Sundeep Kumar Upadhyaya is a Senior Consultant at New Delhi’s Indraprastha Apollo Hospitals. He is involved in the treatment of autoimmune disorders like Arthritides, Vasculitides, Lupus and Spondyloarthritis since 16 years. He is an Associate Professor and Teaching Faculty at the Teaching Program at the AHERF and National Boards of the Apollo Group of Hospitals. He is involved with cutting edge clinical work on these disorders and has developed treatment algorithms for lupus nephritis, early and established rheumatoid arthritis and has been on various national bodies and involved in management protocols for autoimmune disorders.


Rheumatoid arthritis (RA) is conventionally treated with cDMARDs (like Methotrexate, Leflunomide etc) but more severe, cDMARD resistant RA, is treated with a combinations of cDMARDs and Biologics (example Anti-TNF Biologics). Despite close monitoring and follow-up only a fraction of treated patients achieve complete remission and attain a drug free state. A combination of cDMARDs and Biologics in the treatment of early RA has been able to achieve drug free remissions in only a small minority of patients. Complete remissions are rare when patients are treated with cDMARDs alone. Presented here is the clinical description of patients with RA who achieved long-term drug free clinical remissions (CR) with cDMARDs alone at a single rheumatology clinic in northern India and remained in CR over a long period (at least 6 months). The immune-biology of such states and the clinical factors leading to the prolonged CR will be discussed next.

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