Comparison of bone mineral density of osteoporotic and osteopenia menopausal women treated with oral bisphosphonates before stopping the treatment and 1 year after drug holiday period

BACKGROUND

Osteoporosis is a skeletal and bone disorder characterized by bone fractures and decreased bone mineral density (BMD). Bisphosphonates have a great tendency to bind to minerals, and their long-term use can increase the risk of bone fragility in patients. Stopping bisphosphonates after a period of time is called a drug holiday (DH). Recent evidence has shown that patients' BMD may decrease again during DH. However, few studies have been done in this regard. In the present study, we compared the BMD of postmenopausal women during bisphosphonates treatment and 1 year after DH.

MATERIAL AND METHODS

A total of 202 patients were selected with osteopenia (n = 95) and osteoporosis (n = 107); they had been treated with alendronate for 5 years (a rheumatologist confirmed the diagnosis of osteopenia and osteoporosis) and had undergone DH for 1 year. At the arrival of all patients, BMD was checked with the DXA (dual-energy X-ray absorptiometry) method using the 2007 American Explorer model Hologic device based on the Caucasian race. One year later, patients were reassessed for BMD by the same device.

RESULT

The analysis of femoral neck (FN) and lumbar spine (LS) T-score indices in the osteopenia and the osteoporosis groups showed reduction after DH, and the difference was statistically significant in both groups (p = 0.001). After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups (p = 0.001).

CONCLUSION

In general, it can be said that DH can reduce FN and LS T-scores. The results indicated a significant reduction in BMD after the DH period for both the osteoporosis and osteopenia groups in the early months. Also, the effect of DH in osteoporosis patients was more compared to the osteopenia individuals, which could have implications for their treatment approach, and also its effect on bone health. Key Points • The DH can reduce FN and LS T-scores • The BMD reduced after the DH period for both the osteoporosis and osteopenia groups • After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups.

Evaluation of the effectiveness of topical oily solution containing frankincense extract in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial

OBJECTIVE

Pharmacological treatments of osteoarthritis (OA) have several side effects. Boswellia serrata resin (frankincense) is rich in boswellic acids that have antioxidant and anti-inflammatory effects; though, their oral bioavailability is low. The aim of this study was evaluation of the clinical effectiveness of frankincense extract in the treatment of knee OA. In a randomized double-blind placebo-controlled clinical trial, eligible patients with knee OA were randomly divided into two groups of drug (33 patients) and control (37 patients), to use oily solution of frankincense extract or placebo, respectively, on the involved knee three times daily for four weeks. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), VAS (visual analogue scale; for pain severity), and PGA (patient global assessment) scores were determined before and after intervention.

RESULTS

For all evaluated outcome variables, there was a significant decrease from baseline in both groups (P < 0.001 for all). Furthermore, the end-of-intervention values for all parameters were significantly lower in drug group than placebo group (P < 0.001 for all), showing more effectiveness of drug compared to placebo.

CONCLUSION

Topical oily solution containing enriched extract of boswellic acids could decrease pain severity and improve the function in patients with knee OA. Trial Registration Trial registration number: IRCT20150721023282N14. Trial registration date: September 20, 2020. The study was retrospectively registered in Iranian Registry of Clinical Trials (IRCT).

PINEAL GERMINOMA PRESENTED WITH PARALYSIS OF UPWARD GAZE AND DIABETES INSIPIDUS

Intracranial germ cell tumors (GCTs) include two categories: germinoma and non germinoma. The pineal gland and suprasellar are the most common site of involvement. The patient is a 14-year-old boy who presented with paralysis of upward gaze, polyuria, polydipsia and diplopia. Examination of vertical eye movements was impaired. Puberty then progressed to stage 3 of Marshall - Tanner and had stopped. In laboratory studies, the patient had anterior hypopituitarism and diabetes insipidus (DI). In pituitary and hypothalamic MRIs, a mass-like enlargement of the pituitary stalk and pineal region was seen, but due to the small size of the lesions, stereotactic biopsy was not possible. During this time, the patient developed recurrent attacks of hydrocephalus. Serum and CSF β-subunit of Human chorionic gonadotropin levels were negative. Treatment was not started because different lesions could cause disease in this area. After one year, a biopsy was performed and the germ cell tumor was diagnosed. Chemotherapy was started and after treatment the vision disorder and diplopia disappeared, but DI and pituitary dysfunction remained. Treatment of intracranial germinoma is multidisciplinary. GCTs are very sensitive to radiation therapy. They are treated with combination of chemotherapy, radiotherapy, surgery, endocrine therapy and have a good prognosis.

