Publications by authors named "Aadhaar Dhooria"

20 Publications

  • Page 1 of 1

A Rare Grotesque Skeletal Deformity: Munchmeyer's Disease.

Mediterr J Rheumatol 2021 Mar 31;32(1):91. Epub 2021 Mar 31.

Consultant Rheumatologist, Department of Rheumatology, Santokba Durlabhji Memorial Hospital, Jaipur, India.

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http://dx.doi.org/10.31138/mjr.32.1.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314880PMC
March 2021

Spontaneous Subdural Hemorrhage in a Patient With Systemic Sclerosis: A Rare Association.

J Clin Rheumatol 2020 Nov 24. Epub 2020 Nov 24.

From the Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India.

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http://dx.doi.org/10.1097/RHU.0000000000001649DOI Listing
November 2020

Fatigue and its correlates in Indian patients with systemic lupus erythematosus.

Clin Rheumatol 2021 Mar 8;40(3):905-911. Epub 2020 Oct 8.

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Fatigue is a disabling yet poorly understood symptom in patients with systemic lupus erythematosus (SLE). Many variables influence fatigue including physical function, pain, fibromyalgia and psychiatric comorbidity. Literature is conflicted on its association with disease activity. To assess fatigue and its correlates among patients with SLE. Existent data from validation of Hindi LupusPRO study were utilized for this study. SLE patients were enrolled and underwent assessments of disease activity and damage (SELENA-SLEDAI and SLICC/ACR Damage Index (SDI)). Depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), fatigue (Fatigue Severity Scale (FSS)) and fibromyalgia were evaluated. Physical function and bodily pain were assessed using Short Form 36 (SF-36). Statistical analysis was done using the STATA version 14. A total of 140 females and 4 males with SLE with a mean age of 32.48 (SD 7.26) years were recruited. Median duration of illness was 3 years (IQR-4). Fatigue (FSS ≥ 4) was present in 74 (51.39%) participants. Prevalence of depression (PHQ-9 ≥ 10) and anxiety (GAD-7 ≥ 10) were 25% and 22.9%, respectively. Concomitant fibromyalgia was present in 8 participants (5.56%). Higher fatigue scores correlated with greater disease activity, shorter disease duration, worse physical function, bodily pain, depression and anxiety. On stepwise regression, disease duration, disease activity, bodily pain, depression and anxiety were independent predictors of fatigue (R = 0.35, p < 0.001). Fatigue is seen in over half of Indian patients with SLE and is independently associated with disease activity, disease duration, pain and psychiatric comorbidity. Multidisciplinary approach is indicated to address fatigue in SLE. Key Points • Fatigue is common in patients in Indian patients with SLE • Higher disease activity, shorter duration of disease, pain and psychiatric comorbidity were associated with fatigue.
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http://dx.doi.org/10.1007/s10067-020-05445-1DOI Listing
March 2021

Is it time to say goodbye to weekly rituximab in ANCA vasculitis?

Clin Rheumatol 2020 10 26;39(10):3153-3154. Epub 2020 Aug 26.

Department of Clinical Immunology and Rheumatology, Santokba Durlabhji Memorial Hospital, Jaipur, India.

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http://dx.doi.org/10.1007/s10067-020-05360-5DOI Listing
October 2020

Tuberculous Dactylitis: A Rare Form of Skeletal Tuberculosis.

J Clin Rheumatol 2020 Aug;26(5):e93

From the Department of Internal Medicine, Clinical Immunology and Rheumatology Wing, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1097/RHU.0000000000000925DOI Listing
August 2020

The effect of methotrexate on neutrophil reactive oxygen species and CD177 expression in rheumatoid arthritis.

Clin Exp Rheumatol 2021 May-Jun;39(3):479-486. Epub 2020 Jun 23.

Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: Neutrophils are found in abundance in the synovial fluid of patients with rheumatoid arthritis (RA), where they are activated and show high reactive oxygen species (ROS) production. However, there is limited data on circulating neutrophils in peripheral blood of patients with RA in terms of ROS production, expression of activation markers and the effect of treatment with methotrexate (MTX) on ROS.

