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Philip SS, Janardana R, Shenoy P, Kavadichanda C, Bairwa D, Sircar G, Ghosh P, Wakhlu A, Selvam S, Khanna D, Shobha V. Exploratory clinical subgroup clustering in systemic sclerosis: Results from the Indian Progressive Systemic Sclerosis Registry. J Scleroderma Relat Disord 2024; 9:29-37. [PMID: 38333526 PMCID: PMC10848923 DOI: 10.1177/23971983231215470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 02/10/2024]
Abstract
Objective To conduct an exploratory cluster analysis of systemic sclerosis patients from the baseline data of the Indian systemic sclerosis registry. Methods Patients satisfying American College of Rheumatology-European League Against Rheumatism classification criteria for systemic sclerosis were included. The clusters formed using clinical and immunological parameters were compared. Results Of the 564 systemic sclerosis registry participants, 404 patients were included. We derived four clusters of which three were anti-topoisomerase I predominant and one was anti-centromere antibody 2 dominant. Cluster 1 (n-82 (20.3%)) had diffuse cutaneous systemic sclerosis patients with the most severe skin disease, anti-topoisomerase I positivity, males, younger age of onset and high prevalence of musculoskeletal, vasculopathic and gastrointestinal features. Cluster 2 (n-141 (34.9%)) was also diffuse cutaneous systemic sclerosis and anti-topoisomerase I predominant but with less severe skin phenotype than cluster 1 and a lesser prevalence of musculoskeletal, vasculopathic and gastrointestinal features. Cluster 3 (n-119 (29.5%)) had limited cutaneous systemic sclerosis patients with anti-topoisomerase I positivity along with other antibodies. The proximal muscle weakness was higher and digital pitting scars were lower, while other organ involvement was similar between clusters 2 and 3. Cluster 4 (n-62 (15.30%)) was the least severe group with limited cutaneous systemic sclerosis and anti-centromere antibody predominance. Age of onset was higher with low musculoskeletal disease and a higher presence of upper gastrointestinal features. The prevalence of interstitial lung disease was similar in the three anti-topoisomerase I predominant clusters. Conclusion With exploratory cluster analysis, we confirmed the possibility of subclassification of systemic sclerosis along a spectrum based on clinical and immunological characteristics. We also corroborated the presence of anti-topoisomerase I in limited cutaneous systemic sclerosis and the association of interstitial lung disease with anti-topoisomerase I.
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Affiliation(s)
- Shery Susan Philip
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
| | - Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
| | - Padmanabha Shenoy
- Centre for Arthritis and Rheumatism Excellence (CARE), Cochin, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Geetabali Sircar
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, India
| | - Parasar Ghosh
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology, Apollomedics Super Speciality Hospitals, Lucknow, India
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John’s Research Institute, Bengaluru, India
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
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Bhowmick K, Dey S, Roy D, Jain H, Haldar S, Mondal S, Sircar G. Multifocal osteonecrosis in systemic lupus erythematosus. Int J Rheum Dis 2023; 26:2093-2094. [PMID: 37309589 DOI: 10.1111/1756-185x.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Kaustav Bhowmick
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sonali Dey
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debaditya Roy
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Harsh Jain
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Subhankar Haldar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Geetabali Sircar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Kumar MS, Mondal S, Sircar G, Ghorai S, Haldar S, Ghosh A. Microscopic Polyangiitis with Pulmonary-renal Involvement in a Patient with Polyarticular Juvenile Idiopathic Arthritis: A Case Report. Indian J Nephrol 2023; 33:132-135. [PMID: 37234439 PMCID: PMC10208541 DOI: 10.4103/ijn.ijn_414_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022] Open
Abstract
The association of polyarticular juvenile idiopathic arthritis (p-JIA) and microscopic polyangiitis (MPA) is extremely rare. Very few case reports described the coexistence of these two diseases to date. Here we report a 26-year-old female, a diagnosed patient of rheumatoid factor positive p-JIA for 15 years who developed MPA with renal and pulmonary involvement at the age of 26 years. She was successfully treated with intravenous corticosteroid and injection rituximab. This case report is unique as an association between MPA and p-JIA is very rare.
