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Article ; Online: Current approach to diagnosis of inflammatory myopathies: Clinical features and myositis antibody profiles.

Shobha, Vineeta / Rajasekhar, Liza

Indian journal of pathology & microbiology

2022 Volume 65, Issue Supplement, Page(s) S252–S258

Abstract: Diagnosis of inflammatory myositis has been made easier with the availability of commercial assays for myositis-specific and myositis-associated antibodies. Clinico-serological association studies have permitted a better definition of clinical subsets. ... ...

Abstract	Diagnosis of inflammatory myositis has been made easier with the availability of commercial assays for myositis-specific and myositis-associated antibodies. Clinico-serological association studies have permitted a better definition of clinical subsets. Myositis-specific auto-antibodies are highly specific and non-overlapping, whereas myositis-associated antibodies are those seen also in other connective tissue disorders such as systemic lupus erythematosus, primary Sjogren's syndrome, and idiopathic pulmonary auto-immune fibrosis. Their value is pronounced when clinical features are subtle or non-specific or when the muscle is not the primary organ involved. Overall, the muscle-specific and myositis-associated antibodies have changed the landscape in terms of diagnostic utility, prognostication, and the approach to organ-specific evaluation and management of idiopathic inflammatory myopathies (IIMs).
MeSH term(s)	Autoantibodies ; Connective Tissue Diseases ; Humans ; Myositis/diagnosis
Chemical Substances	Autoantibodies
Language	English
Publishing date	2022-05-13
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	197621-7
ISSN	0974-5130 ; 0377-4929
ISSN (online)	0974-5130
ISSN	0377-4929
DOI	10.4103/ijpm.ijpm_1082_21
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Article ; Online: A study to determine the effect of hydroxychloroquine (HCQ) on central corneal thickness (CCT) in patients with rheumatoid arthritis (RA).

Jaichander, Roshan Christina / Thomas, Reji Koshy / Shobha, Vineeta

Indian journal of ophthalmology

2023 Volume 72, Issue 2, Page(s) 270–274

Abstract: Purpose: Corneal thinning is common in rheumatoid arthritis (RA), thereby affecting the central corneal thickness (CCT). Effect of hydroxychloroquine (HCQ) in RA has abounding literature on retinal toxicity, but there is lack of data on its corneal ... ...

Abstract	Purpose: Corneal thinning is common in rheumatoid arthritis (RA), thereby affecting the central corneal thickness (CCT). Effect of hydroxychloroquine (HCQ) in RA has abounding literature on retinal toxicity, but there is lack of data on its corneal effects. Methods: A cross-sectional study was carried out to compare CCT in RA patients before treatment initiation (Group 1) with CCT in those on HCQ for ≥3 months (Group 2). Results: Fifty patients were enrolled in each group. The mean age was 44.36 years with similar age, gender distribution and visual acuity in both groups. The mean CCT of patients in the cohort was 521.80 µm ± 32.57 µm and 523.94 µm ± 33.40 µm in the right eye (RE) and left eye (LE), respectively. Mean CCT in Group 1 was (RE) 522.80 µm/(LE) 524.26 µm and in Group 2 was (RE) 520.80 µm/(LE) 523.62 µm, and there was no significant difference in CCT between both the groups. Median duration of HCQ usage in Group 2 was 24 months, with the median cumulative dosage being 171 g and a majority having a dosage of 200 mg/day. There was no significant correlation between the duration/cumulative dosage of HCQ intake and CCT. No corneal deposits were identified in any patient. Conclusion: CCT of RA patients was similar to those reported in the Indian literature. However, there was no significant change in CCT or corneal deposits identified with an HCQ dosage of 200-400 mg/day. Longer follow-up would provide clarity on the impact of duration and cumulative dosage of HCQ on corneal changes and CCT.
MeSH term(s)	Humans ; Adult ; Hydroxychloroquine/therapeutic use ; Antirheumatic Agents/therapeutic use ; Cross-Sectional Studies ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Cornea ; Eye Diseases
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH) ; Antirheumatic Agents
Language	English
Publishing date	2023-12-15
Publishing country	India
Document type	Journal Article
ZDB-ID	187392-1
ISSN	1998-3689 ; 0301-4738
ISSN (online)	1998-3689
ISSN	0301-4738
DOI	10.4103/IJO.IJO_3052_22
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Article ; Online: Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset.

