فهرست مطالب

Rheumatology Research - Volume:3 Issue: 1, 2017
  • Volume:3 Issue: 1, 2017
  • تاریخ انتشار: 1396/07/25
  • تعداد عناوین: 6
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  • Toktam Kianifard, Arvind Chopra Pages 1-12
    Rheumatoid arthritis is a painful inflammatory disorder. Patients seek relief mostly with analgesics and anti-inflammatory drugs which are rife with life-threatening side effects. Alterations in the body’s potassium (K) status may be one such factor. K along with sodium is critical to cellular homeostasis and the electrophysiology of nerve impulses. This review is based on the premise that K can be used therapeutically to reduce joint pain and inflammation in RA and co-morbidity. K ion channel inhibition was shown to cause persistent nerve stimulation (a prelude to pain sensation) and altered immunity (T cells) in experimental studies. Diets rich in K (with normal/reduced salt intake) have to reduce hypertension in several large population studies. Premature atherosclerosis-related cardiovascular disorders and osteoporosis are important complications of RA. The third National Health and Nutrition Examination Survey (1994) carried out in the USA also reported hypokalemia in several RA patients. A diet deficient in K in RA patients was recently reported by an Indian study. In a controlled clinical trial (Iran), K supplementation (diet-based) led to a significant reduction in pain and arthritis in women suffering from seropositive RA. Some of the benefits of K in RA were postulated to be due to an improved cortisol status. K is not a known therapeutic agent in the treatment of RA. Vegetables and fruits are rich sources of K and provide a safe option for intervention. The existing data on the potential therapeutic role of K in RA is encouraging and merits further research.
    Keywords: arthritis, diet, musculoskeletal pain, Potassium, rheumatoid arthritis
  • Danyal Imani, Ramazan Rezaei, Arash Poorsheikhani, Shahab Alizadeh, Mahdi Mahmoudi Pages 13-20
    Previous articles have evaluated the association between IL-23R gene rs7517847 T>G SNP and systemic lupus erythematosus (SLE). Nevertheless, the results of these studies have been inconclusive. The current study is a meta-analysis that assesses the association between IL-23R gene rs7517847 T>G SNP and SLE susceptibility. Literature searches of Medline, Web of Science, and EMBASE databases were performed to recognize all eligible studies published before August, 2016, and the search was updated in July, 2017. The identified studies were independently reviewed by two authors for eligibility based on inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were applied to assess the strength of association in the allelic model, dominant model, recessive model, heterozygotes contrast, and homozygotes contrast. Because evidence of heterogeneity was detected across the studies, the data was pooled using a random-effects model. A sum of four case-control studies with 1348 SLE patients and 1754 healthy subjects were considered in this study. In the combined analysis, no significant association between the IL-23R gene rs7517847 T>G SNP and SLE disease risk was found in any of the genetic models (dominant model: OR = 0.95, 95% CI = 0.72-1.18; allelic model: OR = 1.08, 95% CI = 0.95-1.21; recessive model: OR = 1.13, 95% CI = 0.80-1.46; TG vs. TT: OR = 0.86, 95% CI = 0.63-1.08; and GG vs. TT: OR = 1.20, 95% CI = 0.81-1.60). Moreover, no publication bias was observed in any genetic models (p> 0.05). First, this study was based on unadjusted ORs. Second, the number of included case-control articles was small. Third, only published English language studies were imported to this meta-analysis. The current meta-analysis suggests that the IL-23R gene rs7517847 T>G SNP might not be related with risk of SLE. More studies are essential to confirm these results. No association was found between the IL-23R gene rs7517847 T>G SNP and SLE risk.
    Keywords: interleukin-23R, polymorphism, SLE, meta-analysis
  • Mohammadhassan Jokar, Mina Jokar Pages 21-27
    Inflammatory rheumatic diseases are a heterogeneous class of often chronic autoimmune disorders. They are among the most common chronic diseases. They cause major health problems in the general population. This study assessed the distribution of inflammatory systemic rheumatic diseases in a rheumatologicoutpatient clinic. The medical records of patients diagnosed with any type of inflammatory rheumatic disease between January 1, 2006 and December 31, 2016 in a non-hospital-based rheumatologic outpatient practice in Mashhad, Iran were retrospectively studied. Diagnoses were made using the agreed-upon classification criteria. Data regarding each patient’s diagnosis, age at onset of disease, and gender was extracted from their files. The total number of patients was 12,626. The most common diseases were rheumatoid arthritis (47.30%), spondyloarthropathies (17.23%), systemic lupus erythematosus (8.10%), gout (7.84%), and vasculitis (6.84%). Patients were aged from 1 to 93 years, with a mean age of 41.17±39.70 years. Most patients were in the third, fourth, and fifth decade of life. Sixty-four percent of all patients were female. The overall sex ratio (women to men) was 1.8:1. The proportion of women was 95% in Takayasu's arteritis, 92% in systemic lupus erythematosus, 87% in Sjögren’s syndrome, 78% in rheumatoid arthritis, and 24% in ankylosing spondylitis. The age at onset of inflammatory rheumatic diseases in Mashhad, Iran is lower than that in some other regions. The frequency of Behcet's disease, systemic lupus erythematosus, and systemic sclerosis was greater in this study than in most other studies, but gout, polymyalgia rheumatica, and psoriatic arthritis were less frequent in the current study.
