Rheumatology Research Journal
Volume:7 Issue: 1, Winter 2022

Our understating of the mechanisms underlying the immunomodulatory properties of mesenchymal stem cells (MSCs) has greatly advanced during previous decades.Considering their unique regulatory effects, numerous applications have been establishedfor treating autoimmune diseases. However, cellular senescence and inefficient functions were found in MSCs isolated from autoimmune patients when they were particularly utilized in autologous settings. Several attempts have beenconducted to provide an in-depth understanding of mechanisms involved in MSC senescence andits negative impacts on autoimmune disease onset/ progression.Accordingly, indirect evidence of the role of immunosenescent MSCs hasbeen reported during the immunopathogenesis of systemic sclerosis, osteoarthritis, systemic lupus erythematosus, diabetes, psoriasis, and immune thrombocytopenia. This connection is mediated primarilythroughthe reduced self-renewability of MSCs and their abnormal immunoregulatory functions in the polarization of immune cells.Such knowledge is critical for developing therapeutic interventions to re-induce autoimmune patients' immune balance.To further explore the basic and clinical characteristics of MSC senescence in autoimmune disorders, this review comprehends the available information regarding molecular mechanisms and cellular interactions that finally perturb immuno-homeostasis of MSCs.

Thromboangiitis obliterans (TAO) is a non-atherosclerotic inflammatory arthritis mainly involving small arteries and veins. Although it is closely related to the tobacco exposure, the general pathophysiology of the disease remains unclear. TAO mainly affects young male patients with ischemic ulcer, pain during rest, limping, chills in limbs, and migratory thrombophlebitis. However, some patients present joints swelling and pain as the first manifestations before the clinical manifestations above. They are easy to be misdiagnosed as rheumatic diseases, which is a challenge to the diagnosis and treatment of rheumatologists. Here we report a case in which TAO was misdiagnosed as Seronegative Spondyloarthritis (SpA) and eventually amputated.

Tuberculosis remains a serious public health concern. Comorbidity in immunocompromised patients makes its diagnosis more difficult. The present study was conducted to assess the prevalence of positive tuberculin skin test and Chest X-ray changes in patients with rheumatologic diseases treated with immunosuppressive medications in the city of Birjand, Iran. The present prospective study was conducted in 2020 in the city of Birjand, Iran on 40 patients with rheumatologic diseases and 40 healthy people. Inclusion criteria were patients with the diagnosed rheumatic disease under treatment with immunosuppressive drugs. Exclusion criteria were active tuberculosis and changes in chest X-ray in favor of tuberculosis. Purified protein derivative solution was used to carry out a tuberculin skin test and screen both groups for latent tuberculosis and Chest X-ray to ascertain the presence or absence of the radiographic signs of old tuberculosis in the patients' group at the initiation of treatment and six months after. The collected data were recorded in a checklist and then analyzed in SPSS-22 using descriptive and statistical tests. Mean age was 47.32 ± 13.61 years in the case group and 46.40 ± 14.19 years in the control. Also, 7.5% of the case group patients taking immunosuppressive medications were tuberculin skin test positive, but no significant difference was observed between the case and control groups (P value = 0.24). In the positive tuberculin skin test group, 66.6% had spondyloarthritis of whom, 100% were taking Cinnora (Adalimumab). The emergence of latent tuberculosis in rheumatic patients after taking immunosuppressive medications is likely, and clinicians should be aware of its risk.

The COVID-19 disease has affected patients with rheumatoid arthritis (RA). Drug adherence is essential for RA control. This study investigated self-medication among RA patients in the COVID-19 pandemic. This cross-sectional study was performed on 288 patients with RA referred to the Rheumatology Clinic of Rafsanjan in 2021. Data were extracted by a checklist. Patients were examined and the type of used drugs, drug dose, and dose change were recorded. Inclusion criteria were diagnosis of rheumatoid arthritis, care during the last year and being over 16 years of age. Data were analyzed using SPSS/18 software. The mean ± SD of patients' age was 53.3 ± 12.6 years and 53.8% of patients were male. The mean ± SD duration of the disease was 7.04 ± 6.37 years. Self-medication was observed in all drugs, where Alendronate (100.0%, n = 13), Folic Acid (100.0%, n = 7), Methotrexate (94.1%, n=32), and Prednisolone (89.3%, n = 25) had the highest frequency of changes among other drugs (P value < 0.001). The mean ± SD dose of Hydroxychloroquine increased from 1358.5 ± 304.4 to 1368.0 ± 336.2 mg before and during the COVID-19 pandemic (P value = 0.319). The odd ratio of self[1]medication was higher in women (OR = 6.130, 95%CI: 2.915-12.993), RA patients with academic education (OR = 2.727, 95%CI: 1.037- 7.166), and lower in RA patients with a governmental occupation (OR = 0.277, 95%CI: 0.086-0.893). Self-medication of rheumatoid arthritis drugs may occur due to the positive effect of these drugs on COVID-19 disease and further reduced drug accessibility. It is necessary to plan to prevent self-medication in these patients by physicians.