bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infection Risk Profiles of Upadacitinib in Patient with Rheumatoid Arthritis: A Meta-Analysis of Randomized Clinical Trials
Authors: Mohd Yusof Mohd Haidir , Jinih Marcel 
Published: November 2024

Background There is a increasing suggestion that upadacitinib may elevate the risk of infections in patients with rheumatoid arthritis (RA). To better understand this potential infection risk, we conducted a meta-analysis using data from randomized clinical trials (RCTs) to evaluate the overall risk of infections in these patients. Methods We conducted a comprehensive systematic search in EMBASE, MEDLINE, and CENTRAL from their inception until 31st December 2023 to identify relevant RCTs reporting the occurrence of infections in patients with RA who were treated with monotherapy upadacitinib (15mg once daily orally) regardless of the background RA therapy used in these patients. The primary outcomes were the incidence of total infections, serious infections, non-serious infections, and opportunistic infections (including herpes zoster and tuberculosis). The secondary outcomes were the incidence of various sites of infections, including the upper respiratory tract, lower respiratory tract, gastrointestinal tract and others. In anticipation of study heterogeneity, the effect estimate was pooled with a random-effects model, to obtain the risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel statistical method. Results Nine RCTs were included, involving a total of 4,575 RA patients. Compared to the control group (placebo and other active treatments), patients treated with upadacitinib exhibited a significant increase in the risk of total infections (RR, 1.18; 95% CI, 1.02-1.36; I2, 49%), and non-serious infections (RR, 1.16; 95% CI, 1.01-1.34; I2, 46%). Patients who were on upadacitinib were significantly at an increased risk of gastrointestinal infections (RR, 3.10; 95% CI, 1.47-6.56; I2, 0%) but not on other types of infections. Conclusion Compared with placebo and other active treatments, upadacitinib signi?cantly increased the overall risk of infections (total infections and non-serious infections), particularly gastrointestinal infections. These ?ndings may assist clinicians to weigh the benefit-risk balance of upadacitinib prior to their administration to patients with RA.
Effects of Secukinumab on Enthesiophyte and Erosion Progression in Psoriatic Arthritis-A One-year Double-blind, Randomized, Placebo-controlled Trial Utilizing High-resolution Peripheral Quantitative Computed Tomography
Authors: Jin Yingzhao , Cheng Isaac T , So Ho , Lai Billy T , Ying Shirley K , Kwok Kitty Y , Griffith James , Hung Vivian , Szeto Cheuk-Chun , Lee Jack Jock-Wai , Qin Ling , Tam Lai-shan 
Published: November 2024

Background This study aimed to ascertain the effect of secukinumab on erosion and enthesiophyte progression in psoriatic arthritis (PsA) by high-resolution peripheral quantitative computed tomography (HR-pQCT). Methods This was a one-year double-blind, randomized, placebo-controlled trial (NCT0362386740). Patients with erosion in the metacarpophalangeal joints (MCPJ) 2-4 were randomised in a 1:1 ratio to either the secukinumab or placebo group. HR-pQCT of the MCPJ 2-4 were performed at baseline, week-24 and 1-year. Progression of enthesiophyte were defined as changes in enthesiophyte volume exceeding smallest detectable change (SDC) (0.12mm3) or the identification of any new enthesiophyte. Partial repair of erosion was defined as a reduction in erosion volume greater than SDC (0.1mm3). Results Forty patients (age: 51.9± 13.4 years, 20 [50%] male) were recruited. Thirty-four patients who completed study treatment were included in the per-protocol analysis. The erosion volume at baseline, week-24 and week-48 revealed significant reduction in the secukinumab group while no differences in the placebo group (Figure-3A). There was a trend suggesting that fewer patients developed new-erosions in the secukinumab group (one-erosion in one-patient) compared to the placebo group (six-erosions in five-patients) (p=0.078) (Figure-3B). A significantly higher proportion of erosions with partial healing was observed in the secukinumab group compared with the placebo group [51%vs30%, p=0.029] (Figure-3C). Regarding enthesiophyte, a total of 25-enthesiophytes were identified in both the secukinumab and placebo groups at baseline. The enthesiophyte volume at baseline, week-24 and week-48 revealed significant differences in the secukinumab group while no differences in the placebo group (Figure-3D). While one (one-enthesiophyte in one-patient) and four-enthesiophytes (four-enthesiophytes in three-patients) were newly identified in the secukinumab group and placebo group respectively (Figure-3E), the proportion of enthesiophyte progression was numerically higher in the placebo group than the secukinumab group [40%vs16%, p=0.114] at week 48 (Figure-3F). GEE results showed that the odds ratio (OR) for enthesiophyte progression in the secukinumab group was 0.264 (95% CI: 0.080-0.878, p=0.030), while the OR for partial erosion healing in the secukinumab group was 2.816 (95% CI: 1.109 to 7.153, p=0.029), adjusting for tender-joint-counts. Conclusions Secukinumab demonstrates a potential benefit in facilitating partial erosion repair and preventing enthesiophyte progression in PsA.
Comparison of Ultrasonographic Findings with Plain Radiography in Patients with Knee Osteoarthritis
Authors: Shrestha Swikriti , Vaidya Binit , Nakarmi Shweta 
Published: November 2024

