Rheumatology Research Journal
Volume:4 Issue: 1, Spring 2019

The physiological changes associated with aging and the presence of comorbid diseases may complicate the treatment of elderly patients with rheumatic diseases. This study aimed to determine the prevalence and main causes of admissions of elderly patients to rheumatology wards and the number and duration of their hospitalizations.Data was collected on patients aged ≥ 60 who were admitted to rheumatology wards from 2008 to 2013. To make a good compar-ison, the last diagnoses of younger patients admitted to these wards were also recorded. In the elderly group, the records of 399 patients admitted to hospitals with a flare-up of a new or known case of rheumatoid ar-thritis (RA) were compared with those of 480 young patients. No significant difference was seen between these two groups in the duration of hospital stay.In the elderly group, hypertension (62.4%) was the most common comorbidity. The presence of psychiatric problems showed a significant association with the number of admissions (P value=0.037) as well as patients receiving infliximab, rituximab, and IV IG (P value=<0.001). Recurrent admissions were seen mostly in patients with psoriatic arthritis (PsA), polymyositis, and Behçet’s disease. Flare-ups or new diagnoses of RA were the most prevalent causes for the admission of elderly patients to rheumatology wards. Recurrent admissions were seen mostly in patients with PsA and were associated with the presence of psychiatric problems and a need for IV medications. The results highlight the need for healthcare centers to support outpatient clinics for elderly patients.

Most patients with rheumatoid arthritis (RA), one of the most common inflammatory diseases, also suffer from periodontitis. This study investigated the effects of periodontal therapy on disease activity in RA patients. In this before-and-after clinical trial study, 30 patients with simultaneous RA and periodontitis were studied from March 2014 to February 2016. The Disease Activity Score with 28-joint Counts (DAS28) questionnaire was completed for all participants. Patients with confirmed periodontitis received non-surgical scaling, root planning, systemic antibiotics, and chlorhexidine. At days 45 and 90 after treatment, the DAS28, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured again. The results of the evaluation of 30 patients with a mean age of 50.2±10.62 years (80% female) showed that the difference in the level of disease activity between baseline versus 45 (5.18±0.092 vs. 4.02±1.22, P value<0.001) and 90 days later (5.18±0.092 vs. 3.84±0.92, P value<0.001), was statistically significant. Serum CRP levels (mg/dl) were lower at 90 days after treatment (5.17±2.96) than at 40 days post-treatment (5.30±3.59). The ESR values (mm/hour) at 45 (20.57±11.01) and 90 (18.23±8.99) days after periodontal therapy were lower in comparison with the baseline (21.67±11.65), but there were no significant differences between the different time points (P value˃0.05). Treating periodontitis resulted in reduced RA disease activity. Hence, routine dental examinations for faster diagnosis and treatment of periodontitis in order to relieve RA symptoms as well as further studies including a control group are recommended.

Microchimerism is defined as the presence of non-self and circulating cells in a host. The current study aimed to assess the effect of microchimerism on scleroderma major organ involvements. This cross-sectional study was conducted on 56 scleroderma patients registered in a tertiary rheumatology center of Shiraz University of Medical Sciences. Information on the patients’ demographics and disease complications was gathered through a review of medical records. Skin score was applied to better assess skin thickening. High Resolution CT-scan as well as pulmonary function test (PFT) results were also used to investigate pulmonary involvement in patients. Y chromosome serum levels were measured using Phenol Chloroform Extraction protocol and following real-time PCR. Fifty-six scleroderma patients with a mean age of 46±10 years were recruited in this study (58.9% with diffuse scleroderma and 41.07% with limited scleroderma). Other than skin thickening, the most common clinical presentation among the patients was interestitial lung disease (67.8%). No significant difference was found between Y chromosome levels of patients with either lung, cardiac, renal, or gastrointestinal involvement and those who did not have these complications. Y chromosome serum levels based on the results of PFT were also shown to have no significant difference. Moreover, no association was demonstrated between serum Y chromosome and skin score. The serum level of chromosome Y has no impact on the severity and frequency of major organ involvement in Iranian scleroderma patients.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disorder with variable clinical manifestations. Acute anterior uveitis is the most common extra-articular manifestation of ankylosing spondylitis. This study assessed the prevalence of uveitis in patients with ankylosing spondylitis in Mashhad, Iran. In this retrospective study, the medical records of patients diagnosed with AS between January 1st, 2007 and December 31st, 2017 in a rheumatology clinic in Mashhad, Iran were reviewed. Diagnoses of ankylosing spondylitis were made based on the modified New York criteria. The records of 317 patients were reviewed (81.4% male, 18.6% female, with a male to female ratio of 4.3:1). The mean age at onset of AS was 27.01±8.63 years (minimum 12 years, maximum 55 years). The mean age at diagnosis of AS was 30.72±9.44 years. The mean age at diagnosis of uveitis was 32.40±10.49 years. The mean follow-up period of patients was 6.19±5.51 years. HLA-B27 was positive in 77% of patients. About 14% of patients had uveitis in the mean follow-up period of 6.19±5.51 years. The frequency of uveitis in patients with AS is lower in the study region than in most other regions. Future studies with a prospetive design, randomized patient selection, and lifelong follow up can provide a more accurate description of acute anterior uveitis in patients with AS.

Musculoskeletal disorders are among the most important health risks in various organizations, especially heavy industry. The current study purposed to determine the effects of personal and occupational position risks on musculoskeletal disorders. This cross-sectional study was carried out from April 2015 to May 2016 in Esfahan’s Mobarakeh Steel Company using a stratified random sampling method. In this study, the risk of occupational duties such as heavy lifting, load carrying, long sitting, standing, and moving as well as unsafe personal behaviors or risky actions involving the waist, shoulder/arm, wrist, neck, knee, elbow, ankle, and chamber were considered as independent variables, while musculoskeletal disorders (evaluated by NMQ) were considered as dependent variables. The study sample included 300 male workers (with the mean age of 41.01±8.17 years and mean work experience of 16.00±7.66 years). The results showed a positive relationship between shoulder injury risk scores and shoulder/arm (OR=2.42, CI=(1.25- 4.71)) and knee (OR=2.39, CI=(1.08-5.28)) disorders. The findings also showed such positive relationship between upper back risk scores and wrist/hand disorders (OR=2.41, CI=(1.01-5.76)), lower back risk scores and waist (OR=2.49, CI=(1.39-4.45)), shoulder/arm (OR=1.63, CI=(1.04-2.57)), and neck (OR=1.85, CI=(0.98-3.49)) disorders. Based on the results, more consideration must be paid to personal and occupational risks, and it is highly recommended that convenient modifications be made in work environments in order to decrease musculoskeletal disorders in workers of the steel company.

Metastatic calcification is the deposition of calcium salts in otherwise normal tissue as a severe complication of hemodialysis. It is associated with high levels of serum calcium and phosphorus product. We report a patient on hemodialysis who presented with progressively increasing, tumor-like calcinosis associated with muscle weakness. A 36-year-old male presented with multiple painful masses in different parts of his body that had been progressively increasing for ten months. We investigated and diagnosed him as secondary hyperparathyroidism and metastatic calcification; he was treated with cinacalcet. Given that the increase in parathormone and the onset of bone symptoms in the patient were not synchronous, the need for other markers to be reviewed for bone problems in this hemodialysis patient was confirmed.