Jain, Vikramraj / Shobha, Vineeta / Kumar, Sharath / Janardana, Ramya / Selvam, Sumithra

Mediterranean journal of rheumatology

2023 Volume 34, Issue 3, Page(s) 342–348

Abstract: Background: The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported.: Aim: To assess the impact and outcome of ... ...

Abstract	Background: The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. Aim: To assess the impact and outcome of conventional risk factors, immunosuppressants, and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Design: Prospective, non-interventional longitudinal cohort study. Methods: This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr-Dec2021); and the 2nd-wave (W2) (Jan-Aug2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities, and COVID-19 occurrence. Risk factors associated with mortality were analysed. The incidence rate was compared with that of the general population in the same geographic region. Results: AIRD patients (n=2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (p<0.01) and duration of AIRD (p<0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (Adjusted Odds Ratio [AOR]-0.81) and comorbidities like hypertension (AOR -0.54) and pre-existing lung disease (AOR -0.38;0.19-0.75) compared to W1. Older age (1.11) and coexistent diabetes mellitus (AOR 6.74) were independent risk factors associated with mortality in W2. Conclusions: We report 1.7 times higher occurrence, and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID-19. Age and diabetes were independent risk factors for mortality.
Language	English
Publishing date	2023-08-27
Publishing country	Greece
Document type	Journal Article
ZDB-ID	3019943-8
ISSN	2529-198X ; 2459-3516
ISSN (online)	2529-198X
ISSN	2459-3516
DOI	10.31138/mjr.20230827.co
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Article ; Online: Timing of tofacitinib therapy is critical to improving outcomes in severe-critical COVID-19 infection: A retrospective study from a tertiary care hospital.

Kodali, Ramya / Umesh, Soumya / Selvam, Sumithra / Kamath, Deepak / Shobha, Vineeta

Medicine

2022 Volume 101, Issue 43, Page(s) e30975

Abstract: Describe the use of tofacitinib in severe and critical coronavirus disease-2019 (COVID-19), and explore the association of drug initiation time with survival. A retrospective study of inpatients with severe or critical COVID-19 at a tertiary care ... ...

Abstract	Describe the use of tofacitinib in severe and critical coronavirus disease-2019 (COVID-19), and explore the association of drug initiation time with survival. A retrospective study of inpatients with severe or critical COVID-19 at a tertiary care hospital, who were prescribed generic tofacitinib for at least 48 hours, was conducted. Baseline demographics, comorbidities, illness severity, treatment, adverse effects and outcomes were analyzed. Patients were grouped based on median duration of symptomatic illness prior to tofacitinib administration, as early or late initiation groups. Forty-one patients ([85.4% males], mean age 52.9 ± 12.5 years), were studied. 65.9% (n = 27) had severe COVID-19, while 34.1% (n = 14) were critically ill. Death occurred in 36.6% patients (n = 15). The median time to prescription of tofacitinib was 13 (9.50, 16.0) days of symptom onset. Tofacitinib was initiated early (8-13 days) in 56.1% of patients (n = 23), while the remaining received it beyond day 14 of symptom onset (late initiation group). Multivariate logistic regression adjusted for age, presence of diabetes mellitus and illness duration prior to hospitalization demonstrated higher odds of survival (adjusted odds ratio 19.3, 95% confidence interval 2.57, 145.2) in the early initiation group, compared to the late initiation group. Early initiation of tofacitinib in severe and critical COVID-19 has potential to improve survival odds.
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; Aged ; Female ; COVID-19/drug therapy ; Retrospective Studies ; Tertiary Care Centers ; Critical Illness
Chemical Substances	tofacitinib (87LA6FU830)
Language	English
Publishing date	2022-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000030975
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Article ; Online: Severe thrombocytopenia is associated with high mortality in systemic lupus erythematosus-analysis from Indian SLE Inception cohort for Research (INSPIRE).

Shobha, Vineeta / Rajasekhar, Liza / Bhat, Vasudha / Mathew, Ashish J / Kavadichanda, Chengappa / Rathi, Manish / Gupta, Ranjan / Selvam, Sumithra / Aggarwal, Amita

Clinical rheumatology

2023 Volume 42, Issue 9, Page(s) 2279–2285

Abstract: Thrombocytopenia in patients with systemic lupus erythematosus (SLE) is associated with higher morbidity and mortality. We report frequency, associations and short-term outcome of moderate-severe thrombocytopenia in a prospective inception cohort from ... ...

