Lepromatous leprosy or rheumatoid arthritis with leprosy? A challenging case

Rheumatoid arthritis (RA) manifestations in leprosy are very common, but often undiagnosed. The present study discussesa challenging case having dilemma in concluding the diagnosis as lepromatous leprosy or RA with leprosy

Moderate regular exercises reduce inflammatory response for physical stress.

Exercises induce pro-inflammatory cytokines. We assessed the effect of different grades of exercises on inflammatory cytokine response. Twenty healthy volunteers performed a single bout of moderate exercise, a single bout of strenuous exercise and one month regular moderate exercise using standardized 10m Shuttle Walk Test. Interleukin-6 (IL-6) and Tumour Necrosis Factor Alpha (TNF-∝) were estimated by Sandwich ELISA method after each exercise regime. Statistics were run using SPSS software version 11.0, Systat software. Repeated measures ANOVA has been used for analysis of IL-6 values and Friedman test has been used for analyzing TNF-∝ and IL-6 values. Twenty healthy volunteers (18 to 30 years) were chosen for this study. The mean and SEM of plasma levels (pg/ ml) of IL-6 before exercise was 10.70±1.11 pg/ml, whereas, after acute moderate exercise and acute strenuous exercise it was 12.00±1.09 pg/ml and 13.35±0.89 pg/ml respectively. Interestingly, after one month of moderate exercise the values decreased to; 8.80±0.65 pg/ml. Mean and SEM of TNF-α before exercise was 121.78±29.06 pg/ml. With acute moderate exercise and after acute strenuous exercise the values were 132.90±35.75 pg/ml and 112.05±29.89 pg/ml respectively. After one month moderate exercise the levels decreased to 94.95±27.29 pg/ml. The observed changes in both IL-6 and TNF-α levels before and after both moderate and strenuous exercise were statistically significant. Although there was a slight decrease in the value of both the cytokines after one month of regular moderate exercise compared to baseline value, the difference in the values was not statistically significant. However, both IL-6 and TNF-∝ levels showed overall statistically significant difference among the different grades of exercise. Plasma IL-6 and TNF-∝ increase with acute moderate exercise and IL-6 increases further with acute strenuous exercise. Their levels tend to fall below baseline with one month of regular moderate exercise indicating that regular moderate exercise has beneficial effects.

Complementary and alternative drug therapy in arthritis.

Utilization of complementary and alternative medicine (CAM) is universal phenomenon. They are used commonly in chronic diseases like arthritis. To understand the pattern of utilization we undertook this study focussing mainly on the systems, where drug is administered orally. MATERIAL AND METHODS: One hundred and fourteen patients suffering from rheumatoid arthritis (RA), satisfying American College of Rheumatology (ACR) criteria were interviewed for the modalities of therapy and drugs used. We analysed prescriptions of both conventional and CAM practitioners. Direct questionnaires regarding CAM were avoided. RESULTS: Fourty three percent (46/114) had used CAM drugs and 50% of them had used more than two modalities. Ayurveda followed by homeopathy were the two common CAM utilized by the patients. Majority believed conventional medicine has no cure for RA and adverse reactions were rare in CAM. These factors predominantly influenced their decision to use CAM. Family income, urban and rural living did not influence usage of CAM. The use of CAM increased as the duration of disease increased. CONCLUSION: Majority of the patients utilize CAM drugs, for treatment of arthritis. Their knowledge is essential to avoid drug interactions, recognise their reactions and also appreciate their risks and benefits. A scientific scrutiny to these practices and absolving them if beneficial is needed.