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Important of exercise in arthritis
Exercise plays a vital role in improving the physical and mental health of an individual. Exercise helps in the production of brain's chemical messengers called endorphins. Endorphins enhance your mood and make you feel good. This helps to attain a state of relaxation. Exercise reduces the inflammation, which is the key mechanism responsible for causing damages in the joint. 


Exercide Guidelines

Gout was once considered a relatively rare condition in India. However, recent reports indicate increasing prevalence of the condition in the country, which could be attributed to increased affluence or may be due to increased diagnosis. The presentation of increased uric acid level without any clinically relatable problem (hyperuricemia) is often misdiagnosed as gout. In the current book, which is a part of the Q&A series, I have tried to address the dilemma often faced in real-time clinical scenarios with reference to the diagnosis of gout and hyperuricemia, and the current concepts in its diagnosis and management. Currently, very few drugs are available for the management of gout or increased uric acid levels. Topiroxostat is a new molecule introduced in India for treating gout and hyperuricemia. The drug is available for more than a decade in certain south-east Asian countries. In the Q&A format, the place of topiroxostat in the management of gout and certain other conditions has been discussed. Hope the book can help in improving your knowledge on the management of gout and using the new molecule in the right perspective.

Topiroxostat - Gout and Hyperuricemia - Q & A

Rheumatoid arthritis is an inflammatory autoimmune disease, which may result in severe disabilities and deformities if not diagnosed early and managed with adequate dose of DMARDs. The early diagnosis is often impaired by initial atypical presentations and its close mimic to other autoimmune rheumatic diseases. From the point of diagnosis to treatment of the disease, the practising rheumatologist confronts various challenges. With an intention to address such challenges and to develop a quick reference guide for all clinicians, I have started publishing the question and answer series on rheumatoid arthritis since 2012. The answers provided are substantiated by well-accepted guidelines, literature evidence and clinical experience. These answers can assist decision making in diverse clinical circumstances. I have made a sincere attempt to make the compiled volume more scenario oriented.


Compiled Volume - Diagnosis to DMARDs

Diagnosis to DMARDs Compiled Volume

Azathioprine (AZA), a cycle-specific antimetabolite, is quickly converted to 6- mercaptopurine within the body. To enhance the treatment efficacy, the drug must be administered during the induction period of the antibody response. The precise mechanism of AZA in supressing the immune response is unknown, but it acts by regulating cell-mediated hypersensitivities and antibody production. The drug also inhibits synthesis of DNA, RNA and proteins, and may interfere with meiosis and cellular metabolism. The mechanism for its effect on autoimmune diseases is unknown. The drug was synthesised in 1957 as an anti-malignancy drug and its potential use in rheumatoid arthritis has been identified later. In 1981, the US food and drug administration approved the drug for treating rheumatoid arthritis. Adverse events and the need for. close monitoring are the major limitations of AZA. Availability of safer DMARDs has reduced the use of AZA. However, the drug is preferred in certain specific clinical scenarios. The drug has found place in treating many other autoimmune diseases. Moreover, the steroid sparing property of AZA has opened up its use for managing various other conditions.

Azathioprine - Question and Answer

The book focuses on the use of tofacitinib in the field of dermatology. The book may serve as a clinical guide to assist healthcare professionals in using the drug safely and effectively, thereby to improve the prescription practice. Recent trials have proven its effectiveness in treating various skin diseases. The availability of the generic form in global markets has improved its accessibility and clinical use. The drug, though very effective in the management of several autoimmune conditions, has narrow therapeutic-to-toxicity ratio. There are set guidelines and pre- introduction evaluation of the drug for safety and probable adverse events. The guidelines and recommendations provided in this book may help to clarify the uncertainties related to tofacitinib prescription. To improve the patients' compliance, it is critical that the physician provides all the necessary information to the patient. Additionally, the clinician should have thorough knowledge on managing special circumstances, including drug-related complications. The content includes a brief introduction of the drug, followed by questions and answers explaining different clinical scenarios.