Impacts of FcγRIIB and FcγRIIIA gene polymorphisms on systemic lupus erythematous disease activity index

OBJECTIVE

Systemic lupus erythematous (SLE) disease is a chronic autoimmune disease with unknown etiology that can involve different organs. Polymorphisms in Fcγ receptors have been identified as genetic factors in susceptibility to SLE. This study was aimed to investigate effects of two single nucleotide polymorphisms (SNPs) within FcγRIIB and FcγRIIIA genes on systemic lupus erythematous disease activity index (SLEDAI) in an Iranian population.

RESULTS

Our findings indicated TT and GG genotypes were the common genotypes of FcγRIIB and FcγRIIIA SNPs in SLE patients, respectively. There were no significant differences in genotype and allele frequencies of FcγRIIB and FcγRIIIA SNPs in SLE and healthy subjects. However, the frequencies of genotypes and alleles of FcγRIIB and FcγRIIIA SNPs were significantly associated with some clinical manifestations used to determine SLEDAI (P < 0.001-0.5).

Correlation between autoantibodies and internal organs involvement in Iranian systemic sclerosis patients

Introduction: Scleroderma is a rare connective tissue disease that leads to fibrosis of the skin and different internal organ. Several autoantibodies can predict disease course and differences among various races. Objectives: The current study aimed to investigate the correlation between autoantibodies and scleroderma organ involvement among the population living in the central region of Iran. Patients and Methods: This is a cross-sectional study in which we reviewed the medical records of patients in the Al-Zahra hospital systemic sclerosis (SSc) clinic in Isfahan. We used the EUROLINE Systemic Sclerosis panel test kit to detect antibody profiles of patients in blood samples. The pertinent physical findings and laboratory data showing organ involvement were extracted from the hospital medical records. Results: Forty-six patients were enrolled in our study (40 patients were women). We found a significant correlation between Scl-70 and diffuse scleroderma, interstitial lung disease (ILD) and cardiac involvement. Anti-centromere antibodies CENP-A correlated with limited scleroderma and digital ulcers. PM/Scl75, PM/Scl100, Ku, and Ro52 autoantibodies correlated with the presence of tendon friction rub. Anti-Th/To is associated with a higher prevalence of myopathy. Cardiomyopathy was more common among patients with higher levels of NOR-90, anti-Th/To, PM/Scl100, Ku, and Ro52 autoantibodies. The remained autoantibodies showed no significant correlation with the clinical features of SSc. Conclusion: Some autoantibodies in this study predict organ damage in Iranian scleroderma patients.

A randomized clinical trial on improving osteopenia in postmenopausal women after two years of preventive treatment with alendronate; a dose of 35 mg per week is more effective or a dose of 70 mg?

Introduction: Osteoporosis is the most common metabolic bone disease worldwide. In this disease, the bone mass decreases and as it progresses, the risk of fracture increases. Osteopenia occurs in the early stages of bone loss. Studies on the effective dose for treatment of osteopenia have been controversial. Objectives: In this randomized clinical trial, low doses versus high doses of alendronate were assessed during the osteopenic stage in postmenopausal women. Patients and Methods: The present study is a randomized clinical trial (RCT) that was performed on 152 postmenopausal women who were visited in Al-Zahra rheumatology clinic between 2016 and 2017. Patients were randomly divided into two groups. The first group with 35 and the second group with 70 mg of weekly alendronate were treated and followed for two years. Densitometry was performed on patients before and 2 years after the intervention, and the findings were compared. Results: The two groups were not significantly different in terms of age, gender, height, weight, body mass index (BMI) and menopause (P>0.05). The bone mineral density (BMD) findings of both groups, including Fracture Risk Assessment Tool (FRAX) hip and vertebra/wrist, T-score hip and vertebrae, as well as Z-score hip and vertebrae, improved significantly after two years (P<0.001), However, a comparison of the two therapeutic doses did not show a significant difference in terms of BMD improvements (P>0.05). Conclusion: The findings of this study reported favorable results for the preventive treatment of alendronate in osteopenic women. In addition, due to gastrointestinal problems that are the main complaint of alendronate use, according to the results, a weekly dose of 35 mg can be recommended