Background Knee osteoarthritis is one of the most commonly encountered joint disease with prevalence ranging upto 7.9%. There are various radiologic instruments to measure the disease severity of knee osteoarthritis. Kellgren Lawrence (KL grading) classification is commonly used radiographic tool to assess severity. High frequency musculoskeletal ultrasound is being used now-a-days as a reliable tool for assessment of osteoarthritis Objective To compare musculoskeletal findings with X-ray findings in knee osteoarthritis Method A prospective crosssectional study was conducted in patients with knee osteoarthritis in national centre for rheumatologic disease. An AP view standing X-ray was done for the involved knee and K-L grading was done. High frequency musculoskeletal ultrasound was done for the same knee. Synovial hypertrophy, Doppler activity, cartilage thickness (medial, lateral, intercondylar), osteophytes were noted. Pearson’s coefficient of correlation was calculated to compare the correlation between musculoskeletal ultrasound and radiographic findings Result A total of 138 patients with knee osteoarthritis were enrolled in the study with female predominance of 83% and mean age of 56.87± 10.61 years. A negative correlation was observed between cartilage thickness (medial) with joint space narrowing (KL grading) Conclusion Musculoskeletal ultrasound may be used in clinical practice to diagnose and monitor cases of knee osteoarthritis. It is potential imaging technique which might help in therapeutic interventions as well as disease monitoring.
Treatment of Juvenile Psoriatic Arthritis with Anti-interlukin-17 – A Case Report
Authors: Ng Daniel Yu Hin , AU Ka-Nam , Tse Kei-Chiu Nico 
Published: November 2024

Background Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory joint disease in children and adolescents. Historically, moderate to severe psoriatic arthritis were treated with disease-modifying anti-rheumatic drugs, such as methotrexate. Since the 2000s, biologics such as TNF-inhibitors had been used for severe or refractory disease. More recently, Secukinumab, an anti-IL-17 monoclonal antibody, was approved in the US for treatment of psoriatic JIA since 2021. Methods We describe a case of psoriatic JIA, who was to our knowledge the first paediatric patient to be treated with Secukinumab in Hong Kong. Results A 12-years-old Chinese girl presented with 6-months history of plaque psoriasis associated with left hip pain. (Figure 1) Her JADAS10 score was 16.5 and her PASI score was 10.4. Naproxen, topical steroids and oral methotrexate were used but did not significantly improve her symptoms. An MRI scan continued to show evidence of active sacroiliitis. The patient was treated with Secukinumab at a loading dose of 150mg weekly SC for five weeks, followed by a maintenance dose of 150mg monthly. After one month, her inflammatory markers normalised and her JADAS10 score was 0, indicating inactive arthritis. After 3 months, her PASI score was 0.6. Follow-up of her skin condition showed complete solution of psoriasis at 6 months. (Figure 2) Conclusion Secukinumab induced rapid disease remission in a Chinese paediatric patient with PsJIA. It helped prevent progressive joint damage and greatly improved her skin’s cosmetic appearance. Our case demonstrated the remarkable efficacy of Secukinumab in the treatment of PsJIA.
Knee Tuberculosis Masquerading as Pigmented Villonodular Synovitis: A Challenging Diagnostic Case Report
Authors: Islam Asif , Nisar Hajira , Khurshid Fatima , Iqbal Nasir 
Published: November 2024

Background: Tuberculous arthritis presents a diagnostic difficulty due to its modest clinical indications and vague imaging data, frequently resulting in a delayed or wrong diagnosis. Pigmented villonodular synovitis (PVNS), which might seem like tuberculous arthritis, complicates the diagnosis. Case Report: This case study features a young child whose knee arthritis was first misdiagnosed as PVNS. Magnetic resonance imaging (MRI) revealed nodular masses and hemosiderin deposits around the knee joint, indicating widespread PVNS. This error caused a delay in accurate diagnosis and treatment. Conclusion: These findings underscore the relevance of investigating TB in patients who appear with PVNS-like characteristics, emphasizing the necessity for a high index of suspicion and quick examination to achieve fast and correct diagnosis for successful care.
Prevalence of Sexual Dysfunction in Ankylosing Spondylitis and Its Correlation with Disease Activity
Authors: Jain Piyush , Giri Avdesh 
Published: November 2024

