Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : OC31 - OC34 Full Version

Assessment of Current Trends in Demographic and Clinical Characteristics of Male Patients with Rheumatoid Arthritis: A Retrospective Study

Published: October 1, 2022 | DOI:
Bharat Kumar Singh, Seema Singh

1. Consultant Rheumatologist, Department of Rheumatology, Santokba Durlabhji Memorial Hospital and Medical Research Institute, Jaipur, Rajasthan, India. 2. Assistant Professor, Department of Pathology, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India.

Correspondence Address :
Dr. Seema Singh,
Assistant Professor, Department of Pathology, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India.


Introduction: Role of gender in development of an autoimmune dysfunction in Rheumatoid Arthritis (RA) is very complex and therefore novel concept of gender medicine has come into limelight.

Aim: To assess current trends in demographic and clinical characteristics of male patients with RA.

Materials and Methods: This retrospective study was conducted among patients with RA attending Outpatient Department of Rheumatology at Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur and Centre for Arthritis and Autoimmune Rheumatic Disorders, Jaipur, Rajasthan, India, during April 2015 to April 2021. Men who qualified the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria for RA were included in this study. The medical records of patients were reviewed for collecting demographic and clinical characteristics, disease activity, disease duration, deformities, extra-articular manifestations, and co-morbid illness.

Results: A total of 179 men were enrolled, and the mean age was 45.3±11.1 years. The majority of patients had severe disease with more than two years of disease duration. Subcutaneous nodule (27.8%) was most frequently observed extra-articular manifestations. Rheumatoid factor positivity and cyclic citrullinated peptide were prevalent in 107 and 110 patients, respectively. Osteoporosis (21.1%) and hypertension (19.2%) were the most common co-morbidities and majority of patients reported wrist deformities.

Conclusion: Overall observations indicate the presence of subcutaneous nodule as the common extra-articular manifestation with more than two years of disease duration, osteoporosis and hypertension as the most common co-morbidities; and high prevalence of wrist deformities in male patients with RA.


Hypertension, Osteoporosis, Subcutaneous nodule

Gender differences in Rheumatoid Arthritis (RA) is a well-established fact and women are more prone to develop RA than men (1),(2),(3),(4). Sex hormones play an important role in the pathogenesis of RA. The severity of RA correlates inversely with androgen levels, therefore there is lower severity of RA in men. Although RA affects more women than men evidence from several studies indicates that long-term conditions of disease impact differently on men compared to women (5). The significance of studying RA in men suggests that RA in men has significantly higher risk and may predispose men to poor outcomes, such as pain and disability and early mortality (6).

However, the role of gender in the development of an autoimmune dysfunction in RA is very complex and it is crucial to gain comprehensive knowledge about impact of each gender on disease prevalence, aetiology, disease progression and outcomes of therapeutic interventions. Therefore, in today’s modern era, a novel concept of gender medicine has come into limelight. Focusing on the impact of gender differences on human physiology, pathophysiology, and clinical features of diseases, analysing the complex interrelation and integration of gender and psychological and cultural behaviour (7).

Gender has been shown to affect the physiological, biological, functional, clinical, social presentation, history, and response to medications in rheumatic disease (8),(9). Male health has emerged as a new paradigmfocused on the dramatic disparities in occurrence, clinical signs, outcome, and therapeutic efficacy (10). Applying this model to RA may allow the identification of gender based outcomes such as activity indices and radiographic damage (11).

Studies evaluating demographic and clinical characteristics of male patients with RA are scarce (6),(12),(13) and there is a need to better investigate the possible factors contributing to the sexual dimorphism in RA. Thus, the present study aimed to assess current trends in demographic and clinical characteristics, disease activity, disease duration, deformities, extra-articular manifestations, and co-morbid illness among male patients with RA.

Material and Methods

This retrospective study was conducted among patients with RA attending Outpatient Department of Rheumatology Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur and Centre for Arthritis and Autoimmune Rheumatic Disorders, Jaipur, Rajasthan, India, during April 2015 to April 2021. The study was approved by the Institutional Ethics Committee (IEC/2022/16).

Inclusion and Exclusion criteria: All male patients qualifying the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria for RA (14) were included in the study. The ACR/EULAR negative patients were excluded from the study.

Study Procedure

The medical records of patients were reviewed for collecting demographic details that included age, gender, medical history of family, associated co-morbidities including osteoporosis, hypertension, diabetes mellitus, hypothyroidism, anaemia, dyslipidaemia, and pattern of joint affected prescribed. The pretreatment parameters including tender joint count, swollen joint count, Visual Analogue Scale Score (VAS), Disease Activity Score (DAS) (15), disease activity, and cyclic citrullinated peptide were evaluated.

Statistical Analysis

Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics was used to describe categorical variables (frequency and percentages) and continuous variables {mean and Standard Deviation (SD)} or median and range
(depending on the normality of data).