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Affiliation(s)
- Mavidi S. Kumar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Geetabali Sircar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sudipta Ghorai
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhankar Haldar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Mondal S, Goswami RP, Sinha D, Sircar G, Hati A, Lahiri D, Ghosh P, Ghosh A. Evaluation of Subclinical Hand Joint Synovitis by Ultrasonography in Patients with Psoriatic Arthritis and Cutaneous Psoriasis: A Case-Control Study. Mediterr J Rheumatol 2022; 33:421-429. [PMID: 37034375 PMCID: PMC10075382 DOI: 10.31138/mjr.33.4.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives To find the frequency of subclinical hand joint synovitis (SS) in patients with psoriatic arthritis (PsA) and cutaneous psoriasis (PsC) compared to healthy controls (HC), and correlation of SS with disease activity. Methods PsA patients (n= 52), without any past/current history of hand joint arthritis, PsC patients (n= 48), and 45 HC were recruited. Grey-scale and power Doppler Ultrasonography of bilateral hand joints were performed. The proportions of hand joints with SS were estimated in each group. A wrist-ray score was devised. Correlations were obtained between the number of joints with SS and disease activity parameters. Results Higher proportion of PsA patients (55.8%) had SS than PsC (29.2%, p= 0.007), and HC (22.2%, p=0.001). Proportion of joints with SS was higher in PsA patients (5.38%) compared to PsC (2.92%, [p=0.0008]), and HC (1.11%, [p=0.0007]). Compared to HC, PsA patients had significantly higher bilateral ray 3 (p=0.002 and 0.01 for left and right ray 3, respectively), and right ray 4 involvement (p=0.037) and PsC patients had higher left ray 3 involvement (p=0.03). Wrist-ray score above 2.5 could distinguish patients of PsC with significant subclinical synovitis compared to controls (area under curve: 0.857, 95% confidence interval: 0.71-1.00). There was a significant correlation of SS with ESR in PsA group (p-value: 0.044), and with CRP in PsC group (p-value: 0.003), but not with other disease activity indices. Conclusion SS was noted in approximately half of PsA and 1/3rd of PsC patients. Both PsA and PsC patients had a significantly higher number of hand joint SS than HC. Ray pattern of hand joint SS could be present in both PsA and PsC.
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Affiliation(s)
- Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
| | - Rudra Prosad Goswami
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
| | - Debanjali Sinha
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India,
| | - Geetabali Sircar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
| | - Arpita Hati
- Department of Dermatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debasish Lahiri
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
| | - Parasar Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,
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Dey S, Roongta R, Mondal S, Haldar S, Sircar G, Ghosh B, Ghosh A. Recurrent macrophage activation syndrome as the initial manifestation of paediatric systemic lupus erythematosus. Lupus 2022; 31:1132-1137. [PMID: 35713230 DOI: 10.1177/09612033221108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Macrophage Activation Syndrome (MAS) is a rare but potentially fatal complication in rheumatic diseases. Here, we report the case of a 14-year-old girl with MAS as the primary manifestation of Systemic Lupus Erythematosus (SLE). She had three episodes of MAS during the course of her treatment. This case is unique as recurrent MAS in pediatric SLE is rare.Methods: Demographic, clinical, laboratory features and outcomes of our patient was noted. We also reviewed the two reported cases of recurrent MAS in pediatric SLE. Literature review was performed on PubMed search forum. Search items included Macrophage activation syndrome, pediatric systemic lupus erythematosus, recurrent MAS.Conclusion: The diagnosis and management of MAS are challenging as it can simulate an infectious complication or can be the exacerbation of the underlying disease. Early detection and prompt treatment can reduce morbidity in these patients.
