Internet Journal of Rheumatology and Clinical Immunology

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https://imsear.searo.who.int/handle/123456789/149653

Editor in Chief: Prof Dr. Ramnath Misra

ISSN: 2320 – 7221 (Online)

Frequency: 1 issue a year

Language: English

Open Access Online Peer-reviewed journal

Web site: https://www.chanrejournals.com/index.php/rheumatology/index/

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Now showing 1 - 20 of 25

A rare presentation of systemic lupus erythematosus associated with thymoma-induced multiorgan autoimmunity
(Chan Re Journals, 2024-01) Oak, Jyotsna; Unavane, Ojas; Subramanian, Aditya; Kulkarni, Bijal; Mistry, Rajesh
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women in their reproductive age. Its typical manifestations include cutaneous symptoms such as alopecia, malar rash, and generalized rash, as well as oral ulcers. The study focuses on a challenging diagnostic case involving an atypical presentation of SLE associated with thymoma-related multiorgan autoimmunity.
Wilson’s disease with anti-CCP positive rheumatoid arthritis: A rare co-existence
(Chan Re Journals, 2023-01) Haridas, Vikram; Haridas, Kiran
Wilson’s disease, a rare autosomal recessive disorder, is characterized by the excessive accumulation of copper in the brain, liver, and other tissues. The present case study deals with a rare co-occurrence of anti-CCP positive RA and Wilson’s disease.
ENT manifestations of Sjogren’s syndrome: A narrative review
(Chan Re Journals, 2024-01) T, M Amulya; Devil G, Nivetha; Mamadapur, Mahabaleshwar; Pragya, Varuni
Sjogren’s syndrome (SS) is an autoimmune condition marked by dryness of the mouth and eyes, frequently manifestingas a range of ENT symptoms that have a major negative impact on the quality of life of patients. Dryness and discomfortin the mouth and eyes, brought on by lacrimal and salivary gland dysfunction are ENT symptoms in SS. However, ENTregions are involved in more areas than just the ocular surface and mouth cavity. Due to aryngopharyngeal involvement,patients may experience hoarseness, dysphagia, and the sensation that something foreign is in their throat. Commonnasal symptoms include nasal dryness, congestion, and recurrent sinusitis, while Eustachian tube dysfunction can leadto middle ear infections and hearing problems. To improve the quality of life in SS patients, clinicians and healthcareprofessionals should be careful in identifying and treating these symptoms. More investigations and clinical trials arerequired to create tailored medicines that can reduce ENT symptoms and enhance long-term outcomes for SS patients.
Mediastinal fibrosis as a puzzling presentation: A clinical conundrum in rheumatology: A case report
(Chan Re Journals, 2024-01) Zope, Aarti A; Akerkar, Shashank M; Akerkar, Prajakti S
Granulomatosis with polyangiitis (GPA) is a type of small vessel vasculitis, most commonly involving the respiratory tract and kidneys. It can occasionally present with mass-like lesions at various sites, including the brain, orbit, skin, genitals, retroperitoneum, and mediastinum. Presentation with mediastinal fibrosis is rare and less commonly recognized. The current study presents the case of a mediastinal mass causing pulmonary artery compression and subsequent pulmonary hypertension (PH) that required stenting. Despite inconclusive mediastinal biopsy results, the integration of clinical, radiological, and laboratory findings led to the diagnosis of ANCA-associated vasculitis, highlighting the challenges and necessity of a multi-modal diagnostic approach in real-world clinical scenarios. This case underscores the importance of considering ANCA-associated vasculitis as a potential etiology in patients presenting with mediastinal fibrosis. Early recognition and appropriate management are crucial in optimizing outcomes for patients with this rare and challenging manifestation.
A rare presentation of essential thrombocytosis masked as vasculitis
(Chan Re Journals, 2024-01) Haridas, Vikram; Haridas, Kiran
This case study presents the clinical journey of a 37-year-old woman who previously experienced gangrene in her fingers and toes. Initial assessments revealed elevated total white blood cell count and platelets, coupled with low hemoglobin levels. Despite normal inflammatory markers and negative results for antiphospholipid syndrome, antinuclear antibodies, and anti-neutrophil cytoplasmic antibodies, arterial Doppler imaging displayed no abnormalities. Suspecting vasculitis, the patient was initially treated with steroids and aspirin. However, subsequent investigations revealed essential thrombocytosis, a myeloproliferative disorder, confirmed by a positive JAK2 gene mutation. This case underscores the complexity of diagnosing rare hematological disorders and the importance of comprehensive evaluations for accurate treatment strategies.
