Dear All

Exam time: March/April/May is always a roller-coaster period for moods and behavior. Studying hard for the exams in March, taking the exams in April, and the post-exam relief/relaxation in May: a few things hardly seem to change from one’s primary school days to tertiary-level education! It always pays to be regular/disciplined: all of us know this; however, acting on this has been the problem since time immemorial.

We continue with the annual review of best paper summaries of 2018 in this issue with lupus, Sjogren’s, myositis, scleroderma, and vasculitides.

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From the IRA

Best wishes to you during the exam period!

Two important announcements from IRA:
Also, we will very likely be shifting to electronic voting from this year for the forthcoming elections. Details will be provided soon and the process started.

IRA Research Grants 2019

5 for DM/DNB residents* (Rs. 1 lac each)
2 for MD residents* (Rs. 50,000 each)
2 for summer project during MBBS *(Rs, 25,000 each)
2 for IRA members who are not trainees (Rs. 2 lacs each)
A 3–4-page summary of your proposal, with brief review of literature, key question (s), novelty in the project, brief methodology,

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Landmark papers in Scleroderma: 2018

1. Cancer Risk and Systemic Sclerosis: New Insights

a. Cancer risk was evaluated in subsets of scleroderma as made by serology and phenotype. Of more than 2000 patients, 205 had cancer. Those with anti-RNA III polymerase antibodies had a standardized incidence ratio of 2.8 and clinical phenotype informed cancer type. Diffuse scleroderma had a breast cancer risk, while limited had a lung cancer risk. Anti-centromere antibodies were protective. Thus autoantibodies and clinical features can be used for cancer risk stratification in scleroderma.

b. The presence of anti-RNAP III antibodies predicts cancer in SSc, but only 15% manifest malignancy. In the remaining 85%, serology is enriched with anti-RNAP I subunit antibodies. The presence of both antibodies together seems to protect against cancer. This was tested in a large cohort of 168 RNAPIII-positive patients, out of which 80 had cancer.

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Patient's Perspective

‘Solving the Myth’

Is ‘remission’ all about calculating disease activity scores? Do we need more drugs in our armamentarium or work on improving compliance? How well do our patients understand their illnesses? Are they able to cope? Do doctors overprescribe? The answers have multiple layers, and are not easy. The first and only step to understand their perspectives better is to engage with them and understand their predicament. Often in a busy OPD, we get lost in counting the joints, particularly in a rheumatoid patient, and forget that the disease has effects beyond joints.


Department of Clinical Immunology and Rheumatology, St. John’s National Academy of Medical Sciences, Bangalore, Karnataka

Polyarteritis nodosa (PAN) is a medium vessel vasculitis that can form microaneurysms in vasculature, affecting various organs. PAN can show a wide spectrum of involvement, from single organ involvement to multiorgan manifestations. According to the American College of Rheumatology, the presence of three of the following 10 criteria are considered diagnostic of diseases: weight loss, livedo reticularis, testicular pain or tenderness, myalgia or myopathy, neuropathy, hypertension, renal impairment, hepatitis B infection, abnormal arteriogram, and positive biopsy results.


Q 1: What prompted you to take up medicine as a branch?

Medicine is a Unique Profession giving "Four-fold" "Satisfaction"

(1) "Spiritual Satisfaction" (In comforting the suffering)

(2)"Intellectual Satisfaction" (In "solving" "Diagnostic" & "Therapeutic" "Riddles"

(3)"Social Satisfaction" (Via Social Status, Respect & Recognition)

(4) "Economic Satisfaction" (at least reasonable financial gains expected)

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Industry Desk

Certolizumab in Pregnancy

Certolizumab is a PEGylated Fab fragment of a humanized TNF inhibitor monoclonal antibody. It is effective in the treatment of moderate-to-severe Crohn’s disease, axial spondyloarthropathy psoriatic arthritis, and rheumatoid arthritis. Studies have shown that that certolizumab does not cross the placenta during pregnancy.

CRIB was a pharmacokinetic (PK) study conducted among women ≥30 weeks pregnant receiving commercial CZP for an approved indication


“Data & Variables – The Chi of the martial art of statistics”

Following the introduction to statistics in the previous issue, let us start getting trained in this martial art of medicine. The concept of statistics is pillared on data and variables – can be called ‘the Chi’ of this martial art. To decipher the complexity of statistics later, we need to start with understanding data.

In this write-up, we will first understand the concept and source of data followed by the classification of data with methods to represent data and the application of this knowledge.


From My Recent Trip to the African Savannah

This trip was all about making images, rather than taking pictures.

There is a lot that goes into making images. You have to see the final image in your mind and be ready.

Being ready involves planning several things, including:

1. Ideal location/setting
2. Ideal subject
3. Lighting, including the position of the sun and angle of light
4. Choice of camera and lens
5. Balance of depth of field and sharpness of subject