Madhumitha Rondla

Objective: Gut microbiota dysbiosis has been implicated in the pathogenesis of autoimmune and immune-mediated arthritis. Biologics may influence gut microbiota composition; however, it is uncertain whether biologics act directly on microbial communities or indirectly through disease modulation and restoration of immune homeostasis. This systematic review explores how biologic therapies modulate gut microbiota in autoimmune arthritis and their potential as biomarkers for treatment response and disease activity. Methods: We searched PubMed, Scopus, Cochrane Library, and Web of Science for studies assessing gut microbiota changes induced by any biologic therapy in immune-mediated or autoimmune arthritis. The outcomes included changes in microbiota and the potential for microbiota as predictive biomarkers for treatment response and disease activity. Results: A total of 12 studies were included. Biologic agents, predominantly tumor necrosis factor inhibitors and interleukin 17 inhibitors, significantly altered gut microbiota composition and diversity, with most studies showing increased α-diversity and normalization of β-diversity post therapy; however, these effects were not uniformly consistent. Treatment restored beneficial short-chain fatty acid–producing taxa, including Faecalibacterium prausnitzii , Megamonas , Lachnoclostridium , and Blautia , while reducing inflammatory genera such as Escherichia - Shigella and Klebsiella . Certain taxa, notably Lachnospiraceae and Megamonas , correlated with clinical improvement and reduced disease activity. Conclusion: Biologic therapy modulates gut microbiota composition in autoimmune and immune-mediated arthritis, promoting a shift toward eubiosis. Specific microbial taxa, including Lachnospiraceae , Blautia , and F. prausnitzii , show potential as noninvasive biomarkers for treatment response and disease activity. These findings guide further longitudinal and interventional studies to validate microbial signatures and their clinical applicability.

Objective We aimed to review the literature on the clinical presentation, renal pathology, treatment, and outcome of renal manifestations in adult-onset Still’s disease (AOSD). Methods We used PRISMA guidelines for our systematic review and included all English-language original articles from inception till September 15, 2023, on AOSD and kidney involvement in any form. Data on patient demographics, diagnostic criteria, clinical presentation, renal pathology, treatment employed including dialysis, outcome, cause of death were collected and analyzed. Results The median age at the diagnosis of renal issues was 37, with a higher prevalence among females (58.1%). Among the cases, 28 experienced renal problems after being diagnosed with AOSD, 12 had simultaneous diagnoses of renal issues and AOSD, and in 4 cases, renal problems appeared before AOSD diagnosis. Out of the 44 cases, 36 underwent renal biopsy, revealing various pathology findings including AA amyloidosis (25%), collapsing glomerulopathy (11.4%), thrombotic microangiopathy (TMA) (11.4%), IgA nephropathy (9.1%), minimal change disease (6.8%), and others. Some cases were clinically diagnosed with TMA, proximal tubular dysfunction, or macrophage activation syndrome-related acute kidney injury. Treatment approaches varied, but glucocorticoids were commonly used. Renal involvement was associated with increased mortality and morbidity, with 6 out of 44 patients passing away, 4 progressing to end-stage renal disease (ESRD), and data on 2 cases’ outcomes not available. Conclusion Renal manifestations in AOSD are diverse but rarely studied owing to the rarity of the disease. Studies with larger data would be essential to study further on the pathogenesis and implications.

Background: Cardiovascular disease (CVD) is the leading cause of death in the developed world. The present study was conducted to assess correlation of plasma 25-Hydroxy-Vitamin D level with angiographic severity in coronary artery disease. Subjects and Methods: The present study was conducted on 120 patients of CAD. Group I were cases and group II were control. Hypertension, type II diabetes mellitus status, smoking etc. was recorded. 2 ml of blood sample was taken from all patients and measurement of 25(OH) vit D levels was performed. Results: The mean BMI in group I was 24.6 kg/m2 and 24.8 kg/m2 in group II, smoking habit was seen in 78 in group I and 34 in group II, hypertension was seen in 65 in group I and 26 in group II, diabetes was seen in 52 in group I and 30 in group II, alcoholism in 36 in group I and 10 in group II, dyslipidemia was seen in 48 in group I and 15 in group II. The mean 25 (OH) vitamin D in group I was 15.1 ng/ml and 19.6 ng/ml in group. The difference was significant (P< 0.05). Maximum dyslipidemia (80.5%) patients had low vitamin D level followed by DM, smoking, BMI, alcoholism and alcoholism. There was no correlation between risk factors and vitamin D deficiency (P> 0.05). Conclusion: Authors found that in cases, vitamin D level was lowered as compared to control, however, there was no correlation between risk factors and CAD.