Anuj Shukla

• MD DM Clinical Immunology and Rheumatology
• Researcher at Niruj Rheumatology Clinic, Ahmedabad

Background: Non-steroid anti-inflammatory drug (NSAID) usage is associated with kidney injury. Rise in serum creatinine (sCr) often represents irreversible process. Thus to assess the early effects of regular NSAID use, we studied sensitive serum and urine biomarkers of kidney injury. Methods: In a protocol-based intervention study, 103 subjects...

Here, we report a family with two children (the elder son and younger daughter) diagnosed with juvenile-onset systemic lupus erythematosus (SLE) and the father diagnosed with hereditary angioedema. Serum C1 inhibitor (C1-INH) levels were low, and clinical exome next-generation sequencing detected a frameshift mutation in the SERPING-1 gene in all t...

Introduction – Post-viral myositis is not a well-defined term and is often confused with autoimmune idiopathic inflammatory myositis (IIM). This can lead to aggressive and prolonged use of immunosuppression and related complications. Here we discuss our experience with the cases of acute myositis developing 4-weeks post-viral like illness. Methods...

Patients with a systemic autoimmune rheumatic disease (AIRD) are vulnerable to SARS Cov-2 infection. Vaccination against this infection can prevent the patients from developing severe disease. But vaccine hesitancy in this group can emerge as a hurdle. So there is a need to understand the perception regarding vaccination in AIRD patients. The study...

Introduction: There have been major changes in the classification and treatment of patients with idiopathic inflammatory myositis (IIM) in the last 2 decades. A major challenge is to identify the parameters that can affect the outcome and prognosis of these patients. Here, we have longitudinally followed a well-characterized cohort of IIM patients...

Objectives To comprehensively compare the disease burden among patients with RA, PsA and AS using Patient-Reported Outcome Measurement Information System (PROMIS) scores and to identify distinct patient clusters based on comorbidity profiles and PROMIS outcomes. Methods Data from the global COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 e-s...

Objective To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs). Methods The study was based on data from 7035 fully vaccin...

Notwithstanding the wealth of literature on COVID-19, studies focusing on young adults with autoimmune diseases (AD) are lacking. To determine early (within 7 days) and late (after 7 days) anti-SARS-CoV-2 vaccine-related adverse events (AEs), post-vaccine disease flares, COVID-19 severity and breakthrough infections (B-INFs) in young people with rh...

Background SLE imposes a substantial economic burden on patients, including medical and non-medical costs. We performed ‘cost-of-illness’ analysis in Indian SLE patients encompassing all expenses incurred in their treatment. Objectives To assess the economic impact of SLE on patients and study its relationship with disease and non-disease variable...

COVID-19 has been suggested as a possible trigger of disease flares in patients with rheumatoid arthritis (RA). However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection (BIs) and disease flares in patients with RA following COVID-19. We analysed data from RA patients...

Idiopathic inflammatory myopathies (IIMs) confer a significant risk of disability and poor quality of life, though fatigue, an important contributing factor, remains under-reported in these individuals. We aimed to compare and analyze differences in visual analog scale (VAS) scores (0–10 cm) for fatigue (VAS-F) in patients with IIMs, non-IIM system...

Objective COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs), however hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors, and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumat...

Dear Editor, Patients with idiopathic inflammatory myopathies (IIMs) represent a high-risk group for adverse pregnancy outcomes (APOs), and post COVID-19 vaccination disease flares have been speculated. However, data on vaccine-associated adverse events (ADEs) in the antenatal period and APOs in this vulnerable group are virtually non-existent, lim...

Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently appro...

Acute pancreatitis (AP) is a rare but life threatening manifestation of Systemic Lupus Erythematosus (SLE). The current study aims to study the clinical characteristics, severity, mortality, and outcome of SLE-related AP in Indian population. We retrospectively reviewed medical records of patients with SLE who had AP in the past. Data from 13 rheum...

The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global morbidity and mortality. Whilst COVID-19 vaccination has emerged as the only tangible solution to reducing poor clinical outcomes, vaccine hesitancy continues to be an obstacle to achieving high levels of vaccine uptake. This represents particular risk...

Introduction: Hyper-IgE Syndrome (HIES) is a rare inborn error of immunity (IEI) characterized by a constellation of symptoms related to susceptibility to Staphylococcal skin and pulmonary infections, eczema, raised serum IgE (>2,000 IU/ml), craniofacial anomalies, and recurrent bone fractures. Data on HIES from the Indian subcontinent is scarce an...

Background There is paucity of literature on XLA from developing countries. Herein we report the clinical and molecular profile and outcome in a multicenter cohort of patients with XLA from India. Methods Data on XLA from all regional centers supported by the Foundation for Primary Immunodeficiency Diseases (FPID), USA and other institutions provi...

Post Viral Myositis (PVM) is characterised by acute (developing within days) myositis after few days to weeks of a viral illness. It can lead to early mortality related to rhabdomyolysis or run a self limiting course of few weeks to a month. Role of immunosuppression is not clear but often used in severe cases. It needs to be differentiated from id...

