Denosumab: A Useful Addition to the Armamentarium for the Management of Male Osteoporosis.

Bone is a dynamic tissue. It remodels, preserving serum calcium, repairing microdamage, and maintaining strength. Osteoporosis is caused by a decrease in bone strength, which manifests clinically as low-energy vertebral and non-vertebral fractures. Osteoporosis poses a significant public health challenge. While it's often portrayed as primarily impacting postmenopausal women, there's been growing recognition among researchers and clinicians regarding its prevalence in men. Major fracture in men has higher mortality rates than in women. Denosumab is a fully human monoclonal immunoglobulin G2 (IgG2) antibody that binds to RANKL, the principal regulator of osteoclastic bone resorption. Multiple studies suggest that denosumab is both effective and safe, exhibiting higher adherence rates and greater patient satisfaction. In this narrative review, we highlighted the effects of denosumab in men with osteoporosis, subsequent changes in bone mineral density, and bone turnover markers outlining the literature and guideline support.

Awareness, perspectives and satisfaction levels among patients with psoriatic arthritis: a multicentric cross-sectional survey.

Perception of the disease and its management impacts patients with Psoriatic arthritis (PsA) to a great degree. Studies examining patients' viewpoints and perception of their disease and its management are scarce. This multicentric cross-sectional survey was undertaken to understand the perspectives of patients with PsA. A survey questionnaire with items on demographics, awareness about their disease, treatment, physical therapy, quality of life and satisfaction with the care received was designed. After internal and external validation, a pilot survey was conducted, and the questionnaire was finalized. The final survey (with translations in local languages) was carried out at 17 centres across India. There were 262 respondents (56% males) with mean age of 45.14 ± 12.89 years. In 40%, the time lag between onset of symptoms and medical assessment for it was more than a year. In most of the patients, the diagnosis of PsA was made by a rheumatologist. Over 83% of patients were consulting their rheumatologist periodically as advised and fully compliant with the treatment. Lack of time and cost of therapy were the most common reasons for non-adherence to therapy. Eighty-eight patients (34%) were not fully satisfied with their current treatment. Over two-third of patients had never seen a physiotherapist due to barriers including a lack of time, pain, and fatigue. The daily activities and employment status were affected in nearly 50% of patients with PsA. The current survey has identified a gap in patients' awareness levels and helps healthcare providers in understanding the varied perceptions of patients with PsA. Addressing these issues in a systematic manner would potentially improve the treatment approaches, outcomes, and patient satisfaction levels.

Covid-19 vaccination in autoimmune rheumatic diseases: A multi-center survey from southern India.

AIM: This survey was conducted to evaluate COVID-19 vaccination status in patients with autoimmune rheumatic diseases (AIRDs). Our objectives were to study vaccine hesitancy, adverse effects, breakthrough infections and flare of underlying disease in this population subgroup. METHODS: This was a multi-center, cross-sectional, interview-based survey done at 6 tertiary care centers across Tamil Nadu, in the southern part of India from September 15, 2021 to October 14, 2021. The survey questionnaire was filled up by AIRD patients attending their clinics. The survey questionnaire comprised a set of 14 questions, distributed between patient characteristics, vaccines taken, their characteristics and COVID-19 infection. RESULTS: There were 2092 participants, with a mean age of 47.5 ± 13.17 years. Among them, 1293 (61.81%) were vaccinated, of which 837 (64.73%) were fully vaccinated. Two-thirds of our subjects were vaccinated with ChAdOx1 nCov-19 (COVISHIELD) (77.64%) and 21.57% with BBV 152 (COVAXIN). Age, gender, education and comorbidities had no association with vaccine hesitancy. The commonest (421; 52.69%) reason for vaccine hesitancy was fear of side effects. The incidence (n = 72) of breakthrough infections was similar in both the vaccine groups, of which 58 (80.55%) were partially vaccinated and 14 (19.44%) were fully vaccinated. Thirty-two patients had a flare of pre-existing rheumatic disease. CONCLUSION: ChAdOx1 nCov-19 and BBV 152 were found to be safe in patients with rheumatic diseases. Fear of side effects was the major cause of vaccine hesitancy. All adverse effects were minor and self-limiting. Breakthrough infections and disease flares occurred only in a small subset of our cohort.

An Evaluation of Efficacy and Safety of Tofacitinib, A JAK Inhibitor in the Management of Hospitalized Patients with Mild to Moderate COVID-19 - An Open-Label Randomized Controlled Study.

Several systemic anti-inflammatory and immunomodulatory agents were tried in the management of hyper inflammatory manifestations of COVID 19. JAK inhibitors have been widely deployed in rheumatology due to their benefits in managing uncontrolled inflammation. Tofacitinib is one of the most widely studied immunomodulators in rheumatology. We assessed the safety and efficacy of Tofacitinib in an open-labeled randomized control study, in addition to the standard of care (SOC) in hospitalized adults with mild to moderate COVID-19 pneumonia. Patients (n=100) with COVID 19 pneumonia admitted during October -December 2020 were randomly assigned to either control (N=50) (SOC treatment alone) or to study groups (N=50) receiving Tofacitinib in addition. Patients, reporting positive RT-PCR for SARS-COV2 and radiological evidence of pneumonia were hospitalized for over 7 days. The study group received Tofacitinib for 14 days irrespective of the discharge status and was followed up to 28 days. There was a greater relative reduction in levels of important markers of inflammation in the Tofacitinib group than in the control group (CRP:78% vs 45%; Ferritin:15% vs 10%; D. Dimer: 37% vs 15%) although there were no differences in duration of hospitalizations or oxygen requirement. Tofacitinib, 10 mg was well-tolerated and was devoid of any serious adverse event. We are the first to record the benefits of Tofacitinib in India to our knowledge although a Brazilian study conducted around the same time showed mortality benefit in severe COVID. We conclude that Tofacitinib use is safe and aids in the reduction of the overwhelming inflammatory response during COVID-19 infections.

