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Outcome in patients with enthesitis related arthritis (ERA): juvenile arthritis damage index (JADI) and functional status
Pradip Sarma, Ramnath Misra, Amita Aggarwal
Pediatric Rheumatology , 2008, DOI: 10.1186/1546-0096-6-18
Abstract: We studied 49 consecutive patients of ERA with age ≥ 5 years and duration ≥ 1 year. Along with JADI, we recorded enthesitis, lumbar spinal anterior flexion by modified Schober's method, presence of inflammatory backache, loss of school years, HAQ-S, growth and pubertal delay. Parent's/patient's and physician's global assessments on 100 mm visual analogue scale.The median age was 18.0 (10–27) years and the median duration of disease was 6.0 (1–17) years. All the patients were male and half (53.1%) were HLA B 27 positive. Fourteen had decreased anterior lumbar flexion movement and 32 had inflammatory backache. Active enthesitis was present in 63.3%. Functionally, mild, moderate and severe disability was seen in 18.4%, 34.7% & 14.3% respectively. Sixty five percent of patients lost education years. Twenty-eight patients had damaged joints with median of 2.0 joints (0–9). Seventeen patients (34.7%) had damaged joints in JADI-A score with a median of 1.0 (0–12). Growth failure was the commonest extra articular damage (8.2%) in JADI-E. JADI correlated with HAQ-S, parent's or patient's & physician's global assessment (p < 0.01). Limitation of spinal mobility had high correlation with HAQ-S; correlation with JADI-A was low.Three fourth of the ERA patients had functional limitations. Half of the patients had damaged joints. Even though JADI correlated well with traditional outcome measures, it underestimates joint damage, and does not assess enthesitis and spinal limitation which affect functional status in ERA. Inclusion of these may make it more useful for ERA.Enthesitis-related arthritis (ERA), as defined by ILAR criteria [1], is characterized by the involvement of the entheses and the axial skeleton along with peripheral joints. It is an HLA B-27 related disease and is similar to traditionally defined juvenile spondylarthropathy, including juvenile ankylosing spondylitis (JAS), seronegative enthesopathy and arthropathy (SEA) syndrome, and undifferentiated juvenile spondy
Circulating Levels of Soluble Receptor Activator of NF-κB Ligand and Matrix Metalloproteinase 3 (and Their Antagonists) in Asian Indian Patients with Ankylosing Spondylitis
Varun Dhir,Rajni Srivastava,Amita Aggarwal
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/814350
Abstract: Background. Bone loss in ankylosing spondylitis may be related to inflammation. Data from previous studies on circulating levels of sRANKL, OPG, MMP3, and TIMP is inconsistent; thus this study is planned to look at this aspect in Asian Indian patients. Methods. Cross-sectional study included patients with ankylosing spondylitis and age- and gender-similar controls. Serum levels of sRANKL, OPG, MMP-3, and TIMP-1 were measured by ELISA. Results. Included 85 patients (M?:?F = 82?:?3) having mean age (±SD) years and disease duration years. BASDAI, BASFI, BASMI, and ESR were , , and respectively. Patients had higher mean (±SD) OPG level ( , ?pg/mL, ). However, there was no difference in sRANKL ( , , ). Serum MMP-3 ( , ?ng/mL, ) and TIMP-1 ( , ?ng/mL, ) levels were higher in patients; however, there was no difference in MMP-3/TIMP-1 ratio. Conclusion. Circulating levels of OPG were higher; however, there was no difference in sRANKL in Asian Indian ankylosing spondylitis patients. Although both MMP-3 and TIMP-1 were raised, their ratio was not different from that of controls. 1. Introduction Patients with ankylosing spondylitis have been shown to have low bone mineral density at spine and propensity for vertebral fractures. The loss of bone mineral density has been shown to be more marked in late than early disease [1]. The bone loss may be related to inflammation, as in other chronic inflammatory diseases [2, 3]. Indeed, ankylosing spondylitis is characterized by chronic inflammation, as evidenced by elevated proinflammatory cytokines like tumour necrosis factor-α (TNFα) and interleukin-6 [4]. These may lead to bone loss by increased expression of receptor activator of NF-κB ligand (RANKL) on osteoblasts and stromal cells and its soluble form (sRANKL). RANKL and cytokines lead to osteoclast and other inflammatory cell activation and release of bone and cartilage degrading enzymes like cathepsin K and matrix metalloproteinases (MMPs) [5, 6]. Their natural antagonists, that is, osteoprotegerin (for RANKL) and tissue inhibitor of metalloproteinase or TIMP (for MMP) oppose their actions. Among the MMPs, there is promising data on the association of disease activity with MMP-3 [7]. There is inconsistent data on circulating levels of these molecules in ankylosing spondylitis, especially in Asian Indians. Thus this study was planned to look at levels of these molecules in this population. 