Infections are closely associated with systemic lupus erythematosus (SLE). SLE patients require aggressive immunosuppression making them vulnerable to unusual or atypical presentations of common infections. They have an inherent immune abnormality predisposing them to infection. On the other hand, infection can act as a trigger for the immune syste...

Acute limb ischemia and peripheral vascular disease (PVD) are unusual presentations of polyarteritis nodosa (PAN). Here, we present a case with PVD of both lower limbs leading to foot claudication. Digital subtraction angiography showed narrowing, irregularity, and occlusion of both lower limb arteries with no involvement of the abdomen visceral ar...

In Asia, enthesitis-related arthritis (ERA) is the most-frequent category of juvenile idiopathic arthritis. ERA has a strong association with HLA-B27 and subclinical gut inflammation. In a HLA-B27 transgenic rat model, presence of Bacteroides bacteria in the gut appears to cause spondyloarthropathy (SpA). Thus, we studied gut microbiota in children...

Gut microflora and dysbiosis as an environmental factor has been linked to the pathogenesis of enthesitis-related-arthritis (JIA-ERA). Thus we did a proof-of-concept study of probiotics to modulate the gut-flora and study the effects on immune and clinical parameters of children having JIA-ERA. Forty- six children with active JIA-ERA were randomize...

Keywords: juvenile idiopathic arthritis (JIA), microbiome and treatment SESSION INFORMATION Background/Purpose: Gut microflora influences the development and homeostasis of the immune system. Dysbiosis has been reported in various immuno-inflammatory diseases. Pathogenesis of enthesitis-related-arthritis (ERA) category of JIA suggests an interactio...

Monocytes of children with enthesitis-related arthritis (ERA) show Toll-like receptor 4 (TLR4) overexpression. Tenascin-C (TNC) is an extracellular matrix glycoprotein and acts as an endogenous TLR4 ligand. Thus, we studied the serum and synovial fluid (SF) levels of TNC in children with ERA. TNC was measured in the serum of 80 children with ERA sa...

Background - NSAIDs are the first-line therapy for spondyloarthritis (SpA) patients and are associated with the risk of kidney injury. Long-term NSAID use is known to cause poor urine concentrating abilities. Short-term NSAID induced subclinical-kidney-injury is not well studied. Herein, we studied the effect of shortterm NSAID use on kidney injury...

Introduction: Monocytes of children with enthesitis related arthritis category of juvenile idio- pathic arthritis (JIA-ERA) show TLR-4 over expression. Tenascin-C is an extracellular matrix glycoprotein which is a known endogenous ligand of TLR-4 and may be involved in activating TLR-4 in JIA patients. Thus we studied the serum and synovial fluid l...

Introduction – The diagnosis of primary immune-deficiency (PID) is often delayed due to lack of awareness regarding the presenting clinical and epidemiological patterns. Antibody deficiency is most frequently seen PID. Here, we studied the spectrum of antibody deficiency PID over last three years at our institution. Objectives – To study the clinic...

Objective – To determine factors affecting morbidity and mortality in hospitalized SLE patients Method – A retrospective review of computerized hospital information system was done for SLE patients admitted from July 2012 to July 2013 in Clinical Immunology ward, SGPGI Hospital, Lucknow, India. For SLE related mortality, total deaths in 10 years (2...

Hemophagocytic syndrome (HPS) is a rare, fatal disorder, presenting with fever, pancytopenia, liver dysfunctions, hepatosplenomegaly, hypertriglyceridemia, and hyperferritinemia [1]. HPS may be primary related to genetic mutations or secondary to various infections, malignancies and rheumatic conditions [2]. These antigenic stimuli cause uncontroll...

Lung involvement in vasculitis can affect upper airways, bronchi, interstitium, and the pulmonary vasculature. The clinical presentation is variable ranging from hoarseness of voice, stridor, cough, hemoptysis, and fever to acute respiratory failure. Diagnosis is relatively easy if it occurs in a patient with prior diagnosis of vasculitis, except f...

Dengue infections may present with neurological complications. Whether these are due to neuromuscular disease or electrolyte imbalance is unclear. Eighty-eight patients of dengue fever required hospitalization during epidemic in year 2010. Twelve of them presented with acute neuromuscular weakness. We enrolled them for study. Diagnosis of dengue in...

BACKGROUND AND OBJECTIVES Tissue hypoxia due to repeated sleep apneas leads to increased serum levels of uric acid (UA) and lactate in patients with obstructive sleep apnea syndrome (OSAS). Studies on assessment of serum level of UA in patients of OSAS are available. However, research on simultaneous evaluation of levels of serum lactate and UA is...

PURPOSE: Hypoxemia resulting among patients of obstructive sleep apnea syndrome (OSAS) increases purine catabolism and enhances anaerobic glycol sis, leading to elevated levels of uric acid and lactate. Studies assessing uric acid are available; however, serum levels of lactate had not been studied in patients of OSAS. METHODS: Twenty consecutive...