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and pelvis. While studies have extensively explored the physical manifestations of AS, the prevalence of sexual dysfunction in male patients and its association with disease activity remains under-explored. The study aims to determine the prevalence of sexual dysfunction in AS and its association with the disease activity. Methods: This comparative cross-sectional observational study was conducted with sexually active male patients diagnosed with AS. Disease activity was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Functional limitations and the extent of spinal and pelvic involvement were assessed through the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI), respectively. Sexual function was evaluated using the International Index of Erectile Function-15 (IIEF-15), and psychological status was measured via the Hospital Anxiety and Depression Scale (HADS). Results: The study reveals a significantly higher prevalence of sexual dysfunction among male patients with AS compared to control subjects, with p-values of < 0.0001 across all five domains of IIEF-15 (Fig.1). Notably, domains such as erectile function, orgasmic function, and overall sexual satisfaction were markedly impaired and exhibited a strong negative correlation with increased disease activity, as measured by BASDAI and the ASDAS-CRP. The erectile function scores demonstrated a pronounced negative correlation with disease activity indices, with correlation coefficients of -0.9840 for BASDAI and -0.9669 for ASDAS-CRP (Fig.2). Conclusion: AS is associated with a high prevalence of sexual dysfunction and correlates with disease severity. The results underscore the importance of integrating sexual health assessments into routine clinical evaluations of AS patients and addressing sexual dysfunction as a critical component of comprehensive disease management.
Gastrointestinal Involvement in Systemic Sclerosis - Review of 250 Patients’ Clinical, Radiological and Serological Profile - A Retrospective Study
Authors: Jacob Manna , Mathew Ashish , Nithin Koshy , Goel Ruchika , Mathew John 
Published: November 2024

Background: Gastrointestinal manifestations are common in Systemic Sclerosis, but studies in the Indian population are sparse. Methods: This is a retrospective study of 100 patients who presented to the Department of Clinical Immunology and Rheumatology between 2014 to 2019. The charts and investigations were reviewed for clinical and serological profile, and the investigations done were recorded. Results: 100 patients diagnosed with systemic sclerosis (SSc) who fulfilled the ACR/EULAR 2013 criteria were included in the study-81 patients were classified as diffuse SSc, 15 as limited SSc and 4 as Sine Scleroderma. In total, 72 out of 100 patients reported reflux symptoms and 4 reported chronic diarrhoea. The imaging studies done for the patients and the findings are summarised in Table 1; the indications for endoscopy and the findings are summarised in Table 2. 2 patients were diagnosed with Chronic liver disease. 90 out of 100 patients were treated with a combination of proton pump inhibitors (PPIs) and prokinetics and 10 patients with PPIs alone. H Pylori eradication and antifungal therapy as per scopy findings were administered. 3 patients with chronic diarrhoea were empirically treated with Rifaximin for probable SIBO with symptomatic improvement. Conclusions: GI involvement is common in Scleroderma patients (93%- symptomatic and subclinical combined); however, the symptoms are under reported. Complications of GERD are less common in our popular, probably due to early initiation of PPIs and prokinetics. HRCT identified esophageal dilatation in 79% of the patients. Patients with refractory symptoms need to undergo scopies to rule out infections and malignancies. Further studies are required for better assessment and management of GI symptoms.
Effect of Achieving Sustained SDAI Remission on Erosion Healing in Early Rheumatoid Arthritis - A One-year Prospective HR-pQCT Study
Authors: Wu Qihan , So Ho , Cheng Tsz-Ho , Jin Yingzhao , Lau Sze-Lok , Tam Lai-shan 
Published: November 2024

