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Background: Receptor activator of nuclear factor κβ ligand (RANKL) and osteoprotegerin (OPG) are pivotal molecules involved in osteoclast activation and resorption. In RA, their alterations mediated through inflammatory cytokines are responsible for erosions and systemic bone loss. This study planned to look at the effect of methotrexate on circulating levels of OPG and RANKL in RA. Methods: Methotrexate-naive patients with active rheumatoid arthritis (RA) between 18 and 65 years of age were included. Controls were derived from voluntary healthy blood donors after written consent. All patients were started on methotrexate at 15 mg/week, increased by 5 mg every 4 weeks till maximum tolerated dose or 25 mg/week whichever was lower. Circulating plasma levels of OPG and RANKL were measured for cases (at baseline and 24 weeks) and controls (at baseline). Results: Fifty-one consecutive patients with RA and 57 controls were recruited. Circulating OPG (mean ± standard deviation) levels were higher in RA patients as compared to controls, 2879.6 ± 1037.9 and 2214.1 ± 705.3 pg/ml, respectively (P < 0.001). RANKL levels did not differ significantly between cases and controls. After treatment, circulating OPG levels fell significantly, from 2879.6 ± 1037.9 to 2059.8 ± 532.1 pg/ml (P < 0.001), however, no significant change in circulating RANKL levels. No difference was found in OPG and RANKL levels between patients with erosive and nonerosive disease. Conclusions: OPG levels are higher in RA patients and normalize in response to treatment with methotrexate. The initial higher levels of OPG may represent a compensatory mechanism to osteoclast activation; they normalize on reduction of disease activity. [ABSTRACT FROM AUTHOR]

Objective There has been a significant decrease in the number of published reports of classical polyarteritis nodosa ( PAN) in the post-Chapel Hill consensus conference ( CHCC) nomenclature era with only two series published from Asia. We report a case series of PAN from north India. Patients and Methods A retrospective study of all patients diagnosed to have PAN according to American College of Rheumatology criteria/ CHCC nomenclature. The details of clinical presentation, investigation findings, treatment details and outcomes were noted from the records. These findings between the hepatitis B positive and negative groups were compared. Results Twenty-seven patients (20 male, seven female) were diagnosed as having PAN, out of which seven (25.9%) were hepatitis B surface antigen positive. Nervous system involvement was most common with 24 patients (88.9%) having mononeuritis multiplex. Weight loss was present in 20 (74%), fever in 14 (51.9%), renal involvement in 16 (59.3%), cutaneous in nine (33.3%), peripheral gangrene in eight (29.6%), gastrointestinal (GI) involvement in eight (29.6%), testicular pain in 6/20 (30%) and cardiac involvement in four (14.8%). Twenty-three (85.2%) patients recovered, three died (11.1%) and one was lost to follow-up. Median follow-up duration was 37 (interquartile range 22.00-69.75) months. The cumulative survival was 114.16 months (95% CI: 98.27-129.95). There was no significant difference in five factor score ( FFS) or revised FFS between those patients who died and those who survived ( P = 0.248, 0.894, respectively). Hepatitis B-related PAN had a lower FFS compared to non-hepatitis B-related PAN ( P = 0.039). No other significant differences were noted between the two groups. Conclusion In comparison to classic PAN in other populations, classic PAN in north India is associated with higher neurological involvement and lower GI involvement. [ABSTRACT FROM AUTHOR]

The article describes the case of a 26-year-old man with deforming polyarthritis, stunted growth and progressive diminution of vision and was diagnosed with Blau's syndrome. Topics discussed include how his illness started, findings on his medical examination, and clinical characteristics of Blau's syndrome.

Competing Interests: The authors declare no conflict of interest.

Background: Antisynthetase syndrome is characterized by a triad of myositis, arthritis, and interstitial lung disease. Anti-Jo-1 is the most common associated autoantibody. This study planned to look at the presentation of anti-Jo-1 antisynthetase syndrome in a single Indian center., Methods and Materials: This was a medical records review single-center study that included patients with anti-Jo-1 antisynthetase syndrome over 10 years., Results: This study included 27 patients with anti-Jo-1 antisynthetase syndrome, with mean age of 40 ± 9.2 years and female preponderance (female-to-male ratio, 4:1). At presentation, the characteristic triad was present in only 4 patients. A majority presented with the incomplete form, with 2 clinical features (of triad) in 11 and single feature (of triad) being present in 12 patients at initial presentation. Seven presented only with polyarthritis, out of which 6 had been earlier diagnosed as rheumatoid arthritis. Time gap from diagnosis of "rheumatoid arthritis" to antisynthetase syndrome ranged from 3 to 20 years. In patients who had only arthritis in the beginning, there was a significantly longer delay to diagnosis of antisynthetase syndrome, higher frequency of rheumatoid factor, and lower frequency of anti-Ro-52. Overall, outcome was good, with Eastern Cooperative Oncology Group class 1 or 2 in most except 2 patients., Conclusions: Anti-Jo-1 antisynthetase syndrome commonly presented as incomplete (not a triad) and often only with arthritis. These patients are diagnosed and treated as rheumatoid arthritis for many years, before a diagnosis of antisynthetase syndrome is made. Being aware of this presentation may help in earlier diagnosis by actively searching for subtle clues., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The manuscript has not been submitted or published elsewhere., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)