Patients with dermatomyositis (DM) are at an elevated risk of developing active tuberculosis (TB), particularly male patients and individuals on immunosuppressive therapy. We present three cases of dermatomyositis complicated by tuberculous pyomyositis during the initial presentation, each with a distinct clinical presentation, highlighting the challenges encountered in both diagnosis and treatment. A heightened level of suspicion, along with additional and repeated diagnostic testing, is crucial for diagnosing ETPB and also identifying and treating any possible secondary infections.

Journal Article Accepted manuscript Azathioprine related alopecia totalis due to NUDT 15 mutation in a pregnant systemic lupus erythematosus patient with successful obstetric outcome Get access Ashish Chandwani, Ashish Chandwani Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Sankar J, Sankar J Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Corresponding Author: Dr Sankar J, Assistant Professor, Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi110010, India. Telephone: +91-8826313724. Email ID: sankarjayaprakash@gmail.com Search for other works by this author on: Oxford Academic PubMed Google Scholar Aradhana Dwivedi, Aradhana Dwivedi Department of Genetics, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Kartik Sivasami, Kartik Sivasami Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Harsh Jain, Harsh Jain Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Nidhi Goel, Nidhi Goel Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Abhishek Kumar, Abhishek Kumar Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Vivek Vasdev Vivek Vasdev Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, keae431, https://doi.org/10.1093/rheumatology/keae431 Published: 08 August 2024 Article history Received: 11 July 2024 Revision received: 30 July 2024 Accepted: 02 August 2024 Published: 08 August 2024

Journal Article Accepted manuscript "Polo mint sign" in pulmonary thromboembolism with Ig A vasculitis Get access Ashish Chandwani, Ashish Chandwani Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Sankar J, Sankar J Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi, India Corresponding Author: Dr Sankar J, Assistant Professor, Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi 110010, India. Telephone: 8826313724. email ID: [email protected] Search for other works by this author on: Oxford Academic PubMed Google Scholar Vikas Marwah, Vikas Marwah Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Akhil K Ravi, Akhil K Ravi Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Ruchira Mukherji, Ruchira Mukherji Department of Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Ramakant Singh, Ramakant Singh Department of Clinical Immunology and Rheumatology, INHS Mumbai Colaba, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Kartik Sivasami, Kartik Sivasami Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Vivek Vasdev Vivek Vasdev Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar QJM: An International Journal of Medicine, hcaf010, https://doi.org/10.1093/qjmed/hcaf010 Published: 10 January 2025 Article history Received: 03 January 2025 Published: 10 January 2025

Journal Article Accepted manuscript Diffuse symmetrical acroosteolysis in systemic sclerosis Get access Nidhi Goel, Nidhi Goel Army Hospital Research and Referral, Department of Rheumatology Corresponding author- Dr Nidhi Goel, Army Hospital Research and Referral, Department of Rheumatology, Dhaula Kuan, New Delhi- 110010 (Mobile Number- +91 9714279355), [email protected] Search for other works by this author on: Oxford Academic PubMed Google Scholar Sankar J, Sankar J Army Hospital Research and Referral, Department of Rheumatology Search for other works by this author on: Oxford Academic PubMed Google Scholar Vivek Vasdev, Vivek Vasdev Army Hospital Research and Referral, Department of Rheumatology Search for other works by this author on: Oxford Academic PubMed Google Scholar Kartik Sivasami, Kartik Sivasami Army Hospital Research and Referral, Department of Rheumatology Search for other works by this author on: Oxford Academic PubMed Google Scholar Abhishek Kumar Abhishek Kumar Army Hospital Research and Referral, Department of Rheumatology Search for other works by this author on: Oxford Academic PubMed Google Scholar QJM: An International Journal of Medicine, hcaf040, https://doi.org/10.1093/qjmed/hcaf040 Published: 10 February 2025 Article history Received: 30 January 2025 Published: 10 February 2025

Background:Falls are common among the elderly population and are usually multifactorial. Most of the falls are preventable if the risk factors are identified early and addressed. The primary objective was to assess the agreement between the fall-risk assessment as measured by the digital sensor-based Kinesis Quantitative Timed Up and Go (QTUG) device and conventional Fall Risk Assessment Tool (FRAT) in elderly Indian population. Methods:The study was conducted in a tertiary care hospital of Western India. Conventional fall-risk assessment was done using the FRAT score and digital sensor-based fall risk was assessed using the Kinesis QTUG device. Agreement between both the fall-risk assessments was done using unweighted kappa. Results:The mean age was 68.54 (±2.62) years with females constituting 53.3%. The mean timed-up-and-go test score was 20.33(±7.7) seconds. A total of 253 falls were noted for 147 elderly individuals. Combined fall risk using the Kinesis QTUG device showed that 59.56% (218/366) elderly patients had a high fall risk, whereas the FRAT score showed high fall risk in only 1.36% (5/366) elderly patients. There was a poor agreement between the two tools with unweighted kappa of 0.634. Conclusions:Prevalence of falls in elderly in the last year was 40% in our study. There was a poor agreement in fall-risk estimate using the Kinesis QTUG device and FRAT score with an unweighted kappa value of 0.634.

