Dear All

Positives and negatives—Positives first: Wishing you all a happy Diwali. We lost Dr Prakash Pispati a few weeks back. Many of us received his emails only a few weeks before that. And at meets, his presence did not need to be specially looked into. We would know he is there. That he had been the APLAR and IRA president at one time is another thing. Motivated till the end and full of energy, he fathered the art of speaking and expressing. A detailed obituary will follow in the next issue. May his soul rest in peace.

1. The use of MRI-detected synovitis to determine the number of involved joints for the 2010 ACR/EULAR classification criteria for Rheumatoid Arthritis – is it of additional benefit?

Objectives:

To assess the value of MRI-detected synovitis to determine the number of involved joints on the performance of the 2010-ACR/EULAR classification criteria for rheumatoid arthritis (RA).

Methods:

277 patients with a clinical suspicion of RA consecutively included in the Leiden Early Arthritis Clinic (EAC) cohort underwent 1.5T MRI of MCP, wrist, and MTP joints. Test characteristics of the 2010 criteria were calculated when the number of involved joints was determined with and without including MRI-detected synovitis. Two outcomes were studied: Disease-modifying anti-rheumatic drug (DMARD) initiation and 1987-criteria fulfilment during the first year.

Dr Shefali Sharma, Rheumatology, PGIMER, Chandigarh

Sanket Shah, Dr. Chengappa KG, Dr. V.S. Negi, Clinical Immunology and Rheumatology, JIPMER, Pondicherry

CLINICAL CASE

A 47-year-old gentleman from Tamil Nadu, involved in agricultural work, presented to the rheumatology department with the manifestation of inflammatory symmetrical polyarthritis, involving small and large joints of upper limbs and lower limbs, which started 2 months back, and was associated with myalgia and fatigue. Twenty days prior to the onset of arthritis, the patient had a high-grade fever associated with chills and dysuria with a borderline rise in serum creatinine (1.6 mg/dl). He received treatment on the lines of urinary tract infection with intravenous antibiotics, with only partial relief in complaints. Twenty days following the onset of arthritis, he developed redness of the right eye with minimal pain. He was diagnosed with episcleritis by an ophthalmologist.

Baricitinib: The Potential Future Treatment of Lupus

Baricitinib, an oral selective inhibitor of Janus kinase (JAK)1 and JAK2, has been already approved for the treatment of RA.

In a double-blind, multicenter, randomized, placebo-controlled, 24-week phase 2 study, patients were recruited from 78 centers in 11 countries. Patients who were ≥18 years of age; had a diagnosis of systemic lupus erythematosus (SLE); and had active disease involving skin or joints were eligible for the study. In all, 314 patients were randomly assigned in a ratio of 1:1:1 to receive once-daily baricitinib 2 mg, baricitinib 4 mg, or placebo for 24 weeks. The primary endpoint was the number of patients achieving resolution of arthritis or rash at week 24, as defined by Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K).

At week 24, resolution of SLEDAI-2K arthritis or rash was achieved by 70 (67%) of 104 patients receiving baricitinib 4 mg (odds ratio [OR] vs. placebo 1·8, 95% CI 1.0–3.3; p=0.0414) and 61 (58%) of 105 patients receiving baricitinib 2 mg (OR 1.3, 0.7–2.3; p=0.39).

God’s Own Country, Truly

Dr. Suma Balan, Prof., Dept. of Rheumatology, Amrita Institute of Medical Sciences, Kochi

On the 14th of August, I was returning home from work in Kochi and discussing how the dams were now closed and how, hopefully, the long, punishing spell of rain we had had would be behind us soon. After a hot, dry summer and water shortages, we were all overjoyed when the monsoons commenced ahead of schedule and with adequate strength. Then, in July, there was this period of heavy rainfall with sporadic flooding and trouble lasting for about 2 weeks. Even the Bharatapuzha, usually a trickle in a sand bed as seen from the windows of a train, was full and