Dear Colleagues and Friends,

It gives me great pleasure to welcome you to this edition of the IRA eNewsletter, centred on a theme that is integral to everyday rheumatology practice: “Beyond Autoimmunity: Tackling Infections, Mimics, and Prevention in the Immunosuppressed.”

As rheumatologists, we increasingly care for patients receiving DMARDs, biologics and targeted synthetic DMARDs. With therapeutic immunomodulation comes the equally important responsibility of recognising infection early, distinguishing infection from autoimmune activity, and preventing avoidable infectious complications. This issue addresses these challenges across a broad clinical spectrum.

The articles on CMV masquerading as autoimmune disease and parasitic infections, melioidosis and other infectious mimics remind us that not every inflammatory presentation is necessarily a flare of rheumatic disease. The discussion on recurring cutaneous fungal infections highlights the diagnostic and therapeutic challenges encountered in patients receiving immunomodulatory therapies.

Equally relevant are the practical updates on NTM, newer LTBI regimens and Cy-TB, as well as Pneumocystis jirovecii pneumonia in AIRD, focusing on early recognition, treatment and prophylaxis. The section on herpes zoster and vaccination reinforces the importance of prevention as an integral component of modern rheumatology care.

I am particularly pleased to see the inclusion of Inborn Errors of Immunity, approached through a pattern-based framework. Increasing recognition of underlying immune defects can be valuable when patients present with unusual, recurrent or severe infections.

Beyond the scientific articles, this edition also celebrates the breadth of our rheumatology community—with the Resident Desk, Rheuma Roots featuring NIMS, State Chapter Chronicles from Karnataka, an interesting case and the ever-engaging Rheuma-riddles.

I sincerely thank the editorial team, under the leadership of Dr Subramanian R, contributors and reviewers for bringing together an issue that is both clinically relevant and educational. I hope this edition encourages each of us to look beyond the obvious diagnosis, think broadly about infection and mimics, and place prevention at the heart of immunosuppressive care.

Happy reading!

Warm regards,

Dr. Rajkiran Dudam
Secretary, Indian Rheumatology Association