Rheumatology Research Journal
Volume:8 Issue: 3, Summer 2023

Rowell syndrome (RS) is a disorder characterized by the occurrence of erythema multiforme-like lesions (EM) coexisting with lupus erythematosus. It may be considered a rare subtype of lupus-specific skin lesions. Here we report a clinical presentation of RS in a 34-year-old woman with diagnosed systemic lupus erythematosus (SLE), and without any cutaneous lesion previously that presented with skin lesions and fever. Clinical, laboratory, and histopathology assessments confirmed the diagnosis of RS in the context of SLE flare-up. She was treated with methylprednisolone 1g IV daily for 3 days, then continued with oral Prednisolone, Hydroxychloroquine, and Mycophenolate mofetil. Over treatment Skin’s lesions and oral ulcers subsided gradually and disappear all skin lesions after a month, without a scar.

Tumor necrosis factor-alpha-blockers in rheumatology have revolutionized the treatment of rheumatoid arthritis. However, they can increase the risk of latent tuberculosis reactivation. This risk is evaluated by tuberculosis skin tests and chest radiography in many nations such as Iran. The interferon-gamma release assay test is a secondary test that is used to rule out the potential risk of latent tuberculosis reactivation but is not mandatory. In this report, we aim to present a 67-year-old rheumatoid arthritis female patient who was on Tumor necrosis factor-alpha-blockers (Adalimumab) and manifested severe symptoms of tuberculosis infection in our service 8 months after taking the initial treatment. The tuberculosis skin test and chest radiography were negative at the initiation of remedy in this case. The patient was cured after a timely diagnosis and receiving treatment for tuberculosis. Mandatory double-checking with tuberculosis skin test and interferon-gamma release assays test is recommended before tumor necrosis factor-alpha-blocker prescription in rheumatoid arthritis patients to prevent the risk of fatal tuberculosis reactivation.

Renal involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA). The current study aims to investigate renal function and its associated factors in RA patients. This cross-sectional study included 443 RA patients who were referred to Rafsanjan's only rheumatology clinic in 2021. Disease Activity Score 28 (DAS28) index was used to determine disease activity. Blood levels of creatinine, C-Reactive Protein test (CRP), Erythrocyte Sedimentation Rate (ESR), and urine analysis were also determined. Renal failure was classified based on Estimated Glomerular Filtration Rate (eGFR). SPSS.20 one-way ANOVA, Kruskal-Wallis test, the Mann-Whitney U test, and Chi-square were used to analyze the data. Patiens' mean age was 53.99 ± 12.34, and 85.8% (380 people) of the participants were female. Ther were 147 (33.2%) patients without renal failure, 260 (58.7%) with mild renal failure, and 36 (8.1%) with moderate/severe failure. Men had a 3.059 higher risk of renal failure than women (P = 0.001). The probability of developing renal failure in patients increased by 1.047 times with each year of age (P < 0.001). As a chronic disease, RA can directly or through the use of disease medications and other risk factors, adversely affect other organs of the body, including the kidney. The current study's findings revealed a high prevalence of mild renal failure in these patients.

The severe acute respiratory syndrome coronavirus 2 (SARS CoV2), also known as coronavirus disease 2019 (COVID-19), originated in Wuhan, China, and has since become an ongoing pandemic. COVID-19 vaccination has been underway since December 2020. The most common vaccination side effects are pain at the injection site, fever, myalgia, and malaise. The study aimed to investigate any potential complications of COVID-19 vaccination in rheumatic patients. This cross-sectional study was conducted in KUMSassociated rheumatology clinics to identify patients with rheumatic diseases who have received COVID-19 vaccines. The following data were obtained from participants: age, sex, type of vaccine, type of rheumatic disease, medications, side effects, and complications after vaccine injection. Participants were divided into two groups: patients who developed complications and those who did not after vaccine injection. The variables mentioned above were compared between our groups. We identified 297 patients with rheumatic diseases (mean age = 49.17 ± 13.79, 81.5% female) who received at least one dose of the COVID-19 vaccine. Among these, 131 (44.66%) reported at least one type of complication following a vaccine injection. The most common side effects were myalgia, fever and chills, headache, injection site pain, and malaise, which were self-limited. Younger patients developed more complications. In contrast, patients taking more than 5mg of prednisolone on a daily basis had fewer complications. Most vaccine complications in rheumatic patients are self-limiting and similar to healthy individuals. More complications are associated with being younger. Using more than 5mg of prednisolone daily could be a preventive measure.