Publications by authors named "Nupoor Acharya"

12 Publications

  • Page 1 of 1

Scleroderma Renal Crisis is Associated with High Mortality: A Real-World Study from India.

J Assoc Physicians India 2021 Oct;69(10):11-12

Additional Professor, Postgraduate Institute of Medical Education and Research, Chandigarh Corresponding Author.

Introduction: Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis. Since the use of ACE inhibitors in this condition, there has been a significant reduction of mortality rates. However, there is limited data on characteristics and outcomes of SRC from developing countries.

Method: This was a single centre, case-control study from India. The records of all patients admitted in the last 5 years were scrutinized, and patients with SRC (as per the updated consensus classification, 2014) were compared with patients of systemic sclerosis who were admitted for other reasons (controls). Disease characteristics, between cases and controls, were compared using chi-squared test, and odds ratios (OR) were calculated. Survival was compared using KaplanMeier statistics.

Results: Ninety-four patients of systemic sclerosis admitted over five-years; among them 15 had SRC. As compared to controls, those with SRC had a significantly higher rates of pericardial effusion (OR 11.7, p=0.02), dilated cardiomyopathy (OR 2.5, p=0.04), myopathy (OR 19.3, p=0.001), taking mediumhigh dose glucocorticoids (OR 7.9, p=0.009) and recent disease onset (OR 39.3, p=0.01). Despite aggressive control of hypertension with ACE inhibitors, 10/12 patients with SRC died. Mean (SD) survival in patients with SRC (11.5, 95% CI 5.7 to 17.6 months) was significantly lower than controls (66.2, 95% CI 58.4 to 73.9 months, p<0.001).

Conclusion: In this single-centre study from a developing country, scleroderma renal crisis was associated with a dismal prognosis, despite the use of ACEI. The recent use of medium-high dose glucocorticoids was associated with SRC.
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October 2021

Clinical presentation and treatment outcomes of arterial involvement in Behçet's disease: a single-centre experience.

Rheumatol Int 2021 Oct 18. Epub 2021 Oct 18.

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

Arterial involvement, although rare, accounts for significant mortality and morbidity in patients of Behçet's disease (BD). There is paucity of data on arterial BD. The objective of this 5-year retrospective cohort study was to examine the clinical presentation, pattern of arterial involvement, and treatment outcome in Indian arterial BD patients. Data on demography, clinical presentation, radiology, instituted therapy, vascular interventions and treatment outcomes were recorded and analyzed. Ten (16.9%) out of 59 patients with BD had arterial involvement in 13 vascular territories [mean age 30 (8) years, 9 (90%) males]. Pulmonary artery was most commonly involved (46%), followed by abdominal aorta (15%), femoral artery (15%), descending thoracic aorta (8%), common iliac (8%), and dorsalis pedis artery (8%). Two patients had multi-territory involvement. The median interval between disease onset and development of arterial aneurysms was 3 years (3 months-12 years). Concomitant deep vein thrombosis was seen in 60% cases. Prednisolone and cyclophosphamide were the most common immunosuppressive therapy used; one patient who relapsed on cyclophosphamide responded to infliximab. Five surgical or endovascular interventions were performed. Four patients (40%) died due to aneurysm rupture-all had a delayed diagnosis, and three had pulmonary artery involvement, with death due to massive hemoptysis. Based on the present study, we concluded that arterial involvement in BD is seen predominantly in males and has a high mortality. Early detection and aggressive treatment with immunosuppression and surgical or endovascular interventions are essential for good outcomes.
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http://dx.doi.org/10.1007/s00296-021-05022-yDOI Listing
October 2021

Fibromyalgia influences health-related quality of life and disease activity in psoriatic arthritis.

Rheumatol Int 2021 Jul 12. Epub 2021 Jul 12.

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

Fibromyalgia syndrome (FMS) is common in patients of psoriatic arthritis (PsA), but the magnitude of its impact is uncertain. This cross-sectional study evaluated the impact of FMS on health-related quality of life (HRQoL) and disease activity in PsA. Adults classified with PsA (CASPAR criteria) at the rheumatology and dermatology outpatient clinics of PGIMER, Chandigarh, India between January 2014 and June 2015 were recruited. All patients were assessed for FMS using the 2010 ACR criteria. Health-related quality of life was assessed using PROMIS-HAQ, HAQ-pain, HAQ-health and revised fibromyalgia impact questionnaire (FIQR). Disease activity measures (SJC, TJC, BASDAI, enthesitis, dactylitis, PASI) and PROMIS-HAQ were correlated with measures of FMS [FIQR, symptom severity scale (SSS) score and widespread pain index (WPI)]. Multivariate regression analyses were used to identify predictors of PROMIS-HAQ and FMS. Out of 106 PsA patients screened, 102 [50 (49%) females; mean age 43.8 (12.4) years] were included. 19 (18.3%) had FMS. Patients of PsA with FMS had significantly (p < 0.05) higher TJC (14 vs 7), SJC (10 vs 5), BASDAI (6.1 vs 4.1) and enthesitis (53 vs 33%), but no difference in dactylitis, severity of skin disease and disease duration. A significant positive correlation of measures of FMS (FIQR, SSS and WPI) with SJC, TJC and BASDAI was noted. PROMIS-HAQ, HAQ-pain and HAQ-health were significantly worse (p < 0.001) in patients of PsA with coexisting FMS. Presence of FMS was found to be an independent predictor of worse PROMIS-HAQ. Female gender and higher TJC independently predicted presence of FMS. To conclude, FMS is an important contributor towards poor HRQoL in patients of PsA and is associated with higher values of joint disease activity measures.
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http://dx.doi.org/10.1007/s00296-021-04925-0DOI Listing
July 2021

Lupus with abdominal pain.