Incidence of psoriasis in patients with active systemic lupus erythematosus

Introduction: Concomitant onset of active systemic lupus erythematosus (SLE) and psoriasis is rare; however, due to the common skin involvement in both and exacerbation of psoriasis with antimalarial medications used for SLE, it is crucial to investigate the concomitant occurrence of both diseases. Objectives: The present study aims to investigate the incidence of psoriasis in people with active SLE. Patients and Methods: The present cross-sectional study was performed on 148 patients with active SLE from 2015 to 2017. Lupus activity was evaluated based on systemic lupus erythematosus disease activity index-2K (SLEDAI-2K), and then, the incidence of psoriasis in patients was investigated. Patients’ demographic information was recorded in the relevant checklist. Results: The mean score of SLEDAI-2K was 14.10±19.77. The duration of SLE was significantly associated with the SLEDAI-2K score (P=0.001, r = 0.294). Psoriasis incidence was remarkably correlated with the gender of patients with SLE (P=0.019). An insignificant association was found between the coincidences of SLE with psoriasis considering the factors, including age, SLE duration, and mean SLEDAI-2K score. Conclusion: Patients’ mean age, SLE duration, and disease activity score were not correlated with concomitant psoriasis among SLE patients; however, we found that males were more prone to concomitant SLE and psoriasis.

Alendronate improves fasting plasma glucose and insulin sensitivity, and decreases insulin resistance in prediabetic osteopenic postmenopausal women: A randomized triple-blind clinical trial

AIMS/INTRODUCTION

Postmenopausal women receive bisphosphonates for osteoporosis treatment. The effect of these medications on developing diabetes mellitus in prediabetic patients is yet to be investigated. We aimed to determine the effect of alendronate on plasma glucose, insulin indices of postmenopausal women with prediabetes and osteopenia.

MATERIALS AND METHODS

The present triple-blind randomized controlled clinical trial included 60 postmenopausal women, aged 45-60 years. All patients were vitamin D sufficient. They were randomly enrolled in intervention (70 mg/week alendronate for 12 weeks) and control (placebo tablet per week for 12 weeks) groups. The morning 8-h fasting blood samples were collected at the baseline and follow-up visits to measure the fasting plasma glucose (mg/dL), insulin and hemoglobin A1c (HbA1c). Plasma glucose and insulin concentration were measured 30, 60 and 120 min after the glucose tolerance test. The Matsuda Index, homeostasis model assessment of insulin resistance, homeostasis model assessment of β-cell function and the area under the curves of glucose and insulin were calculated.

RESULTS

The mean (standard deviation) fasting plasma glucose (102.43 [1.46] mg/dL vs 94.23 [1.17] mg/dL, P = 0.001), 120-min insulin concentration (101.86 [15.70] mU/L vs 72.60 [11.36] mU/L, P = 0.026), HbA1c (5.60 [0.06]% vs 5.40 [0.05]%, P = 0.001), homeostasis model assessment of insulin resistance (3.57 [0.45] vs 2.62 [0.24], P = 0.021) and Matsuda Index (7.7 [0.41] vs 9.2 [0.4], P = 0.001) significantly improved in the alendronate-treated group. There were more statistically significant reductions in fasting plasma glucose (-8.2 [8.63] mg/dL vs -2.5 [14.26] mg/dL, P = 0.002) and HbA1c (-0.2 [0.23]% vs -0.09 [0.26]%, P = 0.015) observed in the alendronate-treated group than the placebo group during the study course, respectively.

CONCLUSIONS

Administration of 70 mg/week alendronate improves fasting plasma glucose, HbA1c and insulin indices in postmenopausal women.

The effects of conventional drugs in the treatment of rheumatoid arthritis on the serum lipids

BACKGROUND

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that leads to damage of human joints. There are various treatment approaches in which different drugs are prescribed which have several alterations in serum lipids. This research aimed to study the effect of RA treatments on the serum lipids.

MATERIALS AND METHODS

Two hundred randomly selected patients with RA were randomly assigned to three different groups. The first group of patients was treated with a combination of prednisolone (PRD) and hydroxychloroquine (HCQ). The second group was treated with three drugs including PRD, HCQ, and methotrexate (MTX). The third group was treated with four medications including PRD, HCQ, MTX, and sulfasalazine. Within each group, the lipid factors such as triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), erythrocyte sedimentation rate, and visual analog scale were measured at the beginning of the experiment and 6 months after exposing the treatments. For each group, we also calculated the Disease Activity Score-28 (DAS-28). The analysis of variance revealed that the overall DAS-28 was significantly different among the three groups.