Therapeutic exercises and rehabilitation in axial spondyloarthropathy: Balancing benefits with unique challenges in the Asia-Pacific countries.

The burden of axial spondyloarthropathy (axSpA) in the Asia-Pacific region is substantial. The management of axSpA has been revolutionized with the advent of biological therapy where the disease activity, functional disability and negative psychological affect can be mitigated to a great extent. On the other hand, exercise remains an essential component of the treatment of axSpA at all stages, which is often discounted or underused. This is compounded by a gap in demand and supply between increasing number patients with axSpA and paucity of trained specialists and rehabilitation personnel in the Asia-Pacific countries. The acceptability and uptake of therapeutic exercise is strikingly poor in this region because of multiple factors such as lack of awareness among health professionals and the general population, poor healthcare infrastructure, lack of resources and limited accessibility to rehabilitation services. Health authorities and professional bodies in these countries need to work in tandem to expand healthcare facilities, encourage training opportunities and promote safe and effective exercise interventions which is accessible to the general population and individuals with axSpA. Adequate patient education, optimum control of disease activity and strict adherence to therapeutic exercise is essential to predict the best clinical outcome. In this narrative review we have appraised the impact of therapeutic exercise in this era of biological therapies in axSpA and have explored the challenges of rehabilitation services in the Asia-Pacific countries. Overall, the available quality of evidence is mixed, acknowledging the beneficial role of exercise and optimum usage and protocols pertaining to axSpA specific exercises and therefore further research is warranted.

Interstitial pneumonia with autoimmune features.

Interstitial lung disease (ILD) is an umbrella term for lung disease characterised by inflammation and fibrosis of the interstitium. ILD can be idiopathic or secondary to connective tissue disorders, drugs or environmental exposures. Before labelling it as idiopathic we have to rule out secondary causes. ILD is one of the most common extra-articular manifestations of connective tissue diseases (CTDs), causing significant morbidity and mortality. Patients with pre-existing CTD can develop ILD; some patients develop ILD against the background of either one or two clinical features of a CTD or isolated auto-antibody positivity. The current terminology for such an entity is interstitial pneumonia with autoimmune features (IPAF). The current criterion is based on three domains: clinical, serologic and morphologic. To satisfy the IPAF classification criteria, one needs to satisfy the mandatory criterion with one feature from two of the three domains. Classifying patients with this criterion helps in early initiation of immunosuppression and in monitoring them closely for development of features of a well defined CTD. There are a few limitations like the clinical domain being more skewed towards systemic sclerosis and in˜flammatory myositis, exclusion of antineutrophilic cytoplasmic antibody (ANCA) and cytoplasmic pattern in antinuclear antibody (ANA). There are no clear protocols for treatment of IPAF and most of the data has been extrapolated from the management of systemic sclerosis (SSc) ILD and idiopathic non-specific c interstitial pneumonia (NSIP). Progressive disease in spite of treatment demands stronger immunosuppressive agents. Studies on the role of antifibrotics in IPAF are underway, with few small studies showing positive outcomes. There are con˜flicting reports on the survival and outcome of the IPAF cohort. Certain studies suggest that they have better survival compared with idiopathic pulmonary fibrosis (IPF) though other studies contradict this statement.

Usefulness of a workshop on scientific writing and publication in improving the baseline knowledge deficit among postgraduates.

BACKGROUND: A well-written manuscript published in a reputable journal is the deserved end-point of good research. It is important for postgraduates to be trained in scientific writing for their academic progression as well as the advancement of science. METHODS: A day-long workshop on scientific writing and publication was conducted at Raipur, India in February 2020. The medical postgraduate (UK equivalent: Core Medical Trainee) participants were engaged with lectures, discussions and a practical session requiring critical appraisal of a manuscript. The lectures also discussed publication ethics and the perils of falling prey to predatory journals. Pre and post-workshop surveys were given to the participants to assess the impact of the workshop on the baseline knowledge of scientific writing and publishing. RESULTS: Out of 69 participants, there were 67 (response rate 97%) and 41 (response rate 59%) respondents to the pre and post-workshop surveys respectively. The former identified a lack of baseline knowledge ranging from 6% for determining the components of the individual sections of the manuscript such as Introduction or Methods, 40% for the use of acronyms, and 55% for knowledge of different referencing styles, to 61% for knowledge of indexing agencies. The post-workshop survey revealed improvement in participants' knowledge of the contents of various sections of the manuscript and their knowledge about referencing styles and indexing agencies. In the post-workshop survey, 20% of respondents said that they would be open to engaging with predatory journals, which underscored the need to educate them continuously regarding the demerits of such practice. Participants expressed the need for longer workshops, preferably spread over two days, with discussion on research methodology and statistical analysis, and more 'hands-on' sessions. CONCLUSION: This survey underscores the need for structured training in scientific writing. Its inclusion in the medical postgraduate curriculum appears desirable.