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Affiliation(s)
- Sonali Dey
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Rashmi Roongta
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Subhankar Haldar
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Geetabali Sircar
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Biswadip Ghosh
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, 30164Institute of Postgraduate Medical Education and Research, Kolkata, India
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Roongta R, Sircar G, Ghosh P, Sit H, Ghosh D. AB0399 COMPARISON OF RITUXIMAB VERSUS LEFLUNOMIDE IN COMBINATION WITH METHOTREXATE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS DESPITE METHOTREXATE TREATMENT- AN OPEN LABEL, RANDOMISED CONTROLLED TRIAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundActive rheumatoid arthritis (RA) despite methotrexate monotherapy is seen in about 43% of patients1. The current American College of Rheumatology (ACR) guidelines recommend adding a biologic or targeted synthetic Disease Modifying Anti-rheumatic Drug (DMARD) to methotrexate (MTX) therapy in such cases. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend combination DMARDs but the most commonly used combination is that of MTX with sulphasalazine and hydroxychloroquine. In a resource limited country like ours, it is not always possible to give a biological or a targeted synthetic DMARD, and a more cost effective method needs to be implemented. Often, leflunomide (LEF) is added in such cases and is effective.ObjectivesWe aimed to study if LEF with MTX combination is non inferior to rituximab (RTX) and MTX combination in patients with active RA despite MTX.MethodsThis open label, randomised controlled trial, carried out on patients with moderate to high disease activity despite MTX therapy for atleast 3 months (Clinical Trials Registry- India - REF/2021/04/042755) was conducted in a tertiary care centre in India. Patients were randomised to receive either LEF (10-20mg/day) or RTX (2 doses of 1gm, 2 weeks apart) along with background MTX (10-25mg/week) and followed up at 12, 18 and 24 weeks. The primary outcome ACR20 response at 24 weeks and secondary outcomes were ACR50 and 70 responses at 24 weeks.ResultsThere were 21 patients in each arm. At baseline, all patients in both groups had seropositive RA and had high disease activity according to Disease Activity Score (DAS)28 scores. The ACR20 response at 24 weeks was achieved by 14 (66.6%) and 16 (76.19%) patients respectively in the LEF and RTX arms. The ACR50 response was achieved by 11 (52.38%) patients in both groups and ACR70 response by 4 (19%) and 7 (33.3%) in the LEF and RTX arms respectively (Figure 1). The mean dose of LEF at week 24 was 17.6 mg/day. Improvement of various parameters at week 24 as compared to the baseline values were similar in both groups (Table 1). No major adverse events were noted. Two patients receiving RTX had a mild infusion reaction. Elevation in liver enzymes (<3 times the upper limit of normal) were noted in 4 patients in the LEF arm which normalised subsequently. No patient required drug withdrawal.Table 1.Responses in both groups at week 24 (p= Not significant for all)Leflunomide, n=21Rituximab, n=21Mean ±SD reduction in SJC-4.57 ± 3.4-5.43 ± 4.6Mean ±SD reduction in TJC-6.2 ± 3.9-7.1 ± 6.1Mean ±SD reduction in PhGA-3.42 ± 1.8-4.04 ± 2.5Mean ±SD reduction in PGA-3.05 ± 1.8-3.42 ± 2.4Mean ±SD reduction in pain VAS-33.57 ± 23.2-38.57 ± 24.4Mean ±SD reduction in DAS28-ESR-1.95 ± 1.2-2.08 ± 1.4Mean ±SD reduction in DAS28-CRP-1.81 ± 1.2-2.07 ± 1.4Mean ±SD reduction in HAQ-DI-0.65 ± 0.5-0.82 ± 0.6EULAR good response (%)1 (4.76%)1 (4.76%)EULAR moderate response (%)15 (71.43%)14 (66.6%)EULAR non-responders (%)5 (23.81%)6 (28.57%)CRP, C- Reactive Protein; DAS, Disease Activity Score; ESR, Erythrocyte Sedimentation Rate; HAQ-DI, Healthy Assessment Questionnaire-Disability Index; PGA, Patient’s global assessment of disease activity; PhGA, Physician’s global assessment of disease activity; SJC, Swollen Joint Count; TJC, Tender Joint Count; VAS, Visual analogue scale.Figure 1.Number of patients achieving ACR20, 50 and 70 responses at week 24ConclusionIn our study, LEF was comparable to RTX for achievement of ACR20/50/70 responses at 24 weeks. LEF can be considered as an add-on option to MTX instead of more expensive biologic agents in MTX refractory RA. Larger studies are needed to confirm this hypothesis.References[1]Sergeant JC, Hyrich KL, Anderson J, et al. Prediction of primary non-response to methotrexate therapy using demographic, clinical and psychosocial variables: results from the UK Rheumatoid Arthritis Medication Study (RAMS). Arthritis Res Ther. 2018;20(1):147. Published 2018 Jul 13.Disclosure of InterestsNone declared