RESULTS

In the first group, the level of TG and TC significantly decreased (P = 0.015 and P ≤ 0.001, respectively). In the second group, the level of TG and LDL significantly decreased (P = 0.009). In the third group, the LDL level increased considerably (P < 0.001). The HDL level significantly increased in all three groups (P = 0.012, P = 0.014, and P = 0.028, respectively).

CONCLUSION

The treatment PRD + HCQ + MTX was more effective in reducing the LDL level and increasing the HDL level. To reduce the risk of cardiovascular diseases in patients with RA, it is important to prescribe the combination of drugs which leads and normalizes the lipid profile levels.

Prevalence of Chondrocalcinosis in Patients above 50 Years and the Relationship with Osteoarthritis

BACKGROUND

Some studies showed a relation between chondrocalcinosis and osteoarthritis (OA). Hence, considering the importance of chondrocalcinosis diagnosis andnecessity for its integration with OA, the current study aims at investigating prevalence of chondrocalcinosis in patients above 50 years admitted to Isfahan Al-Zahra Medical Center and its relationship with OA.

MATERIALS AND METHODS

In a cross-sectional study, 600 patients who referred to the radiology units of Al-Zahra Hospital for radiography of different joints were studied during 2013-2014. The patients images were studied for chondrocalcinosis and OA by a radiologist and also examined clinically and results of imaging by an expert rheumatologist. The prevalence of chondrocalcinosis and it relation with OA was determined by Statistical Package for Social Sciences software and using of Chi-square and t-test.

RESULTS

23 patients under study had chondrocalcinosis (3.83%). patients with chondrocalcinosis had higher age average, and they were in age group of 70 years and older, but no significant difference was observed regarding the prevalence of the disease in both genders. Chondrocalcinosis prevalence in terms of body mass index showed significant differences (P = 0.001). All patients with chondrocalcinosis had a history of joint disease and prevalence of chondrocalcinosis in terms of joint disease history showed a significant difference (P < 0.001).

CONCLUSION

Prevalence of chondrocalcinosis is relatively high in the Iranian population of 70 years and older. Hence, more investigation considering to the diagnosis of chondrocalcinosis among patients with OA is very important.

Evaluation of the effect of Elaeagnus angustifolia alone and combined with Boswellia thurifera compared with ibuprofen in patients with knee osteoarthritis: a randomized double-blind controlled clinical trial

Osteoarthritis (OA) is one of the most common articular disorders. Many patients do not respond to acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), the mainstay of pharmacotherapy for knee OA. The plants Elaeagnus angustifolia and Boswellia thurifera have anti-inflammatory and analgesic properties. This study aimed to evaluate the effect of E. angustifolia alone and in combination with B. thurifera compared with ibuprofen in patients with knee osteoarthritis. In a randomized double-blind controlled clinical trial, 75 patients with knee OA were randomly and equally assigned to one of three groups Elaeagnus (n = 23), Elaeagnus/Boswellia (n = 26), and ibuprofen (n = 26) to receive the capsules of Elaeagnus, Elaeagnus/Boswellia, and ibuprofen, respectively, three times daily with meals for 4 weeks. Pain severity based on VAS (visual analog scale, 0 to 10 scale) and the scores of LPFI (Lequesne Pain and Function Index) and PGA (patient global assessment) were determined pre- and post-intervention for all patients. All interventions had significant lowering effects on VAS, LPFI, and PGA scores (P < 0.001 for all parameters) with no significant difference between groups in terms of effects on all evaluated parameters. Consumption of E. angustifolia fruit extract either alone or in combination with Boswellia oleo-gum resin extract could decrease pain and improve function in patients with knee osteoarthritis comparable to ibuprofen.

Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism

OBJECTIVE

Previous studies on bone mineral density (BMD) abnormalities associated with hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on BMD has shown mixed results. The aim of the present study was to determine the severities of osteoporosis in female patients with hypothyroidism in comparison to healthy women.

METHODS

This cross-sectional descriptive study was performed on 150 women aged over 50 years. Totally, 100 patients with primary hypothyroidism and 50 healthy subjects were enrolled in this study and divided into three groups. Group A, which consisted the patients who had been recently diagnosed with primary hypothyroidism. The second group of patients diagnosed with primary hypothyroidism for at least 2 years and was treated with levothyroxine (Group B). The third group of healthy individuals was selected as a control group (Group C). Blood samples were taken for the measurements of thyroid stimulating hormone (TSH), and bone densitometry was performed to determine the BMD reported as T-score in order to measure the severity of osteoporosis. T-score of the lumbar vertebra (L2-L4) and femoral neck were measured with dual energy X-ray absorptiometry and were compared between the three groups. Data were analyzed by SPSS using regression analysis and Mann-Whitney, Kruskal-Wallis, or analysis of variances statistical tests. The statistical significance was set at a P < 0.05.

