 2019 (COVID-19) patients or not. Patients and Methods: A randomized, open-labeled, clinical trial of Colchicine for the treatment of COVID-19, allocated between May 8, and June 18, 2021. The colchicine tablet dosage was 0.5 mg twice daily for 14 days added to the standard treatment versus control group who receive standard treatment without colchicine, with the trial registration ID: NCT04867226. The study was conducted in Erbil city-Iraq with the endpoints being clinical, laboratory parameters and duration of hospitalization. Results: Eighty patients participated in the study. Fewer patients in the colchicine group had musculoskeletal symptoms (17.5%, P = 0.001) in comparison to the patients, who received control treatment. The serum ferritin level in most of patients who treated with colchicine returned to normal in contrast to the control group, whose serum ferritin level was still high (P = 0.041). Similarly, the average of C-reactive protein and D-dimer after treatment among the colchicine group participants was significantly lower than the control group, the P values were 0.011 and 0.043 consecutively. The colchicine group patients stayed for a shorter duration at the hospital (18.4 days) compared to the control group (24.24 days). P value was 0.009. In addition to that the response and cure rate were higher in the colchicine group (56%) in the comparison to control group (43.1%). Conclusion: The colchicine drug can be effective in treating patients with COVID-19 infection by improving musculoskeletal symptoms and inhibiting inflammatory biomarkers; it is also effective in reducing duration of hospitalization.
  2,915 67 -
Vaccine hesitancy in patients with autoimmune diseases: Data from the coronavirus disease-2019 vaccination in autoimmune diseases study
Parikshit Sen, James B Lilleker, Vishwesh Agarwal, Sinan Kardes, Marcin Milchert, Tamer Gheita, Babur Salim, Tsvetelina Velikova, Abraham Edgar Gracia-Ramos, Ioannis Parodis, Albert Selva O'Callaghan, Elena Nikiphorou, Ai Lyn Tan, Lorenzo Cavagna, Miguel A Saavedra, Samuel Katsuyuki Shinjo, Nelly Ziade, Johannes Knitza, Masataka Kuwana, Giovanni Cagnotto, Arvind Nune, Oliver Distler, Hector Chinoy, Rohit Aggarwal, Latika Gupta
June 2022, 17(2):188-191
  1,667 66 -
IgA vasculitis post-ChAdOx1 nCoV-19 vaccine in a patient with rheumatoid arthritis
Kunal Chandwar, Digvijay Gajanan Ekbote, Juhi Dixit, Kriti Kishor, Kiran Preet Malhotra, Urmila Dhakad
June 2022, 17(2):186-187
  1,655 58 -
Herpes zoster reactivation after COVID-19 vaccination in patients with autoimmune diseases
Srinivasan Sanjay, Deepika Ponnuru, Sharath Kumar, Vijay K R Rao, Ankush Kawali, Padmamalini Mahendradas
June 2022, 17(2):216-221
  1,628 57 -
Individuals with reactive arthritis suffer from poor health-related quality of life akin to individuals with ankylosing spondylitis: A multigroup study
Prakash Gupta, Rajat Kharbanda, Maryam Abbasi, Roma Raj, Latika Gupta
June 2022, 17(2):110-117
Background: Reactive arthritis (ReA) and ankylosing spondylitis (AS), both spondyloarthropathies predominantly affecting young men seriously hamper mobility during the active phases of disease. While AS is thoroughly researched, specific studies on ReA are relatively scarce despite its pervasive nature and ever evolving epidemiology. Thus, it is imperative to understand the quality of life (QoL) of ReA patients in comparison to those with AS and healthy controls (HC) to reduce the disparity in patient care. Methods: An inception cohort of adults with ReA (Braun’s criteria) was surveyed to collect the data on demographics, clinical profile, disease activity (Bath AS Disease Activity Index [BASDAI], pain Visual Analog Scale [VAS]), functional status Bath AS Functional Index (BASFI), and QoL (ASQoL instrument) between November 2019 and January 2020. HC and AS were surveyed for the same parameters using an anonymized e-survey ( All the data are expressed as medians and interquartile range. Results: A total of 147 participants (62 ReA, 45 AS and 40 HC) were included. Patients with ReA were younger than those with AS and HC - 25, 29, and 28 years, respectively, and had a shorter disease duration (P < 0.0001). Baseline clinical characteristics (peripheral arthritis and enthesitis), pain VAS (body pain and back pain) were comparable in ReA and AS groups. All the clinical characteristics of ReA and AS cohorts were significant in comparison to the HC cohort. Notably, functional and activity scores of AS and ReA patients were similar, whereas all functional scores of patients with either spondyloarthropathy were significantly worse than HC (BASDAI, BASFI, ASQoL, P < 0.0001). ASQoL scores were comparable across all domains of ReA and AS except in upper limb activities where patients with ReA fared better than AS. No difference in QoL was observed between acute or chronic ReA. Conclusion: QoL in ReA and AS is comparable, thus the impact of disease on physical function must be recognized to improve patient care. Patients with ReA exhibit significantly worse QoL than HC using ASQoL instrument.