Rheumatology (Oxford) 2021 01;60(1):475

Division of Rheumatology, Department of Internal Medicine.

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http://dx.doi.org/10.1093/rheumatology/keaa384DOI Listing
January 2021

Efficacy and safety of pirfenidone in systemic sclerosis-related interstitial lung disease-a randomised controlled trial.

Rheumatol Int 2020 May 1;40(5):703-710. Epub 2020 Apr 1.

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

To assess the efficacy and safety of pirfenidone in systemic sclerosis-related interstitial lung disease (SSc-ILD). This was a double-blind, randomised, placebo-controlled, pilot study. Subjects with SSc-ILD and forced vital capacity (FVC) between 50 and 80% of the predicted (%pred) value were randomised in 1:1 ratio to receive either pirfenidone (2400 mg/day) or placebo for 6 months. Primary outcome was the proportion of subjects with either stabilisation or improvement in FVC at 6 months. Secondary outcomes were the absolute change in the %pred FVC, Mahler's dyspnoea index, 6-min walk distance (6MWD), modified Rodnan skin score (MRSS) and serum levels of tumour necrosis factor α (TNF-α) and transforming growth factor β (TGF-β). Thirty-four subjects with median (range) age of 41 (20-63) years (91.2% women) and median (range) %pred FVC of 65 (51-78) were enrolled. Stabilisation/improvement in FVC was seen in 16 (94.1%) and 13 (76.5%) subjects in the pirfenidone and placebo groups, respectively (p = 0.33). The median (range) absolute change in %pred FVC was - 0.55 (- 9 to 7%) and 1.0 (- 42 to 11.5%) in the treatment and control groups, respectively (p = 0.51). The changes in 6MWD, dyspnoea scores, MRSS, and levels of TNF-α and TGF-β were not significantly different between groups. Common adverse events were gastrointestinal disturbances and skin rash. We failed to find a significant beneficial effect of pirfenidone over placebo in improving/stabilising FVC, exercise capacity, symptoms, or skin disease. Study is underpowered to provide conclusive evidence. Larger studies with longer follow-up periods are required.
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http://dx.doi.org/10.1007/s00296-020-04565-wDOI Listing
May 2020

Glucocorticoid withdrawal in lupus - to do or not to do?

Authors:
Nupoor Acharya

Ann Rheum Dis 2020 Mar 10. Epub 2020 Mar 10.

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

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http://dx.doi.org/10.1136/annrheumdis-2020-217261DOI Listing
March 2020

Rhupus With Pyoderma Gangrenosum Treated With Immunosuppression and Skin Grafting.

J Clin Rheumatol 2021 Aug;27(5):e192

From the Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1097/RHU.0000000000001341DOI Listing
August 2021

'DESIRABLE' or not?

Ann Rheum Dis 2019 Sep 6. Epub 2019 Sep 6.

Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education & Research, Chandigarh, India

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http://dx.doi.org/10.1136/annrheumdis-2019-216236DOI Listing
September 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

Splenic granulomas: a rare manifestation of complex in an immunocompetent host.

BMJ Case Rep 2018 Nov 8;2018. Epub 2018 Nov 8.

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

Infections caused by complex (MAC) are commonly seen in immunocompromised individuals. Though disseminated MAC infections with splenic granulomas are seen in some patients, MAC infection clinically manifesting as only splenic granulomas is rare. This presentation is even less common in immunocompetent individuals. We report a case of a young adult who presented with fever of unknown origin and was found to have multiple splenic granulomas. Fine needle aspiration cytology and PCR for of the granulomas revealed a diagnosis of MAC infection. The patient was not found to have any immunodeficiency on investigations. This case is perhaps the first case of MAC clinically presenting as splenic granulomas in an immunocompetent individual.
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http://dx.doi.org/10.1136/bcr-2018-225788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6229131PMC
November 2018

'MAINRITSAN2-the future', with some doubts!

Ann Rheum Dis 2019 12 12;78(12):e139. Epub 2018 Oct 12.

Department of Internal Medicine, Clinical Immunology and Rheumatology services, PGIMER, Chandigarh, India

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http://dx.doi.org/10.1136/annrheumdis-2018-214486DOI Listing
December 2019

Novel CECR1 gene mutations causing deficiency of adenosine deaminase 2, mimicking antiphospholipid syndrome.

Rheumatology (Oxford) 2019 01;58(1):181-182

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/key258DOI Listing
January 2019
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