Methods: This single-centre prospective study recruited patients of RA classified as per the 2010 ACR/EULAR criteria. In the cross-sectional arm, we included three groups, treatment-naïve RA (naïve-RA), MTX-treated RA (MTX-RA) and healthy controls, and compared ROS production and surface markers of neutrophil activation. In the longitudinal arm, we studied the change in neutrophil ROS production after 8 weeks of MTX treatment in naïve-RA patients. Neutrophil ROS production was measured by flow cytometry using dihydrorhodamine-123 (DHR) and by chemiluminescence using luminol. Surface expression of CD177, CD11b and CD64 was measured by flow cytometry.

Results: This study included 103 patients (50 naïve-RA, 53 MTX-RA) and 20 controls. Both naïve-RA and MTX-RA patients showed higher ROS production than healthy controls in unstimulated neutrophils in the DHR assay (p<0.001 and p=0.004). MTX-RA patients showed significantly lower ROS production than naive-RA, in both unstimulated (p=0.004) and PMA-stimulated neutrophils in the DHR assay (p=0.03). On longitudinal follow-up of 24 naïve-RA patients, there was a significant reduction of neutrophil ROS production (by 55% from baseline) (p<0.001) after 8 weeks of MTX. Neutrophil CD177 expression was higher in both naïve-RA and MTX-RA (trend) than controls (p=0.001 and p=0.09). MTX-RA neutrophils showed lower expression of CD177 than naïve-RA (p=0.01). CD11b expression was higher in MTX-RA compared to controls (p=0.01).

Conclusions: Circulating neutrophils in RA showed higher ROS production and higher expression of CD177 and CD11b compared to controls. MTX treatment was associated with a reduction in ROS production and CD177 expression, which may be one of the mechanisms by which MTX works in RA.
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May 2021

Acute myocardial dysfunction in lupus: outcomes in Asian Indians.

Clin Rheumatol 2020 Dec 22;39(12):3661-3667. Epub 2020 May 22.

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Background: Acute myocardial dysfunction is an uncommon but potentially fatal complication in systemic lupus erythematosus (SLE). We describe the outcome in a small series of Asian Indian patients and examine associated factors.

Methods: SLE patients who fulfilled the 2012 SLICC criteria and developed new-onset myocardial dysfunction were included in this retrospective case series. Acute myocardial dysfunction was defined as global hypokinesia and left ventricular ejection fraction (LVEF)<50% on echocardiography (with or without symptoms) in patients with SLE. Survival was assessed using Kaplan-Meier survival analysis and Cox regression.

Results: This study included 37 patients with mean age 28.2 ± 11.2 years and median (range) LVEF of 35% (18-48%) at presentation. A majority had active disease, with SLEDAI-2k ≥ 5 in 26 (of 28). All patients received oral corticosteroids and a majority received additional immunosuppression, including pulse methylprednisolone in 28 and cyclophosphamide in 27. Nine patients died during hospitalisation (25%), a majority due to infections. Death was significantly associated with elevated procalcitonin at presentation (p = 0.05), elevated white cell count (p = 0.02) and low complement C3 (p = 0.03). In those who survived, long-term outcomes were good, with complete myocardial recovery in 14 (64%). A higher ejection fraction at presentation was associated with complete recovery.

Conclusions: In this small series of patients of SLE with acute myocardial dysfunction, we report a significant in-hospital mortality due to infections. Many of the patients who died had elevated procalcitonin at presentation. A diligent search for infection seems prudent in lupus patients who present with acute myocardial dysfunction. Key Points • In patients of SLE with acute myocardial dysfunction who were treated with immunosuppression, there was significant short-term mortality due to infections. • This mortality was associated with elevated procalcitonin at baseline and may suggest some of them had pre-existing hidden sepsis. • A prudent search for infections in these patients before immunosuppression may help to decrease short-term mortality.
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http://dx.doi.org/10.1007/s10067-020-05177-2DOI Listing
December 2020

Phenobarbital rheumatism-A fresh look at an old malady: Case report and systematic review of literature.

Int J Rheum Dis 2020 Apr 25;23(4):589-594. Epub 2020 Feb 25.

Clinical Immunology & Rheumatology Unit, Department of Internal Medicine, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.1111/1756-185X.13813DOI Listing
April 2020

Anti-Jo-1 Syndrome Often Misdiagnosed as Rheumatoid Arthritis (for Many Years): A Single-Center Experience.

J Clin Rheumatol 2021 Jun;27(4):150-155

From the Clinical Immunology and Rheumatology Division, Department of Internal Medicine.