Abstract	Thrombocytopenia in patients with systemic lupus erythematosus (SLE) is associated with higher morbidity and mortality. We report frequency, associations and short-term outcome of moderate-severe thrombocytopenia in a prospective inception cohort from India (INSPIRE). We evaluated consecutive SLE patients classified per SLICC2012 for the occurrence of thrombocytopenia and its associations. The outcomes assessed included bleeding manifestations, kinetics of thrombocytopenia recovery, mortality and recurrence of thrombocytopenia. Among a total of 2210 patients in the cohort, 230 (10.4%) had incident thrombocytopenia, of whom moderate (platelet count [PC] 20-50 × 10
MeSH term(s)	Humans ; Lupus Erythematosus, Systemic ; Prospective Studies ; Symptom Flare Up ; Thrombocytopenia/complications ; Leukopenia/complications ; Antiphospholipid Syndrome/complications ; Lupus Coagulation Inhibitor
Chemical Substances	Lupus Coagulation Inhibitor
Language	English
Publishing date	2023-06-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-023-06641-5
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Article ; Online: Eltrombopag: Efficacy and Safety in Steroid Refractory Lupus-Associated Immune Thrombocytopenia.

Shobha, Vineeta / Sanil, Sandra / Roongta, Rashmi

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2019 Volume 26, Issue 7, Page(s) 274–278

Abstract: Background: Eltrombopag, a thrombopoietin receptor agonist, is effective in chronic immune thrombocytopenia (ITP). The data in lupus ITP are sparse. This study aimed to assess the efficacy and safety of eltrombopag in lupus ITP.: Methods: This is a ... ...

Abstract	Background: Eltrombopag, a thrombopoietin receptor agonist, is effective in chronic immune thrombocytopenia (ITP). The data in lupus ITP are sparse. This study aimed to assess the efficacy and safety of eltrombopag in lupus ITP. Methods: This is a single-center study conducted between 2012 and 2017 of 12 subjects with systemic lupus erythematosus-associated ITP. Patients with inadequate or suboptimal response to steroids and other immunosuppressants treated with eltrombopag were included in the study. Time taken for response to therapy (defined as platelets >1 lakh), dose, duration of treatment, and adverse effects of the drug were noted. Results: A total of 12 subjects were included in the study. The median platelet count at initiation of eltrombopag was 19,000 per μL. The time taken for response to therapy was 8 days. The median platelet count at 1-month follow-up was 241,000 per μL. All patients were concurrently treated with steroids and other immunosuppressants. Sustained benefit after stopping eltrombopag was noted in all patients. No adverse events including thrombotic complication were noted. Conclusions: Eltrombopag is a new drug in our arsenal for treatment of ITP in lupus. It is a rapidly effective, safe, and orally administered medication. It indirectly contributes to reduction in the dose of steroids and immunosuppressants, thereby minimizing their cumulative adverse effects. It is a promising and safe option for the treatment of lupus-associated thrombocytopenia, but this needs further confirmation from multicenter, multiethnic, randomized controlled trials.
MeSH term(s)	Benzoates ; Humans ; Hydrazines/adverse effects ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/drug therapy ; Purpura, Thrombocytopenic, Idiopathic/diagnosis ; Purpura, Thrombocytopenic, Idiopathic/drug therapy ; Pyrazoles ; Steroids
Chemical Substances	Benzoates ; Hydrazines ; Pyrazoles ; Steroids ; eltrombopag (S56D65XJ9G)
Language	English
Publishing date	2019-06-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001083
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Article: Prevalence and Clinical Correlates of Myositis Specific Autoantibodies in Idiopathic Immune-Mediated Inflammatory Myositis - Results from a Multicentric Cohort (MyoIN) from India.

Rajasekhar, Liza / Shobha, Vineeta / Narasimhan, Anitha / Bhat, Vasudha / Amin, S N / Misra, Ramnath

The Journal of the Association of Physicians of India

2021 Volume 69, Issue 1, Page(s) 36–40

Abstract: There is a need to understand the clinical and antibody associations in patients with IIM in various ethnicities and geographical areas. Patients who fulfilled Bohan's and Peter criteria of IIM and seen between October 2017 through Jan 2020 were enrolled ...