Hyperinflammatory syndrome: Two viruses, similar story
(Chan Re Journals, 2023-01) Ramachandran, Veena; S, Chandrashekara; Kori, Devaraj; J, Prakruthi
Objective: In countries where the co-existence of both dengue fever and COVID-19 infection is predominant, it is often difficult to clinically distinguish between the two entities. The present study highlights the similarities and differences between these viral diseases through two cases. Results: The first case was of a 38-year-old hypertensive and diabetic female, diagnosed with dengue hemorrhagic fever with leucopenia and thrombocytopenia (26000/mm3). HRCT chest revealed diffuse mosaic attenuation and small pleural effusion in both lower lobes. Elevation in D-dimer and deranged liver function test were noted. One-month follow-up revealed that she had persistent fever, fatigue, and musculoskeletal and psychological symptoms. Her symptoms improved with hydroxychloroquine 400 mg/day and a tapering course of steroids.The second case was of a 57-year-old hypertensive male, who presented with resolved mild COVID infection, blanching rash over the dorsal aspect of both hands with active synovitis around left wrist, elbow, and right ankle, and severe painful restriction of the joints. Positive COVID IgG, increased inflammatory parameters, and raised ferritin were noted. The patient showed symptomatic improvement with gradual reduction in inflammatory parameters following tapering dose of steroids and hydroxychloroquine treatment.Conclusion: Persistence of symptoms and increased inflammatory parameters were noted in both cases post viral clearance, suggesting a non-degenerative immune response, leading to collateral damage. The treating physicians should consider such a possibility and treatment with glucocorticoids in this scenario would be prudent.
Dilemmas of recurrent ocular inflammatory disease on immunosuppression and corona virus disease vaccination
(Chan Re Journals, 2023-01) Sanjay, Srinivasan; Devi, Sathi; Kumar, Sharath; Kawali, Ankush; Mahendradas, Padmamalini
The current study explores the occurrence of ophthalmic manifestations following coronavirus disease-19 (COVID-19) vaccination. The study discusses the case of a 72-year-old Indian male, who received oral methotrexate for ocular inflammation (recurrent post-operative uveitis with pseudoexfoliative glaucoma) and two doses of COVISHIELD™ vaccine and a booster in 2022. While he discontinued methotrexate for 2 weeks after the first dose, he continued the medication during the second and booster doses. Subsequently, he experienced mild ocular inflammation two weeks after the first dose, one day after the second dose, and one week after the booster dose. Topical steroids effectively controlled the inflammation, and an increased oral methotrexate dosage was used after the second dose. The study highlights the potential for autoimmune inflammatory syndrome following vaccination, although a definite causal link cannot be established. Nonetheless, the presence of side effects should not discourage individuals from receiving vaccinations.
Late-onset rheumatoid arthritis (LORA)
(Chan Re Journals, 2023-01) Benjamin, Dominic; KR, Chaitra; John, Vinod Kumar Manohar
The proportion of older adults (>65 years of age) has been on the rise. According to the global estimates, there were 700 million elderly subjects (aged 65+) in 2019. The overall number of elderly is expected to increase 2-fold in the next three decades to reach around 1.5 billion by 2050. Presentation of autoimmune disorders like rheumatoid arthritis (RA) is often misunderstood and misdiagnosed in this population due to varied presentations. Diagnosis is often challenging in elderly due to the common presentations of aches and pain despite various underlying etiologies. The acute onset of polyarthritis in elderly is associated with prominent myalgia, fatigue, low-grade fever, weight loss, and depression. Less often, extraarticular manifestations such as nodules or episcleritis may also be present. It is important to understand the altered mechanisms and presentations of existing diseases in younger adults and their manifestations in elderly. The present review article highlighting the varied presentations of RA in elderly may help clinicians in customizing the treatment modalities to address the associated complications.
Dietary beliefs of patients with rheumatoid arthritis: Which food items do they think worsen their disease?
(Chan Re Journals, 2023-01) V, Shaleni; Salim, M. Salih; J, Ramya; Shobha, Vineeta
