Thrissur Rheumatology Centre

25/02/2025

New research explores the wide world of the positives, and potential drawbacks, of new obesity medications. And each brings a new consideration for physicians.

02/02/2025

Dr Tsun Sean Law details the ARISE trials and outlines other orthobiologic treatments currently available — but not yet reimbursable — for osteoarthritis.

24/12/2024

17/03/2024

Infertility is a frequently encountered issue in medicine, seen in about 9% of men and about 11% of women of reproductive age in the U.S.1 Many rheumatologists may not be aware of the prevalence of infertility and the implications this issue may have on the care of their patients. Here, Anat Chemeri...

12/08/2023

As part of our social commitment to patients Mrs Padma Mohan wife of Dr Madan Mohan MD & CEO , chief rheumatologist , Thrissur rheumatology centre ,Olarikkara Thrissur donated a wheel chair to Miss Geetha from Avitathur Irinjalakuda, a Rheumatoid arthritis patient with serious damage to both hips and knee with total disability to walk.Her surgery requires both double THR and TKR and donations are welcome for this patient who comes from a very poor socio-economic status.

06/06/2023

Antioxidants have been assessed in combination with hyaluronic acid because the injected hyaluronate is rapidly degraded by the reactive oxygen species, present in large amounts in the OA synovial fluid, limiting its residence time into the joint. Sorbitol and mannitol which have intrinsic free radical scavenger properties have been the most studied antioxidants. Sodium hyaluronate and polyols develop together a complex based on a dense network of hydrogen bonds which do not modify the visco-elsatic properties of hyaluronic acid. The oxygen free radicals neutralization by mannitol has been proven to delay the degradation of both linear and cross-linked HA in several in vitro models of oxidative stress. The antioxidant effect of these polyols may also play a role in accelerating onset of analgesia, as demonstrated in a double blind controlled trial comparing a mannitol-modified viscosupplement to regular hyaluronic acid. The addition of mannitol and sorbitol to hyaluronic acid does not alter the safety and local tolerability. In summary, adding a polyol to hyaluronic acid may improve the effects of viscosupplementation by reducing the rate of degradation of HA leading to a faster effect on pain relief without increasing the risk of adverse effect.

30/04/2023

Pseudoxanthomatous rheumatoid nodule. Taro Horino, MD Satoshi Inotani, MD Hideki Nakajima, MD
Hiroshi Ohnishi, MD Masahiro Komori, MD Osamu Ichii, PhD et al. The Lancet Rheumatology. VOLUME 5,
ISSUE 2, E110, FEBRUARY 2023
A 69-year-old woman with a 27-year history of rheumatoid arthritis presented to the rheumatology
clinic at Kochi Medical School hospital, Japan, with polyarthralgia of both hands and painless
subcutaneous nodules on her right hand that had slowly grown over a year. Physical examination
revealed arthritis mutilans with ulnar deviation and yellow masses on the metacarpophalangeal joints of
the fingers of the right hand (figure A). There were no abnormal findings in any part of the body other
than the joints, such as the eyelids and trunk. Laboratory investigations revealed that the levels of C-
reactive protein (CRP) and rheumatoid factor were 1·78 mg/dL (normal range <0·15 mg/dL) and 1 096·0
IU/mL (<15 IU/mL), respectively. Hyperlipidaemia, cryoglobulinemia, hypocomplementemia, and
monoclonal paraproteins were not detected. We performed a bone marrow biopsy, which was
normocellular. An x-ray revealed severe erosion and deformities of the hand bones and punched-out
bony radiolucencies associated with the subcutaneous nodular lesions (figure B). A skin biopsy specimen
of the subcutaneous mass showed areas of cholesterol clefts and necrobiosis surrounded by foamy
histiocytes, lymphocytes, Touton giant cells, and foreign body-type multinucleated giant cells (figure
C–F). These findings confirmed a diagnosis of pseudoxanthomatous rheumatoid nodule.
Pseudoxanthomatous rheumatoid nodules are an unusual form of rheumatoid nodule resembling
tendon xanthomas, are often mistakenly diagnosed as xanthomatosis, and have been previously
regarded by investigators as subcutaneous xanthogranuloma, observed in the juxta-articular sites of the
hand, wrist, elbow, knee, foot, and acromioclavicular joints. Pseudoxanthomatous rheumatoid nodules
are distinguished from xanthomatosis by x-ray findings of demonstrable punched-out bony
radiolucencies, which are not present in xanthomatosis. Cholesterol clefts surrounded by granulomatous
reactions can also be observed in rheumatoid synovial fluid and bursitis, sometimes presenting as
migrating chylous cysts. Pseudoxanthomatous rheumatoid nodule and xanthomatosis are easily
misdiagnosed because their histopathological findings are similar. However, xanthomatosis is often
associated with hyperlipidaemia, cryoglobulinemia, hypocomplementemia, and monoclonal
paraproteins, whereas pseudoxanthomatous rheumatoid nodule is not accompanied by these diseases
and is found in the juxta-articular sites with punched-out bony radiolucencies. After initiating treatment
with 6 mg oral methotrexate per week, the concentrations of CRP reduced to 0·63 mg/dL, polyarthralgia
improved, and the pseudoxanthomatous rheumatoid nodules shrank.

