Arghya Chattopadhyay

Background: Sjögren’s disease (SS) is a chronic autoimmune disease with an estimated global prevalence of 6.9 per 100,000 person-years. However, population-based data from India are lacking. Information on reproductive health in Indian women with SS, particularly concerning marital status and pregnancy outcomes, is limited. Objective: To assess the impact of marital status on clinical and reproductive characteristics in women with SS and to compare pregnancy outcomes before and after disease onset among married women in India. Methods: This multicentre prospective observational study used data from the Indian Rheumatology Association (IRA) registry across seven centres. Female patients fulfilling the 2016 ACR/EULAR criteria for primary SS were included. Data on demographics, menstrual and reproductive history, and disease characteristics were collected using structured proformas. Reproductive health indicators were calculated using standard epidemiological methods. Results: Of 124 records, 115 female patients were included in the final analysis. The mean age at recruitment was 49.63 ± 10.31 years. The mean age at menarche was 13.74 ± 1.08 years, and 78.3% reported regular menstrual cycles. The mean age at disease onset was 41.34 ± 9.74 years, with a mean illness duration of 8.43 ± 5.4 years. Among married women ( n = 112), there were 236 pre-disease pregnancies resulting in 212 live births, with a CFR of 1.89. Pregnancy wastage ratio was 80.51 per 1,000 pregnancies, and stillbirth and abortion rates were 4.71 per 1,000 live births and 76.27 per 1,000 pregnancies, respectively. Vaginal delivery was the most common mode. Due to the very small number of unmarried participants ( n = 3) and those with pregnancy after disease onset ( n = 1), comparative analysis was not performed. Conclusion: Reproductive events in women with SS predominantly occurred before disease onset. Marital status was associated with age at diagnosis but not with adverse reproductive outcomes.

Objectives Systemic lupus erythematosus (SLE) significantly impacts patients’ lives beyond the traditionally chased outcomes of mortality and organ damage. Increased access to social media has aided health information dissemination, but a gap remains between patient and physician perspectives. This study explores the online trends on SLE to identify the overall theme of community engagement. Methods An online social listening tool (Brand24) was utilised by two rheumatologists in this cross-sectional study to search for keywords related to lupus and diabetes. Data on reach, engagement, themes and sentiments were extracted over 3 months between June and September 2024. Ethical considerations were maintained by accessing public domain data, and thematic content analysis was performed. Results Content on SLE had an expectedly lower number of mentions compared to diabetes (85,662 vs 405,000), but with a substantial reach (289 million). User-generated content formed most of the lupus-related discussions online, and sentiment analysis revealed a higher proportion of positive connotations on SLE topics (21% vs 11%). Key themes in SLE were related to the burden of chronic illnesses and celebrity influences. Unsurprisingly, unverified sources of online content had a notable influence on the themes, too. Conclusion Despite the low prevalence, the online footprint of SLE is quite notable. Discussions and themes range from personal experience to online support. Celebrity voices and unverified sources can shape social media content. These findings highlight the need for healthcare professionals to think of social media strategies to minimise misinformation and provide credible guidance. Key Points • Mentions of lupus have a surprisingly strong online presence, more than its prevalence would suggest. • Celebrities and unverified sources often shape the online narrative on lupus. • The tone of lupus-related posts is more positive than expected, revealing patient identities centred around resilience and community.

Macrophage activation syndrome (MAS) with hypoplastic marrow is a rare but life-threatening presenting manifestation of systemic lupus erythematosus. Lupus orbitopathy is also very rarely reported in the literature. We hereby report for the first time a 19-year-old girl who had a unique combination of MAS, with hypoplastic marrow and orbitopathy as a presenting feature of lupus. We discussed in detail our patient’s demographic characteristics, clinical features, treatment, and outcome. Our patient responded well to high-dose glucocorticoids along with 6 monthly doses of intravenous cyclophosphamide as per the modified National Institute of Health protocol followed by tacrolimus as maintenance treatment. Her prednisolone dose could be tapered to 7.5 mg daily after 8 months of treatment. We made a search on PubMed and Scopus for a literature review. We obtained 15 cases of MAS as a presenting feature in lupus, of which four had associated hypoplastic marrow. Males and juvenile age groups were equally affected with MAS as a presenting feature of lupus. Most of the patients responded to high-dose glucocorticoids. Only one patient succumbed to MAS. We also reviewed 14 cases of lupus orbitopathy with their clinical, and imaging characteristics, treatment, and outcome. Females predominated in these cases with the mean age being 43.6 years (SD ± 16.9 years). Treatment with glucocorticoids and immunosuppressive agents lead to complete resolution in most patients. The diagnosis of MAS with orbitopathy as a presenting feature of lupus in a 19-year-old girl poses a diagnostic challenge and requires the prompt exclusion of the common mimickers before initiation of aggressive immunosuppression.

To compare the efficacy of methotrexate and apremilast in psoriatic arthritis (PsA). This Single blinded (physician), parallel group, randomized controlled trial was conducted at a single centre between October 2019 and December 2020. Adult PsA patients (age > 18 years), fulfilling CASPAR criteria, not on methotrexate/apremilast in last 3 months and never receiving bDMARDs or, JAK inhibitors, having active articular disease (one or more swollen joint or, having one or more tender entheseal point) were recruited. Primary outcome measure was rate of major cDAPSA response at week 24 and secondary outcome measures were ACR 20 response, change in PASI score, Maastricht enthesitis score, Leeds dactylitis index, and health assessment questionnaire-disability index (HAQ-DI) and number of adverse events at week 24 between methotrexate and apremilast groups. A total of 31 patients were recruited (15 in the apremilast arm and 16 in the methotrexate arm) amongst whom 26 patients completed 24 weeks follow up (13 patients in the apremilast arm and 13 patients in the methotrexate arm). Median cDAPSA score at baseline was 23 (9) in the apremilast group and 20 (21) in the methotrexate group. No difference in major cDAPSA response at week 24 was observed between apremilast and methotrexate arm (20% vs. 37.5%; p = 0.433). In the secondary outcome measures, there was no significant differences between both the groups. Both the drugs were safe without any serious adverse events. There was no significant difference between methotrexate and apremilast in terms of efficacy as measured by cDAPSA and ACR20 responses.