Arterial thrombosis in an immunocompetent adult is rarely associated with varicella infection. Anticoagulation with warfarin stabilised the disease, homocysteine levels normalised, and therapy could be safely discontinued after three months, with full clinical recovery, preventing unnecessary long-term anticoagulation.

Background and Aim: Fibromyalgia is an idiopathic chronic widespread pain syndrome affecting 2-4% of the general population globally. Besides widespread fibromyalgia pain, morning stiffness, associated neurologic as well as sleep problems are also reported. Disease is more prevalent in females of middle-age group with low socioeconomic status, thus deteriorating overall productivity and psychosocial health. There is no permanent cure of the disease. This study aimed to explore, validate and assess the effect of four weeks of supervised yogic intervention on pain status, quality of life, sleep, cortical excitability, flexibility and range of motion in fibromyalgia patients, as compared to standard therapy. Method: Case-control study, interventional study and assessor-blind randomized controlled trial, conducted in 120 fibromyalgia patients (60 yoga group: 60 waitlisted controls) and 60 age-matched healthy controls. Pain was assessed subjectively, using questionnaires and objectively, using quantitative sensory testing and ELISA. Sleep and quality of life were assessed using common and disease specific descriptors. Flexibility and range of motion was assessed using sit and reach box, lateral goniometry and modified Schober test. Transcranial magnetic stimulation on M1 was used to assess corticomotor excitability of participants. Study parameters were assessed at baseline and after four weeks of the intervention. Results: A significantly poor sleep, flexibility and quality of life was reported in the fibromyalgia patients due to excruciating pain (VAS = 6.90, 0.12); corticomotor function was also abnormal in the patients, which were restored after four weeks of yogic intervention. On subjective and objective assessment of pain, we found significant relief and improvement in pain status in the yoga group as compared to the waitlisted controls. Fibromyalgia impact, sleep, quality of life and flexibility were also found solely better in fibromyalgia patients undergoing yogic interventions. Cortical parameters, specifically RMT, MEPs and MEP recruitment curves showed a significant improvement in yoga group as compared to waitlisted controls. Conclusion: Four weeks of regular and supervised yogic intervention may ameliorate pain, improve flexibility and range of motion and change cortical plasticity in the Indian cohort of fibromyalgia patients, as compared to standard therapy. Yoga-based interventions can also improve overall quality of life and sleep impairments by reducing catastrophization and fibromyalgia impact. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial CTRI/2023/06/054093 ### Funding Statement Department of Science and Technology, Government of India Indian Council of Medical Research ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, India I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

Serous membrane involvement, including pericardium, peritoneum or pleura, may be observed in more than half of the patients with systemic lupus erythematosus (SLE). However, chylothorax, that is, accumulation of chyle in the pleural space due to SLE is exceedingly rare. The exact pathogenesis of chylothorax in SLE is elusive. SLE-derived inflammation of lymphatic vessels leading to endoluminal back pressure and increased permeability has been hypothesised as the mechanism of development of chylothorax. Due to the rarity of the condition, the ideal treatment protocol is unknown. We hereby present a case of SLE chylothorax with its management and 12-month follow-up. Initially, the patient responded well to immunosuppressive therapy with documented resolution of chylothorax; however, serositis recurred after tapering of steroids, which responded to rituximab.

Objective This study aimed to assess the prevalence and pattern of familial autoimmunity and comorbidities among patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). Methods This multicentre, cross-sectional study utilized data from the Indian Rheumatology Association database and included patients diagnosed with RA, SLE, or SSc according to ACR/EULAR criteria. Family histories of autoimmune diseases and comorbidities (diabetes, hypertension, and cardiovascular disease) were recorded up to third-degree relatives. Data were analyzed using descriptive statistics, Pearson’s chi-square, and Fisher-Freeman-Halton exact tests. Results Among 4,384 RA, 819 SLE, and 180 SSc patients, valid family history data were available for 3,638, 489, and 135 cases, respectively. A positive family history of autoimmune disease was observed in 19.6% of RA, 11.4% of SLE, and 10% of SSc patients (P < 0.001). Familial RA was most common among RA patients (13.3%), whereas SLE-like disease was more frequent among relatives of SLE patients (2.6%). First-degree relatives were predominantly affected (RA 91%, SLE 89.3%, SSc 83.3%). Diabetes (16.7–22.2%) and hypertension (9.5–13.9%) were the most prevalent familial comorbidities, with diabetes showing higher aggregation in SSc families (P = 0.002). Conclusion Familial autoimmunity is common across major AIRDs, showing strong first-degree aggregation and disease-specific clustering. Distinct familial patterns are observed for autoimmune and metabolic comorbidities. RA demonstrates the strongest immediate familial clustering, whereas SLE displays a broader generational spread.

