Indian Journal of Rheumatology

Psoriasis and psoriatic arthritis (PsA) are systemic inflammatory diseases that affect both large vessels and the microcirculation. Nailfold capillaroscopy (NFC) offers a non-invasive tool to detect these vascular changes. This study aimed to identify nailfold capillaroscopic changes in patients with psoriasis and PsA.

We conducted a case-control study including 40 patients with psoriasis (20 only with skin psoriasis, 20 with PsA associated with skin psoriasis) and 20 healthy controls. Demographic, clinical, and laboratory data were collected. Capillary density and morphology were assessed using NFC.

Capillary loop density was significantly lower in PsA patients compared to those with only psoriasis (P ≤ .05). Both psoriasis and PsA groups showed a highly significant increase in rarefaction, avascularity, arterial limb diameter, and apical diameter compared to controls (P ≤ .01). Capillary tortuosity was observed in 60% of psoriasis patients and 65% of those with PsA.

NFC revealed characteristic microvascular abnormalities in psoriatic disease, supporting its value as a non-invasive tool for assessing systemic vascular involvement. Specific correlations with Psoriasis Area Severity Index score (PASI) and Disease Activity in Psoriatic Arthritis score (DAPSA) highlight its potential role in monitoring disease activity. Larger longitudinal studies are warranted to confirm these findings.

There are limited randomised control trials (RCTs) on peripheral arthritis in spondyloarthritis (SpA) and none on oral glucocorticoids (GCs). This study aimed to evaluate the efficacy and safety of oral GCs in treating peripheral arthritis associated with SpA.

This double-blind randomised controlled trial included patients of SpA (non-psoriatic) with active peripheral arthritis (TJC ≥ 2 and SJC ≥ 2) despite NSAIDs and randomised them to receive either oral GC or placebo for 24 weeks. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and intra-articular and/or intramuscular GCs were allowed in both groups. The primary endpoint was ACR50 at 24 weeks and the secondary endpoint included ACR70 and the Peripheral SpA Response Criterion (PSpARC). Analysis was intention-to-treat (ITT) with non-response imputation.

Ninety-four patients (76% male), with a mean age of 31.9 years, with a mean tender joint and swollen joint count of 10 and 3.6, were included and 47 were randomised to receive oral GC and 47 to placebo. Almost all (96%) were receiving csDMARDs by the end of the study. At 24 weeks, there was no significant difference in ACR50 in the GC group compared to placebo (+12.8%; 95% CI, −7.2, 32.7%; P = .213). Secondary endpoints were also not significantly different, including ACR70 (+14.9%, CI −3.2, 32.9%, P = .111) and PSpARC (+10.6%, CI −6.1, 27.3%, P = .216) at 24 weeks. GC was associated with higher adverse effects, specifically, hyperglycaemia.

This study did not find oral GCs to be significantly efficacious in peripheral arthritis of SpA patients. However, there was a trend to improvement with GC and it may have missed a significant difference due to the small sample size included. Oral GC was associated with higher adverse effects.

Clinical Trial Registry of India (CTRI/2021/08/035887).

YouTube, the second most visited website globally, is a major source of health information. While it holds educational potential, the prevalence of misleading medical content is concerning. This study evaluated the content, reliability and quality of YouTube videos on Ankylosing spondylitis (AS).

In October 2024, a YouTube search using the keyword ‘Ankylosing spondylitis’ and the default ‘Relevance’ filter was conducted. The top 100 eligible English-language videos were included. Exclusion criteria were duplicates, non-English videos, irrelevant content, and YouTube Shorts. Reliability and quality were assessed using the modified DISCERN (mDISCERN) and Global Quality Scale (GQS) scores.

