فهرست مطالب

Rheumatology Research - Volume:2 Issue: 3, 2017
  • Volume:2 Issue: 3, 2017
  • تاریخ انتشار: 1396/02/10
  • تعداد عناوین: 6
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  • Bruce Rothschild Page 79
    Back pain is one of the more challenging aspects of medical care, for which many physicians feel unprepared. The dichotomy between mechanical and inflammatory derivation is blurred and the possibility of referred pain is always present. Solutions are facilitated with careful localization and identification of exacerbating and ameliorating factors. Fibromyalgia, pain reproducible by pressure on specific points, must be distinguished from general body pain. It is the clinical evaluation that allows distinguishing among the most common causes of back pain and assures minimal chance of overlooking non-musculoskeletal explanations. Removal of narcotics from the therapeutic armamentarium is a good start. Pain is often accompanied by depression, although common measures of depression are not specific, being a component of the pain itself. Mechanical solutions to back pain, whether perceived as mechanical or inflammatory in derivation, are reasonable initial approaches. Finally, the importance of sleep hygiene cannot be overemphasized, as disturbed sleep aggravates pain, even if it is not the initiating factor. This article addresses back pain amenability not only to clinical diagnosis but also to effective intervention.
    Keywords: back pain, clinical evaluation, fibromyalgia, MRI, sleep, spondyloarthropathy
  • Ali Javinani, Hoda Kavosi Page 85
    Systemic sclerosis (SSc) is an autoimmune disorder which can affect nearly every body organ. Muscle involvement is one of the most serious manifestations of SSc. It can present itself in a wide range of pathologies. It can be as indolent as a subclinical myopathy which manifests simply as a mild muscle enzyme level elevation, or it can present itself in a similar manner to other SSc organ involvements in the form of fibrosing myopathy without any existing evidence of inflammation. It can also present itself aggressively as an idiopathic inflammatory myopathy, the overlap syndrome of SSc-myositis. Due to the wide range of witnessed pathologies and the different diagnostic criteria that are used, opinions vary on the estimated prevalence of myopathy in SSc with estimates ranging from 3.3% to 14%. The severity and distribution of clinical manifestations differ among SSc-myopathy and SSc patients. These manifestations have different effects on the survival rates of patients, which will be discussed in this review. This paper will also focus on the existing treatment methods for SSc patients suffering from myopathy and their challenges.
    Keywords: fibrosing myopathy, idiopathic inflammatory myopathy, muscle histopathology, systemic sclerosis
  • Zahra Zakeri, Ali Davarian, Seyyed Amirhossein Fazeli, Mahnaz Sandoughi, Sogol Shahbakhsh, Yas Shahbakhsh, Farzaneh Barzkar Page 91
    Treatment with tumor necrosis factor alpha inhibitors has been increasingly implicated in the management of autoimmune diseases.In spite of their promising effects, they are commonly associated with side effects. This issue indicates the need for newer drugs with the same efficacy and fewer serious adverse effects. Pentoxifylline is aphosphodiesterase which inhibits TNF secretion and exerts to some degree an anti-inflammatory effect. The purpose of this randomized clinical trial was to evaluate the effect of pentoxifylline as an adjunctive therapy in the management of ankylosing spondylitis.Twenty-five patients suffering from ankylosing spondylitis were randomly assigned to treatment or placebo groups having been matched for age and gender.The treatment group received pentoxifylline (1200 mg daily), and the placebo group received a placebo in addition to the standard treatment of sulfasalazine 2-3 gram daily and indomethacin 50-75 mg per day that were given to all the patients in both groups.Serum levels of TNF-α were measured before and after the study intervention.Serum levels of TNF-α were reduced significantly in both groups with a p-value of