BackgroundFertility remains a controversial issue in women with systemic lupus erythematosus (SLE); it is largely preserved, though a subset experiences subfertility due to multiple interacting factors. Small studies on anti-mullerian hormone (AMH) as an ovarian reserve marker in SLE have yielded conflicting results; data on antral follicular count (AFC) and ovarian volume (OV) are sketchy. Potential ethno-geographic differences exist, but there is no data on ovarian reserve of Indian lupus patients. There is lack of clarity on the factors affecting ovarian reserve in SLE.MethodsIn this single-centre observational study, female SLE patients aged 18–45 years were tested for AMH, FSH, and estradiol at D2–D5 of menstrual cycle. Ultrasonographic assessment of AFC and OV was done in a subset. Age-specific nomograms of AMH and AFC of healthy fertile women were used for comparison. Proportion of patients with premature ovarian insufficiency (POI), early menopause, and those having low AMH (<1 ng/mL) were calculated. Clinico-immunological determinants of reduced ovarian reserve were identified through multivariable logistic regression.Results168 lupus women [mean age 27(6.4) years] were included. 93(55%) were married. 120(72%) had regular menstrual cycles. 3(1.8%) had POI (at 21, 22, and 37 years of age), while an additional two (1.2%) had early menopause at 41 and 44 years. 82(49%) were found to have low AMH. Comparison with age-specific nomograms showed 64% patients had AMH and 47% had AFC less than the corresponding tenth centile of healthy fertile women. Multivariable regression showed higher age [OR = 1.12(1.05–1.20), p = 0.001], active disease [OR = 3.87(1.56–9.62), p = 0.004], menstrual irregularities [OR = 4.56(1.95–10.65), p < 0.001], and anti-Ro60 positivity [OR = 1.89(0.92–3.88), p = 0.08] independently predicted reduced AMH. There was no association with organ involvement (including nephritis), disease duration, anti-dsDNA, anti-Sm, or aPL positivity, or prior CYC use.ConclusionsPrevalence of POI and early menopause in our study was found to be 1.8% and 1.2%, respectively. A high proportion (49%) of Indian SLE patients had evidence of low ovarian reserve in the absence of known risk factors. Higher age, active disease, menstrual irregularities, and anti-Ro60 positivity were found to be independently associated with diminished ovarian reserve. No association was found with prior CYC use, nephritis, or antiphospholipid antibodies.

OBJECTIVE:To identify HLA associations with clinical and autoantibody-defined subgroups of idiopathic inflammatory myopathy (IIM) and predict potential immunogenic epitopes presented by subgroup-specific HLA alleles. METHODS:An observational case-control study was conducted including 147 biopsy-confirmed IIM patients and 114 ethnically matched healthy controls. Patients were classified into clinical and autoantibody-defined subgroups. High-resolution HLA genotyping was performed, and allele/amino acid frequencies were compared between the groups. Epitope prediction was carried out for key HLA-associated autoantibody subgroups using in silico tools assessing antigenicity, allergenicity, toxicity and molecular docking with HLA alleles. RESULTS:HLA-C*07:01 was protective in IIM (Pa = 1.23 × 10-2, OR = 0.17, 95% CI 0.06-0.41). Subgroup analysis showed associations of HLA-A*33:03 with DM (Pa = 3.97 × 10-3, OR = 14.8, 95% CI 4.38-68.07) and DQB1*06:03 with PM (Pa = 2.40 × 10-2, OR = 7.24, 95% CI 2.42-22.61). The anti-Mi2 subgroup showed strong associations with A*33:03 (Pa = 2.82 × 10-3, OR = 19.73, 95% CI 5.11-98.01), DQA1*02:01 (Pa = 1.03 × 10-2, OR = 10.28, 95% CI 2.33-53.75) and DQB1*03:03 (Pa = 1.98 × 10-2, OR = 8.99, 95% CI 2.71-30.51). Anti-Ro52 was associated with B*08:01 (Pa = 2.94 × 10-3, OR = 11.67, 95% CI 3.56-39.83). Fine mapping pinpointed phenylalanine at position 25 of DQA1 to the risk allele DQA1*02:01 in anti-Mi2a/b autoantibody positive patients. From 49 predicted Mi-2 peptides, 'YYKYILTR', 'QAFSRAHR' and 'DYWEKLLR' bound stably to A*33:03 and were non-allergenic and non-toxic. CONCLUSION:In the anti-Mi2 subgroup, we identified novel HLA alleles, amino acid variants and immunogenic epitopes, supporting a role for HLA-restricted antigen presentation in disease pathogenesis and indicating candidate targets for antigen-specific immunotherapy. However, the HLA/epitope findings related to anti-Mi2 are exploratory due to limited power, and require confirmation in larger cohorts together with experimental validation.

