Rheumatology Research Journal
Volume:1 Issue: 1, Winter 2016

We aimed to evaluate the safety and efficacy of ANGIPARS™ in a phase 2 clinical trial.
This study was performed as a phase 2 clinical trial without a control group between May 2007 and September 2008 in the Iranian Rheumatology Research Center on a group of volunteer patients that were diagnosed with scleroderma. Patients with the diagnosis of diffuse or limited scleroderma without the involvement ofinternal organs were given 100 mg ANGIPARSTM capsules three times a day for 6 months, followed by 2 capsules a day for a further 3 months. Follow-up continued for a year. At the baseline, modified Rodnan score, pain severity and number of pitting ulcers, number of perioral folds, finger to palm distance, and open- mouth area were assessed in each patient. The measurements were repeated on a monthly basis and their change from the baseline was calculated. Possible adverse effects were monitored at regular monthly intervals through a complete set of laboratory tests and clinical examination.
Eleven patients including 10 females were recruited. The mean age was 39 years (SD = 10.2). No significant changes and no abnormality in laboratory measures were found during the study. Repeated measure analysis revealed a significant reduction in the modified Rodnan score (Mean reduction= 38%, P value ANGIPARSTM is efficient and safe for the treatment of the skin manifestations of scleroderma. Conducting a phase III placebo controlled randomized trial is recommended.

Systemic Lupus Erythematosus (SLE) is a heterogeneous complex relapsing-remitting autoimmune disease. The role of genetics is obvious in predisposition of the disease. Several Single Nucleotide Polymorphisms (SNPs) in ETS1 and WDFY4 showed association with SLE in genome-wide association studies. The aim of this study was to examine the association of the SNPs in ETS1 and WDFY4 genes with SLE in an Iranian population.
This study was performed on 280 patients that were not related to one another, and 281 healthy control subjects matched based on age, sex, and ethnicity, all of which were of Iranian origin. Rs10893872 and rs1128334 in the ETS1 gene, and rs877819 and rs707397 in the WDFY4 gene were genotyped using MGB TaqMan Allelic Discrimination Real-Time PCR.
Our results showed no association in all mentioned SNPs with the susceptibility and clinical features of SLE in the Iranian population.
The results were not consistent with genome-wide association studies performed on Asian and Caucasian populations.

Bone mineral densitometry (BMD) has been well known as a practical method in the detection of osteoporosis. However, it is not accurate in the identification of fracture risk in non- osteoporotic patients because of its low sensitivity. Fracture Risk Assessment Tool (FRAX) is a sensitive WHO recommended risk assessment tool for the prediction of the risk of fracture in order to diagnose patients who would benefit the most from pharmacological treatment.
This cross-sectional study included a sample of 361 Iranian women aged 40 to 80 years- old who, for any reason, were referred for humeral BMD. Femoral BMD and FRAX were performed on all of the subjects and the results were compared to one another to figure out the accuracy of FRAX to detect the patients at high risk of fracture.
There were 361 participants in the study with a mean age of 56.4 ± 5.5 years, and comprised of 89 (24.7%) osteoporotic (T-score -2.5), 125 (34.7%) osteopenic (T-Score between -1 and -2.5) and 147 (40.7%) subjects with T-score > -1. A 10-year probability of hip fracture of more than 3% was detected in only in six women (1.6%) and a major osteoporotic fracture risk (of higher than 20%) was not detected in any subject.
Applying FRAX in osteopenic and osteoporotic Iranian women showed no extra benefit in comparison to using BMD alone. It seems that FRAX is not accurate in our population as it underestimates the number of patients that could benefit from osteoporosis treatment.

