Alakendu Ghosh

Background: Chronic lowgrade inflammation in long standing rheumatoid arthritis (RA) contributes not only to joint damage but also to metabolic dysregulation, endothelial dysfunction, and elevated cardiovascular (CV) risk. Although combination disease modifying anti rheumatic drugs (DMARDs) remain the mainstay of therapy, their long term efficacy in controlling systemic inflammation and preventing metabolic complications appears limited. Phytochemicals such as resveratrol, a polyphenolic compound widely used in traditional and complementary medicine, possess anti inflammatory and immunomodulatory properties. Objectives: To investigate whether resveratrol can complement the immunomodulatory effects of combination DMARDs in long duration RA patients by modulating inflammatory cytokines and the JNK−IRS−Akt insulin signaling axis. Methods: This study enrolled early and late rheumatoid arthritis patients to assess disease activity, vascular markers, and ex vivo PBMC responses. PBMCs were isolated for cytotoxicity testing and resveratrol treatment, followed by ELISA and Western blot analysis. Statistical comparisons evaluated immunomodulatory effects and alterations in inflammatory signaling. Results: Longitudinal follow up of RA patients showed significant first year improvement in disease activity and atherosclerotic markers, correlated with MTX dose. An early versus late RA comparison revealed elevated cytokines and enhanced JNK mediated stress signaling in longstanding disease. Resveratrol maintained PBMC viability, reduced LPS induced TNF&alpha and adipokine levels, and downregulated pJNK and GSK&beta, indicating targeted anti inflammatory modulation independent of Akt activation. Conclusion: Chronic RA showed persistent inflammatory and metabolic dysregulation driven by JNK−NF&kappaB activation. Resveratrol reduced cytokines, corrected adipokine imbalance, and selectively inhibited JNK, suggesting adjunct therapeutic value alongside DMARDs for improving immunometabolic disturbances in long-standing RA.

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.

Background: Comorbidities in rheumatoid arthritis (RA) patients vary significantly, with prevalence ranging from 3% to 60%. However, limited data exist from India. This study aims to evaluate the prevalence of comorbidities in RA patients in Indian clinical settings. Methods: The multicentre, observational study was conducted across eight centres in India using data from the Indian Rheumatology Association database. Comorbidities were classified using the International Classification of Diseases, Tenth revision (ICD-10) Charlson Comorbidity Index. Data were categorised by comorbidity, age and region and analysed using descriptive statistics, Fisher’s exact test, chi-squared test, t -test, analysis of variance (ANOVA) and logistic regression. Results: The study included 4,655 RA patients who met the European League Against Rheumatism (EULAR) classification criteria, with a mean age of 52.42 ± 12.18 years. Comorbidities were present in 41.72% of the patients. Those with comorbidities were older (56.16 vs. 49.74 years) and had a longer duration of RA (122.34 vs. 107.67 months). Out of 1,942 patients with comorbidities, 90% were female and 72% were from Southern India. The major comorbidities included hypertension (21.87%), thyroid disorders (14.5%) and diabetes (11.99%). Patients over 50 years had higher prevalence of diabetes, hypertension and cardiac diseases, while younger patients had more migraines and thyroid disorders. Conclusion: RA patients in India have a significantly higher burden of comorbidities, with hypertension, thyroid disorders and diabetes being the most common. Older age and a greater proportion of patients residing in Southern India were associated with increased comorbidities, suggesting potential regional differences in risk factors, healthcare access or lifestyle. These findings highlight the need for region- and age-specific management strategies.

Background: Several countries have participated in WHO COPCORD. The Global Disease Burden program (GBD) reports selected MSK disorders. We used a COPCORD India protocol to estimate the national burden of MSK disorders.Materials and Methods: Trained paramedics used standard questionnaires to screen the population and identify respondents with current and/or past MSK pain (non‐traumatic) in 12 survey sites (8 rural); cross‐sectional design and prospective data. Several standard measures were recorded; MSK pain was self‐reported (on human manikin). The site rheumatologist examined each respondent and provided a clinical diagnosis. Pooled data (anonymized) from all sites was analyzed using standard statistical software. Standardized point prevalence rates (adjusted to Indian Census) and odds ratios (risk factors) were calculated: 95% confidence intervals in parentheses.Results: 56 548 population (60% rural, response rate > 70%) was screened; 10 273 respondents (18%, 65% women). The prevalence of MSK pain was 16.14 (14.2, 18.3) and higher in the rural population (20% vs. 10.3%); rheumatoid arthritis 0.34%, undifferentiated inflammatory arthritis 0.22%, spondyloarthritis 0.23%, osteoarthritis 4.39%, Gout 0.05%, chikungunya arthritis 1.2%. Non‐specific arthralgias, soft tissue pains, and degenerative arthritis were dominant disorders; 12% of respondents reported inflammatory arthritis. Significant risk factors associated with MSK pain included female gender, poor literacy, non‐vegetarian diet, chronic non‐MSK illness, past trauma, and tobacco use. Limitations included non‐random selection, clinical diagnosis, and limited investigations. However, in comparison to GBD, the COPCORD outcome seemed all‐inclusive and clinically meaningful.Conclusion: The high prevalence of MSK pain and arthritis indicates a huge disease burden in India and prioritizes the need for a national control program.