  1,393 137 -
Infliximab in treatment of refractory multisystem inflammatory syndrome in children with severe cardiac dysfunction
Guruprasad Hassan Shankar, Jitendra S Oswal, Bhakti U Sarangi, Ajay Walimbe, Prithvichandra Markal, Karthik V Badarayan
June 2022, 17(2):166-169
Multisystem inflammatory syndrome in children (MIS-C) has emerged as one of the several challenges thrown by the ongoing severe acute respiratory syndrome-coronavirus 2 pandemic. Although diagnostic criteria of MIS-C have now been established to raise the clinical suspicion for the condition, the Kawasaki disease (KD)-like phenotype of MIS-C presents with additional therapeutic dilemmas. The treatment guidance till date remains empirical with consideration of intravenous immunoglobulin (IVIG) and glucocorticoids. However, treatment of cases refractory to the current conventional therapy with respect to biologics remains uncertain. We describe here, an 8-year-old boy with MIS-C (KD-like phenotype) with severe cardiac dysfunction refractory to IVIG and pulse methylprednisolone who responded to tumor necrosis factor-α inhibition using infliximab.
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Therapeutic drug monitoring of mycophenolate mofetil for the treatment of pediatric lupus nephritis: A cross-sectional study
Navamani Kirubakaran, Anu Punnen, Ratna Prabha, Indira Agarwal, Sathish Kumar
June 2022, 17(2):124-128
Objectives: This study aimed to determine whether mycophenolic acid area under the curve 0–12 h (MPA AUC0–12) concentrations correlate with the disease activity in children with lupus nephritis. Methodology: Twenty-five children who fulfilled the inclusion criteria were recruited. MPA levels were measured at specific intervals between 0 and 12 h of drug administration, including the baseline (trough) levels. Disease activity is determined by systemic lupus erythematosus disease activity index (SLEDAI) scoring along with laboratory parameters, and serological status was also compared with MPA AUC0-12 concentrations. Results: Out of 25 children, 20 (80%) were girls and 5 (20%) were boys. Mean MPA AUC0-12 concentrations was significantly lower in patients with active disease (SLEDAI score >6) (38.46 ± 14.3 μg.h/ml) than the patients with inactive disease (SLEDAI <6) (69 ± 19.24 μg.h/ml) with a P = 0.003. MPA AUC 0-12 concentrations correlated with hemoglobin complement level (C3, C4) and SLEDAI. Multivariable analysis revealed that daily mycophenolate mofetil (MMF) doses were recognized as independent variables influencing the MPA AUC0–12 concentrations. Conclusion: Our study strongly suggests that the dose of MMF needs to be based on the MPA AUC0–12 levels.
  1,261 139 -
Sacroiliitis as presenting manifestation in immune-mediated inflammatory disorders other than spondyloarthritis: Case series and review of literature
Kunal Chandwar, Kriti Kishor, PM Ankush, Mukesh Kumar Maurya, Puneet Kumar, Urmila Dhakad
June 2022, 17(2):174-179
Sacroiliitis has long been thought to be a fiefdom of the spondyloarthritides. We present 5 different cases of Immune mediated inflammatory disorders (IMIDs) presenting with sacroilitis. Though sacroilitis on Imaging can be seen in postpartum women, Athletes and even normal people, erosions in sacroiliac joint and deep SI joint edema are likely to favour a pathological cause of sacroilitis seen on imaging. We also review the prevalence of sacroilitis in different IMIDs from the available literature.
