Clinical features, severity and outcome of acute pancreatitis in systemic lupus erythematosus.

Acute pancreatitis (AP) is a rare but life threatening manifestation of Systemic Lupus Erythematosus (SLE). The current study aims to study the clinical characteristics, severity, mortality, and outcome of SLE-related AP in Indian population. We retrospectively reviewed medical records of patients with SLE who had AP in the past. Data from 13 rheumatology centers across India were compiled. All patients satisfied SLICC criteria for SLE and ATLANTA criteria for AP. AP was classified in to mild, moderate and severe using revised Atlanta classification. Patients with known risk factors like gall stone and alcohol were excluded.Sixty-six patients (six, children) were studied. Majority of patients were females (82%). The median age of presentation was 24 (11-63) years and most patients (57.5%) presented within first year of diagnosis of lupus. AP occurred mostly in the setting of active lupus (89%). Active nephritis was seen in 39% while a fourth had CNS disease. Patients with severe AP had lower C3. Ascites and sepsis were most common local and systemic complications, respectively. Mortality was 17%. Hypocalcemia, presence of sepsis and shock predicted mortality. In the multivariate analysis, only presence of shock remained as independent predictor of death (OR 63.0, 95% CI: 5.2-760.3). Pancreatitis is an early manifestation of SLE and is associated with active disease. Significant mortality is seen particularly with severe pancreatitis.

Scleroderma Renal Crisis is Associated with High Mortality: A Real-World Study from India.

INTRODUCTION: Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis. Since the use of ACE inhibitors in this condition, there has been a significant reduction of mortality rates. However, there is limited data on characteristics and outcomes of SRC from developing countries. METHOD: This was a single centre, case-control study from India. The records of all patients admitted in the last 5 years were scrutinized, and patients with SRC (as per the updated consensus classification, 2014) were compared with patients of systemic sclerosis who were admitted for other reasons (controls). Disease characteristics, between cases and controls, were compared using chi-squared test, and odds ratios (OR) were calculated. Survival was compared using KaplanMeier statistics. RESULTS: Ninety-four patients of systemic sclerosis admitted over five-years; among them 15 had SRC. As compared to controls, those with SRC had a significantly higher rates of pericardial effusion (OR 11.7, p=0.02), dilated cardiomyopathy (OR 2.5, p=0.04), myopathy (OR 19.3, p=0.001), taking mediumhigh dose glucocorticoids (OR 7.9, p=0.009) and recent disease onset (OR 39.3, p=0.01). Despite aggressive control of hypertension with ACE inhibitors, 10/12 patients with SRC died. Mean (SD) survival in patients with SRC (11.5, 95% CI 5.7 to 17.6 months) was significantly lower than controls (66.2, 95% CI 58.4 to 73.9 months, p<0.001). CONCLUSION: In this single-centre study from a developing country, scleroderma renal crisis was associated with a dismal prognosis, despite the use of ACEI. The recent use of medium-high dose glucocorticoids was associated with SRC.

Methotrexate in Early Chikungunya Arthritis: A 6 Month Randomized Controlled Open-label Trial.

OBJECTIVE: Evidence for treating chikungunya arthritis early in the course of illness is scarce. This study assesses the efficacy of Methotrexate in early Chikungunya arthritis. METHODS: It is a randomized controlled open-label assessor-blinded trial with a crossover design. Sixty patients with persistent post chikungunya arthritis with at least 3 or more tender or swollen joints (28 joint count) were recruited. MTX arm was given oral Methotrexate and NSAID arm was given NSAIDs (Naproxen 1 gm/day or Etoricoxib 120 mg/day). Patients were followed at 1, 2, 4 and 6 months. After 2 months patients in NSAID arm who have not achieved remission were given MTX. The primary endpoint was remission (no tender or swollen joints by 28 joint count) at 6 months. Secondary endpoints were change in CDAI, Indian HAQ, total steroid use, total NSAID use, and serious adverse effects. Intention to treat analysis was used. RESULTS: TJC, SJC, CDAI and HAQ were matched between two at baseline. Remission was achieved by 28 patients (93%, CI- 78%-98%) in the NSAID arm and 26 patients (86%, CI-70%- 94%) in MTX arm (p=0.18). There was no significant difference in steroid need, change in HAQ, CDAI, TJC or SJC. Those who have not achieved remission had higher disease activity at baseline. CONCLUSION: A protocol-based approach with steroid and NSAIDs helped to achieve remission in most patients with early subacute phase of post-Chikungunya arthritis and the effect was comparable to that of early initiation of methotrexate.