Background: Psoriatic arthritis (PsA) significantly contributes to increased morbidity, reduced life expectancy, and higher healthcare costs due to the burden of comorbidities. This study assessed the prevalence of comorbidities in PsA patients in India and explored the influence of age and disease duration on these comorbidities. Methods: The prospective, multicenter observational study was conducted across seven centers in India, utilizing data from the Indian Rheumatology Association. Data were collected using expert-validated proformas, with comorbidities classified according to the ICD-10 Charlson Comorbidity Index. Participants were divided into two age groups: P < 0.001). The older group also had higher rates of hyperlipidemia (4.83% vs. 0.71%, P = 0.035) and hypertension (22.14%). Logistic regression revealed a significant association between age and the prevalence of diabetes, hypertension, and thyroid disorders (P = 0.003). Among patients over 40, 44.27% had at least one comorbidity. Conclusion: The study underscores the significant association between age and the prevalence of comorbidities in PsA patients, particularly in those over 40 years. These findings highlight the importance of targeted screening and management in older PsA patients.

Introduction: Systemic juvenile idiopathic arthritis (sJIA) is a distinct disease subset, with a poorer prognosis compared with other JIA subsets. Tocilizumab has an important role in the management of sJIA refractory to standard initial therapy. However, no specific guidelines exist for the tapering of tocilizumab therapy in sJIA, which could have implications on the overall cost and side effects of treatment.Methods: This was an observational study which included 21 children with refractory sJIA, who were initially put on injection tocilizumab every 2 weekly, with subsequent dosing tapered to 4 weekly and 6 weekly intervals based on JIA ACR 70 responses at 12 and 24 weeks, respectively. The primary outcome at week 36 included JIA ACR 30, 50, 70, and 90 response rates with other efficacy and safety measures as secondary outcomes.Results: At 36 weeks, JIA ACR 30, 50, 70, and 90 responses were observed in 90.5%, 90.5%, 71.4%, and 52.4% patients respectively along with significant improvement in hematological and inflammatory parameters. The mean prednisolone dose could be reduced from 0.54 to 0.13 mg/kg/day and around 29% patients were able to discontinue steroids altogether. No serious adverse events were recorded. With drug tapering, we could curtail on 26% of the total tocilizumab dose that would have been otherwise required on the continuous 2 weekly protocol.Conclusions: Tocilizumab, used in an early response‐based tapering regimen, was both safe and efficacious in children with sJIA refractory to standard therapy. Larger and longer duration studies are required to further validate our observations.

There is uncertainty regarding the effect of the SARS-CoV-2 infection on patients with autoimmune rheumatic diseases (AIRD) who are on immunosuppressive drugs. We did a multicity cross-sectional seroprevalence study conducted in five different cities in India before COVID-19 immunization. Patients with a diagnosis of AIRD and DMARDs were included. Relatives of the patients, preferably staying in the same household with no known rheumatic diseases served as controls. Serum IgG antibodies to SARS-CoV-2 Receptor Binding Domain (RBD) of the spike protein and nucleoprotein (NP) were assayed in eight hundred and eighty nine sera (subjects with disease = 379 and in subjects without disease = 510). IgG antibodies to either RBD and/or NP were positive in 135 (36%) subjects with AIRD as compared to 196 (38%) controls. The seroprevalence of anti-RBD and anti-NP varied between different cities but was not significantly different between subjects with and without disease in Mumbai, Ahmedabad, Bengaluru and Bhubaneswar. However, the occurrence of IgG antibodies to RBD was significantly (p < 0.05) lower in subjects with disease (28/65;43%) as compared to subjects without disease (42/65;65%) in Kolkata, where the positivity rate was lower in connective tissue disease group than in inflammatory arthritis group. Overall, patients with rheumatic diseases on DMARDs have IgG antibodies to RBD and NP of SARSCoV-2 at a comparable level with that of subjects without disease, but the level of antibodies to RBD is lower in patients with connective tissue disease on immunosuppressive drugs in one centre.