Latika Gupta

Epidemiology: Time to revisit the concept of reactive arthritis

The changing microbial and clinical profile of reactive arthritis suggests that rheumatologists need to reconsider the approach to its identification and treatment.

Cutis marmorata persisting into adulthood

The differential diagnosis of livedoid rashes in an adult includes a broad range of conditions. Persistence of physiologic cutis marmorata into adulthood is noted in certain cases. Fine retiform rash, appearing on cold exposure, is one of the characteristic features. Fixed asymmetric livedo with secondary skin changes or associated systemic symptoms could be a harbinger of underlying anti-phospholipid syndrome or vasculitis.

Poor quality of life in Indian ankylosing spondylitis patients

Background: Ankylosing Spondylitis (AS) is a chronic inflammatory disease that leads to significant disability. We sought to study the impact of the disease activity and functional impairment on QoL in Indian patients with AS. Methods: World Health Organization- Quality of Life-BREF (WHOQoL-BREF) questionnaire was used to measure quality of life (QoL) in 99 adults with AS (modified Rome criteria), 72 healthy individuals, and 20 rheumatoid arthritis patients. Apart from demographic variable such as age, gender, clinical manifestations, and treatment received, disease activity parameters such as duration of early morning stiffness, BASDAI, swollen and tender joint count, Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) were also recorded. Presence of damage was assessed using spinal radiographs. All values are in median (IQR). Results: Out of the 99 patients, 5 were females and 5 had juvenile onset AS. Median age was 32 (26-42) years and median disease duration was 6 (1.25-10) years. Forty-three had peripheral arthritis and 18 had enthesitis. Syndesmophytes were present on spinal radiographs in 54 cases. BASDAI correlated negatively with the physical, psychological and environmental domains (P Conclusion: Indian AS patients have poorer quality of life than patients with rheumatoid arthritis and healthy individuals, possibly due to poor control of disease activity.

Tenascin-C, a biomarker of disease activity in early ankylosing spondylitis

Monocytes of patients with ankylosing spondylitis (AS) over-express toll-like receptor (TLR) 4. Tenascin-C (TNC) is an endogenous TLR4 ligand. Thus, we studied the serum and synovial fluid levels of TNC in AS. TNC was measured in serum of 36 AS patients (ASAS 2010 criteria) and 39 healthy controls by ELISA. Twenty-two patients were followed up after 3 months of standard treatment. Five paired serum-synovial fluid samples were also analyzed. Disease activity was assessed by BASDAI, ASDAS, swollen joint count, ESR, and CRP. All values are in median (IQR). Median age was 30 (20–35) years, and disease duration was 5.5 (1.3–10) years. Thirty-one were male. Twenty-five (69.5%) had peripheral arthritis. Median BASDAI was 5.3 (3.3–6.7). HLA B27 was positive in 34 (94.5%) cases. Median serum tenascin C levels were higher in AS [578.5 ng/ml] as compared to healthy controls [32.88 ng/ml, p < 0.0001]. Serum tenascin C levels correlated with ASDAS ESR [r = 0.367, p = 0.028] and ESR [r = 0.39, p = 0.035]. In patients with early disease (duration ≤ 5 years), serum levels had better correlation with ESR [r = 0.59, p = 0.009] and CRP [r = 0.479, p = 0.044]. On ROC analysis for active (PhGA ≥ 6) vs. inactive (PhGA ≤ 4) disease, tenascin-C (AUC = 0.60) performed as well as CRP (AUC = 0.65) and ESR (AUC = 0.73). Synovial fluid levels [11.61 (5.99–176.9) ng/ml] were lower than in serum [627.4 (488.5–779.1) ng/ml, p = 0.008]. Tenascin C fell levels with treatment [n = 11, 630.8 ng/ml to 376.4 ng/ml p = 0.0006] in treatment responders but not in non-responders [n = 11, 562.3 to 445.6, p = 0.33]. Serum TNC levels are raised in AS and may serve as marker of inflammation in early disease.

Ganglion Cyst of the Hoffa Fat Pad

Submit Manuscript | http://medcraveonline.com knee. Range of motion of the right knee was from 0° to 125° with pain at the extreme of flexion. There was full extension and flexion to 135° in the contralateral left knee. Palpation of the joint line elicited no tenderness or palpable masses. There was no varus or valgus instability of the right knee. Anterior and posterior drawer tests were negative. The Lachman’s test was also negative. Neurologic examination of the lower extremity revealed no deficits and the dorsalis pedis and posterior tibialis pulses were symmetric in both lower extremities.

Leprosy in the rheumatology clinic: an update on this great mimic

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. The first description of the disease dates back to the 6th century BC by Indian surgeon Sushruta. The invasion of Asia by the armies of Alexander the Great saw the spread of the disease across Europe. Leprosy now remains endemic predominantly in the developing world, with pockets of high prevalence identified in Brazil, Indonesia and India (South-east Asia [SEA]). Together, these three countries account for 80% of all newly registered cases. Although the number of new cases detected globally has been on the declining trend, it remains a major problem in some of developing countries. Improved connectivity across the continents has led to increasing global travel, and case reports of this disease amongst the migrants have surfaced in developed nations as well. These are likely to be missed by unaware physicians. The use of newer immunosuppressants, anti-tumor necrosis factor in particular, have also been associated with reports of leprosy. Early diagnosis and full course of treatment are critical for prevention of lifelong neuropathy and disability in these cases. Although a vast majority of cases manifest with dermatologic and neurologic features, musculoskeletal manifestation are also quite common. The prevalence of rheumatic manifestations in leprosy varies across case series, ranging from 1–2% described in large dermatology series to 60–80% from rheumatology clinics. This wide variability in the reported prevalence suggests that documentation of rheumatologic signs and symptoms depends on the specialty in which the patient is being treated, and rheumatic manifestations of leprosy as a whole is often under-reported by non-rheumatology services. Therefore, it is a felt need for awareness of the condition among rheumatologists, as joint involvement can be the only manifestation in some cases.