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Kavadichanda C, Shobha V, Ghosh P, Wakhlu A, Bairwa D, Mohanan M, Janardana R, Sircar G, Sahoo RR, Joseph S, Negi VS, Khanna D, Shenoy P. Clinical and psychosocioeconomic impact of COVID-19 pandemic on patients of the Indian Progressive Systemic Sclerosis Registry (IPSSR). Rheumatol Adv Pract 2021; 5:rkab027. [PMID: 34095747 PMCID: PMC8135468 DOI: 10.1093/rap/rkab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim was to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health care among patients with scleroderma and to analyse the economic and psychosocial impacts and the infection prevention measures taken by them during the pandemic. METHODS A 25-item questionnaire designed to assess the components of the objectives was tele-administered between October 2020 and January 2021 to the patients enrolled in the Indian Progressive Systemic Sclerosis Registry. RESULTS Of the 428 patients in the registry, 336 took part in the study. A scheduled outpatient visit was missed by 310 (92.3%) patients, and 75 (22.3%) skipped prescription drugs. During the pandemic, 75 (22.3%) had a family member lose a job. Financial difficulties were reported by 155 (46.1%), with 116 (34.5%) patients having to spend an additional INR 4000 (2000-10 000) [USD 54.9 (27.0-137.4)] to continue treatment. Although 35 patients (10.4%) had at least one symptom suggestive of COVID-19, infection was confirmed in only 4. None of them needed hospitalization or had adverse outcomes. Worsening of scleroderma was seen in 133 (39.6%) individuals, with 15 (4.5%) requiring hospitalization. Most (96%) of the patients were aware of infection prevention measures, and 91 (27.1%) had taken unproven prophylactic medications. CONCLUSION Individuals with scleroderma in India have been affected during the pandemic owing to closure of hospital services, lack of transport, loss of jobs and the additional financial burden. Health-care providers should continue to educate patients to stay on their medications and encourage them to be vaccinated for COVID-19.
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Affiliation(s)
- Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka
| | - Parasar Ghosh
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, West Bengal
| | - Anupam Wakhlu
- Department of Clinical Immunology and Rheumatology, RALC Campus, King George's Medical University, Lucknow, Uttar Pradesh
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
| | - Manju Mohanan
- Centre for Arthritis and Rheumatism Excellence (CARE), Cochin, Kerala, India
| | - Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka
| | - Geetabali Sircar
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, West Bengal
| | - Rasmi Ranjan Sahoo
- Department of Clinical Immunology and Rheumatology, RALC Campus, King George's Medical University, Lucknow, Uttar Pradesh
| | - Sneha Joseph
- Centre for Arthritis and Rheumatism Excellence (CARE), Cochin, Kerala, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Padmanabha Shenoy
- Centre for Arthritis and Rheumatism Excellence (CARE), Cochin, Kerala, India
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Goswami RP, Ray A, Chatterjee M, Mukherjee A, Sircar G, Ghosh P. Rituximab in the treatment of systemic sclerosis-related interstitial lung disease: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60:557-567. [PMID: 33164098 DOI: 10.1093/rheumatology/keaa550] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/04/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the effect of rituximab (RTX) on the lung function parameters in SSc interstitial lung disease (SSc-ILD) patients. METHODS PubMed and Embase were searched to identify studies on SSc-ILD treated with RTX, confined to a predefined inclusion and exclusion criteria. A systematic review and meta-analysis were performed on the included studies on changes in forced vital capacity (FVC) and diffusion capacity of carbon monoxide (DLCO) from baseline to 6 and 12 months of follow-up. RESULTS A total of 20 studies (2 randomized controlled trials, 6 prospective studies, 5 retrospective studies and 7 conference abstracts) were included (n = 575). RTX improved FVC from baseline by 4.49% (95% CI 0.25, 8.73) at 6 months and by 7.03% (95% CI 4.37, 9.7) at 12 months. Similarly, RTX improved DLCO by 3.47% (95% CI 0.99, 5.96) at 6 months and 4.08% (95% CI 1.51, 6.65) at 12 months. In the two studies comparing RTX with other immunosuppressants, improvement of FVC by 6 months in the RTX group was 1.03% (95% CI 0.11, 1.94) greater than controls. At the 12 month follow-up, RTX treatment was similar to controls in terms of both FVC and DLCO. Patients treated with RTX had a lower chance of developing infections compared with controls [odds ratio 0.256 (95% CI 0.104, 0.626), I2 = 0%, P = 0.47). CONCLUSIONS Treatment with RTX in SSc-ILD was associated with a significant improvement of both FVC and DLCO during the first year of treatment. RTX use was associated with lower infectious adverse events.