    Keywords: ankylosing spondylitis, NSAIDs, pentoxifylline, spondyloarthritis, TNF-α
  • Seyedeh Tahereh Faezi, Pedram Paragomi, Mahmood Akbarian, Seyed Arash Tehrani Banihashemi, Bahar Sadeghi, Farhad Shahram, Ahmad Reza Jamshidi, Farhad Gharibdoost, Abdolhadi Naji, Maasoumeh Akhlaghi, Fereydoun Davatchi Page 97
    Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement. Patients with SLE feature a lower tendency to develop erosive arthritis in comparison with rheumatoid arthritis (RA); however, in some arthritis cases it may be difficult to differentiate SLE from RA. Anti-cyclic citrullinated peptide (Anti-CCP) antibodies are highly-specific for RA. The current study evaluated the relationship between anti-CCP and arthritis in SLE patients. In this study, anti-CCP antibodies were tested in 300 patients with SLE. The INOVA Diagnostics QUANTA Lite™ CCP IgG ELISA and the Axis-Shield Diagnostics Diastat™ anti-CCP ELISA test were applied. Patients were divided into two groups: those with and those without arthritis. Patients with chronic arthritis (>6 weeks) had radiography done on the involved joints. Chi square and Fisher’s exact tests were applied to compare the two subsets. Anti-CCP antibodies were detected in 4.7% of all patients (CI: 2.6-7.8). Anti-CCP was positive in 6.4% of patients with arthritis and 2.3% of patients without arthritis (P=0.09). From seven patients with chronic arthritis, one had both positive anti-CCP and erosions. In the studied Iranian SLE patients, anti-CCP levels were higher in patients with arthritis than in those without arthritis. This study did not show any association of anti-CCP with erosion in SLE patients with arthritis. Ethnic and geographical variance may have influenced the results. More studies on chronic arthritis in SLE are needed to confirm this hypothesis.
    Keywords: anti-CCP, arthritis, arthropathy, systemic lupus erythematosus
  • Farin Vaez, Ali Farazmand, Sarvenaz Shaaheen, Shayan Mostafaei, Ahmadreza Jamshidi, Mahdi Vojdanian, Ashkan Asadollahbaik, Mahdi Mahmoudi Page 103
    Ankylosing spondylitis is a chronic inflammatory disorder of the axial skeleton. The transforming growth factor-beta (TGF-β) is a cytokine that has the dual action of suppressing inflammatory cytokines and augmenting inflammation. The role of this cytokine in ankylosing spondylitis is still unknown. The current study purposed to determine TGF-B1 gene expression in ankylosing spondylitis. A case-control study of 48 ankylosing spondylitis patients and 47 age- and gender-matched healthy controls was conducted. Quantitative polymerase chain reaction with specific primers was used to measure the expression of TGF-B1 gene in participants. Clinical indices of the disease, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Metrology Index (BASMI), Functional Index (BASFI), and AS quality of life (ASQoL) were determined. The expression of TGF-B1 was compared between cases and controls. Correlations between gene expression and clinical indices were assessed. The expression of TGF-B1 was significantly higher in AS patients than in the control group (P-value
    Keywords: ankylosing spondylitis, clinical manifestations, expression, transforming growth factor-beta
  • Nayereh Saadati, Mandana Khodashahi, Bahram Naghibzadeh, Elham Adibi Page 109
    Celiac disease is considered a malabsorption syndrome and is characterized by chronicsmall intestinal disease caused by hypersensitivity to the gliadin fraction of gluten. Celiac disease comes with diarrhea, occasional steatorrhea, weight loss, and other complications which might be caused by anemia. Reports of osteomalacia as the only symptom of celiac disease are very rare; however, osteomalacia can be a detected sign of celiac disease. Herein is described a case of osteomalaciawith a Looser zone in a 39-year-old woman who had low bone mineral density caused by severe osteomalacia associated with chronic celiac disease. In patients with pain in the spine and proximal muscle, the risk of osteomalacia should be considered in any kind of diagnosis.
    Keywords: bone loss, celiac disease, Looser zone, osteomalacia