2. Methods 2.1. Study Design This cross-sectional study was carried out in a North Indian university hospital between April 2010 and February 2011. Institutional ethical clearance
Psoriatic Arthritis of Hand Joints
Vikas Aggarwal,Anupam Wakhlu,Amita Aggarwal,Ramnath Misra
JK Science : Journal of Medical Education & Research , 2002,
Abstract: Not available
Arthritis in lymphomatoid granulomatosis: Report of a case and review of literature
Agarwal Vikas,Aggarwal Amita,Pal Lily,Misra Ramnath
Indian Journal of Medical Sciences , 2004,
Abstract: Lymphomatoid granulomatosis (LG) is a rare systemic vasculitis caused by Epstein Barr virus induced transformation of the B-cells in a T-cell rich environment. The predominant clinical presentations are confined to the pulmonary system however; extra-pulmonary manifestations can sometimes be the main feature of the disease. Here in we describe a 52-year-old female who presented with symmetric polyarthritis and generalized stiffness for 7 months and papular lesions over extremities for 3 months duration. She in addition had generalized lymphadenopathy. Histopathological examination of the cutaneous lesions confirmed LG. Patient died despite therapy with cyclophosphamide and prednisolone. This is the first report of LG mimicking rheumatoid arthritis from India.
An unusual case of systemic lupus erythematosus mimic: Disseminated gastric signet ring cell carcinoma
Haroon Nigil,Aggarwal Amita,Garg Naveen,Krishnani Narendra
Indian Journal of Medical Sciences , 2006,
Transfusion-associated immunomodulation: Quantitative changes in cytokines as a measure of immune responsiveness after one time blood transfusion in neurosurgery patients
Pandey Prashant,Chaudhary Rajendra,Aggarwal Amita,Kumar Raj
Asian Journal of Transfusion Science , 2010,
Abstract: Very few studies in humans have investigated the laboratory evidences suggestive of transfusion-associated immunologic changes. In this prospective study, we examined the effects of perioperative blood transfusion on immune response, by measuring various cytokines production, namely, interferon-gamma (IFN-γ), interleukin-10 (IL-10), and Fas Ligand (FasL). A total of 40 patients undergoing neurosurgery were randomly allocated into four groups: (a) no transfusion, (b) allogeneic non-leukofiltered transfusion, (c) prestorage leukofiltered transfusion, (d) autologous transfusion. Samples were collected before operation (day 0) and postoperative days (post-op) 1, 7, and 14. IFN-γ and IL-10 production capacity was measured in supernatant after whole blood culture and serum FasL levels in patients′ sera using commercially available ELISA kits. Change in ratios (cytokine value after PHA stimulation/control value) of IFN-γ and IL-10 and percentage change from baseline for serum FasL levels across different transfusion groups during the sampling period were calculated. There was an increase in IL-10 production in patients receiving allogeneic non-leukofiltered transfusion on days 1 and 7 (mean ratio 2.22 (± 2.16), 4.12 (± 1.71), 4.46 (± 1.97) on days 0, 1, and 7, respectively). Similarly there was a significant (P<0.05) decrease in IFN-γ production in patients who received allogeneic non-leukofiltered red cell transfusion on post-op days 1, 7, and 14 (mean ratio 6.88 (± 4.56), 2.53 (± 0.95), 3.04 (± 1.38) and 2.58 (± 1.48) on day 0, 1, 7, and 14, respectively). Serum FasL production was increased across all patients till 7th day except for ′no transfusion′ group and this increase was most significant in the non-leukofiltered group. We conclude that one time transfusion leads to quantitative changes in levels of these cytokines largely through interplay of Th2/Th1 pathways in allogeneic nonleukofiltered blood transfusion; however, soluble mediators like FasL which are also present in autologous and leukofiltered blood products may contribute toward minor immunologic effect in these settings.