Of 120 videos screened, 20 were excluded (12 duplicates, 8 non-English). Among the 100 included, 89% were useful and 11% misleading. Useful videos had higher mDISCERN scores (median 3; range 2–3) than misleading ones (median 2; range 2–2) (P = .002) and higher GQS scores (median 4; range 3–4) compared to misleading ones (median 2; range 1.5–2.5) (P < .001). All videos by academic institutions, professional organisations and rheumatologists were useful. Misleading videos originated mainly from alternative system professionals, non-rheumatologist doctors and independent users. Despite lower quality, misleading videos had higher engagement. The median number of comments was significantly greater for misleading videos (161, range 53–306) than for useful ones (26.5, range 5.8–89.5) (P = .019), and they received more likes on average.

YouTube is a valuable source of health information, but it lacks regulation of medical accuracy. Rheumatologists should collaborate with content creators to produce engaging, evidence-based videos. YouTube must prioritise reliable health content.

This multicentre prospective observational study assessed the clinical characteristics, treatment modalities and short-term outcomes of patients diagnosed with early axial spondyloarthritis (axSpA) in India.

Fourteen rheumatology outpatient clinics in India enrolled patients aged ≥18 years with axial symptoms of <2 years who met the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA. Disease activity indices (Ankylosing Spondylitis Disease Activity Score [ASDAS] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), functional index (Bath Ankylosing Spondylitis Functional Index [BASFI]), non-steroidal anti-inflammatory drug (NSAID) intake scores, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed at baseline, 3 months and 6 months. Correlation analysis was conducted between the study results and comparable international early axSpA inception cohorts.

A total of 155 patients (81% men, mean age 28 years) were included in the study. Eighty-five percent of patients were human leukocyte antigen B27 (HLA-B27) positive. Peripheral arthritis (31%), enthesitis (32%) and uveitis (14%) were common. At baseline, the mean (standard deviation (SD), 95% confidence interval) of the ASDAS-CRP, BASDAI and BASFI indices was 3.5 (1.1, 3.3–3.7), 4.2 (1.7, 3.9–4.5) and 3.8 (1.8, 3.5–4.2), respectively. After 6 months, these indices decreased to 1.7 (0.8, 1.5–1.8; P < .01), 2.0 (1.5, 1.7–2.2; P < .01) and 1.6 (1.2, 1.3–1.8; P < .01), respectively. The median NSAID intake score decreased from 50 to 10 (P < .01). Radiographic sacroiliitis was observed in 54% of patients and magnetic resonance imaging (MRI) sacroiliitis was observed in 97% of patients.

This study demonstrates that early diagnosis and treatment of axSpA significantly improved clinical outcomes and reduced NSAID use in the study participants. The genetic and clinical profiles of Indian patients with early axSpA are comparable to those of patients worldwide. The high radiographic sacroiliitis observed in this study suggests a delayed diagnosis of axSpA in Indian patients.

There are only single-centre small studies on the prevalence of uveitis in Indian patients with spondyloarthritis (SpA). Thus, we planned this study, which utilised a large multicentric database of SpA to determine the prevalence and associations of uveitis.

This study utilises data from a database that enrolled patients with SpA across six different Indian hospitals between October 2021 and 2024. Data was collected by face-to-face interviews and subsequently entered into an online database. Details collected included age, gender, disease duration, type of SpA, HLA-B27 status, BASDAI, occurrence of uveitis, including type and number of episodes. The primary objective was to determine the prevalence of uveitis and the secondary objective was to assess its associations with demographic and clinical variables.

A total of 1,756 patients with SpA were enrolled in this study. Their age (mean ± SD) was 40 ± 12.8 years and the median (IQR) disease duration was 5 (2–10) years. HLA-B27 was positive in 78%. Uveitis occurred in 271 of 1,756 patients, giving a prevalence of 15.4%. A majority of these patients reported multiple episodes of uveitis. On multivariable logistic regression, uveitis was positively associated with positive HLA-B27 (odds ratio 1.866, P = .004), disease duration (odds ratio 1.045, P < .001) and age (1.014, P = .049).

Uveitis occurred in 271 (15.4%) of 1,756 patients with SpA and was positively associated with age, duration of disease and HLAB27.