Prevalence of systemic lupus erythematosus (SLE) was studied in the northern Indian population by means of a two-pronged approach: (a) antinuclear antibody (ANA) screening of the general population by a new well-standardized finger-prick 'filter paper' technique (sensitivity and specificity: 95.4% and 86.2%, respectively); and (b) a questionnaire survey carried out primarily by trained personnel in the community (sensitivity and specificity: 100% and 68.6% respectively). The low specificity of the two methods was improved by the introduction of a step of secondary screening by the authors, thus excluding false positives. ANA screening of 52,062 individuals yielded 13 positive results, of which only two were found to be true cases of SLE after secondary screening. Questionnaire survey of 39,826 individuals similarly yielded 3393 positive results. On secondary screening, only one of these persons was found to be a case of SLE. Thus, three cases of SLE were detected in a population survey of 91,888, giving a point prevalence of 3.2 per 100,000 (95% CI = 0-6.86 per 100,000). The reported prevalence of SLE ranges from 14 to 60 per 100,000. Thus, the prevalence of SLE in India is comparatively low. Although the reasons for low prevalence are not clear, the study used highly sensitive methodology and it is therefore unlikely that SLE cases were missed. It is hypothesized that SLE is a disease of modernization and therefore its prevalence in a predominantly rural population like that of India is low.

In this study, a large number of truck drivers were found to be having sex with the prostitutes in rural areas along the highways of India. Some were having sex with men also. HIV/AIDS awareness and condom use was poor among them. Three out of 302 truck drivers were found to be infected with HIV. The truck drivers could play an important role in the spread of the infection in rural India.

Survival in patients with systemic lupus erythematosus (SLE) in developed countries has improved considerably over the last 2 decades. In India, however, survival in patients with SLE reported 5 years ago from this tertiary referral centre was very poor. The present study was conducted to examine trends, if any, towards improvement in the survival of patients with SLE attending the same centre during the period 1981-1990. No statistically significant change in survival was noted. It appears that improvement in the survival of SLE patients would require an overall improvement in the standard of medical care in India.

The distribution of HLA class II antigens in the Asian Indian patients with rheumatoid arthritis (RA) was studied in the present investigation. The results demonstrated that DR4 was significantly increased in both northern (chi 2 = 36.9, P less than 0.00001) as well as southern Indian (chi 2 = 17.3, P less than 0.0001) patients. HLA haplotype analysis revealed the presence of B17-DR4 among southern Indians. Amongst northern Indians, four DR4 haplotypes occurred significantly: A1,B17,DR4; A19,B7, DR4; A30,B13,DR4; and A33,B44,DR4. An analysis of TA10 and DQ'Wa' specificities revealed that all the DR4-DQw3 positive northern Indian RA patients were DQw8 as compared to its frequency of 33.3% in controls. A positive association observed between DR4-DQw7 and RA in some western Caucasian populations was not present in this series. A group of three DR4 positive RA patients were found to be DQw3 negative and DQ'Wa' or DQw4 positive. These results indicated that susceptibility to RA may be controlled by genes in the DR locus independent of any DQ associations.

In a group of 33 patients with miliary tuberculosis (MTB), pulmonary function testing and bronchoalveolar lavage (BAL) were each performed in 31. The arterial blood gas analysis was done in 13 patients. Mild restrictive ventilatory defect, hypoxemia, and hypocapnia were observed. BAL revealed lymphocytic alveolitis. The lymphocyte subsets were measured in the BAL fluid and peripheral blood in 10 patients. The helper lymphocytes were decreased in the peripheral blood and increased in the BAL fluid. The immunoglobulins (IgG, IgA, and IgM) were significantly increased in the peripheral blood and BAL fluid in 18 patients. Serum complement (C3) (n = 23) and BAL fluid fibronectin (n = 22) were also significantly increased. Lymphocytic alveolitis and the raised levels of IgG and IgA in the peripheral blood and BAL fluid persisted at the end of 9 months of standard chemotherapy for tuberculosis. Long-term studies with larger numbers of patients are required to monitor the course of alveolitis in MTB. An addition of corticosteroids to the antituberculosis drug regimen may be considered in the treatment of these patients.

The present study attempts to investigate the pathological basis of the two clinically different forms of idiopathic inflammatory myopathy (IIM) namely, polymyositis (PM) and dermatomyositis (DM). Clinicopathological analysis of 73 cases showed that muscle fibre necrosis and regeneration were more frequent in PM than in DM, the latter being significantly so (P < 0.05). On the other hand, vasculitis was more associated with DM while perifascicular atrophy of the muscle fibres was confined to it. Vasculitis was present in eight cases. Its incidence in patients with myositis with systemic connective tissue disease (4/9) was significantly more than in other PM and DM patients (P < 0.01). An equally significant higher frequency of perimysial inflammatory infiltrate was also seen in the former as compared to the latter. Interestingly, idiopathic DM affected men as often as women and juvenile IIM affected boys more frequently than girls. A female predilection was noted in the remaining groups of IIM. These observations indicate that there may be some basic immunopathogenetic differences between polymyositis and dermatomyositis as well as between idiopathic PM/DM and that associated with systemic connective tissue diseases. Though the number of patients studied is small, the absence of female predilection in idiopathic DM and juvenile IIM may be peculiar to the IIM in the tropics.

This paper describes the effect of HIV prevention intervention among female sex workers in Delhi. Over a 2-year period we found a marked increase in condom use with little increase in HIV seroprevalence. The prevalence of HIV infection did not increase during the study period (1 positive among 701 in 1988 vs 1 positive in 600 in 1990).

Adult onset Still's disease was provisionally diagnosed in 31 patients from northern India over a period of five years, in 27 of whom the diagnosis was subsequently felt to have been confirmed. This report describes the clinical characteristics of these patients along with the different therapeutic measures used and their response. Adult onset Still's disease should be considered in the differential diagnosis of 'pyrexia of unknown origin'.