Musculoskeletal problems remain among the main limitations of the quality of life of patients undergoing hemodialysis. This study was designed to evaluate the musculoskeletal system involvement in hemodialysis patients.
This study was carried out on the all of the hemodialysis patients of Khatam-al Anbia Hospital, Zahedan, Iran. All patients underwent a precide physical examination. Venous blood samples were obtained for the measurement of calcium, phosphorous, alkaline phosphatase, and parathyroid hormone. An x-ray of the hand was taken from each patient.
Thirty seven (37) patients completed the study. The most common symptoms were: carpopedal spasm 54.0%, symptoms of carpal tunnel syndrome 24.2%, arthralgia 21.6%, and bone pain 13.5%. The most common clinical findings were: a positive Phalen test 32.4%, muscle weakness 40.5%, bone deformity 21.6%, and bone tenderness 18.9%. The most common abnormal laboratory tests were: hypocalcemia 51.4%, hyperphosphatemia 43.2%, increased alkaline phosphatase 75.6%, and raised Parathyroid hormone 81.0%.
Musculoskeletal involvement is common in our hemodialysis patients.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which mostly affects women of reproductive age. We evaluated the impact of pregnancy on maternal/fetal health, the pattern of organ involvements and the fare-up risk.
In a retrospective study we studied the thirty-year medical records of patients between 1976-2005. Maternal, neonatal and infantile health data was retrieved. Incidence of flare-ups, pattern of organ involvements and the outcome of pregnancy was analyzed.
We studied 155 pregnancies in 129 SLE patients. Mean age of patients was 27.0 ± 5.5 years (range, 16-44). Thirty one cases (20.2%) experienced flares in the course of pregnancy. During pregnancy, SLE disease activity index (SLEDAI) score increased in 92 (59.3%) patients (median increase = 6 scores). On the other hand, 38 cases (24.5%) SLEDAI score remained unaltered and in 25 cases (16.1%) SLEDAI score decreased (median decrease = 1). Mean SLEDAI during pregnancy were significantly higher than preconceptional scores (P-value = 0.002).Term delivery was more common in quiescent SLE (54.2% vs. 34.6%, P-value = 0.04). Number of therapeutic abortions was higher in active SLE (38.5% vs. 10.2% P-value = 0.003).
In this study increased SLEDAI and flare-up episodes were observed during pregnancy. However the majority of cases did not face major fetal or maternal complications.

Total knee arthroplasty (TKA) is an effective and commonly performed procedure in knee arthritis. The most common wound complications in TKA are erythema, infection, prolonged drainage, and skin necrosis. Disruption of the operative wound is a rare complication. This paper presents a case where knee prostheses were exposed 17 days after the knee replacement operation.
Case Report: A 67-year-old male patient was admitted to our hospital for bilateral osteoarthritis of the knee. Simultaneous bilateral total knee arthroplasty was applied. The postoperative hospital stay reached ten days, and with 90º of flexion and mobilization, the patient was discharged. 17 days after the operation the patient was re-admitted to hospital after having a fall. A physical examination revealed dehiscence of the wound and median parapatellar arthrotomy sutures. Both prostheses were exposed and visible. Under general anesthesia P/E was repeated and stress tests revealed medial collateral ligament injury on the right knee and a lateral collateral ligament injury on the left knee.
The role of the extensor mechanism is important in knee prosthesis. Any weakness in the extensor mechanism may lead to prosthetic instability and concurrent complications. If the strength of the quadriceps mechanism is not sufficient, it must be strengthened postoperatively, and rehabilitation and mobilization should be applied carefully until collagen maturation is complete.

IgG4-positive plasma cell infiltration has been observed in patients with other conditions, including retroperitoneal and mediastinal fibrosis, inflammatory pseudotumor of the lungs and liver, Küttner tumors, and interstitial nephritis, indicating that these diseases and conditions collectively constitute a new disease concept known as "IgG4-related disease". The aim of this study was to present a case of a typical IgG4 syndrome.
Case Report: The case presentation involves a 33-year-old man with a soft tissue mass (3 × 4 cm) on the right side of his frontal area which had enlarged over the space of a year. He had not experienced any allergic disorder, weight loss, night sweating, or anorexia, and did not smoke or use illicit drugs. On examination his vital signs were normal. He had no complains of fever, rash or urticaria. The soft, round mass in the right side of the frontal area had no pain and tenderness, redness, or discharge for the year. Other examinations gave normal results. He was then referred to a rheumatologist.
In further laboratory work, high IgG4 level (119.6; normal range: 5.9-86) was detected and in histopathological studies, chronic inflammation, fibrosis, lymphomononuclear and eosinophilic infiltration with a dilated vascular network were reported.