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Affiliation(s)
- Rudra P Goswami
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Moumita Chatterjee
- Department of Mathematics and Statistics, Aliah University, Kolkata, India
| | - Arindam Mukherjee
- Department of Pulmonology, TATA Medical Center, Rajarhat, Kolkata, India
| | - Geetabali Sircar
- Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Parasar Ghosh
- Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Sircar G, Goswami RP, Sircar D, Ghosh A, Ghosh P. Comment on: Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial: reply. Rheumatology (Oxford) 2019; 58:925-926. [PMID: 30809671 DOI: 10.1093/rheumatology/kez054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Geetabali Sircar
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Rudra Prosad Goswami
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Dipankar Sircar
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Alakendu Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Parasar Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
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Sircar G, Goswami RP, Sircar D, Ghosh A, Ghosh P. Comment on: Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial: reply. Rheumatology (Oxford) 2019; 58:929. [PMID: 30933265 DOI: 10.1093/rheumatology/kez122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Geetabali Sircar
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Rudra Prosad Goswami
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Dipankar Sircar
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Alakendu Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
| | - Parasar Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata
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Rahaman O, Bhattacharya R, Liu CSC, Raychaudhuri D, Ghosh AR, Bandopadhyay P, Pal S, Goswami RP, Sircar G, Ghosh P, Ganguly D. Cutting Edge: Dysregulated Endocannabinoid-Rheostat for Plasmacytoid Dendritic Cell Activation in a Systemic Lupus Endophenotype. J I 2019; 202:1674-1679. [DOI: 10.4049/jimmunol.1801521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
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Goswami RP, Sit H, Ghosh P, Sircar G, Ghosh A. Steroid-free remission in lupus: myth or reality; an observational study from a tertiary referral centre. Clin Rheumatol 2018; 38:1089-1097. [DOI: 10.1007/s10067-018-4377-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022]
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Sircar G, Goswami RP, Sircar D, Ghosh A, Ghosh P. Intravenous cyclophosphamidevsrituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial. Rheumatology (Oxford) 2018; 57:2106-2113. [DOI: 10.1093/rheumatology/key213] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Geetabali Sircar
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Rudra Prosad Goswami
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Dipankar Sircar
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Alakendu Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Parasar Ghosh
- Department of Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Abstract
BACKGROUND Cardiac tamponade is a rare but life-threatening complication of systemic lupus erythematosus (SLE). AIMS/OBJECTIVES To describe incidence, risk factors and treatment of cardiac tamponade in a large cohort of Indian patients with SLE. METHODS This retrospective study was conducted at the Department of Rheumatology, IPGMER, Kolkata, India from May 2014 to December 2016 on admitted patients with SLE. Lupus-related serositis was diagnosed after excluding other causes, such as infection, malignancy or heart failure. RESULTS Of 409 patients with SLE, pericarditis was diagnosed in 25.4% (104/409) and cardiac tamponade in 5.9% (24/409). Tamponade was the presenting feature of SLE in 50% (12/24). Tamponade occurred in 77.8% (14/18) of large effusions and in 11.63% (10/86) of small-to-moderate effusions. The commonest autoantibody in serum and pericardial fluid was anti-nucleosme antibody. Large pericardial effusion (>20 mm) (Odd's ratio (OR): 