The author has attempted to address almost all plausible clinical scenarios pertaining to the use of tofacitinib in managing skin disorders.


Tofacitinib in Dermatology

The seventh volume of the book series focuses on the use of tofacitinib for managing rheumatoid arthritis (RA). The book may serve as a clinical guide to assist healthcare professionals for using the drug safely and effectively, thereby to improve the prescription practice.
In the past one decade, tofacitinib has emerged as a potent target synthetic (ts) DMARD for managing RA. The availability of the generic form in global markets has improved its accessibility and clinical use. The drug though very effective in the management of RA, has narrow therapeutic to toxicity ratio. The drug needs to be prescribed with caution. There are set guidelines and pre-introduction evaluation of the drug for safety and probable adverse events. The guidelines and recommendations provided in this book may help to clarify the uncertainties related to tofacitinib prescription. To improve the patient’s compliance, it is critical that the physician provides all the necessary information to the patient. Additionally, the clinician should have thorough knowledge on managing special circumstances, including drug-related complications. The content includes a brief introduction of the drug, followed by questions and answers explaining different clinical scenarios. The author has attempted to address almost all plausible clinical scenarios involved in the RA management using tofacitinib.


Managing Rheumatoid Arthritis - Q & A - Vol VII - Tofacitinib

This book provides the latest information on cutting-edge research concerning inflammation, its fundamentals including the direct and indirect determinants, besides the advanced management protocols employed in clinical practice. This volume of the book deals with basic molecular aspects of antibody response in various inflammatory conditions like sepsis, organ transplantation, role of lipid metabolism in inflammation, followed by detailed description on certain disease entities caused due to inflammation. Each topic is dealt in detail in different chapters, authored by proficient professionals in their respective fields.

The host response to extraneous insult is mediated by the innate and adaptive immunity. The innate immune system mounts a relatively non-specific reaction to 'nonself foreign substances, proteins, or lipopolysaccharides mediated by cytokines, meanwhile generation of more specific and 'learnt' response is developed by the adaptive/acquired immune system through T and B cells.

As is well established, inflammation is the first line of defense of the body to protect tissues from infection, injury or disease. It is also the first step in healing response, but an exacerbated inflammatory response can cause extensive tissue damage. Moving forward wie our existing knowledge in inflammation, researchers in the last decade have established chronic inflammation in pathogenesis of lifestyle diseases like type 2 diabetes mellitus. Obesity and type 2 diabetes are linked to a low-grade inflammation state that reflects the activation of innate immunity. Inflammatory markers are predictive of the risk to develop diabetes, and are associated with an increased cardiovascular risk. The role of chronic inflammation in neurodegenerative diseases like Alzheimer's disease, Parkinson's disease, multiple sclerosis, and Huntington's disease has grabbed attention of neuroscientists and basic molecular researchers. The immune response in the central nervous system, particularly the activation of brain-resident microglia contributes to neurotoxicity, oxidative stress, and synaptic and neuronal damage. However, a decrease in the microglia can also be detrimental, as they play a role in clearing cell debris, and helps in the process of neurodegenerations.

The immune response of the various organs is unique. For example, many parts of the eye like cornea, anterior chamber, and retina are immune-privileged. The inflammatory response is attenuated in these structures so as to preserve transparency of the visual axis. However, the other sites of the eye such as the conjunctiva and the uveal tract, which are not immune- privileged, mount a robust immune response resulting in acute or chronic inflammation.


Inflammation - Volume 1 - 2020

This book purports to provide the latest information on cutting-edge research concerning inflammation, its fundamentals including the direct and indirect determinants, besides the advanced management protocols employed in clinical practice. This volume of the book widens the horizon delving deeper to understand the molecular aspects of inflammation such as role of memory T cells, cytokines, concept of self-tolerance and autoimmunity.