Background Fibromyalgia (FM) is a widespread chronic musculoskeletal pain condition which affects approximately 1%-2% of the world's population predominantly females (female:male ratio, 9:1). The most common symptoms include musculoskeletal pain at 18 paired tender points along with morning stiffness, brain fogging, sleep disturbances, anxiety, depression and fatigue. We studied explores the demographic and clinical characteristics of the Indian FM population. Methods We screened 118 FM patients, aged 18-65 years; with moderate to high pain scores. Demographic attributes such as age and body mass index (BMI); and clinical attributes such as pain, flexibility, tender point counts, origin and duration of pain along with its clinical manifestations were recorded and analyzed. Correlation analysis was also performed between the clinical parameters. Results The mean age, weight, height and BMI of the FM patients (n=107) were 35.9 (10.1) years, 62.3 (9.9) kg, 1.56 (0.08) m and 25.6 (3.9) kg/m2, respectively. Patients felt an average pain of 6.9 (0.9) on the Visual Analog Scale (VAS); that was distributed on 15.9 (2.4) mean tender point counts (TPCs) for an average duration of 7.3 (6.2) years. We found a significant correlation between VAS and TPCs. No correlation was seen between lumbar flexion, BMI and VAS. Conclusion Indian patients with FM have a wide range of demographic and social attributes which significantly affect their clinical outcomes. So, while planning treatment strategies especially in developing countries the demographic and socioeconomic characteristics should be considered before administering any treatment strategy.

OBJECTIVES:ARL15, coding for a small GTPase, was identified as a non-HLA susceptibility gene in rheumatoid arthritis (RA) through a GWAS in a North Indian cohort, with serum adiponectin and ARL15 levels higher in RA patients with the associated genotype. This study aimed to delineate the functional role of ARL15 in RA pathobiology. METHODS:Differential transcriptomics in both ex vivo RA synovial fibroblasts and in vitro MH7A cells using a gene knockdown (KD) approach and standard analyses pipeline were performed to obtain insights into ARL15's role. RESULTS:In RASF, ARL15 KD led to downregulation of COMP-an extracellular matrix stabilizer linked to severe RA-alongside upregulation of adiponectin and IFN response genes like IFI6 and USP18. Furthermore, upregulation of NPTX1 and MX1, previously associated with disease modulation and treatment response, was observed. Downregulation of CTGF, CD248, and PTX3 suggested involvement of ARL15 in inflammation and RA-associated cardiovascular risk. Conversely, ARL15 KD in MH7A cells displayed distinct signatures with upregulated cytokines (IL1A, IL8, CXCLs) and downregulated inflammatory regulators (DOCK2, TLR4, TGFB2), reflecting an inflammatory bias distinct from patient-derived RASF. CONCLUSION:The dual-system approach, despite its divergent differential expression, underscores the multifaceted role of ARL15 in regulating connective tissue architecture, inflammation, and immune response. Limitations of immortalized cell models in capturing patient heterogeneity and disease complexity are apparent, but the key findings position ARL15 as a promising therapeutic target, warranting further investigation in RA animal models and genomic medicine. Taken together, this work provides a compelling rationale to pursue ARL15 targeted interventions in RA management.

Background: Sj & ouml;gren'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.