A total of 179 men were enrolled in this study. The mean age of study population was 45.3±11.1 years and 9.4% of patients had family history of RA. The average number of swollen and tender joints affected were 4.8% and 6%, respectively. In extra-articular manifestations, subcutaneous nodule (27.8%), Sjögren’s syndrome (22.2%) and interstitial lung disease (22.2%) were common. The mean visual analogue scale was 37.3 and mean disease activity score was 5.2. More than half (51.7%) of patients had severe disease activity score (15/28) (Table/Fig 1). Majority of patients (47.9%) reported longer disease duration (more than 2 years). Total 107 patients had Rheumatoid Factor (RF) positive and 110 patients showed presence of cyclic citrullinated peptide.

(Table/Fig 2) presents distribution of co-morbidities observed among patients. Osteoporosis (21.1%) and hypertension (19.2%) were the most common co-morbidities observed. Among the joint deformities observed, bilateral deformities were prevalent than unilateral ones. Among these, the majority of patients reported wrist deformities (62.5% and 17.1%) (Table/Fig 3).


Past literature has established the evidence in support of the concept that gender has major impact on several pathogenic and epidemiologic aspects of RA, resulting in differences between affected males and females. Accordingly, there will be different patterns of disease onset and presentation, disease activity, response to treatments, disability, radiographic progression, and extra-articular manifestations/co-morbidities in men and women (16). Gender may have indirect effect on increased RA susceptibility through environmental/behavioural factors, such as smoking, known to be implicated in seropositive RA (17).

Extensive literature search revealed that there is no Indian study which assessed pattern of disease epidemiology and pathogenicity in male patients alone. Therefore, the present study is of its first kind that evaluated trend of RA epidemiology in men. The key findings were: i) presence of subcutaneous nodule, Sjögren’s syndrome and interstitial lung disease as the common extra-articular manifestations; ii) majority of patients having severe disease and with more than 2 years of disease duration; iii) patients having RF positive and presence of cyclic citrullinated peptide were prevalent; iv) osteoporosis and hypertension were the most common co-morbidities; and v) wrist deformities were prevalent among both bilateral and unilateral joint deformities.

There are no similar studies to compare these results. However, landmark studies which evaluated gender differences in epidemiology of RA demonstrated that men were slightly more likely to be RF positive, to have arthritis in large joints, to develop early radiographic damage, and to have a different pattern of extra-articular manifestations (more nodules and lung and pericardial disease) (18),(19).

Although RA is more common in women, extra-articular manifestations of RA are more common in men. Generally, the constitutional factors such as male gender, a disease associated HLA genes, high titres of rheumatoid factor, and environmental factors such as a history of smoking were predictors of extra-articular manifestations and complications (20). In the present study, subcutaneous nodule, interstitial lung disease, and Sjögren’s syndrome were common extraarticular manifestations associated with the male gender. In a recent study, men with RA from a population-based incident case cohort were presented with more concomitant extra-articular manifestations and had a higher incidence of interstitial lung disease and dermal vasculitis complications than women (21). In accordance with the previous study, the present study also revealed that male gender was recognised as a risk factor for developing interstitial lung disease (22). Similarly, a recently published national register-based cohort revealed a significant male propensity towards extra-articular manifestation presentation than women (23). These findings strongly suggest that men affected by RA have more severe disease.

The RA patients with other co-morbidities may play a major role in the outcome of the disease (24). During the past few years, it has been concluded that RA is an independent risk factor for the development of Cardiovascular (CV) disease. Moreover, CV is one of the leading causes of mortality in patients with RA (25). Similarly in the present study, have found important differences in the co-morbidity profile of male patients. Men presented with a higher prevalence of HTN. Women with RA are more prone to develop osteoporosis. Quite to the contrary, this study observed higher rates of osteoporosis among men patients (26),(27). These findings suggest the importance of HTN and osteoporosis prevention and detection particularly in male patients.

Several hand and wrist deformities have been described as secondary to RA (28). A study found that men with RA on average have higher grip force (29). Nordenskiold UM and Grimby G, found that the majority of women (80.0%) with RA with a disease duration of 5-32 years (mean 12) had wrist deformity compared to healthy women (30). Men showed significantly less disease activity in terms of including swollen joint count, tender joint count, pain, and patient global status (31). However, in the present study wrist deformities were prevalent among both bilateral and unilateral joint deformities among men patients.


This study did not record the impact of RA on the quality of life of the patients which could have added valuable data while inferring the observations. Additionally, the small sample size has restricted its applicability to a general population.


Overall observations indicate the presence of subcutaneous nodule as the common extra-articular manifestation with more than two years of disease duration, prevalence of RF positive and cyclic citrullinated peptide, osteoporosis and hypertension as the most common co-morbidities; and wrist deformities as prevalent joint deformities in male patients with RA. It is evident that male have greater activity of RA and associated co-morbidities such as hypertension and osteoporosis. Due to this, it is important to implement screening protocol and multidisciplinary management approach. Lastly, while considering gender differences, one has to take into account the fact that disease activity may be influenced by gender. The present study sheds light on the importance of the increased risk of osteoporosis in male patients with RA, but further researches are needed to confirm the findings.


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DOI and Others

DOI: 10.7860/JCDR/2022/58811.17098

Date of Submission: Jul 01, 2022
Date of Peer Review: Aug 12, 2022
Date of Acceptance: Sep 01, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 02, 2022
• Manual Googling: Aug 22, 2022
• iThenticate Software: Aug 31, 2022 (13%)

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