FINDINGS

The average age of patients and baseline serum TSH levels in Group B was significantly different from the other two groups (P < 0.001). T-score of the lumbar spine (L2-L4) in Group B was significantly lower than the other groups (P = 0.01). The linear regression between serum TSH levels and BMD categories were not clearly associated. However, after removing the effect of the baseline TSH level in Group B, bone loss was significantly greater than the other two groups (P = 0.01).

CONCLUSION

According to the present study, it seems that the treatment of hypothyroidism with thyroid hormones reduces both serum levels of TSH and bone density. Hence, proper control of this risk factor can be an effective way in prevention of osteoporosis.

The association of immunoglobulin A, immunoglobulin G and anti-cyclic citrullinated peptide antibodies with disease activity in seronegative rheumatoid arthritis patients

BACKGROUND

Rheumatoid arthritis (RA) is a common autoimmune disease that is associated with progressive disability, systemic complications, and early death. The present study was aimed to investigate the level of immunoglobulin G (IgG) and IgA isotypes and anti-cyclic citrullinated peptide (CCP) antibody and to assess their association with disease severity based on disease activity score (DAS-28) in patients with IgM rheumatoid factor (IgM-RF) negative RA.

MATERIALS AND METHODS

In this cross-sectional study, 62 RA patients with IgM-RF negative were assessed. Radiographs were obtained for all RA patients. The RF (IgG, and IgA) and anti-CCP were measured by using the enzyme-linked immunosorbent assay. Values of cut-off points over 15 UI/mL for IgA IgA-RF, 20 UI/mL for IgG-RF and over 20 units for anti-CCP were considered positive. DAS-28 score was compared in regard to the IgA-RF and IgG-RF and anti-CCP positivity using Mann-Whitney test.

RESULTS

DAS-28 score in IgA-RF positive was significantly higher than IgA-RF negative (mean score, 6.03 ± 0.33 vs. 5.44 ± 0.76 respectively, P = 0.035). In IgG-RF positive patients, DAS-28 score was similar to patients with IgG-RF negative (5.64 ± 0.59 vs. 5.46 ± 0.78 respectively, P = 0.396). Furthermore, in patients with anti-CCP positive DAS-28 score was significantly higher than patients with anti-CCP negative (5.72 ± 0.61 vs. 5.38 ± 0.79 respectively, P = 0.049).

CONCLUSION

Findings indicated that there was a significant association between the amounts of IgA and anti-CCP with severity of disease in RF negative RA patients while there was no significant association between the amounts of IgG and severity of RA disease.

Serum adenosine deaminase in patients with rheumatoid arthritis treated with methotrexate

Objective:

Recently, adenosine deaminase (ADA) is introduced as helpful marker in diagnosis, prognosis, and monitoring of treatment in rheumatoid arthritis (RA). The aim of this study was to determine the efficacy of the serum ADA in diagnosis, prognosis, and monitoring of treatment with methotrexate (MTX) in RA.

Methods:

This was a self-controlled clinical trial conducted in university hospitals of Isfahan, Iran. The serum level of ADA, erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were measured for 70 patients with active RA (Disease Activity Score-28 [DAS28] > 3/2). After three months of MTX treatment and disease remission (DAS28 < 2.6) these markers were measured again. ANCOVA multiregression and paired t-test were used to compare and evaluate the mean level and correlation of ADA, ESR, IgM-RF, and DAS before and after RA remission.

Findings:

The mean value for ADA activity was significantly higher than the normal one compared with other studies. Significant decreases were seen in values of ADA, ESR, RF, visual analogue scale (VAS), and DAS after remission. Also, the correlation coefficient between the values of ADA with ESR and DAS were statistically significant in baseline. Moreover, the statistically significant correlation between ADA and ESR, VAS, and DAS were seen after remission. No correlation was found in the case of the dosage of MTX with the value of ADA.

Conclusion:

It was concluded that ADA may be considered useful as a marker in diagnosis, prognosis, and monitoring of treatment with Methotrexate in RA.