  1,273 68 -
Experience with macrophage activation syndrome associated with systemic lupus erythematosus: A single-center study from Pakistan
Saira Elaine Anwer Khan, Roshila Shamim, Asadullah Khan, Shabnam Batool, Muhammad Zeeshan Aslam
June 2022, 17(2):118-123
Objective: The objective of the study was to evaluate the clinical, laboratory manifestations, and associations of macrophage activation syndrome (MAS) in a cohort of Pakistani patients with systemic lupus erythematous and to compare it with a well-characterized cohort of active systemic lupus erythematosus (SLE) without MAS. Materials and Methods: Patients with a diagnosis of SLE admitted from January 2017 to July 2019 were retrospectively reviewed. MAS ascertained by either clinical criteria or bone marrow biopsy were studied. Demographics, clinical, and laboratory parameters of MAS patients were evaluated and compared with a cohort of non-MAS active SLE. Results: A total of 305 patients of SLE were evaluated, out of these 18 patients had a diagnosis of MAS, making a MAS prevalence of 5.9%. Mean age of the patients was 27.25 ± 10.16 years. Female comprised 13 (72%) of MAS group. Fever was the most common clinical presentation (100%), followed by splenomegaly (38.9%) and lymphadenopathy (33.3%). At least 5 (27.8%0 patients had MAS as their initial manifestation. Anemia (88.9%), thrombocytopenia (88.9%), leukopenia (72%), and pancytopenia (55.6%) were prominent laboratory parameters. Mean serum ferritin of 1584 ng/ml and mean triglyceride of 270 mg/dl were reported. On comparing with non-MAS cohort; younger age, fever, lymphadenopathy, splenomegaly, mucocutaneous features, any type of cytopenia, high aspartate aminotransferase (AST), low albumin, and lactate dehydrogenase, all showed significant association with MAS (P < 0.05). Conclusion: Fever and associated cytopenias coupled with raised AST are strong predictors of MAS in patients with SLE.
  1,205 119 -
The changing paradigm of glucocorticoid therapy in antineutrophil cytoplasmic antibody-associated vasculitis
Kunal Chandwar, Chandani Shah, Puja Srivastava
June 2022, 17(2):193-195
  1,088 36 -
Coronavirus disease 2019 infection and autoimmunity: We see only a tip of the iceberg
R Naveen
June 2022, 17(2):107-109
  921 148 -
Effects of fibromyalgia syndrome in patients with diffuse systemic sclerosis: Evaluation with 2010 American college of rheumatology criteria set
Ayse Ayan, Hanife Hale Hekim, Sebahat Yaprak Cetin
June 2022, 17(2):129-135
Backgrounds: The aim of this study was to evaluate the frequency of fibromyalgia syndrome (FMS) according to the 2010 FMS criteria and to investigate its effects on quality of life in patients with diffuse systemic sclerosis (SSc). Methods: The study included 44 SSc patients with a mean age of 52.84 ± 13.35 years and 96 healthy adults with a mean age of 53.43 ± 14.67 years. The symptom severity scale, fibromyalgia impact questionnaire, beck depression and anxiety inventory, and the short form (SF)-36 were used for evaluations in the study. FMS was detected in 27 patients with SSc (62.79%) and 13 health controls (13.5%). Results: When SF-36 subscales were compared, a statistically significant difference was found in favor of the fibromyalgia patient group in respect of physical function, physical role difficulty, mental role, and pain scores (P: 0.04-0.00). Conclusion: Our results showed that FMS frequency was increased in patients with diffuse SSc and that FMS significantly affected the quality of life. In addition, the anxiety and depression levels were also increased in SSc patients with FMS. It can be recommended to assess patients with SSc for FMS during routine clinic examinations.
  966 96 -
The perils of generic small molecules: Has tofacitinib become a toffee
Kunal Chandwar, Prasanna Dogga, Juhi Dixit, Digvijay Gajanan Ekbote, Kriti Kishor
June 2022, 17(2):192-192
  814 57 -
Is T-helper 17 inhibition the knight in shining armor we were looking for? Comments on the article by shumy et al.