93.2, 95% confidence interval (CI): 11.1-782.5, P < 0.001) predicted tamponade. In the subset of patients with small-to-moderate sized pericardial effusion, tamponade was associated with pleuritis (OR: 44.5, 95% CI: 1.6-1243, P = 0.025), anti-nucleosome antibody (OR: 42.9, 95% CI: 1.6-1176, P = 0.026) and size of pericardial effusion (OR: 1.36, 95% CI: 1.04-1.76, P = 0.025). Repeated pericardiocentesis was required in 3 patients and one needed surgical intervention. Immunosuppressives used were: prednisolone with monthly intravenous cyclophosphamide (in 33.33%) and intravenous methylprednisolone with monthly cyclophosphamide (in 50%). CONCLUSIONS Pleuritis, anti-nucleosome antibody and size of pericardial effusion predicted development of tamponade. High dose immunosuppression (methylprednisolone and IV cyclophosphamide) alleviated need for surgery in majority.
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Affiliation(s)
- R P Goswami
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - G Sircar
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - A Ghosh
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - P Ghosh
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
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Chowdhury K, Kumar U, Das S, Chaudhuri J, Kumar P, Kanjilal M, Ghosh P, Sircar G, Basyal RK, Kanga U, Bandyopadhaya S, Mitra DK. Synovial IL-9 facilitates neutrophil survival, function and differentiation of Th17 cells in rheumatoid arthritis. Arthritis Res Ther 2018; 20:18. [PMID: 29382374 PMCID: PMC5791733 DOI: 10.1186/s13075-017-1505-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 12/27/2017] [Indexed: 01/08/2023] Open
Abstract
Background Role of Th9 cells and interleukin-9 (IL-9) in human autoimmune diseases such as psoriasis and ulcerative colitis has been explored only very recently. However, their involvement in human rheumatoid arthritis (RA) is not conclusive. Pathogenesis of RA is complex and involves various T cell subsets and neutrophils. Here, we aimed at understanding the impact of IL-9 on infiltrating immune cells and their eventual role in synovial inflammation in RA. Methods In vitro stimulation of T cells was performed by engagement of anti-CD3 and anti-CD28 monoclonal antibodies. Flow cytometry was employed for measuring intracellular cytokine, RORγt in T cells, evaluating apoptosis of neutrophils. ELISA was used for measuring soluble cytokine, Western blot analysis and confocal microscopy were used for STAT3 phosphorylation and nuclear translocation. Results We demonstrated synovial enrichment of Th9 cells and their positive correlation with disease activity (DAS28-ESR) in RA. Synovial IL-9 prolonged the survival of neutrophils, increased their matrix metalloprotienase-9 production and facilitated Th17 cell differentiation evidenced by induction of transcription factor RORγt and STAT3 phosphorylation. IL-9 also augmented the function of IFN-γ + and TNF-α + synovial T cells. Conclusions We provide evidences for critical role of IL-9 in disease pathogenesis and propose that targeting IL-9 may be an effective strategy to ameliorate synovial inflammation in RA. Inhibiting IL-9 may have wider impact on the production of pathogenic cytokines involved in autoimmune diseases including RA and may offer better control over the disease. Electronic supplementary material The online version of this article (10.1186/s13075-017-1505-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaustav Chowdhury
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), Room No-75, New Delhi, 110029, India
| | - Uma Kumar
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Soumabha Das
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jaydeep Chaudhuri
- Indian Institute of Chemical Biology, Council of Scientific and Industrial Research (CSIR), Kolkata, India
| | - Prabin Kumar
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), Room No-75, New Delhi, 110029, India
| | - Maumita Kanjilal
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Parashar Ghosh
- Rheumatology Center, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, India
| | - Geetabali Sircar
- Rheumatology Center, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, India
| | - Ravi Kiran Basyal
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Uma Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), Room No-75, New Delhi, 110029, India
| | - Santu Bandyopadhaya
- Indian Institute of Chemical Biology, Council of Scientific and Industrial Research (CSIR), Kolkata, India
| | - Dipendra Kumar Mitra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), Room No-75, New Delhi, 110029, India.
