RHEUMATOLOGY: MADE IN INDIA (Camps, COPCORD, HLA, Ayurveda, HAQ, WOMAC and Drug Trials)

This coveted oration describes my clinical and research career. The focus is on ‘Indian-ness’ and contributions to Indian Rheumatology. Methods: This oration will focus on clinical profile, camps, HAQ, Community oriented program for control of rheumatic diseases (COPCORD) Bhigwan, Ayurveda, drug trials, ANA, HLA, BJD, New Millennium Indian Technology Leadership Initiative (NMITLI), MAI, database & CRD. Results: The clinical profile of Indian arthritides is different and Caucasian population based classification criteria do not suffice. Comparative data from free arthritis camps is presented. Validated versions of HAQ and WOMAC suitable for Indian use were developed and are presented. The maiden Indian WHO COPCORD, an ongoing rural population program in Bhigwan (Pune), has provided statistics on prevalence, incidence, risk factors. The Bhigwan model, unlike any other COPCORD, provides free clinical services. The Bhigwan longitudinal observational seven year data from RA patients (unpublished)showed that (i)regular DMARD use had lower HAQ scores(better functional ability)(ii)chloroquin was safe(iii)steroids had higher HAQ scores. The HLA DR. profile in RA, both from Bhigwan and hospital referrals, was remarkably different. We have demonstrated the efficacy and safety of certain standardized Ayurvedic drugs in RA and OA knees through several controlled randomized drug trials; one of these drugs is now marketed worldwide. These trials also showed an unprecedented robust placebo response. A multicentric NMITLI arthritis program, funded by Government of India, has been launched to identify evidence based Ayurvedic medicinal plants and will be co-ordinated from CRD, Pune. The Bone and Joint Decade (BJD) 2000-2010 India program, also run from CRD, has launched several national research programs. Conclusion: As clinicians, we can do significant research, especially pertaining to community needs. Arthritis camps are useful. But we also need population studies such the WHO COPCORD Bhigwan. BJD has begun to measure the national disease burden. Ayurvedic medicines can treat arthritis and need further scientific exploration. Rheumatology needs to be recognized both as a specialty and a research area.