Kunal Chandwar, Chandani J Shah, Puja Srivastava
June 2022, 17(2):196-198
  800 27 -
Human leukocyte antigen-B alleles in spondyloarthritides: A single-center, prospective, cross-sectional study
Jeet Hemantkumar Patel, Ved Chaturvedi, Lalit Duggal, Neeraj Jain, Gurbir Bhandari, Monika Jain
June 2022, 17(2):142-148
Objective: The objective of this study is to study distribution of human leukocyte antigen (HLA)-B alleles in Spondyloarthritis (SpA) and to find its clinical relevance in the patient management. Materials and Methods: A prospective, cross-sectional, pilot study was carried out on 100 participants at the single center of Northern India (Sir Ganga Ram Hospital, New Delhi). Assessment in ankylosing spondylitis (ASAS) classification criteria for axial/peripheral spondyloarthritis (SPA) (conventionally AS-ankylosing spondylitis), classification criteria for reactive arthritis (ReA), and CASPAR (classification criteria for psoriatic arthritis) criteria for psoriatic arthritis were used to sub-classify patients. Inflammatory bowel disease (IBD) patients who classified for ASAS criteria for SPA were classified as IBD-related SPA. Demographic data, disease characteristics, and relevant investigations were noted. HLA-B genotyping was carried out by the polymerase chain reaction method. HLA-B genotyping of 100 healthy kidney transplant donors were taken as controls. Fisher's exact test was used. P < 0.05 was considered as statistically significant. Results: Out of 100 patients, 58 were male and 42 were female. SPA (AS), ReA, PSA, and IBD-related SPA were 65, 12, 16, and 07, respectively. HLA-B 27+ve participants were 57. HLA-B40 and HLA-B52 were present in 25 and 19 participants, respectively. HLA-B27 allele was associated with SPA, PSA, and IBD-related SPA (P < 0.01, 0.034, and 0.037, respectively). In HLA-B27-ve cases, the frequency of HLA-B40 was increased (P value – 0.033, odds ratio [OR] with 95% confidence interval-2.44, [1.09, 5.48]). Similarly, the frequency of HLA-B15 and HLA-B13 were increased in PSA (P value – 0.034, 0.020 with OR – 4.09, 6.33, respectively). The presence of HLA-B27 allele favored axial ± peripheral disease while its absence favored peripheral disease (P value– 0.019). HLA-B27+ve participants had more active disease compared to HLA-B27-ve and HLA-B40+ve cases (P < 0.01 and 0.013, respectively). Conclusion: The utility of HLA-B alleles other than HLA-B27 is limited in SpA patients' management. To find their use in diagnosis, prognosis and treatment need further studies.xs
  715 43 -
How to practice academic medicine and publish from developing countries? A practical guide
Madhuri H Radhakrishna, Vinod Ravindran
June 2022, 17(2):222-223
  690 52 -
The emergence of rheumatic immune-mediated inflammatory disease manifestations following SARS-CoV-2 vaccination
Arvind Nune, Hem Raj Sapkota, Karthikeyan P Iyengar
June 2022, 17(2):214-215
  666 62 -
Glucocorticoids in rheumatology
Shrikant Wagh
June 2022, 17(2):224-224
  666 57 -
Granulomatosis with polyangiitis and COVID-19 pneumonia
Arvind Nune, Karthikeyan P Iyengar, D Mulherin, Pranav Ish, CA Musat, Hem Raj Sapkota
June 2022, 17(2):210-212
  640 57 -
New-onset henoch–Schonlein purpura after COVID-19 vaccination
Rija Mathew Roy, Anna Mani, Joseph John, Thomas Antony, Lydia Jacob
June 2022, 17(2):206-207
  616 56 -
Coronavirus Disease-19 associated arthritis – An observational study
Debanjali Sinha, Sumantro Mondal, Alakendu Ghosh
June 2022, 17(2):153-156
Background: The coronavirus disease or COVID-19 pandemic is the major global health crisis of the present time. Various rheumatological manifestations have been reported during or after COVID-19 infection, but data are scarce. In this observational study, we have tried to analyze the clinical characteristics of COVID-19 associated arthralgia/arthritis. Methods: We have collected the clinical data of 14 patients over the past 6 months who have developed arthralgia or arthritis during or after symptomatic COVID-19 infection, proven by a positive reverse transcription-polymerase chain reaction test from nasopharyngeal swab. Results: The most common symptoms during COVID-19 infection in the 14 patients were fever and myalgia, being present in 92.8% and 64.3% patients, respectively. Arthralgia/arthritis occurred at a mean interval of 20 days (range: 0–60 days). Knee was the most commonly involved joint (78.6%), followed by the wrist and metacarpophalangeal joints (each in 57.1%). Enthesitis was documented in 21.4% patients. The mean duration of COVID-19 associated arthralgia or arthritis was 53.9 days (range: 7–210 days). In 85.7% patients, joint pains improved within 2 months; in only a small proportion of patients (14.3%), joint pains persisted after 6 months. Nonsteroidal anti-inflammatory drugs (NSAIDs) (given in 64.3% patients) and corticosteroids (in 50%) were the most commonly prescribed and effective treatment options. Conclusion: COVID-19 infections mostly caused reactive arthritis, though acute and chronic arthritis is also seen. In the majority of cases, arthritis started about 3 weeks after COVID-19 infection and subsided within 2 months. NSAIDs and corticosteroids are the most effective treatment options.
