i n d i a n j o u rn a l o f r h e uma t o l o g y 9 ( 2 0 1 4 ) S 7eS 6 7 S57

P170. Systemic onset juvenile idiopathic arthritis (SoJIA):Delayed diagnosis leads to joint damage

Pradeepta Sekhar Patro, Ranjan Gupta, Able Lawrence,

Vikas Agarwal, Ramnath Misra, Amita Aggarwal; Department ofClinical Immunology, Sanjay Gandhi Postgraduate Institute of MedicalSciences, Lucknow, India

Introduction: SoJIA is a systemic inflammatory disease which in-

volves multiple organ systems. Early diagnosis is the key to

effective therapy to suppress inflammation and future damage. In

India the diagnosis is often delayed due to lack of awareness

Methods: Retrospective case records based analysis of 123 pa-

tients with SoJIA was done. Data on baseline clinical features,

duration of symptoms and presence of damage as well as in-

flammatory markers was retrieved.

Results: Of the total 123 patients, 41(33.3%) were girls. Mean age

at the onset of symptoms was 6.75 years and mean delay in

making a diagnosis was 35 months. Fever (98.70%) and inflam-

matory polyarthritis (96.2%) were the most common presenting

symptoms. Lymphadenopathy (58.6%), hepatomegaly (44.60%)

splenomegaly (33.75%) rashes (39.50%) were also common.

Three patients presented first time with macrophage activation

syndrome. Deformities were present in 39 out of 123 children

(32%) at the first visit itself. Wrist (73%) was the most commonly

damaged joint. Investigations revealed high inflammatory

burden: mean CRP of 10.7 mg/dl, mean ESR of 77 mm/hr and

mean platelet count of 4, 29,353/mm3 at the time of

presentation.

Conclusions: Delay in making the correct diagnosis of SoJIA leads

to the high inflammatory burden in these patients and results in

significant joint damage. Thus increased awareness about this

disease is required among pediatricians.

P171. Viscosupplementation in osteoarthritis: A single centerexperience

Darshan Singh Bhakuni, Krishnan Shanmuganandan,

Amar Tej Atal, Arun Hegde, Abhishek Kumar; Army HospitalResearch & Referral, Delhi Cantt, India

Introduction: Viscosupplementation helps to restore the rheo-

logical and physiological state of joints in osteoarthritis. Several

systematic reviews on this modality have offered differing

results.

Methods: We carried out a retrospective analysis of 353 patients of

knee osteoarthritis, given intra-articular Hylan G-F 20 at our

center and evaluated during the period 05 February 2011 to 08

August 2014. Data was collated from patients for each target knee

injected. Response to injection was quantified as ‘improvement’,

‘no change’ and ‘worsening’ of pain and function at baseline and

24 weeks post injection.

Results: Out of a total of 543 knees injected, 216 were Kellgren-

Lawrence grade 2, 299 were grade 3 and 28 were grade 4. Of these

knees, 449 (82.7%) responded favourablyat24weeks.Transientpost

procedure pain was reported over 24-72 hours in 34 knees, while

pain and swelling requiring prolonged rest and NSAIDs were

demonstrable in 2 knees. Response pertaining to 186 knees collated

after the second injection of viscosupplementation, revealed

improvement in 142 knees (76.3%). Response related to 63 knees,

after their third injection of Hylan G-F 20 demonstrated

improvement in 41 (65%). Failure to respond to treatment over 8

weeks was related to lack of improvement or worsening of pain at

24 weeks.

Conclusion: Viscosupplementation with Hylan G- F 20 is safe and

effective in reducing pain and improving function in patients of

knee osteoarthritis.

P172. Is body fat distribution correlated with osteoarthritisand its severity? A preliminary study

Ragini Srivastava, Shweta Agarwal, S.K. Das, R.N. Srivastava;Department of Rheumatology and Orthopedic Surgery, KG MedicalUniversity, Lucknow, India

Introduction: Obesity and quadriceps weakness have been

considered to be important risk factors for osteoarthritis. Osteo-

arthritis also occurs in non-obese persons. Here we have tried to

study if there is any difference in fat distribution pattern and lean

musclemass between non obese OA patients and similar controls.

Methods: Non obese (BMI<30) patients of (a) knee osteoarthritis

and (b) controls were selected from the patients attending Rheu-

matology / Orthopedics OPD. Patients having clinico radiological

OA were evaluated after taking informed consent. 56 patients and

14 controls were studied. Whole body BMD was conducted in

patients and controls by GE Lunar machine. OA disease activity

was assessed using WOMAC and KGMC scale.

Result: Body fat and lean mass of Whole body, Trunk, Legs,

Android and Gynoid distribution of OA patients were compared

with controls of similar BMI. OA patients were divided ac-

cording to disease activity and disease activity compared with

body fat distribution. No difference was observed in patients vs

controls and disease activity and body fat distribution. High

Body fat and less lean muscle mass was reported in females

(n¼42) than males (n¼12) which correlated with Total KGMC

score (p<0.05).

Conclusion: No correlation was observed in OA, disease severity

and Body fat and leg muscle mass. However as expected signifi-

cant difference were observed among the female vsmale patients.

This appeared to be correlated to higher disease activity in fe-

males. The limitations are number of patients is small and sta-

tistical analysis is preliminary.

P173. Leprosy: In disguise and blending in with the crowd

Deepak Rath, Bijit Kumar Kundu; Department of Medicine, PGIMER &Dr RML Hospital, New Delhi, India

Affection of skin and nerves by leprosy is quiet common and

easily diagnosed. However diagnosing musculoskeletal involve-

ment as being due to leprosy is difficult given its protean mani-

festations and the fact that it is a great mimic of many

autoimmune conditions. We present two cases where leprosy

presented with features similar to and were diagnosed and

treated initially as Rheumatoid Arthritis (RA), and Seronegative

Spondyloarthritis (SpA) respectively. Only later was the true

diagnosis revealed. In leprosy endemic areas it is imperative to

keep in mind the myriad presentations of leprosy including its

musculoskeletal manifestations as consequences of misdiagnosis

and hence mistreatment can be catastrophic, especially in the era

of increasing use of biologic disease modifying agents. We

conclude that in endemic areas leprosy should be ‘actively’ ruled

out and should be made an integral part of pre-biologic screening.