Abstract	There is a need to understand the clinical and antibody associations in patients with IIM in various ethnicities and geographical areas. Patients who fulfilled Bohan's and Peter criteria of IIM and seen between October 2017 through Jan 2020 were enrolled in this study at 3 centres. Clinical and relevant laboratory parameters were recorded in a pre designed case record form. MSA and MAA to 16 antigens were performed by line blot assay using Euroimmun (Luebec, Germany) as per manufacturer's instruction. Of the 150 patients, 13 were juvenile onset. Ninety sera had either one MSA or MAA. Sixty sera had neither MSA/MAA. anti-Ro 52 were the commonest antibody and anti-Mi-2α and b the commonest MSA. Novel associations identified were severe myositis with anti-Ro 52, cutaneous ulcerations with anti-MDA5 and anti-PM-Scl and calcinosis with anti-PM-Scl. One-third sera had no MSA or MAA. Larger sample size and use of antibody assays together with muscle biopsy will improve subtyping and phenotype associations in IIM.
MeSH term(s)	Autoantibodies ; Germany ; Humans ; India/epidemiology ; Myositis/epidemiology ; Prevalence
Chemical Substances	Autoantibodies
Language	English
Publishing date	2021-07-09
Publishing country	India
Document type	Journal Article
ZDB-ID	800766-4
ISSN	0004-5772
ISSN	0004-5772
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Article ; Online: Granulomatosis with polyangiitis: clinical course and outcome of 60 patients from a single center in South India.

Shobha, Vineeta / Fathima, Saba / Prakash, Ravi

Clinical and experimental medicine

2018 Volume 18, Issue 3, Page(s) 347–353

Abstract: Granulomatosis with polyangiitis (GPA) previously known as Wegener's granulomatosis is one of the forms of idiopathic systemic vasculitis. There is very scanty data available on GPA in Asian and Indian population. We studied data of 60 patients from ... ...

Abstract	Granulomatosis with polyangiitis (GPA) previously known as Wegener's granulomatosis is one of the forms of idiopathic systemic vasculitis. There is very scanty data available on GPA in Asian and Indian population. We studied data of 60 patients from southern India, diagnosed with GPA to describe the physical characteristics, the treatment, and outcome. Patients who fulfilled any two of the four criteria proposed by the American College of Rheumatology, and those with clinical features of GPA with ANCA positivity and histopathological confirmation, were included in the study. Disease activity and damage were assessed by Birmingham Vasculitis Activity Score v. 3 (BVAS v. 3) and Vasculitis Damage Index (VDI), respectively. Relapses were defined as recurrence of GPA of sufficient severity to require treatment or increase in the dose of treatment on a patient who was previously stable. Out of 60 patients, initial BVAS evaluation showed that 57 (95%) patients had severe disease and 3 (5%) patients had limited disease where median BVAS was 21.5 (range 17-44). Follow-up BVAS evaluation for severe disease showed that 13 (22.8%) patients continued with severe disease of which 9 patients did not survive, 24 (42.3%) had remission, 11 (19.2%) had persistent disease, and 9 (15.7%) were lost to follow-up. The mean VDI score was 2.5 ± 2. Renal involvement was established in 42 (70%) patients. Upper and lower respiratory involvement was seen in 38 (63%) patients. Nervous system involvement was noted in the 15 (25%) patients. Articular manifestations were seen in 16 (27%) patients. Diverse clinical manifestation delay early diagnosis and treatment of this potentially treatable vasculitis. Focused approach could expedite early diagnosis and can reduce the mortality.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Vessels/drug effects ; Blood Vessels/immunology ; Blood Vessels/pathology ; Cyclophosphamide/therapeutic use ; Delayed Diagnosis ; Female ; Granulomatosis with Polyangiitis/diagnosis ; Granulomatosis with Polyangiitis/drug therapy ; Granulomatosis with Polyangiitis/immunology ; Granulomatosis with Polyangiitis/pathology ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/immunology ; Hypertension/pathology ; Immunoglobulins, Intravenous/therapeutic use ; India ; Kidney/drug effects ; Kidney/immunology ; Kidney/pathology ; Lung/drug effects ; Lung/immunology ; Lung/pathology ; Male ; Middle Aged ; Nervous System/drug effects ; Nervous System/immunology ; Nervous System/pathology ; Prednisolone/therapeutic use ; Recurrence ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome
Chemical Substances	Immunoglobulins, Intravenous ; Cyclophosphamide (8N3DW7272P) ; Prednisolone (9PHQ9Y1OLM)
Keywords	covid19
Language	English
Publishing date	2018-02-28
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2053018-3
ISSN	1591-9528 ; 1591-8890
ISSN (online)	1591-9528
ISSN	1591-8890
DOI	10.1007/s10238-018-0492-7
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Article ; Online: Low-dose rituximab is efficacious in refractory idiopathic inflammatory myopathies.