Background: Antisynthetase syndrome is characterized by a triad of myositis, arthritis, and interstitial lung disease. Anti-Jo-1 is the most common associated autoantibody. This study planned to look at the presentation of anti-Jo-1 antisynthetase syndrome in a single Indian center.

Methods And Materials: This was a medical records review single-center study that included patients with anti-Jo-1 antisynthetase syndrome over 10 years.

Results: This study included 27 patients with anti-Jo-1 antisynthetase syndrome, with mean age of 40 ± 9.2 years and female preponderance (female-to-male ratio, 4:1). At presentation, the characteristic triad was present in only 4 patients. A majority presented with the incomplete form, with 2 clinical features (of triad) in 11 and single feature (of triad) being present in 12 patients at initial presentation. Seven presented only with polyarthritis, out of which 6 had been earlier diagnosed as rheumatoid arthritis. Time gap from diagnosis of "rheumatoid arthritis" to antisynthetase syndrome ranged from 3 to 20 years. In patients who had only arthritis in the beginning, there was a significantly longer delay to diagnosis of antisynthetase syndrome, higher frequency of rheumatoid factor, and lower frequency of anti-Ro-52. Overall, outcome was good, with Eastern Cooperative Oncology Group class 1 or 2 in most except 2 patients.

Conclusions: Anti-Jo-1 antisynthetase syndrome commonly presented as incomplete (not a triad) and often only with arthritis. These patients are diagnosed and treated as rheumatoid arthritis for many years, before a diagnosis of antisynthetase syndrome is made. Being aware of this presentation may help in earlier diagnosis by actively searching for subtle clues.
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http://dx.doi.org/10.1097/RHU.0000000000001234DOI Listing
June 2021

A Case of Leprosy Misdiagnosed as Lupus.

J Clin Rheumatol 2020 Dec;26(8):e301-e302

From the Clinical Immunology and Rheumatology Wing, Department of Internal Medicine.

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http://dx.doi.org/10.1097/RHU.0000000000001154DOI Listing
December 2020

Telescoping of Fingers.

J Clin Rheumatol 2020 Dec;26(8):e291-e292

From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1097/RHU.0000000000001142DOI Listing
December 2020

Neurological Manifestations Do not Affect Cumulative Survival in Indian Patients with Antineutrophil Cytoplasmic Antibody Associated Vasculitis.

Neurol India 2019 Jul-Aug;67(4):1043-1047

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Neurological manifestations are an important cause of morbidity in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It is not clear whether or not they are indicative of a severe disease course with multiple organ involvement and shortened survival.

Aims And Objectives: To characterize the neurological manifestations of AAV and analyze their relationship with other organ system and cumulative survival.

Methods: This was a retrospective single-center cohort study of AAV patients at a tertiary care hospital in North India. Data was collected from medical records regarding clinical history, neurological examination, Birmingham Vasculitis Activity Score (BVAS), serology, electrophysiology, imaging, and histopathological examination findings of patients.

Results: Ninety-two patients of systemic vasculitis were identified, 67 with granulomatosis with polyangiitis (GPA), 14 with microscopic polyangiitis, 8 with Churg-Strauss syndrome (CSS), and 3 with undifferentiated AAV. The median BVAS at presentation was 18.0 (interquartile range (IQR): 12.0). The median duration of follow-up was 31.3 months (IQR: 40.5). A total of 45.7% patients had neurological manifestations among which 23.8% presented with neurological complaints. Peripheral neuropathy was the most common manifestation noted in 23.9% of the patients. Among patients with GPA, 40.3% had neurological involvement (seen in 33.3% patients at presentation). Patients with nervous system disease were more likely to have associated musculoskeletal manifestations (P = 0.046) and less likely to have renal involvement (P = 0.017). The estimated cumulative survival of the subgroup with neurological involvement was 95.1 months from the time of diagnosis, which was not significantly different from the cohort without neurological involvement (113.8 months, P = 0.631).

Conclusion: Neurological morbidity commonly accompanies systemic vasculitis. Nervous system disease does not affect the survival significantly in these patients.
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http://dx.doi.org/10.4103/0028-3886.266234DOI Listing
March 2020

Sexual functioning and its correlates in premenopausal married Indian women with systemic lupus erythematosus.

Int J Rheum Dis 2019 Oct 19;22(10):1814-1819. Epub 2019 Aug 19.