Introduction Dietary factors have been linked to the development of rheumatoid arthritis (RA) and efforts have been made to mitigate its inflammatory burden through dietary manipulations. MethodsThe cross-sectional, descriptive study conducted at a tertiary care referral hospital in Bengaluru, India, evaluated the dietary habits of participants using a structured questionnaire administered by a nutritionist in the outpatient department.Results The study included 100 patients (91 women) with a mean age of 46.95 (± 10.65) years and a mean illness duration of 60 (±71.41) months. The BMI categories showed 16 individuals classified as overweight, and 40 in the type 1 obese category. Forty-four patients believed that articular symptoms were influenced by their diet. Among the perceived trigger foods, roots and tubers were reported by 25 patients, while legumes, poultry, and egg products were mentioned by a smaller number of patients. Almost half of the selected patients had self-experimented with their diet to reduce articular symptoms, primarily with food items such as potatoes, tubers, poultry, and eggs.Conclusion Patients with RA frequently self-experiment with diet modification, specifically targeting tubers and poultry in an attempt to reduce articular symptoms. Taking cue from this, structured diet elimination could be considered in the future.
A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis
(ChanRe Healthcare, 2019-02) Haridas, V; Haridas, K
Sacroiliitis is considered as the most important sign of spondyloarthropathy. Rheumatoid arthritis mainly affects peripheraljoints and the involvement of sacroiliac joint is very rare. The present case study discusses the rare existence of RA andconcurrent chronic bilateral sacroiliitis.
Extensive oral telangiectasias in systemic sclerosis
(ChanRe Healthcare, 2019-04) Gupta, M; Sharma, RK; Singh, A; Thakur, S
The word telangiectasia is derived from tel- end, angos- vessels and ectasis- dilatation. Telangiectasia can be primary orsecondary. Connective tissue diseases like systemic sclerosis, dermatomyositis and systemic lupus erythematosus maybe associated with secondary telangiectasias. Systemic sclerosis presents with mat-like telangiectasias over face, handsand rarely oral mucosa. The present study discusses a case of extensive oral telangiectasias without significant sclerosisover face.
Venous malformation of lower limb with hypertrophy of limb, early terminalization of hair and hyperhidrosis
(ChanRe Healthcare, 2019-06) Gupta, M; Sharma, R; Tegta, GR; Gupta, A
Vascular anomalies are the commonest developmental disorders. Venous malformations (VM) result due todysmorphogenesis in the development of veins. Most commonly these disorders are localized to skin and subcutaneoustissue. Deeper venous malformation may affect the underlying muscle, bone and joints. Early terminalization of hair andincreased sweating in VM plaque has been rarely reported. The present study deals with the case of a 15-year-old boywho had VM involving skin, subcutaneous tissue and bones with terminal hair and increased sweating over the plaque.Radiological examination showed bone hypertrophy with slow flow channels and phleboliths due to superficial and deepVM. He was treated with ethanol sclerotherapy.
Lepromatous leprosy or rheumatoid arthritis with leprosy? A challenging case
(ChanRe Healthcare, 2019-04) Bharathraj, MY; Chandrashekara, S; Ghanti, S; Kori, D; Krishna, R
Rheumatoid arthritis (RA) manifestations in leprosy are very common, but often undiagnosed. The present study discussesa challenging case having dilemma in concluding the diagnosis as lepromatous leprosy or RA with leprosy
Managing chikungunya arthritis using etanercept
(ChanRe Healthcare, 2019-08) V, Haridas; K, Haridas
Chikungunya virus or Aedes-borne alpha virus causes infection through an acute viremic phase and can be complicatedwith a chronic arthritis phase. The present case highlights the benefits of using etanercept for managing chikungunyaarthritis, especially in scenarios where NSAIDS and steroids are contraindicated due to multiple comorbidities.
A study of clinical profile in female spondyloarthropathy
(ChanRe Healthcare, 2019-11) Oak, Jyotsna; Patil, L.N