Hemophilic Arthritis of Knee Joints
Vikas Agarwal, Anupam Wakhlu, Amita Aggarwal,Ramnath Misra
JK Science : Journal of Medical Education & Research , 2001,
Abstract: Not Available
Reactivation of Old Scars in an Elderly Man Revealing L fgren's Syndrome
Vishnu Vardhan Reddy Munagala,Vaishali Tomar,Amita Aggarwal
Case Reports in Rheumatology , 2013, DOI: 10.1155/2013/736143
Reactivation of Old Scars in an Elderly Man Revealing L?fgren's Syndrome
Vishnu Vardhan Reddy Munagala,Vaishali Tomar,Amita Aggarwal
Case Reports in Rheumatology , 2013, DOI: 10.1155/2013/736143
Abstract: Here, we report the case of a 55-year-old man with reactivation of old cutaneous scars associated with a febrile illness, episcleritis, polyarthralgias, erythema nodosum and hilar adenopathy. High-resolution computed tomography (HRCT) revealed right paratracheal, bilateral hilar, and subcarinal lymphadenopathy without any nodular densities in both lung fields. A scar biopsy revealed multiple noncaseating granulomas and confirmed the diagnosis of sarcoidosis. A short course of oral steroids led to regression of systemic symptoms, and the scars returned to baseline size. This patient represented a rare case of simultaneous L?fgren’s syndrome and scar sarcoidosis. 1. Introduction Sarcoidosis is a multisystem granulomatous disease of unknown cause. The diagnosis usually requires a compatible clinical picture, histologic demonstration of noncaseating granulomas, and exclusion of other diseases capable of producing similar histology or clinical features [1]. Systemic ?symptoms? such? as ?fatigue,? night? sweats,? and ?weight? loss are ?common;? the? organ ?system ?that ?is? most ?affected? varies? with? the ?given ?patient [2]. The differential diagnosis of skin lesions in a patient with acute febrile illness and joint pains and hilar lymphadenopathy is extensive. We report a case of L?fgren’s syndrome associated with scar sarcoidosis. 2. Case Presentation A 55-year-old man presented to our hospital with 6-week history of low-grade intermittent fever, malaise, fatigue, joint pains involving both knees and ankles along with painful nodules on left lower limb, and redness of both eyes of 1-week duration. He had loss of appetite and a weight loss of 3?kg over this period. He complained of increasing size of old scars present on his forehead (Figure 1). These scars occurred following a road traffic accident 10?years ago. He denies any pruritus or pain in scars. There was no history of breathlessness, chest pain, or night sweats. Figure 1: ? Scar enlarged on the forehead. Physical examination revealed the following: pulse rate—84/minute, blood pressure—120/80?mm?Hg, and respiratory rate—18/minute. The lesions on the forehead were subcutaneous, firm, nontender, and minimally mobile, and he also tender subcutaneous nodules on left shin suggestive of erythema nodosum. Eye examination revealed bilateral episcleritis. He had tenderness in both knees and ankles without any swelling. There were no lymph nodes or hepatosplenomegaly. Chest and cardiac examination was unremarkable. Laboratory investigations showed the following: hemoglobin 14.0?Gm%, TLC of 10800 with 70%
HIV Vaccine:Current Status
Vinod Chandran,Anupam Wakhlu,R.N. Mishra Vikas Aggarwal,Annil Mahajan,Amita Aggarwal
JK Science : Journal of Medical Education & Research , 2002,
Abstract: Not available
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