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: This study aimed to evaluate sexual functioning and its association with disease activity, damage, marital satisfaction, fatigue and psychiatric comorbidity in married women with systemic lupus erythematosus (SLE).

Methods: One hundred and twelve premenopausal married women with SLE were included in the study. Disease activity and damage were assessed using Safety of Estrogens in Lupus Erythematosus National Assessment Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) respectively. Female sexual function index (FSFI) and couple satisfaction index (CSI) were used to evaluate sexual function and marital satisfaction respectively. Depression, anxiety and fatigue were assessed using Patient Health Questionnaire 9 (PHQ9), Generalized Anxiety Disorder 7 (GAD7) and fatigue severity scale (FSS) respectively.

Results: The mean age of the study group was 34.0 (SD 6.8) years. Mean SELENA-SLEDAI was 3.67 (SD 4.2) and mean SDI was 0.25 (SD 0.62). Median steroid dose at the time of evaluation was 7.5 mg/d of prednisolone. Based on FSFI total score, impaired sexual functioning was found in 60.7%. However, when the cut-off of different domains was considered, more than 90% of the participants reported problems in desire, arousal and lubrication. The mean CSI score was 130.39 ± 26.17. Eighteen patients (16.1%) had CSI lower than the cut-off score (104.5) suggestive of marital distress. On univariate analysis sexual function showed a correlation with marital satisfaction (r = .34, P < .001), dose of steroids(r = -.26, P = .008), disease activity (r = -.21, P = .027), depression (r = -.19, P = .039) and anxiety (r = -.201, P = .034).

Conclusion: Sexual dysfunction is highly prevalent in premenopausal married females with SLE. Higher dose of steroids, disease activity, depression,anxiety and marital satisfaction were associated with poor sexual functioning in one or more domains.
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http://dx.doi.org/10.1111/1756-185X.13675DOI Listing
October 2019

An unusual cause of deforming erosive arthritis in an adult.

Rheumatology (Oxford) 2020 Mar;59(3):602

Clinical and Rheumatology Wing, Department of Internal Medicine, Chandigarh, India.

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http://dx.doi.org/10.1093/rheumatology/kez312DOI Listing
March 2020

Nail pitting: a key clinical sign of psoriatic arthritis.

Rheumatology (Oxford) 2019 12;58(12):2250

Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1093/rheumatology/kez183DOI Listing
December 2019

Hemorrhagic Myositis: Fatal Presentation of a Common Muscle Disease.

J Clin Rheumatol 2020 Aug;26(5):e112

From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1097/RHU.0000000000000978DOI Listing
August 2020

Successful treatment outcomes in pregnant patients with ANCA-associated vasculitides: A systematic review of literature.

Int J Rheum Dis 2018 Sep;21(9):1734-1740

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Aim: Antineutrophil cytoplasmic antibody-associated vasculitides (AAV) are a group of small vessel vasculitis with systemic presentations and considerable morbidity and mortality. Pregnancy in these patients poses a significant therapeutic challenge. There is limited published literature regarding pregnancy in AAV.

Methods: Two cases of successful pregnancy outcomes in patients with active AAV are described. A systematic review was conducted on the lines of the PRISMA statement for conducting systemic reviews: PubMed (inception of PubMed until 30 April 2017, English language only) and EmBase databases were searched using the following terms: 'pregnancy' AND 'ANCA associated vasculitis' OR 'granulomatosis with polyangiitis' OR 'eosinophilic granulomatosis with polyangiitis' OR 'microscopic polyangiitis' OR 'Churg-Strauss syndrome' OR 'Wegener's granulomatosis'.

Results: One hundred and thirty-seven pregnancies were documented in 110 patients of AAV. Vasculitis diagnosis was made before pregnancy in 69, during pregnancy in 32 and after pregnancy in 9 patients. Mean age at the time of pregnancy was 29.3 ± 5.3 years. There were 91 term pregnancies, 28 were preterm pregnancies, 15 abortions and 3 still births; 78 had normal delivery and 26 had caesarian section.

Conclusion: Successful pregnancies have been reported in AAV patients.
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http://dx.doi.org/10.1111/1756-185X.13342DOI Listing
September 2018

Polyarteritis nodosa in north India: clinical manifestations and outcomes.

Int J Rheum Dis 2017 Mar 19;20(3):390-397. Epub 2016 Dec 19.

