Aim: Comparison of ankylosing spondylitis (AS) with non-radiographic axial spondyloarthritis (nr-axSpA) classified with the recent ASsessment of spondyloArthritis International Society (ASAS) criteria. Patients & Methods:This study included 288 patients clinically diagnosed as having spondyloarthritis (SpA) where a satisfactory radiograph of sacroiliac (S-I) joints was available. The AS and the nr-axSpA groups were compared for the various SpA-related variables.Results: Of 288 axSpA patients, there were 187 with AS. Of the remaining 101 patients without radiographic sacroiliitis, S-I joint magnetic resonance imaging (MRI) was available in 72; 54 of them showed active sacroiliitis thus classified as nr-axSpA according to the ASAS criteria. The remaining 18 patients with normal MRI and the other 29 patients without MRI of the S-I joints (total 47 patients), were classified as nr-axSpA using the 'clinical arm' of the ASAS criteria. On comparing the 187 AS with 101 patients in the nr-axSpA group, the AS group showed significantly more males, longer disease duration, more axial symptoms at disease onset, higher Bath Ankylosing Spondylitis Metrology Index and more syndesmophytes. Biologicals were offered significantly more often to the AS group but methotrexate as monotherapy or in combination with other disease-modifying antirheumatic drugs was offered more often in nr-axSpA group. There was no statistically significant difference between AS and nr-axSpA in other SpA parameters. Conclusion:The differences brought out between AS and nr-axSpA groups show that they may not be the same disease. A prospective long-term follow-up of large cohorts may help in clarifying if nr-axSpA is simply an early stage in the spectrum of SpA evolving into AS over time or is there inherent difference between them.

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Aim: India is a high burden tuberculosis country. Past BCG vaccination could cause sensitisation against TB antigens. Patients with systemic inflammatory rheumatic diseases (SIRDs) have inherent anergy. Also, they are often treated with glucocorticoids and other immunomodulatory drugs. These two confounders may affect TST, which is otherwise a robust screening method for studying TB epidemiology. Possibly for these reasons Indian Rheumatology Association did not recommend TST for the screening of TB infection (latent or disease) before initiating TNFi treatment. The present work examined TST results in SIRDs with the objective of whether it could be used for the screening of latent TB infection among SIRD patients in the Indian context. Method: 60 adult rheumatoid arthritis (RA) and 191 axial Spondyloarthritis (axSpA) patients were Mantoux tested using a higher PPD strength of 10 TU to offset inherent disease anergy. The test was read after 48 to 72 hours. It was interpreted according to the nationally recommended cutoffs that takes into account sensitisation to BCG or environmental mycobacteria. Thus, in this study, an induration of >10 mm was considered as 'latent TB infection'. Results: The positivity among RA and axSpA patients was 31.66% and 40.31% respectively, similar to that seen in adult Indians. Conclusion: Based upon these results use of modified TST with 10 TUPPD using >10 mm induration as the cutoff point is recommended for diagnosing TB infection; the test may be appropriate for the screening of latent TB infection in the Indian setting. IRA may consider revising its policy for latent TB screening accordingly.

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Systemic lupus erythematosus (SLE) is a multisystem disease characterized by loss of self-tolerance resulting in development of autoantibodies and formation of immune complexes. Multiple organ involvement can be seen with renal and neurological involvement carrying the worst prognosis. This case report is of 13-year-old Indian boy who presented with fever and rash, along with Macrophage Activation Syndrome secondary to sepsis. Patient showed improvement in symptoms with steroid therapy and IVIG.

The study was conducted on 164 patients who underwent LIFTin the Fourth unit of Department of General Surgery, Chengalpattu Medical College Hospital from Jan 2019 to Dec 2019. The aim of the study was to evaluate effectiveness of ligation of intersphincteric stula tract (lift) in anal stulas”. The study was conducted by performing LIFTamong 164 patients after satisfying the inclusion and exclusion criteria. In this study, Fistula in ano was more common among the male population with mean age group being the third and the fourth decade. Postoperatively, there was minimal signicant development in wound infection. As a consequence, the stay in the hospital was reduced and so the overall expenditure for patients is decreased. To summarize, the ligation of the intersphincteric stula tract technique for stula in ano appears to be effective, safe and easy to perform with encouraging early outcomes.