Janardana, Ramya / Amin, S N / Rajasekhar, Liza / Pinto, Benzeeta / Kodishala, Chanakya / Selvam, Sumithra / Shobha, Vineeta

Rheumatology (Oxford, England)

2022 Volume 62, Issue 3, Page(s) 1243–1247

Abstract: Objectives: Rituximab (RTX) use early in the course of refractory idiopathic inflammatory myopathy (IIM) is not well studied. This study sought to determine the short-term efficacy of RTX in a registry-based cohort of refractory IIM.: Methods: ... ...

Abstract	Objectives: Rituximab (RTX) use early in the course of refractory idiopathic inflammatory myopathy (IIM) is not well studied. This study sought to determine the short-term efficacy of RTX in a registry-based cohort of refractory IIM. Methods: Registry-based observational data about IIM patients receiving RTX between 2018 and 2021 were included. Total improvement score was calculated from the core set measures as per International Myositis Assessment and Clinical Studies group (IMACS) at baseline, 6 months and 12 months of follow-up. Results: Forty-two patients (F:M, 29:13), with a mean (s.d.) age of 39.5 (11.5) years were studied. Majority of patients received RTX for refractory myositis, after a median (interquartile range) duration of 8 (4,18) months. Twenty-eight received RTX at a dosage of 1 g × two doses, while 14 received 500 mg × two doses with an interval of 15 days. At 6 months and 12 months post-RTX, the improvement was recorded in manual muscle testing (MMT-8) scores, physician global assessment (PGA), patient global assessment (PtGA) and median steroid dosage as compared with the baseline (P < 0.01 for all). A mean (s.d.) improvement of 44.5 (16) and 48.7 (19.2) in total improvement score was recorded at 6 and 12 months, respectively. The change in MMT-8, PGA and PtGA scores from baseline between the two dosage regimens of RTX were comparable at 6 and 12 months. Severe lower respiratory tract infections requiring hospitalization occurred in three patients of the cohort. Conclusion: RTX improved IMACS core set measures and had steroid sparing efficacy at 6 and 12 months in patients with IIM in this registry-based study. Rituximab as an induction regimen of two doses of 500 mg can be as efficacious as 1 g at 6 months and 12 months of follow-up.
MeSH term(s)	Humans ; Adult ; Rituximab ; Treatment Outcome ; Myositis ; Retrospective Studies
Chemical Substances	Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2022-08-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keac438
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Article ; Online: Exploratory clinical subgroup clustering in systemic sclerosis: Results from the Indian Progressive Systemic Sclerosis Registry.

Philip, Shery Susan / Janardana, Ramya / Shenoy, Padmanabha / Kavadichanda, Chengappa / Bairwa, Devender / Sircar, Geetabali / Ghosh, Parasar / Wakhlu, Anupam / Selvam, Sumithra / Khanna, Dinesh / Shobha, Vineeta

Journal of scleroderma and related disorders

2023 Volume 9, Issue 1, Page(s) 29–37

Abstract: Objective: To conduct an exploratory cluster analysis of systemic sclerosis patients from the baseline data of the Indian systemic sclerosis registry.: Methods: Patients satisfying American College of Rheumatology-European League Against Rheumatism ... ...

Abstract	Objective: To conduct an exploratory cluster analysis of systemic sclerosis patients from the baseline data of the Indian systemic sclerosis registry. Methods: Patients satisfying American College of Rheumatology-European League Against Rheumatism classification criteria for systemic sclerosis were included. The clusters formed using clinical and immunological parameters were compared. Results: Of the 564 systemic sclerosis registry participants, 404 patients were included. We derived four clusters of which three were anti-topoisomerase I predominant and one was anti-centromere antibody 2 dominant. Conclusion: With exploratory cluster analysis, we confirmed the possibility of subclassification of systemic sclerosis along a spectrum based on clinical and immunological characteristics. We also corroborated the presence of anti-topoisomerase I in limited cutaneous systemic sclerosis and the association of interstitial lung disease with anti-topoisomerase I.
Language	English
Publishing date	2023-12-14
Publishing country	England
Document type	Journal Article
ISSN	2397-1991
ISSN (online)	2397-1991
DOI	10.1177/23971983231215470
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