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Mondal S, Goswami R, Sinha D, Sircar G, Ghosh P, Ghosh A. Osteonecrosis and intra-articular fat deposition in a patient with polyarteritis nodosa on high-dose glucocorticoid therapy. Indian J Rheumatol 2017. [DOI: 10.4103/0973-3698.199128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sircar G, Saha B, Jana T, Dasgupta A, Gupta Bhattacharya S, Saha S. DAAB: a manually curated database of allergy and asthma biomarkers. Clin Exp Allergy 2016; 45:1259-61. [PMID: 25973645 DOI: 10.1111/cea.12569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Sircar
- Division of Plant Biology, Bose Institute, Kolkata, India
| | - B Saha
- Division of Plant Biology, Bose Institute, Kolkata, India
| | - T Jana
- Bioinformatics Center, Bose Institute, Kolkata, India
| | - A Dasgupta
- Department of Medicine, BR Singh Hospital and Centre for Medical Education and Research, Kolkata, India
| | | | - S Saha
- Bioinformatics Center, Bose Institute, Kolkata, India
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Mandal D, Sircar G, Pandey A, Mandal S, Banerjee D, Ghosh A, Panja M. Menstrual and Gonadal Function Alterations in Women with Systemic Lupus Erythematosus. J Assoc Physicians India 2015; 63:38-42. [PMID: 27604434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Systemic lupus erythematosus (SLE) is an autoimmune disorder and may affect the reproductive health status of the women. Objective is to analyze the types, incidence of various menstrual disturbances in these women, to identify risk factors and to assess the gonadal function. METHODS The prospective cohort study was conducted in the SLE clinic of the Rheumatology Department of IPGMEandR, Kolkata from April 2010 to April 2011. Out of 152 females attending clinic, 110 patients fulfilling criteria were included in the study. RESULTS Mean age of the study population was 27.25±3.4 years. Sixty six cases had menstrual abnormalities (12.72% amenorrhea, 44.45% oligomenorrhea, 2.7% premature ovarian failure, 10.9% menorrhogia). When comparative analysis of demographic, hormonal, ovarian Doppler and therapeutic variables of normal and abnormal cycles was carried out, following parameters were significantly more related to patients with abnormal cycle ; SLEDAI score (12.48±5.53 vs 8.69±4.9; p=0.00), disease duration (6.46±3.08 vs 4.3±1.36; p< 0.05), TSH (7.73±8.64 vs 3.07±2.06; p=0.00.), LH (6.55±4.38 vs 4.56±3.29; p=0.02), a high normal prolactin (12.57±7.75 vs 8.73±3.07; p=0.02), peak systolic velocity (6.53±2.17 vs 9.12±2.1; p=0.00), end-diastolic volume (4.21±2.9 vs 9.35±2.32; p=0.00) and cumulative dose of steroid (24.02±41.44 vs 9.32±9.96; p=0.01).Cyclophosphamide with cumulative dose ≥10 gm was related to amenorrhea and affected gonadal function. Gonadal insufficiency was evident in 33.63% and 2.72% had ovarian failure. CONCLUSIONS Reduced menstruation is a major health concern in women with SLE as it is frequent and can result in depressed and failed gonadal function later. Doppler study of ovaries is a novel way of depiction of gonadal status in these women. Certain risk factors and revolving treatment part can be preventable.