30/04/2023

Satoyoshi syndrome (SS) is a rare, multisystem disease of presumed autoimmune aetiology,
characterized by painful intermittent muscle spasms, diarrhoea, endocrinopathy,
alopecia, and skeletal abnormalities
The mean age at diagnosis was 21.2 years. All cases had
painful muscular spasms and alopecia. Frequent manifestations included: diarrhoea,
malabsorption, growth retardation, amenorrhea and bone deformity. SS was associated
with other autoimmune diseases: myasthenia gravis, autoimmune thyroiditis, idiopathic
thrombocytopenic purpura, atopic dermatitis, bronchial and lupus erythematosus.
Autoantibody determinations were performed in 39 patients, of which 27 had positive
results. The most frequently detected autoantibodies were antinuclear antibodies. Other

less frequently found auto-antibodies were: anti-acetylcholine receptor antibodies, anti-
DNA antibodies, antithyroid antibodies, anti-GAD and anti-gliadin antibodies.

Pharmacological treatment was reported in 50 patients. Most of them improved with
corticosteroids, immunosuppressants and immunoglobulins, or a combination of these
medications.SS is associated with other autoimmune diseases

05/03/2023

Experts say the 2022 ACR/AAHKS guideline for patients undergoing total hip or total knee arthroplasty have a number of caveats that limit the usefulness of the recommendations.

05/03/2023

Ocular manifestations of HLA B 27 associated uveitis: a study of 255 cases from a tertiary eye care centre from South India
Ruchika Lakra, Nandhini Elango, Amala Elizabeth George, Sudha K. Ganesh, Jyotirmay Biswas & Parthopratim Dutta Majumder
International Ophthalmology volume 41, pages3743–3748 (2021)

The study observed a male preponderance (75.7%) and the mean age of patients was 35.6 ± 13.3 years. A total of 412 (95.3%) eyes had anterior uveitis, 17(3.9%) eyes had anterior and intermediate uveitis and 3 eyes (0.7%) had intermediate uveitis. Retinal vasculitis was detected in four eyes (0.9%). A total of 176 patients (69%) in the study had evidence of systemic disease and 85% patients developed recurrences. In addition to the treatment with topical and oral steroid, immunosuppressive was required in 39.6% patients and 4% patients received biological therapy. The majority of the eyes (78.4%) had a good visual outcome, while 61 (14.2%) eyes had moderate visual impairment and 32 (7.4%) eyes had severe visual impairment at the time of final follow-up.

21/02/2023

A BRASS registry study shows that specific isotypes of anti-citrullinated protein antibodies (ACPAs) can be associated with incident rheumatoid arthritis-associated ILD (RA-ILD). Early idtentification of RA-ILD is extremely important as it is a major contributor to premature death among patients wit...