Rheumatology Research Journal
Volume:6 Issue: 1, Winter 2021

Interferon regulatory factor 5 (IRF5) has been described as an important factor in regulating inflammatory response and a key transcription factor in the immune system. In antiviral response, IRF5 promotes the expression of type 1 interferon (IFN) and is also important in the differentiation of macrophages towards pro-inflammatory phenotypes, regulating B-cell maturity and antibody production. Some cancer patients treated with IFNα manifest symptoms resembling systemic lupus erythematosus (SLE). An important mechanism in this response is IRF5 that triggers apoptosis. Herein, we discuss the functional importance of IRF5 in rheumatoid arthritis (RA) and SLE in a setting of polymorphic mutations at the human Irf5 locus. This paper describes murine models, the lessons of IRF functionality learned from these models and the consequences of autoimmune diseases. It is hypothesized that modulation of IRF5 activity may be beneficial in autoimmune diseases therapies.

This study was designed to reveal the variety and contribution of different rheumatic diseases in a non-referral rheumatology outpatient clinic. In this retrospective cross-sectional study, the data in medical records of all patients visited for the first time in the rheumatology clinic of a general hospital from the beginning of April 2016 to the end of March 2017 was gathered and evaluated for demographic characteristics, complaints, and diagnoses. A total of 2063 medical records were assessed. Among them, 2006 individuals were diagnosed with a rheumatologic disease. The mean age of patients was 48.72 ± 15.51, and females constituted 74.88% of patients. The distribution of diseases was as follows: 345 (17.20%) inflammatory, 1594 (79.46%) noninflammatory, and 67 (3.34%) both groups. The most common diagnosis was knee osteoarthritis (29.42%). Frequency distribution of other common diagnoses was in the following order: periarticular disease (15.53%), nonspecific generalized pain (8.75%), lumbar discopathy (6.24%), and rheumatoid arthritis (6.20%). The most frequent complaints were knee pain (30.96%), back pain (10.18%), and hand pain (9.35%). Among periarticular diseases, plantar fasciitis (17.27%), carpal tunnel syndrome (16.36%), and rotator cuff tendinitis (12.05%) were the most frequent disorders. More than half of the diseases included degenerative joint diseases, periarticular diseases, nonspecific musculoskeletal pain, and low back pain. The most prevalent diseases should be prioritized in the curriculum of medical education for undergraduate students. Proper policies for patient education, public health programs, and modified lifestyle may reduce morbidity among patients and costs forced upon healthcare providers and governments.

Rheumatoid arthritis (RA) and osteoarthritis (OA) are two of the most prevalent forms of arthritis and may exhibit common etiology and clinical manifestations. Distinguishing between them is very important in determining effective treatment and management strategies.In the present study, the Affymetrix microarray gene expression dataset (GSE55457) was retrieved from 10 healthy controls, 13 patients with RA, and 10 OA patients and analyzed to identify hub genes so as to distinguish between RA and OA by weighted gene co-expression network (WGCNA) analysis and functional enrichment analysis. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database was used to construct a protein-protein interaction (PPI) network.The most significant immune pathways associated with RA disease obtained from functional enrichment analysis were Th17, Th1, and Th2 cell differentiation and cytokine-cytokine receptor interaction pathways. The results of the present study demonstrated that two hub genes, IL2RB and HLA-DOB, may help differentiate patients with RA from those with OA at the time of diagnosis. This study introduces potential pathways and candidate biomarker genes to discriminate between RA and OA.