  598 52 -
Arterial stiffness in rheumatoid arthritis: Current knowledge and future perspectivess
Panagiota Anyfanti, Eleni Bekiari, Elena Angeloudi, Eleni Pagkopoulou, George D Kitas, Theodoros Dimitroulas
June 2022, 17(2):157-165
Rheumatoid arthritis (RA) is characterized by the excess cardiovascular risk that remains essentially unaltered despite current medical advances. The introduction of reliable markers towards early identification and subsequently effective management of high-risk patients with RA are urgently needed. Arterial stiffness represents an early indicator of cardiovascular morbidity and mortality and has emerged as a surrogate marker of cardiovascular disease. From a pathophysiological perspective, it is significantly accelerated by the accumulation of cardiovascular risk factors and is considered an intermediate process towards the development and progression of atherosclerotic cardiovascular disease. The aim of this review is to critically upraise current knowledge on arterial stiffness in patients with RA. Although not all studies concur, increased Pulse Wave Velocity (PWV) has been repeatedly reported in patients with RA. However, results need to be interpreted with caution as most studies enrolled patients with multiple cardiovascular risk factors and/or established cardiovascular disease, or with uncontrolled RA with high levels of systemic inflammation. Whether and to which extent increased arterial stiffness among patients with RA is associated with the disease per se, or rather represents the composite effect of hypertension and other classical cardiovascular risk factors, warrants further investigation. The impact of antirheumatic drugs on arterial stiffness is also discussed. Considering the well-established predictive value of increased PWV both in the general population and patients at high cardiovascular risk, future studies need to focus on the clinical utility of this surrogate risk marker specifically in patients with RA.
  585 42 -
Clinical characteristics and outcomes of macrophage activation syndrome among patients attending a rheumatology tertiary care center in North India
Rasmi Ranjan Sahoo, Manesh Manoj, Prashant Bafna, Kasturi Hazarika, Anupam Wakhlu
June 2022, 17(2):149-152
Background: Macrophage activation syndrome (MAS) is a potentially fatal condition complicating several rheumatologic disorders. This retrospective analysis studied the clinical characteristics and outcomes of patients diagnosed with MAS from a rheumatology tertiary care center. Methods: Pediatric and adult patients diagnosed with rheumatologic disorders and fulfilling the 2016 European League against Rheumatism/American College of Rheumatology classification criteria for MAS associated with systemic juvenile idiopathic arthritis (sJIA) or the hemophagocytic lymphohistiocytosis (2004) criteria, as appropriate, were included over a period of 1 year. Detailed clinical history and laboratory parameters were extracted from the patients' records. Treatment details, duration of hospitalization, and outcomes were recorded. Results: The study included nine patients (five males and four females) with a median age of 27 years, range 10–48 years. The median duration of illness was 6 months, range 2–60 months. Five patients were diagnosed with systemic lupus erythematosus, two patients with adult-onset Still's disease, and one each with sJIA and sarcoidosis. Infection (three patients), malignancy (one patient), and uncontrolled or aggressive disease (five patients) were recognized as the possible precipitating factors. Three patients had pancytopenia at presentation, whereas bicytopenia was observed in five patients. Hemophagocytosis on bone marrow biopsy was seen in seven patients. The median duration of hospital stay was 3 weeks, range 2–4 weeks. High-dose steroids were administered to all patients, along with oral cyclosporine in seven patients. One patient was given weekly etoposide infusion for unabated MAS. Two patients expired. Conclusion: Prompt diagnosis and aggressive treatment strategy are pivotal for improving prognosis in MAS complicating rheumatologic disorders.