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Affiliation(s)
| | | | | | | | | | | | - Manotosh Panja
- Ex HOD, ICVS, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal
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Sircar G, Ghosh P, Maity A, Ghosh A. Comparison of efficacy of euro-lupus regimen with NIH regimen in management of lupus nephritis: A retrospective analysis. Indian Journal of Rheumatology 2014. [DOI: 10.1016/j.injr.2014.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A. Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India. Indian J Dermatol 2014; 59:35-40. [PMID: 24470658 PMCID: PMC3884926 DOI: 10.4103/0019-5154.123491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Mixed connective tissue disorder is an uncommon disease. Some scientists are reluctant to recognize it as a separate entity. Some others have defined this ailment. Cutaneous features of this condition are unique. Researchers from India have described these features to relate to those described in the studies from other parts of the globe. Aims: This study aims to delineate the skin manifestations of clearly defined mixed connective tissue disease (MCTD) patients, to compare them with those established as overlap syndrome, and to relate them with studies from other parts of the globe. Settings and Design: Successive patients who fulfilled the specific criteria for MCTD presenting in the skin outpatient department of a tertiary care hospital in eastern India were clinically examined from 2009 for 3 years. Materials and Methods: The number of participants was 23 and the dermatological features of these were compared with 22 patients with overlap syndrome. The antibody to uridine-rich U1 ribonucleoprotein was measured for all patients. Statistical Analysis Used: SPSS (Version 17) and MedCalc (Version 11.6). Results: The Male: Female ratio among the MCTD patients was 1:6.67 and that of the overlap syndrome was 1:10. Twenty patients of the MCTD group presented with synovitis as against only seven in the overlap group. Raynaud's phenomenon was present in some of the subjects. Puffy fingers were rare in our study. Facial numbness was reported by four of those suffering from MCTD. Antinuclear antibody (ANA) was essentially of a speckled pattern in this disease Conclusions: Cutaneous indicators of MCTD are distinct from overlap syndrome. Knowledge of these manifestations prevalent in a region may lead to early diagnosis of the disease.
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Affiliation(s)
- Sumit Sen
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Pradyot Sinhamahapatra
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Supriyo Choudhury
- Department of Pharmacology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Anusree Gangopadhyay
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Sanchaita Bala
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Geetabali Sircar
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Gobinda Chatterjee
- Department of Dermatology, Venereology and Leprosy, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
| | - Alakendu Ghosh
- Department of Rheumatology, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Salt Lake City, Kolkata, India
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Sircar D, Sircar G, Waikhom R, Raychowdhury A, Pandey R. Clinical features, epidemiology, and short-term outcomes of proliferative lupus nephritis in Eastern India. Indian J Nephrol 2013; 23:5-11. [PMID: 23580798 PMCID: PMC3621239 DOI: 10.4103/0971-4065.107187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Race and ethnicity are important predictors of prognosis in lupus nephritis. This study was conducted to determine the clinical features, epidemiological profile, and short-term outcomes in patients of lupus nephritis from a single center in Eastern India. A total of 86 patients of class III/IV lupus nephritis were studied. Seventy-eight of them received cyclophosphamide for induction and eight of them received mycophenolate. The patients were evaluated for response, estimated glomerular filtration rate (eGFR), and proteinuria at 6 months. About 44% patients had a partial or complete response at 6 months and 64% at 1 year. The factors correlating with response at 6 months were older age at diagnosis, hypertension, activity, and chronicity indices and duration of symptoms prior to therapy. Chronicity index and hypertension were the predictors of response by logistic regression at 6 months. Compared to the Caucasian and African American patients, patients with proliferative lupus in Eastern India presented with a lower eGFR, lower proteinuria, and higher chronicity scores. Older age at diagnosis, hypertension, activity, chronicity indices, and duration of symptoms correlated with response. Short-term outcomes were similar to those described in Caucasian patients.
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Affiliation(s)
- D Sircar
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Sarkar D, Sircar G, Waikhom R, Raychowdhury A, Pandey R, Ghosh A. Severe systemic sclerosis developing in a patient of membranous nephropathy. Rheumatology (Oxford) 2011; 50:1522-3. [PMID: 21546352 DOI: 10.1093/rheumatology/ker171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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