Objective: To assess the clinical features of SpA including BATH indices and to compare clinical data of male and femalespondyloarthropathy patients.Methods: The study included male and female patients (60 each) fulfilling the European Spondyloarthropathy StudyGroup (ESSG) or assessment of ankylosing spondylitis (ASAS) criteria for SpA and the CASPER criteria for PsA or themodified New York criteria for AS. The subjects completed initial clinical evaluation and radiological and laboratoryassessment.Results: The mean age of presentation was found to be higher in females (34.6± 9.6 years). Backache was the mostcommon features identified in both the groups. Peripheral arthritis was present in 51.7% of total patients (56.7% malesand 46.7% females). Asymmetrical lower limb arthritis was found to be more predominant; however, 10% of the patientsreported involvement of wrist. Psoriasis and inflammatory bowel disease, and uveitis were noted in 13 (7 males and 6females), three (1 male and 2 females) and 14 patients (9 males and 5 females) respectively. Dorsal and neck pain werefrequently prevalent among the patients.Conclusion: Though the severity of symptoms and disability are comparable across both the genders, females haveincreasingly been diagnosed with SpA. Most common symptom of presentation is low back pain followed by gluteal pain.Peripheral arthritis, predominantly lower limb oligoarthritis is common in Indian population when compared to theirwestern counterparts.
Successful treatment of POEMS syndrome in a young male with stem cell transplantation
(ChanRe Healthcare, 2020-05) Oak, J; Shah, I; Pandey, A; Das, T; Tulpule, S
POEMs syndrome is a rare paraneoplastic disorder related to plasma cell dyscrasia. The present study deals with anunusual case of POEMs syndrome in a young male who came with ascending demyelinating polyneuropathy, resultingin complete quadriparesis. The diagnosis was based on clinical findings of gynecomastia, hyperpigmentation andhypertrichosis of skin and lymphadenitis. Detailed laboratory investigations and imaging confirmed POEMS syndrome.In view of the rapidly progressing polyneuropathy, the patient was treated with chemotherapy followed by stem celltransplantation. The patient recovered completely after the treatment.
Patterns of drug use and factors affecting adherence to medication in patients with rheumatoid arthritis: A prospective, observational, hospital- based study
(ChanRe Healthcare, 2019-11) P, Bharthi; V, Shobha; A, Subramanya
Introduction: RA affecting ~ 1% of the world population, is associated with high level of non-adherence in clinical practice.The adherence to RA treatment therapy is affected by multiple factors. The present study evaluated the factors affectingadherence to medications among RA patients.Methodology: The prospective study was conducted from April 2014 to March 2015. Male and female subjects, aged≥18 years, and diagnosed with RA were included in the study. Demographic data, disease- and treatment-related data,adverse event profile and investigation data were obtained from all the participants. Adherence to medication of thesubjects was measured using adherence questionnaire. All the subjects were followed up at one month and at the end of6 months. McNemar’s test was used to analyse the difference in adherence from baseline to follow up. All the statisticalanalyses were performed using SPSS statistical software, version 17.0.Results: The study included 124 subjects, with a male to female ratio of 0.25:1, mean age of 45 years and RA duration of5 years. Mono and combination drug therapies were used in 59.1% and 41.9% of the subjects respectively. Methotrexatewas the most frequently used drug as a part of the regimen (82.3%). Among the subjects, 88 (71%) were found to beadherent. The comparison of various factors revealed significant difference only for the duration of RA (P 0.04).Conclusion: The adherence to antirheumatic medications among RA patients remains moderate and factors such asrural residence and older age (>45 years) can be associated with good adherence to RA medication. The study alsocorroborates the previous literature evidence suggesting methotrexate as the commonly used drug for managing RA.
Commentary: A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis
(ChanRe Healthcare, 2020-01) Commentary, Dalal A.
Acute lung involvement in RA is not always ILD
(ChanRe Healthcare, 2019-06) SC, Ghanti; S, Chandrashekara; Raj, B; Kori, D; R, Giri
Rheumatoid arthritis is a systemic inflammatory disorder with diverse extra-articular manifestations including vasculitis,lung disease, inflammatory eye disease and subcutaneous nodule formation. Among these manifestations, lung diseasehas been identified as a primary contributor of morbidity and mortality. The predominance of non-specific interstitialpneumonia pattern has been observed in most forms of connective tissue-associated ILD. Studies have demonstratedthat the usual interstitial pneumonia (UIP) pattern is more prevalent among patients with RA-associated ILD. The extraarticular manifestations have been noted in nearly 50% of the patients, and the lung involvement in majority of thecases.8, 9 This study details the occurrence of lung involvement of viral etiology in RA, which could be misdiagnosed asRA-associated ILD
Rebuttal: A rare co-occurrence of anti-CCP-positive rheumatoid arthritis with sacroiliitis
(ChanRe Healthcare, 2020-04) Haridas, VM

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