Rheumatology Research Journal
Volume:4 Issue: 4, Summer 2016

General practitioners (GPs) have an important role in early diagnosis, treatment, and referring rheumatoid arthritis (RA) patients. Many patients didn’t receive rheumatologist care on appropriate time. Therefore, it seems necessary to evaluate GPs’ knowledge and attitude about RA to identify some of the barriers in the optimal care of patients with RA delivered by GPs. 120 GPs who were selected through simple and non-random sampling from physicians participating in 5 educational seminars which were held in Tehran. The survey questioned their confronting with RA, experience with prescribing disease-modifying anti-rheumatic drugs (DMARDs) and referral to the rheumatologist.28.3% of GPs had no RA patients monthly. 35.8% declared that they visit 3-5 RA patients per month on average. 95 out of 120 (79.2%) referred RA to a rheumatologist as soon as possible. Physicians' knowledge sources about rheumatoid arthritis were mostly general medical training (87.5%). 47.5% had low and 5% lacked self-esteem in managing RA patients. 92.5% of GPs were familiar with DMARDs but 22.1% of them have been ordered them. Lack of knowledge about the side effects of DMARDs was the main reason for hesitance to prescribe them. Also, we found being older, male and more experienced GPs are more comfortable in managing RA patients.RA care delivered by GPs was not consistent with current treatment guidelines focusing on early DMARDs therapy. GPs do not have enough information and confidence in managing patients with RA. Improving physicians’ knowledge and continued educational programs are suggested.

To test the hypotheses that surgical joint denervation produces a significant reduction of synovitis possibly through a depletion of intra-articular inflammatory neuropeptides such as substance P and CGRP.

Retrospective analysis of sonographic Doppler images was used to assess the synovitic changes in 16 first carpometacarpal joints of 15 patients (mean age 63.31 +/- 8.20) that had undergone surgical denervation to treat osteoarthritic pain. We used a paired t-test to compare Doppler sonographic image differences between two time-points, pre-operative and at least six months after the operation in order to evaluate variations in articular synovitis.

A significant difference (p

Temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) patients has been described in the literature; however, its incidence varies greatly. In this study, we aimed to determine the prevalence and clinical characteristics of TMJ involvement in RA patients.

The present study consisted of 60 individuals with RA. The patients were assigned to two groups, based on TMJ involvement: patients with TMJ involvement and patients without TMJ involvement. We defined TMJ involvement based on the findings of the questionnaires and clinical examination by a rheumatologist. The symptoms and signs were recorded by a single trained dentist.

The majority of the participants were women (n=49, 81.66%), with the mean age of 43.9±15.52 years (range: 21-78 years). Thirty-five patients (58.3%) had clinical evidence of TMJ involvement. The levels of C-reactive protein (CRP) and rheumatoid factor (RF) were found to be correlated with TMJ involvement. There was no significant correlation between TMJ involvement and erythrocyte sedimentation rate (ESR), age, gender, treatment duration, and disease duration.

The high level of CRP in RA patients with TMJ involvement was reported. TMJ pain was reported in almost half of the patients. There was also a significant correlation between TMJ involvement and RF.

Patients with systemic sclerosis (SSc) have some musculoskeletal manifestations. The radiologic manifestations can be articular or non-articular. There is inconsistency in the correlation between clinical manifestations and radiologic changes; there are few reports on the correlation between them and capillaroscopy. We evaluated 81 patients with SSc, using a cross- sectional single center study, referred to scleroderma clinic affiliated to Shiraz University of Medical Sciences, Iran. Skin score and capillaroscopy were performed and an expert radiologist did the radiologic evaluation of the posterior-anterior views of both hands and wrists. For data analysis, SPSS version 19 was used. The participants consisted of 73 women and eight men aged 42±2.6 years old. There were 60.5% limited scleroderma (lcSSc) and 39.5% diffuse scleroderma (dcSSc) patients. After 5 years, 91% of them had some radiologic changes mostly asymptomatic.The most common radiologic changes were non-articular (70.1%), including acro-osteolysis, subcutaneous and peri-articular calcinosis and avascular necrosis. Flexion deformities and DIP joint space narrowing were more seen in patients with dcSSc. Resorption of the distal ulna and avascular necrosis was observed more in lcSSc. There was a correlation between radiologic changes and duration, but not with the skin score. The most common capillaroscopic pattern in patients with radiologic change was late scleroderma pattern. Radiologic changes which were mostly asymptomatic were common in patients with SSc. The changes were different in patients with dcSSc and lcSSc and there were associations with duration and capillaroscopic patterns, but not with the skin score.

Granulomatosis with polyangiitis vasculitis (GPA), or formerly known as Wegener’s Granulomatosis (WG) and sarcoidosis are two distinct granulomatous diseases characterized by multisystem involvement. The sequential development of these two diseases is very rare. We report a patient who initially exhibited the symptoms of sarcoidosis and then limited GPA, predominantly affecting the nose and paranasal sinus, which was histologically proven. Imaging, pathological, and laboratory findings were described. After treatment, controlled clinical symptoms and changes in laboratory findings and imaging were demonstrated.

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder and characterized by hypercholesterolemia and early onset atherosclerosis. It may be misdiagnosed as rheumatoid arthritis (RA) because of swelling in joints and periarticular area can mimic arthritis or rheumatoid nodules. This report presents the case of a patient with FH manifested by seropositive RA. Treatment included lipid lowering therapy and management of RA. It is important to recognize the association between rheumatologic manifestations and familial hypercholesterolemia for diagnostic and therapeutic reasons.