A case of sine scleroderma with parenchymal lung disease

Systemic sclerosis sine scleroderma is a subtype of scleroderma, which is characterized by involvement of visceral organs, but no characteristic skin alteration. The involved organs could be kidneys, heart, gastrointestinal system, and lungs. Interstitial lung disease (ILD) is one of the pulmonary manifestations of sine scleroderma. We report a 38-year-old woman presenting with chill, fever, generalized malaise, dyspnea on exertion, and dry cough with a history of Raynaud's phenomenon, who was evaluated by physical examination, spirometry, and computed tomography scan, that all lead to the diagnosis of ILD. Combination of high-titer positive anti-nuclear antibody, high erythrocyte sedimentation rate, positive C-reactive protein, and ILD could be explained by sine scleroderma.

Anti-ribosomal P antibodies related to depression in early clinical course of systemic lupus erythematosus

BACKGROUND

Diagnosis and treatment of neuropsychiatric lupus is still a major challenge in clinical practice. We investigated the association between depression and anti-ribosomal P (anti-P) antibodies in a sample of Iranian patients with systemic lupus erythematosus (SLE).

MATERIALS AND METHODS

This cross-sectional study was conducted on adult patients with SLE referring to a referral out-patient clinic of rheumatology. Demographic data and clinical data with regards to measuring disease activity with the systemic lupus erythematosus disease activity index were gathered. Anti-P antibodies were measured with the enzyme-linked immunosorbent assay method. Depression severity was measured by the Beck Depression Inventory-II.

RESULTS

One hundred patients (80% female and 20% male, age = 34.8 ± 10.9 years) were included. Anti-P antibodies were present more frequently in depressed than non-depressed patients (30% vs. 10%, P = 0.015). Depression severity was correlated with anti-P antibodies level only in patients with disease duration of less than 2 years (r = 0.517, P = 0.019). There was no association between the depression severity and disease activity. Binary logistic regression analysis showed age (B = 0.953, CI 95%: 0.914-0.993) and positive anti-P antibodies (B = 4.30, CI 95%: 1.18-15.59) as factors that independently associated with depression.

CONCLUSION

We found an association between depression and presence of anti-P antibodies, and also strong correlation between depression severity and anti-P antibodies level in newly diagnosed SLE patients. Depression severity in newly diagnosed SLE patients may reflect a neuropsychiatric involvement, and in later phases, it is more affected by the chronicity of the disease as well as other environmental factors.

Serum cryoglobulins and disease activity in systematic lupus erythematosus

BACKGROUND

To determine the prevalence of cryoglobulins in Iranian patients with systemic lupus erythematosus (SLE) and evaluate the correlation of cryoglobulins with disease activity in these patients.

MATERIALS AND METHODS

In a cross-sectional study, we investigated 80 consecutive women who fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. All the patients had undergone a medical interview and general physical examination by a rheumatologist for clinical and serologic characteristics of SLE. For the determination of cryoglobulins, sera were collected by a standard protocol at 37°C, and after incubation at 4°C for seven days, the level of cryoglobulins was estimated for each patient.

RESULTS

Cryoglobulins were detected in the sera of 39 (48.8%) patients. All of these patients had cryocrit over 5%. Disease was active in 30 patients [SLEDAI ≥6 (DAI: disease activity index)] and inactive in 50 (SLEDAI <6). There was no significant difference between active and inactive patients for the presence of serum cryoglobulins (r = 0.086, P = 0.56). A significant positive correlation was observed between antinuclear antibody (ANA), anti-dsDNA (dsDNA: Double-stranded deoxyribonucleic acid), CH50 (CH50: total hemolytic complement assay), and C-reactive protein (CRP) (r = 0.21, P = 0.004, r = 0.65, P = 0.001, r = 0.45, P = 0.023, r = 0.38, P = 0.036, respectively). Hepatitis C virus (HCV) infection was not detected in any of the SLE patients.

CONCLUSION

Although the presence of cryoglobulins in the SLE patients correlated with positive anti-ds DNA and low CH50, it could not be predict activity of the disease.

Evaluation of bone loss in diabetic postmenopausal women

BACKGROUND

Osteoporosis and diabetes mellitus are major and growing public health problems particularly among postmenopausal women. This study was conducted to evaluate the relationship between osteoporosis and osteopenia with type 2 diabetes mellitus (DM) in postmenopausal women.