    Keywords: arthritis, epidemiology, inflammatory, rheumatic diseases, rheumatology
  • Maassoumeh Akhlaghi, Seyedeh Tahereh Faezi, Pedram Paragomi, Farimah Ashofteh, Pari Alinejad, Neda Hatami, Laleh Ghadirian Pages 29-34
    This study evaluated the effect of cognitive-behavioral therapy (CBT) compared with other treatments on improving the quality of life in rheumatoid arthritis (RA) patients. This study was carried out in a rheumatologic referral clinic at an academic hospital. RA patients were categorized in three subgroups: cognitive behavioral therapy group, educational therapy group, and conventional treatment as the control group. Quality of life was assessed with the Arthritis Impact Measurement Scales (AIMS-2) questionnaire. The CBT subgroup (n=30) received cognitive-behavioral treatment with 7 two-hour sessions twice a week; the educational therapy group (n=30) received education about nutrition and osteoporosis, while controls (n=30) received conventional RA medical treatment. Outcomes were gathered in 14 domains of AIMS-2 including activity, walking, pain, self-care, social activity, depression, and anxiety. The 90 studied patients comprised 72 female patients (80.0%) with a mean age of 41.7 years. The degree of improvement in physical activity (p=0.2), hand/finger function (p=0.18), arm function (p=0.28), social activity (p=0.6), satisfaction (p=0.05), household tasks (p=0.9), health perception (p=0.3), self-care ability (p=0.59) showed no significant difference between the three subgroups. Moreover, CBT was effective in improving mood, ability to walking and bend, working, reducing pain and tension, and these effects were independent of age, gender, or education. Additionally, education about nutrition in RA patients improved their ability to work and their mood, and it effectively reduced tension. Based on the findings, CBT is a recommended modality adjunct to RA medical treatment. CBT is specifically beneficial for patients with depressed mood, problems in walking, bending or working, and in subjects who are suffering psychosocial tension.
    Keywords: AIMS-2, cognitive-behavioral therapy, psychotherapy, Quality of life, rheumatoid arthritis
  • Yousef Mohammadi Kebar, Maassoomeh Akhlaghi, Zahra Malekshahi, Ahmadreza Jamshidi, Shayan Mostafaei, Mahdi Mahmoudi Pages 35-40
    Several genome-wide association studies (GWASs) have identified numerous susceptibility genes for risk of rheumatoid arthritis (RA). Moreover, a bulk of the individual association studies in various populations has disclosed that genetics are significantly responsible for RA pathogenesis. CCR6 is a chemokine which is involved in the infiltration of inflammatory cells to sites of immune response. In this study, the association of CCR6 gene rs1854853 single nucleotide polymorphism (SNP) with susceptibility to RA was evaluated in an Iranian population. The investigated population comprised 250 RA patients and 500 healthy individuals. Real time TaqMan MGB-based PCR allelic discrimination approach was employed to genotype the samples with regard to the CCR6 gene rs1854853 SNP. Considering the A allele of rs1854853 SNP as reference, the G allele did not demonstrate a different prevalence between RA patients and controls (p= 0.17). Moreover, AG and GG genotypes were almost equally distributed between cases and controls (p= 0.61 and 0.14, respectively). Alternately, the dominant model of AG had no significant difference in frequency between the study groups (p= 0.36). However, genotypes did show a correlation with the clinicopathological specifications of RA patients. Results suggest that the CCR6 gene rs1854853 SNP is not involved in the genetic pathogenesis of RA in the Iranian population.
    Keywords: CCR6 gene, rheumatoid arthritis, single nucleotide polymorphism
  • Nayereh Saadati, Bahram Naghibzadeh, Zeinab Saremi Pages 41-44
    Hyperuricemia is reported to have a high prevalence in patients with psoriasis. This metabolic derangement can be associated with the development of gout in such patients. Presented herein is the case of a 53-year-old male who referred to the hospital because of worsening of skin lesions and multiple swollen and painful joints. Physical examination showed symmetric involvement of the patient’s knee, first metatarsophalangeal, and subtalar joints. Knee fluid aspiration revealed numerous monosodium urate monohydrate (MSUM) crystals. The patient’s serum uric acid level was 10 mg/dL. Kidney function was normal. Although he had experienced a similar episode two years earlier with involvement of the first metatarsophalangeal joint, he did not seek medical attention then and was not receiving prophylaxis for gout. Treatment with prednisone, allopurinol, colchicine, and sulfasalazine resulted in improvement of the symptoms. The patient was followed for six months and no relapse in his skin conditions or gouty attacks were observed. It is prudent to measure uric acid levels in psoriatic patients. Psoriatic patients with hyperuricemia, even without a known cause for hyperuricemia, are at increased risk of developing gouty arthritis. This presentation suggests that psoriasis can be an independent risk factor for gouty attacks, though this requires further larger studies.
    Keywords: gout, hyperuricemia, psoriasis