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objective: There has been a significant decrease in the number of published reports of classical polyarteritis nodosa (PAN) in the post-Chapel Hill consensus conference (CHCC) nomenclature era with only two series published from Asia. We report a case series of PAN from north India.

Patients And Methods: A retrospective study of all patients diagnosed to have PAN according to American College of Rheumatology criteria/CHCC nomenclature. The details of clinical presentation, investigation findings, treatment details and outcomes were noted from the records. These findings between the hepatitis B positive and negative groups were compared.

Results: Twenty-seven patients (20 male, seven female) were diagnosed as having PAN, out of which seven (25.9%) were hepatitis B surface antigen positive. Nervous system involvement was most common with 24 patients (88.9%) having mononeuritis multiplex. Weight loss was present in 20 (74%), fever in 14 (51.9%), renal involvement in 16 (59.3%), cutaneous in nine (33.3%), peripheral gangrene in eight (29.6%), gastrointestinal (GI) involvement in eight (29.6%), testicular pain in 6/20 (30%) and cardiac involvement in four (14.8%). Twenty-three (85.2%) patients recovered, three died (11.1%) and one was lost to follow-up. Median follow-up duration was 37 (interquartile range 22.00-69.75) months. The cumulative survival was 114.16 months (95% CI: 98.27-129.95). There was no significant difference in five factor score (FFS) or revised FFS between those patients who died and those who survived (P = 0.248, 0.894, respectively). Hepatitis B-related PAN had a lower FFS compared to non-hepatitis B-related PAN (P = 0.039). No other significant differences were noted between the two groups.

Conclusion: In comparison to classic PAN in other populations, classic PAN in north India is associated with higher neurological involvement and lower GI involvement.
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http://dx.doi.org/10.1111/1756-185X.12954DOI Listing
March 2017

Impact of renal involvement on survival in ANCA-associated vasculitis.

Int Urol Nephrol 2016 Sep 6;48(9):1477-82. Epub 2016 Jun 6.

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

Background: Renal involvement is a serious complication of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We describe the pattern of renal involvement and its correlation with outcomes.

Patients And Methods: Medical records of 92 patients seen in rheumatology clinic and diagnosed as AAV between January 2007 and June 2014 were analysed. Patients were classified as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA) and undifferentiated AAV. Overall and renal outcomes were analysed. Patients were classified as advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), deranged RFT not qualifying the above parameters, and normal renal function.

Results: Sixty-seven (72.8 %) patients had GPA, 14 (15.2 %) had MPA, 8 (8.7 %) had EGPA, and 3 (3.3 %) had undifferentiated AAV. Renal involvement was seen in 51 (55.4 %) patients (46.3 % of GPA patients, 78.6 % of MPA, 37.5 % of EGPA and 33.3 % of unclassifiable AAV patients). Renal involvement was more common in males (p = 0.008). Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p < 0.01). Thirteen patients (25.5 %) presented with advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), 21 (41.2 %) had deranged renal functions but did not require dialysis, and the rest had proteinuria and active sediments with normal serum creatinine. Twenty-four patients (47.1 %) had good renal outcome with normal creatinine, 12 (23.5 %) had persistent renal insufficiency, 12 (23.5 %) died, and one (2 %) remained dialysis dependent. Mean survival and mortality did not differ in patients with and without renal involvement (p = 0.454, p = 0.388).

Conclusions: Renal involvement was more common in males. BVAS was higher in patients with renal involvement. The mean survival and mortality were similar in patients with or without renal involvement.
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http://dx.doi.org/10.1007/s11255-016-1330-zDOI Listing
September 2016

Connective Tissue Disorder-Associated Vasculitis.

Curr Rheumatol Rep 2016 Jun;18(6):31

Department of Medicine, Division of Rheumatology, & Division of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.

Vasculitides secondary to connective tissue diseases are classified under the category of 'vasculitis associated with systemic disease' in the revised International Chapel Hill Consensus Conference (CHCC) nomenclature. These secondary vasculitides may affect any of the small, medium or large vessels and usually portend a poor prognosis. Any organ system can be involved and the presentation would vary depending upon that involvement. Treatment depends upon the type and severity of presentation. In this review, we describe secondary vasculitis associated with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, relapsing polychondritis, systemic sclerosis, Sjogren's syndrome and idiopathic inflammatory myositis, focusing mainly on recent advances in the past 3 years.
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http://dx.doi.org/10.1007/s11926-016-0584-xDOI Listing
June 2016
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