This study aimed to compare the efficacy of infliximab and etanercept in rheumatoid arthritis (RA) patients to help clinicians select the most effective treatment options. This was a cross sectional study conducted in Urmia, Iran, from March 21, 2017, to February 20, 2018. Data was collected by checklists from RA patients referred to the Rheumatology Clinic of Urmia Imam Khomeini Hospital who were receiving either infliximab or etanercept. Inclusion criteria were a diagnosis of RA according to the revised 2016 criteria of the American College of Rheumatology (ACR)/European League Against Rheumatism, aged over 18, consent to participate in the study, and poor response to other drugs. Both genders were included. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender joint count (TJC), swollen joint count (SJC), and disease activity score (DAS) (28 scores) were analyzed before and after treatment. In a total of 44 eligible patients, 13 patients received infliximab and 31 received etanercept. The mean age was 53.92 ± 10.94 and 52.8 ± 64.13 years in the infliximab and etanercept groups, respectively. No significant differences were reported concerning ESR (p value = 0.97) or CRP (p value = 0.96), while a significant decrease in the infliximab group compared to the etanercept group was demonstrated in terms of DAS28 scores (p value = 0.028), global health (GH)1 (p value = 0.005), SJC (p value = 0.008), and TJC (p value = 0.01). This study demonstrated a significant difference between the two groups in the DAS scores 28, SJC, TJC, and GH.

Recently, several infectious agents including Epstein-Barr virus and Escherichia coli have been suggested as possible contributing factors to the pathogenesis of rheumatoid arthritis (RA). This study was designed to compare serum and synovial fluid markers of herpes simplex virus (HSV) and Helicobacter pylori of RA and osteoarthritis (OA) patients.This comparative study was conducted on two hundred OA and RA patients who referred to the Rheumatic Diseases Research Center (RDRC) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2015 to 2016. Synovial fluid was obtained from all individuals. Two years later, participants attended a follow-up session to collect blood samples for serum markers of these two infectious agents.Twenty-five patients (96.15%) in the RA group and 23 individuals (92%) in the OA group had positive serum IgG antibodies for HSV. As for Helicobacter pylori, 13 individuals (50%) in RA and 12 individuals (48%) had positive serum IgG antibodies (p value = 0.66). In addition, 9 (34.6%) and 8 (30.8%) in the RA group and 10 (40%) and 3 (12%) in the OA group had positive serum IgA and IgM antibodies for Helicobacter pylori, respectively (p value = 0.89 and p value = 0.13, respectively). Collected fluid samples were negative for both Helicobacter pylori and HSV1 and 2 DNA particles in all individuals.Based on the results of the current study, there is no difference between RA and OA patients in terms of Herpes simplex virus and Helicobacter pylori infection.

GCA (Giant cell arteritis) is a granulomatous vasculitis of large arteries. Frequently typical cranial symptoms are observed, but sometimes nonspecific extracranial involvements are dominant. Diagnosis of this “occult” or “extracranial” GCA as a medical emergency is crucial to preventing irreversible complications. The current article presents the case of a 52-year-old man with no cranial manifestations who developed acute peritonitis and died. Elevated inflammatory markers without cranial manifestations should cause extracranial GCA to be considered. Delayed diagnosis in GCA, especially the extracranial type, could lead to severe, irreversible complications.

Paget’s disease (osteitis deformans) of bone is a focal skeletal disorder that can be mono- or polyostotic. Paget's disease might be asymptomatic as with normal biomarkers, or it can be symptomatic such as bony enlargement or deformity. The diagnosis can be made by laboratory findings and specific findings in radiology or radionuclide scan, and it is sometimes confirmed by bone biopsy.In this report, we present the case of a 37-year-old man whose initial symptoms indicated sacroiliitis, which led to the suspicion of ankylosing spondylitis. Following other diagnostic evaluations and based on imaging features and bone biopsy, active Paget’s bone disease without abnormal biochemical markers was diagnosed. The laboratory diagnosis tests were normal. Other biomarkers including procollagen type I N-terminal propeptide (PINP), serum C-telopeptide (CTx), urinary N-telopeptide (NTx), and urinary hydroxyproline, are not routinely checked.The patient also showed a coincidence of unilateral idiopathic gynecomastia. A single dose of 5 mg of zoledronic acid intravenously was prescribed, and the patient was followed for six months. Paget's bone disease can occur without any change in biochemical markers. In such cases, the response to treatment can becontrolled by improving the clinical picture or evaluating the correct imaging findings.