MATERIALS AND METHODS

In a cross sectional study, we compared 200 diabetic postmenopausal women with 400 non-diabetic postmenopausal women over the age of 60 years. Age, Body Mass Index (BMI), T score of the lumbar vertebra (L2-L4) and femoral neck were measured with Dual Energy X-ray Absorptiometry (DXA) and were compared between the two groups. Hemoglobin A1C (HbA1C) was also measured in patients with type 2 DM and its relationship with osteoporosis was studied. Chi-square, Fisher's exact test and Independent T-test was used for analyzing the data. The statistical significance was set at a P value of 0.05 or lower.

RESULTS

Mean, SD ages were 65.23 ± 4.80 vs. 66.91 ± 5.78 years and BMI were 28.94 ± 4.06 vs. 31.65 ± 4.42 kg/m(2) in non-diabetic and diabetic groups, respectively. Lumber T scores was -2.10 ± 1.08 vs.-2.16 ± 1.27 (P = 0.60), femoral neck T-score was -0.72 ± 1.00 vs. -1.09 ± 0.96 (P = 0.00) in non-diabetic and diabetic groups, respectively. There was a significant difference in femoral neck T score between the diabetic and non-diabetic group (P = 0.00). In diabetic women, bone loss was more common in those with HbA1C ≥7 compare to those with HbA1C <7 (P = 0.006).

CONCLUSION

Osteopenia and osteoporosis is more common in diabetic postmenopausal women compare to the non-diabetic postmenopausal women.

Wegener's granulomatosis and mucoromycosis: A case study and review of literature

Mucormycosis is a fatal invasive infection which mostly involves diabetic or immunosuppressed patients. Early diagnosis, improving immunosuppression, systemic antifungal therapy, and surgical debridement are necessary for successful treatment. In this case study, we represent a known case of Wegener's granulomatosis (WG), with concomitant sinusal mucormycosis mimicking vasculitic disease relapse, which was successfully treated with surgical debridement, amphotericine, and intravenous immunoglobuline.

The association of anti-CCP1 antibodies with disease activity score 28 (DAS-28) in rheumatoid arthritis

Background:

Rheumatoid arthritis (RA) is one of the most frequent autoimmune diseases in the world which affect about 1% of people. Measurement of the anti-CCP1 antibody titer in these patients is one of the new tests that is available in our country and in the multiple studies has been shown to be more specific than rheumatoid factor in the diagnosis of RA (97%). This test becomes positive in early stage of disease and it has a high predictive value. The aim of our study was to determine the relationship between anti-CCP1 antibody and disease activity score 28 (DAS-28) in patients with rheumatoid arthritis.

Materials and Methods:

A cross-sectional study was performed in 90 patients with RA for evaluating the relation between anti-CCP1 antibody titer and DAS-28, patients were selected by consecutive method; serum samples were collected from patients. Anti-CCP1 antibody was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rates (ESR), rheumatoid factor (RF), DAS-28, visual analog scale (VAS) were determined in patients with RA. Statistical analysis performed with t-test and Pearson's correlations coefficient.

Results:

Anti-CCP1 level was associated with DAS-28 (P<0.001, r=0.35). The largest linear correlation was between anti-CCP1 antibody levels and VAS; it means that higher titers of anti-CCP1 antibody are associated with more painful joints in our patients. The average of DAS-28 in our positive and negative anti-CCP1 antibody patients was 5.07±1.1 and 3.5±1.5, respectively (P<0.05).

Conclusion:

There was moderate correlation between anti-CCP1 titer and DAS-28.

A case of Takayasu's arteritis with pulsatile neck mass

Takayasu's arteritis (TA), also known as pulseless disease or occlusive thromboaortopathy, is a form of vasculitis of unknown cause that chiefly affects the aorta and its major branches, most frequently in young women. We describe an 18-year-old female with a soft and pulsatile mass in the left side of her neck.

Evaluation of damage index and its association with risk factors in patients with systemic lupus erythematosus

BACKGROUND

This study aimed to determine the value of damage index in patients with systemic lupus erythematosus (SLE) and the association between damage index and disease severity, flare up numbers, disease duration, and antiphospholipid antibodies.

METHODS

Eighty patients with systemic lupus erythematosus were included. The damage was measured using the SLICC (Systemic Lupus International Collaborating Clinics)/ACR damage index (SDI). The disease flare was defined by the increase in the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). The disease severity surrogates were the presence of class III/IV glomerulonephritis, the presence of severe central nervous system (CNS) involvement, and cyclophosphamide administration. Analysis was performed by independent Student-t and chi-square tests via SPSS(16) software.