Background: Connective tissue disease (CTD)-related interstitial lung diseases (ILDs) are one of the most common ILDs which affect relatively younger populations and can lead to extensive lung damage and fibrosis. Early detection and initiation of anti-inflammatory therapy can curtail the extent of lung damage. The diffusing capacity of the lungs for carbon monoxide (DLCO) is a well-established early marker of ILD. While most of the studies have shown specific nailfold capillaroscopy (NFC) findings in patients with CTD-ILD, none of them has evaluated the relation between diffusion impairment and nailfold capillary changes. The present study was carried out to evaluate the relationship between DLCO and NFC as markers for lung involvement in CTD-ILDs. Materials and Methods: This was a medical record-based observational study wherein the medical records of 100 diagnosed patients of CTD-ILD attending the pulmonology and rheumatology outpatient department were screened. Data concerning NFC, spirometry, and DLCO were collected and analyzed. Results: In our study of 100 patients, the minimum age was 29 years, and the maximum age was 78 years. A majority of patients in the study were found to be males (58%) and were suffering from CTD-ILD for a duration ranging from 2 to 5 years (58%). Eighty-nine percentage had a functional impairment on spirometry in the form of reduced forced vital capacity, and 61% had impaired DLCO. Nailfold capillary abnormalities were observed in all but one patient. The most common abnormal finding was a loss of capillary density (95% of patients) and a decrease in the intercapillary distance (94% of patients). A significant correlation was seen between diffusion impairment and abnormal nailfold capillary length. However, there was no significant correlation between DLCO and overall nailfold capillary abnormalities. Conclusion: The study concludes that NFC cannot be used as a tool to monitor diffusion impairment of the lungs in CTD-ILD. DLCO is a better assessment method compared to NFC changes as an indicator of lung involvement in CTD-ILD.

Monogenic lupus is a rare variant of systemic lupus erythematosus (SLE) that develops in patients with a single gene disorder. Early complement component deficiencies were the first forms of monogenic lupus to be described, and C1Q gene mutations are one of the most common forms. C1QA complement deficiency has been reported to occur usually due to biallelic variants in C1QA gene, and compound heterozygous variants in C1QA gene have rarely been reported. A majority of monogenic lupus patients with C1Q deficiency present with mucocutaneous, renal, and musculoskeletal manifestations. Our patient is an unusual case of monogenic lupus with severe neurological manifestations along with cutaneous, haematological, and hepatic manifestations secondary to rare compound heterozygous variants in C1QA gene and antiribosomal P autoantibody positivity. She was treated with glucocorticoids, rituximab, and fresh frozen plasma with partial neurological recovery. Thus, we present a unique case of monogenic lupus due to a rare compound heterozygous variant in C1QA gene with a brief review of literature.

Aim: The aim of this study was to study the safety profile of a rituximab (RTX) biosimilar Reditux (R) in patients of rheumatological disorders at a tertiary care hospital in North India. Methodology: An observational study was carried out to ascertain the safety of RTX in rheumatology patients. A total of 60 patients initiated on RTX were followed up for a mean duration of 14 months for adverse events. Results: A total of seven mild infusion reactions were recorded during the first infusion of RTX. Eighteen infective events were recorded including a case of extrapulmonary tuberculosis (TB), three cases of hepatitis B virus (HBV) reactivation, four cases of herpes zoster, and a fatal case of disseminated varicella infection. There were no cases of JC virus infection or malignancies in our study. Conclusion: This study highlights a much higher incidence of infections following the use of RTX in India as compared to international studies published so far. We also observed a higher rate of reactivation of HBV, varicella zoster virus, and TB in our cohort. This emphasizes the need for revising protocols for screening, vaccination, and chemoprophylaxis for chronic infections in countries with high burden of infections.