Moving forward with our existing knowledge in inflammation, researchers in the last decade have established chronic inflammation in pathogenesis of lifestyle diseases like type 2 diabetes mellitus. Obesity and type 2 diabetes are linked to low-grade inflammation state that reflects the activation of innate immunity. Inflammatory markers are predictive of the risk to develop diabetes, and are associated with an increased cardiovascular risk. The role of chronic inflammation in neurodegenerative diseases like Alzheimer's disease, Parkinson's disease, multiple sclerosis, and Huntington's disease has grabbed the attention of neuroscientists and basic molecular researchers. The role of adipokines in neuro-inflammation and neuroinflammatory diseases has been dealt in a separate chapter in the present volume.

Ocular inflammation basics and latest updates on few diseases like ocular sarcoid, Vogt- Koyanagi-Harada disease, HLA B27-associated uveitis and sympathetic ophthalmia are discussed in this volume. Baseline immunological investigation in uveitis and guidelines for use of immunosuppressive agents for managing uveitis are also discussed in this volume by eminent faculty.

Inflammation - Volume 2 - 2021

This volume features 10 chapters authored by eminent scientists and clinicians. The topics encompass inflammation and its impacts on a diverse array of disorders, including lifestyle diseases like diabetes, systemic manifestations in RBCs, and the emerging roles of senolytics and biologics in anti-inflammation management strategies. Tocilizumab, a biologic found effective in combating cytokine storms in COVID, has been discussed. A comprehensive description of the use of anti-TNF and anti-IL-17 in systemic inflammatory diseases has been presented eloquently in clear language. These drugs are now also employed in ocular inflammation. Specific chapters delve into the functions of B cells and NK cells in inflammation, which were not previously considered. The activation of natural killer cells plays a crucial role in inflammation. They can respond to various inflammatory stimuli generated by tissue damage, contributing to both the progression and resolution of diseases.

The volume includes two chapters focusing on ocular diseases. One of these chapters delves into the immunopathology of central serous retinopathy. Despite being known for quite some time, central serous retinopathy remains an enigma when it comes to its etiopathogenesis. An ocular immunologist has discussed the immunopathogenesis of this disease. Our group has contributed an update on autoimmune uveitis. Autoimmune uveitis is a topic that can intrigue any immunologist.

Inflammation - Volume 3 - 2022

The experience of hydroxychloroquine in managing RA patients with diabetes mellitus suggested the anti-diabetic potential of the drug. The anti-diabetic effect has been effectively proven by clinical trials and the drug has been recently approved for managing diabetes. Emerging studies suggest its clinical use in obstetrical  ntiphospholipid syndrome (APS) and other recurrent
pregnancy loss, especially in refractory cases. Several studies are being conducted to determine whether hydroxychloroquine should be recommended as a part of APS treatment. The immune modulation potential
of the drug has also been investigated for the  anagement of cancer.

Hydroxychloroquine in Diabetes Q & A

In this book, the author has attempted to discuss the problems related with Recurrent Pregnancy Loss and the treatment for various causes in the form of  question and answers.  Also, the author has adequately addressed the controversial areas with suitable literature evidence. 

Recurrent Pregnancy Loss - Causes and Treatment

DescriptionThe book focuses on the use of tofacitinib in the management of ulcerative colitis (UC). The book may serve as a clinical guide to assist healthcare professionals for using the drug safely and effectively, thereby to improve the prescription practice. In the past one decade, tofacitinib has emerged as a potent target synthetic DMARD for managing RA. Recent trials have proven its effectiveness in UC. The availability of the generic form in global markets has improved its accessibility and clinical use. The drug, though very effective in the management of several autoimmune conditions, has narrow therapeutic-to toxicity-ratio. The drug needs to be prescribed with caution. There are set guidelines and pre-introduction evaluation of the drug for safety and probable adverse events. The guidelines and recommendations provided in this book may help to clarify the uncertainties related to tofacitinib prescription. To improve the patients' compliance, it is critical that the physician provides all the necessary information to the patient. Additionally, the clinician should have thorough knowledge on managing special circumstances, including drug-related complications. The content includes a brief introduction of the drug, followed by questions and answers explaining different clinical scenarios.

The author has attempted to address almost all plausible clinical scenarios involved in the UC management using tofacitinib.



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