  556 43 -
Unilateral retinopathy in a case of systemic lupus erythematosus
Pradeep Kumar Panigrahi, Lipika Mehra
June 2022, 17(2):202-203
  559 40 -
Childhood-onset enthesitis-related arthritis leading to nephrotic syndrome due to secondary amyloidosis complicated by acute pulmonary embolism - The domino effect
Vishal Mangal, Bhaskar Datt, Arun Hegde, AW Kashif, Ankit Kumar, Jaspreet Kaur, Nidhi Goel, Anil Shankar Menon
June 2022, 17(2):180-185
The prevalence of Juvenile idiopathic arthritis (JIA) in India is 0.001% among the population under 16 years old and 0.00029% among the total population. Of the total JIA population, enthesitis-related arthritis (ERA) constitutes 35% of the cases. In the past, chronic infections, mainly, tuberculosis were the most common cause of AA amyloidosis in India; however, chronic inflammatory arthropathies have become the most common cause of AA amyloidosis in India over the past three to four decades. In 95% of the patients with AA amyloidosis, the kidney is the most affected organ presenting as proteinuria of nephrotic syndrome. The prevalence of AA amyloidosis in JIA is estimated to be 7.7% and 3.1% among the ERA group, making it an infrequent association. This translates to one case of AA amyloidosis secondary to ERA per 1,00,000,00 population in India. Similarly, the incidence of pulmonary thromboembolism in patients with nephrotic syndrome is 7.8%. We present a case of a young male who was diagnosed with JIA-ERA at the age of 13 years with multiple flares in childhood had now developed nephrotic syndrome secondary to AA amyloidosis demonstrated on renal biopsy complicated by acute pulmonary embolism and occult hepatitis B infection. He was managed with anti-tumor necrosis factor inhibitor therapy with a favorable outcome. This is the first such case of multiple rare associations occurring together in a single patient to the best of our knowledge.
  521 48 -
Bacillus calmette–Guérin scar inflammation after COVID vaccination
BN Shiva Prasad
June 2022, 17(2):170-173
Bacillus Calmette–Guérin (BCG) scar inflammatory reactions have been commonly reported with Kawasaki disease in children and less commonly with other viral infections. Postvaccination BCG scar inflammation has only been reported with the influenza vaccine. Two cases of post-COVID vaccination BCG scar inflammation has been recently reported. we report a case of BCG scar inflammation appeared after 24 h of vaccination of both the doses of vaccine.
  471 59 -
Hydroxychloroquine in COVID-19 widespread use despite unproven benefit
Pranav Ish
June 2022, 17(2):213-213
  472 36 -
Comment to “Does gender gap exist in indian rheumatology? Analysis of faculty gender representation at its annual conferences” by Mohansundaram et al.
Sahla Sathar, Nivedita Jha, Molly Mary Thabah
June 2022, 17(2):200-201
  480 27 -
Optimizing corticosteroid therapy in takayasu arteritis
Pallavi Patro
June 2022, 17(2):199-199
  450 39 -
Anti-synthetase syndrome masquerading as COVID-19
Rajat Kharbanda, Neeraj Jain, Latika Gupta
June 2022, 17(2):208-209
  414 36 -
Assessing the risk of retinopathy in indian patients using hydroxychloroquine for rheumatic and musculoskeletal diseases: A retrospective observational study – Reply
Arindam Nandy Roy, Vinitha Samala, Yarram Ashok Kumar, Syeda Sana Fatima
June 2022, 17(2):204-205
  341 31 -