Journal Article Accepted manuscript Occlusive retinal vasculitis in IgA vasculitis Get access Nidhi Goel, Nidhi Goel Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Sankar J, Sankar J Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Corresponding Author: Dr Sankar J, Assistant Professor, Department of Clinical Immunology and Rheumatology, Army Hospital Research and Referral, New Delhi110010, India. Telephone: +91-8826313724. Email ID: sankarjayaprakash@gmail.com Search for other works by this author on: Oxford Academic PubMed Google Scholar Soham Sen, Soham Sen Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Manisha Singh, Manisha Singh Department of Ophthalmology, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Pradeep Kumar, Pradeep Kumar Department of Ophthalmology, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Sreenivasa S Iyengar, Sreenivasa S Iyengar Department of Nephrology, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Shamresh Kumar Singh, Shamresh Kumar Singh Department of Pathology, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Abhishek Kumar, Abhishek Kumar Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Kartik Sivasami, Kartik Sivasami Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Vivek Vasdev Vivek Vasdev Clinical Immunology and Rheumatology Unit, Army Hospital Research & Referral, New Delhi, 110010, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, keae337, https://doi.org/10.1093/rheumatology/keae337 Published: 14 June 2024 Article history Received: 19 April 2024 Revision received: 13 May 2024 Accepted: 27 May 2024 Published: 14 June 2024

response to conventional glucocorticoid and immunosuppressant therapy and has a poor overall prognosis. 2We highlight this case to sensitize the physicians about the typical cutaneous findings and ILD that clinch the diagnosis.

Background: Raynaud’s phenomenon (RP) is a common symptom characterized by episodic digital ischemia with color changes on exposure to cold. It is imperative to distinguish between Primary RP (pRP) which is a benign condition from secondary RP (sRP) owing to its association with serious Connective tissue disorders (CTD). The available tools for differentiating between the two entities are clinical as well as laboratory-based tests including Antinuclear antibody and Nailfold capillaroscopy (NFC). All these tools have inherent limitations and require technical expertise for evaluation and interpretation. The relative changes in temperature of hand digits are characteristic of RP and Infrared thermal imaging (IRT) can be utilized as a simple, objective tool to assess the same. Objectives: 1)To evaluate the ability of IRT to distinguish between pRP and sRP2)To estimate an optimal cut off for differential temperature(DT) in digits to differentiate betwen pRP and sRP Methods: A cross-sectional diagnostic test study for adult RP patients was conducted at a tertiary care hospital in India. Those with severe manifestations, ongoing complications or on medications for RP were excluded. The participants were classified into pRP and sRP based on clinical and investigation findings by a Rheumatologist. The sRP subjects were further classified into vasculopathic CTD(VCTD) and non-vasculopathic CTD (NVCTD). The VCTD included Systemic sclerosis, Mixed connective tissue disorder, dermatomyositis and overlap syndromes. NFC was carried out to categorize participants with normal, nonspecific and scleroderma pattern. For IRT, hands were exposed to 10 deg Centigrade temperatures in water bath for a few minutes followed by rewarming with hot air hand dryer for 3 minutes. The IRT of hands was carried out 05 mins after rewarming of hands by a thermal camera. The area of interest (AOI) was skin overlying terminal phalanx for each digit where average temperature was calculated with software. The DT was defined as the maximum difference between AOI of all digits. Results: A total of 118 patients with a mean age of 32 years were analyzed and majority were males (n = 96). The wide difference in temperature between hand digits in sRP patients can be easily appreciated on IRT camera display and objectively evaluated on software (Figure 1). Table 1 represents the comparison of DT in various subgroups (pRP vs sRP, NFC findings and vasculopathies). The mean DT was significantly higher among patients with sRP, scleroderma pattern, and VCTD (p < 0.001). The sRP and VCTD group had shown statistically significant DT as compared to pRP and NVCTD, respectively. The NFC findings of scleroderma pattern had statistically significant higher DT as compared to normal and non-specific pattern. The optimal cutoff to differentiate pRP from sRP was one degree temperature difference with a sensitivity of 83.8 percent and specificity of 98 percent with AUC of 0.93 (Figure 1). For a cut-off of DT of 1 with a Youden index of 0.79, the diagnostic accuracy of IRT was 0.89 and number needed to diagnose was 1.25. Conclusion: RP is a common symptom in general population and the diagnosis of sRP is imperative owing to its association with CTD. The present study highlights the role of IRT as a simple, cost effective and easy to interpret bedside tool with a potential for differentiating between pRP and sRP. This study infers that a cut-off of DT of 1 deg Centigrade can be utilized in clinical practice to differentiate between pRP and sRP. The study also highlights significant differences in DT between VCTD and NVCTD. REFERENCES NIL.Table 1. Comparison of digital temperatures amongst various subgroups Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Infrared thermal images of hands in a subject and ROC analysisA) During an episode of Raynaud’s phenomenonB) Depicting area of interest for recording average temp of digits.C) Showing asymmetrical distribution of temp in distal segments of digits during recovery from Raynaud’s phenomenonD) ROC analysis of optimal cut-off point for differential temperature