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease with progressive joint destruction. High-resolution peripheral quantitative CT (HR-pQCT) is a novel technique for detailed bone microstructure analysis allowing volumetric assessment of bone erosions. While most patients demonstrating little baseline joint damage on radiography in the early stage of RA, whether achieving simple disease activity index (SDAI) remission can lead to better structural outcome is to be confirmed. Methods Patients with ERA were recruited and treated to the target of simple disease activity index (SDAI) remission using a standardized algorithm. One hundred patients who received the one-year tight-control treatment were grouped by achieving SDAI sustained LDA [SDAI [Formula: see text] at 6, 9 and 12 months (sLDA group) or not (non-sLDA group). HR-pQCT of the second to fourth metacarpophalangeal joints were performed at baseline, month 6 and one-year. Erosion volume and marginal bone mineral density (BMD) were measured. On an individual patient basis, erosion progression was defined as at least one erosion showing (1) an increase in erosion volume exceeding the smallest detectable change [SDC] (0.08 mm 3) AND (2) a decrease in marginal BMD exceeding SDC (7.8 mmHA/cm 3). Erosion healing was defined as at least one erosion showing (1) a reduction in erosion volume greater than SDC AND an increase in BMD exceeding SDC OR complete disappearance of the lesion AND (2) the absence of any erosion progression. Results Fourteen patients (12.8%) achieved sustained SDAI remission from 6-12 months (SDI group). After 12 months, a significant reduction in erosion volume and marginal osteosclerosis was observed in both groups. The SDI group showed a lower incidence of erosion progression (increase in volume [Formula: see text]0.08mm 3 and decrease in marginal osteosclerosis [Formula: see text]7.8mg HA/cm 3 : 0% vs 16%, p=0.135) and exhibited a higher rate of erosion healing (56% vs 29%, p=0.083) compared with the non-SDI group. In the GEE model, patients in the SDI group showed a higher likelihood of erosion healing (OR: 2.976, 95% CI: 1.0 - 8.9, p=0.050). The changes in erosion depth and width were similar between two groups. Conclusion Achieving sustained SDAI remission could improve erosion healing and limit erosion progression in patients with ERA.
Bone Mineral Density and Fracture Risk Assessment in Patients of Systemic Sclerosis
Authors: Jain Piyush , Parihari Satyajt , Taneja Anil 
Published: November 2024

Background: Systemic sclerosis (SSc) is a chronic disease presenting in the age group of 20-50yrs and females are more affected than males. Osteoporosis is common in many rheumatological diseases and an association has been well established in Rheumatoid Arthritis and Systemic Lupus Erythematosus. However, there is no such robust data in patients affected with SSc. Our study aimed to measure Bone Mineral Density and assess the risk of fracture in patients of systemic sclerosis using the Fracture Risk Assessment using (FRAX) algorithm. Methodology: The case control study conducted in a tertiary care hospital included 24 patients of age 18-45years with systemic sclerosis and 24 age and sex matched healthy controls. 62.5% cases were antiScl-70 antibody positive, 62.5% had interstitial lung disease and 37.5% had pulmonary arterial hypertension. The BMD of Scl-70 antibody positive patients was 0.64± 0.08 gm/sq.cm at neck of femur, 0.70± 0.08 gm/sq cm at lumbar spine and 0.37± 0.06 gm/sq. cm at forearm. A significant lower T score at neck of femur was noted in cases as compared to controls (-1.91± 10 vs -0.32± 1.06, p=0.001). The mean FRAX score value for major osteoporotic fracture in cases, was 1.46± 0.61% with maximum value of 3% and minimum value of 0.9%. Whereas, for the hip fracture mean FRAX was 0.83± 0.07% with range of 0.7% to 1.9%. A significant difference was noted in risk of major osteoporotic fractures between cases and controls (p=0.017). On multivariate regression models computed to analyse the covariates of BMD for neck of femur, lumbar spine and forearm, it was observed that serum vitamin D levels, presence of pulmonary hypertension and/or ILD were significant covariates of BMD neck of femur. Conclusion: Systemic sclerosis is associated with significantly low bone mineral density compared to controls. The bone mass was negatively correlated with involvement of internal organs and serum iPTH levels. SSc may be considered as an independent risk factor for osteoporosis and patients of SSc should be evaluated for BMD with DEXA scan to prevent osteoporotic fractures.
Immunodeficiency 70 (IMD 70)
Authors: Gopal Manikandan , Mathew John 
Published: November 2024