RESULTS

There were significant association between the damage accrual and the disease severity, flare-up, and antiphospholipid antibodies (p = 0.001, p = 0.004, and p = 0.05, respectively).

CONCLUSIONS

The disease severity, frequency of flares, and positive antiphospholipid antibodies are associated with damage accrual in patients with systemic lupus erythematosus.

Rapidly evolving purpuric lesions to massive hemorrhagic bullae, with rapid improvement by Prednisolone: as a coetaneous manifestation of Systemic Lupus Erythematosus: a case report

Background

Systemic lupus Erythematosus is a chronic autodestructive disease, with loss of immune tolerance to nucleic acid and other cross reactive antigens. Despite of the numerous studies, the presence of some new manifestations indicates the greater proportion of unknown data.

Case presentation

Our case, is a 26-year-old female, by the chief complaint of headache, vomiting, fever and arthralgia. Some hemorrhagic ulcers in her mouth with fulminant pethechia/purpura on her limbs and buttocks were prominent. On admission, she was in hypotensive state. By the clinical suspicion to meningococcal septicemia, lumbar puncture was performed, and antibiotic therapy was started. Cerebrospinal fluid was normal. Suddenly, on the 3^rd day of admission, hemorrhagic bullae were evolved from those purpuric lesions. Leukocytosis, immune hemolytic anemia, thrombocytopenia and high antinuclear antibody/double stranded DNA level and hypocomplemania were present simultaneously. In skin biopsy, immune complex deposition in dermoepidermal junction was seen. The diagnosis of Systemic lupus Erythematosus was made. The patient responded well to corticosteroid therapy.

Conclusion

Coetaneous manifestations are very common in Systemic lupus Erythematosus, and help the physician making differential diagnoses and proper diagnosis. The rapidly evolving hemorrhagic bulla from primary purpuric lesions, with rapid response to Prednisolone, is a rare manifestation of Systemic lupus Erythematosus, which should be considered in such a disease setting.

The prevalence of oral aphthosis in a normal population in Iran: a WHO-ILAR COPCORD study

This study was conducted to determine the prevalence of oral aphthosis in a normal population in Iran, using the data of the WHO-ILAR COPCORD study in Iran. We conducted this study in Tehran, the capital of Iran which was selected as the COPCORD study field. In 22 districts of Tehran, 50 clusters were randomly selected. Of the selected houses, 4,096 households were visited and 10,291 persons were interviewed (response rate of 75%). Out of the 10291 subjects interviewed, 2592 had aphthous ulcers which translated to a prevalence of 25.2% (95% confidence interval: 24.4% to 26.0%). The prevalence of oral aphthosis was rather high in this normal population.

WHO-ILAR COPCORD Study (Stage 1, Urban Study) in Iran

OBJECTIVE

To find the prevalence of musculoskeletal complaints and rheumatic disorders in Iran.

METHODS

Tehran, with one-ninth of the population of Iran and of mixed ethnic origins, was selected as the field. Subjects were randomly selected from the 22 districts. Interviews were conducted once a week, on the weekend. The 3 phases of stage 1 were done on the same day, in parallel, like the fast-track Community Oriented Program for Control of Rheumatic Diseases (COPCORD).

RESULTS

Four thousand ninety-six houses were visited and 10,291 persons were interviewed. Musculoskeletal complaints during the past 7 days were detected in 41.9% of the interviewed subjects. The distribution was: shoulder 14.5%, wrist 10%, hands and fingers 9.4%, hip 7.1%, knee 25.5%, ankle 9.8%, toes 6.1%, cervical spine 13.4%, and dorsal and lumbar spine 21.7%. Degenerative joint diseases were detected in 16.6% of subjects: cervical spondylosis 1.8%, knee osteoarthritis (OA) 15.3%, hand OA 2.9%, and hip OA 0.32%. Low back pain was detected in 15.4% and soft tissue rheumatism in 4.6%. Inflammatory disorders were rheumatoid arthritis 0.33%, seronegative spondyloarthropathies 0.23%, ankylosing spondylitis 0.12%, systemic lupus erythematosus 0.04%, and Behçet's disease 0.08%. Fibromyalgia was detected in 0.69% and gout in 0.13% of the studied population.

CONCLUSION

The large urban COPCORD study in Iran showed a high prevalence of rheumatic complaints in the population over the age of 15 years, 41.9%. Knee OA and low back pain were the most frequent complaints.