Objective: Fibromyalgia (FM) is an idiopathic progressive musculoskeletal pain syndrome affecting 2%–8% of the global population, predominantly females. Symptoms such as morning stiffness, brain fogging, and sleep disturbances are also common in the FM patients. There is no permanent cure of the disease except for temporary symptomatic relief by few FDA-approved medications. The aim of the current study was to investigate the effect of 4 weeks of regular and supervised medical yoga therapy (MYT) on pain status, lumbar flexion, and corticomotor excitability (CME) in FM patients. Methods: It is an assessor-blinded, randomized controlled trial where the pain was assessed both subjectively and objectively; lumbar flexibility and CME of both male and female FM patients of yoga and waitlisted group were also assessed and compared before and after 4 weeks of MYT and same course of standard care therapy. We have used pressure modality of quantitative sensory testing for objective assessment of pain. Corticomotor parameters were assessed using transcranial magnetic stimulation. Block randomization and opaque concealed envelope method was performed for randomizing and allocating patients in the yoga and waitlisted groups. Parametric tests were applied for the inter-and intragroup comparisons. Results: Demographic and clinical parameters of FM patients of both the arms were comparable at baseline (age: waitlisted group = 36.76 ± 9.20; yoga group = 35.71 ± 8.46; P > 0.05). Pain profile of the patient showed significant improvement, and tender point counts were also found to be reduced in the patients administered with MYT. In the waitlisted group, no significant changes were noted. A significant increase in lumbar flexion was reported bilaterally only after MYT. Former stayed unaltered in the waitlisted group. Moreover, improvements in some CME parameters of FM patients of the yoga group were also recorded. Such cortical changes were not marked in the waitlisted group. Conclusions: MYT can alleviate pain, improve flexibility, and alter CME in FM patients more than the standard therapy. MYT can be adopted in day-to-day lifestyle for symptomatic relief by FM patients.

Objective. This study aims to identify factors associated with higher Rheumatoid Arthritis Articular Damage (RAAD) scores in rheumatoid arthritis (RA) patients and to evaluate correlations between disease duration, joint involvement, extra-articular manifestations, and functional outcomes with the severity of articular damage. Methods. This multicenter, cross-sectional study was conducted across 8 tertiary care centers in India using the Indian Rheumatology Association database (2019-2022). Patients fulfilling the 2010 ACR/EULAR RA criteria were included. Demographic, clinical, socioeconomic, comorbidity, and disease-specific variables were collected. Articular damage was assessed using the RAAD score. Logistic regression was performed to identify predictors of damage. Results. Of 4641 recruited patients, 4213 were analyzed (mean age 52.8 years; 87.6% female). Severe damage was observed in 9%, moderate in 9.2%, and absent in 81.9%. Patients with severe damage had longer disease duration (median 13 vs. 8 years; p<0.001), more frequent extra-articular (10.3%) and systemic features (7.9%), and greater functional disability (mean health assessment questionnaire 11.12 vs. 3.96; p<0.001). Logistic regression identified longer disease duration [odds ratio (OR) 1.008, p<0.001], higher visual analog scale pain (OR 1.054, p=0.009), physician (OR 1.134, p=0.004) and patient global assessments (OR 1.224, p<0.001), extra-articular features (OR 2.885, p<0.001), and systemic features (OR 4.935, p<0.001) as independent predictors of joint damage. Conclusions. Severe joint damage is associated with delayed presentation, higher disease activity, and extra-articular/systemic features. Socioeconomic factors and comorbidities also influence outcomes. Early referral and comprehensive management are essential to reduce long-term disability in RA.

BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune disorder characterized by unpredictable flares and variable clinical quiescence. Despite validated clinical indices like the British Isles Lupus Assessment Group (BILAG) score, reliable molecular biomarkers for monitoring disease activity remain limited, particularly in underrepresented South Asian populations. Weaimed to identify arobust molecular framework to distinguish SLE flares from remission in an Indian cohort.MethodsWe conducted a discovery-phase study in an Indian cohort (n=16) stratified by Easy-BILAG scoring. Plasma proteomic profiling via LC-MS/MS was integrated with targeted cytokine quantification using the Olink Proximity Extension Assay (PEA). Differential expression and network analyses delineated immune-regulatory, hypoxic-vascular, and myeloid-activation pathways. A Random Forest classifier was trained on selected biomarkers and evaluated using leave-one-out cross-validation (LOOCV), permutation testing, and bootstrapped AUROC confidence intervals, with model interpretability assessed by SHAP values. Data are available via ProteomeXchange with identifier PXD075349.ResultsProteomic comparison identified a compact panel of proteins distinguishing flare from remission, characterized by a molecular polarization; flare states exhibited upregulation of COL18A1 and CSF1 (vascular and myeloid activation), while remission showed sustained expression of cytoskeletal scaffolding and immunoregulatory components, including FLNA, SH3BGRL3, and IGHG4. Cytokine analyses identified coordinated chemokine modules (CXCL9, CCL2, CCL3, and CCL13) preferentially upregulated during flare. The machine-learning model achieved robust internal discrimination with a mean AUROC of 0.96. Notably, a COL18A1 normalized protein expression cut-off yielded 100% specificity and 87.5% sensitivity, acting as an objective ‘rule-in’ adjunct for active disease. Normalized protein expression (NPX) cut-off yielded 100% specificity and 87.5% sensitivity, acting as an objective “rule-in” adjunct for active disease.ConclusionsThis study establishes a parsimonious 5-protein biosignature of candidate leads (COL18A1, HYOU1, IGHG4, FLNA, and SH3BGRL3) that effectively captures the multifactorial pathophysiology of SLE flare. By anchoring discovery in a systematically under sampled Indian population, this work enhances global diversity in lupus biomarker research and establishes a scalable, AI-driven framework for precision assessment of disease activity.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder marked by dysregulated humoral immunity, autoantibody production against nuclear and cytoplasmic antigens, and immune complex deposition that triggers widespread inflammation and tissue damage. Central to its pathogenesis are breakdowns in peripheral tolerance, aberrant T and B cell activation, and chronic type I interferon signalling, driving the disease’s heterogeneity. Emerging evidence highlights trogocytosis, a process involving the direct transfer of membrane-associated molecules between immune cells as a key immunomodulatory mechanism in autoimmunity. Through bidirectional membrane exchange, trogocytosis alters the surface receptor landscape, antigen presentation, and signalling capacity of immune cells without requiring new protein synthesis. In SLE, trogocytosis has been linked to the dysregulation of HLA-G, a non-classical MHC class I molecule with immunosuppressive properties. HLA-G interacts with inhibitory receptors such as ILT-2, ILT-4, and KIR2DL4, modulating immune responses. In SLE, aberrant HLA-G expression on immune cells, abnormal levels of soluble HLA-G in serum, and disrupted tissue-specific expression suggest impaired immune checkpoint control. These abnormalities contribute to immune dysregulation and the loss of tolerance, sustaining chronic autoimmunity. Understanding trogocytosis-mediated modulation of HLA-G may offer novel insights into disease mechanisms and therapeutic targets in SLE. This mini review examines the molecular mechanisms underlying trogocytic HLA-G transfer, characterises the dysregulated trogocytosis pathways observed in SLE patient immune cells, and evaluates the therapeutic potential of targeting these intercellular communication networks for disease management. The present review encompasses mechanistic studies of trogocytosis regulation in disease-relevant immune cell populations, analysis of HLA-G transfer kinetics and functional consequences, and assessment of pharmacological interventions that can modulate trogocytic activity to restore immune homeostasis and reduce disease activity in lupus patients, potentially offering novel precision medicine approaches for this heterogeneous autoimmune disorder.

Neurological manifestations can precede the sicca symptoms in Sjögren's syndrome. These patients may develop systemic features of Sjögren's syndrome in the future. In such patients, early diagnosis and management can avoid morbidity. In this case series, we describe three patients who presented with lumbar and brachial plexopathy due to Sjögren's syndrome. These patients tested positive for Ro and La autoantibodies and had a positive Schirmer test. All patients were initiated on immunomodulation therapy, with notable clinical improvement.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can significantly affect reproductive health. This study aims to assess reproductive health metrics among SLE patients in Indian settings to compare fertility rates and the impact of the disease on pregnancy with data from the general population. The independent, prospective, multicenter, observational study collected data from SLE patients at seven centres in India through a database created by the Indian Rheumatology Association. Data were gathered using structured proformas validated by experts. The final analysis included women aged > 15 years (total cohort), after excluding male subjects and those with inadequate data. Participants were categorized into married and unmarried cohorts, and various reproductive health metrics were analyzed pre- and post-disease. The total cohort included 631 subjects with an average age at recruitment of 36.46 ± 12.31 years, and mean age at menarche of 13.74 ± 1.44 years. The total cohort had an average of 1.8 pregnancies per woman, with an abortion rate of 0.35. The married cohort showed a pregnancy wastage ratio of 201.43. The cumulative fertility rate noted for the married cohort was 1.40, while for the total cohort was 1.04. Significant differences in pregnancy outcomes were observed before and after the onset of SLE, with pregnancies declining from 703 to 136 (P < 0.0001). A significant increase in pregnancy complications, including pregnancy-induced hypertension, small for gestational age, and pre-eclampsia, was noted before and after disease onset (P < 0.0001). Central nervous system and skin involvement also became more prevalent post-disease (P = 0.046 and P = 0.040, respectively). The study highlights the significant impact of SLE on pregnancy, both before and after disease onset, noting reduced pregnancies and live births, along with increased rates of pregnancy loss, stillbirths, and abortions. Complications such as hypertension and pre-eclampsia were more common after disease onset. These findings emphasize the need for targeted healthcare strategies and collaborative efforts to improve reproductive outcomes in patients with SLE.

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.