Background: Immunodeficiency 70 is a rare disease and there are only very few cases in the literature. Case History: Young boy in his early 20’s from Indian subcontinent presented with recurrent episodes of fever, oral ulcers, loss of weight for past 3 years. Four episodes (july 2019, april 2020, APRIL 2021, Jan 2022) of fever, each high grade associated with chills, rigor, nausea, myalgia, throat pain, holo-cranial headache, painful oral ulcers over the tongue and painless over lips. Initial episode of fever was associated with leucopenia (3200) and thrombocytopenia (122000), acute kidney injury (creatinie-3.0) and pyelonephritis, transaminitis. He received 2 weeks of parenteral antibiotics and improved. Subsequent episodes of fever is not associated with any localizing symptoms or signs. No history Suggestive of connective tissue disease. Family history was non contributory. Physical examination: He was febrile (101 degree F), pulse rate 100/minute, respiratory rate 18/minute, tongue ulceration in lateral border, no lymphadenopathy, no organomegaly, normal sytemic examination. Evaluation: The patient was evaluated for chronic infections, hematalogical malignancy, Behcet’s disease, auto inflammatory syndromes like Haplo insufficiency of A20. His complete blood count, electrolytes, renal function test, liver function test urine microscopy, blood culture were normal. CRP was elevated (58 mg/l). Tzanck smear from buccal mucosa was negative. CT thorax and abdomen showed no significant lymphadenopathy, organomegaly, evidence of infections or malignancy. In view of oral ulcers & fever Behcet’s disease was considered and HLA b51 was sent and came negative. Exome genome sequencing was done to diagnose immunodeficiency or autoinflammatory syndromes which came positive for immunodeficiency 70. Treatment: He was treated with colchicine and fever subsided and leucopenia improved Discussion: Immunodeficiency-70 (IMD70) is an autosomal dominant immunologic disorder characterized by severe cutaneous warts on the hands, feet, and face, suggesting increased susceptibility to human papillomavirus (HPV) infection. Affected individuals may also have recurrent bacterial infections like pneumonia, boils, sinusitis, as well as feature of autoinflammation, such as colitis, celiac disease, and retinal vasculitis. Laboratory studies show decreased CD4+ T cells and decreased CD19+ B cells; hypogammaglobulinemia, combined T cell and B cell immunodeficiency characterized by decreased CD4+ T cells, decreased CD19+ B cells, recurrent bacterial infections, and severe cutaneous warts on the hands, feet, and face that has material basis in heterozygous mutation in IVNS1ABP on chromosome 1q25.3.
Tafro Syndrome - Mimicker of SLE
Authors: Gopal Manikandan , Mathew John 
Published: November 2024

Background: TAFRO SYNDROME mimics SLE. Differentiating both is essential for correct manangement. Case report: 40 year old lady came with complaints of fever, insidious onset of painless abdominal distension which was gradually progressive to form tense ascities in a span of 2 months. On examination she was pallor, having pedal edema, tense ascities and cervical and axillary lymph node enlargement (mazimum 1* 1 cm). Lymph nodes were firm, non matted, not fixed. On evaluation found to have pancytopenia. (Hb: 5.3 gm%, platelet count, Wbc-3600/cu mm, 90,000/cu mm), Her LFT -alkaline phosphate -639 U/L, Hyperbilirubinemia with total Bil of 1.73 mg/dl and direct fraction of 1 mg/dl and LDH of 139 U/L. Renal - 24 hour urine protien = 301 mg. She had malena at presentation and her Hb dropped to 3.2 gm% platelets count of 10,000. Ct abdomen showed -Mild to moderate ascites, mild hepatomegaly. Ascitic Tap of 3 litre was done which showed high SAAG and High protein. Ugi endoscopy was done which showed Antral gastritis and no feature of porat hypertension. Infective workup including tuberculosis came negative. Autoimmune work ANA - 2+ speckled. (1:100 dilution) Coombs test direct - 3+ C3 = 115 (90 to 180) C4 = 39.8 (10 to 40) Ds DNA = 121 (< 100 IU/ ml) Urine UP/UC = 0.48 24 hour urine protien = 301 mg Anti SSA ELISA test - 63 (< 20 RU/ml) Anti SM ELISA test 1 (< 20 Ru/ml) ELISA Anti RNP - 2 Ru/ml (< 20) APLA work up was within normal limit and lupus anticoagulant was mildy positve. She was satifying the ACR EULAR 2019 classification criteria for SLE and SLE can have lymphadenopathy features suggestive of castle man disease. She was intially diagnosed as SLE and treated with Sle protocol and was not reposnding. Lymphnode biopsy later was done suggestive of Hypervascular type of castle man disease and intiated on R - CEP (Rituximab, Cyclophosphamide, etosposide, prednsiolone) LEARNING POINT 1) SLE is a great mimicker of variety of other diseases and rheumatologist should be aware of the disease that mimics SLE. 2) TAFRO syndrome is variety of castleman disease.  T-Thrombocytopenia  A-Ascities  F-Fever  R-renal dysfunction  O-Organomegaly 3) TAFRO syndrome has autoimmune manifestations that mimics SLE and it an aggressive variety of castleman disease