Rheumatology Research Journal
Volume:5 Issue: 2, Spring 2020

Graves' disease is the most common autoimmune disease in hyperthyroidism. Sarcoidosis is an inflammatory granulomatousdisease of unknown cause. The association of the two diseases has rarely been reported in the literature. We report a new caseof newly diagnosed sarcoidosis in a patient followed for Graves' disease. This is an original case of Graves' disease, the courseof which was marked by the onset of active sarcoidosis presented as Löfgren's syndrome complicated by hypercalcemia. Givenits rarity and the lack of a causal link, the association between Graves' disease and sarcoidosis may be a mere coincidence. Morestudies could allow us to understand more common etiopathogenic mechanisms since both are chronic inflammatory diseases.

Adhesive Capsulitis (AC) is a self-limiting disease of the shoulder joint characterized by progressive painful restriction of theshoulder’s motion. This study aimed to search the findings on AC in non-contrast MRI. Although AC is a clinical diagnosis,imaging can provide helpful data for earlier diagnosis and treatment. It seems that some findings are specific and sensitive foraccurate diagnosis and staging of AC such as coracohumeral ligament thickening, joint capsule edema, and rotator intervalinfiltration. Non-contrast MRI can provide an abundance of information on AC and help clinicians make a more definitivediagnosis, stage the disease, and choose better treatment plans.

Systemic sclerosis (SSc) is a rheumatologic disease, and fibroblasts are the main cells responsible for SSc pathogenesis. TheBIRC5 gene encodes survivin, an inhibitor of apoptosis protein. Studies have suggested a role for survivin overexpression inleading to decreased apoptosis of fibroblasts in SSc patients. This study explored the frequencies of two single nucleotidepolymorphisms (SNPs) in the BIRC5 gene (rs9904341 [G>C] and rs17878467 [C>T]) in SSc patients and evaluated survivingene expression in the peripheral blood mononuclear cells (PBMC) of patients and compared it with that of healthy individuals.The allelic and genotypic frequencies of rs9904341 in 459 SSc patients and 487 healthy controls were assessed. For thers17878467 SNP, the survivin gene in 214 SSc patients and 246 controls was analyzed. Genomic analyses were carried out onDNA samples isolated from whole blood by the phenol-chloroform method. TaqMan rt-PCR was used to investigate the survivingene alleles. Survivin gene expression was also investigated in 53 patients (lSSc = 25, dSSc = 28) and 55 controls by specificprimers for the survivin gene (SYBR Green Real-time PCR method). The allelic and genotypic frequencies of both SNPs showedno significant difference in patients and controls; however, survivin expression level was significantly lower in limited SSc(lSSc) and total SSc patients than in controls. The results suggest that survivin might have a role in the pathogenesis of SSc;however, more research is needed to confirm the relationship.

Cartilage diameter evaluation is critical for cartilage assessment. Magnetic resonance imaging (MRI) is the gold standard toolin cartilage evaluation. This observational and analytical study was designed to answer the question of whether there is arelationship between MRI and ultrasound in measuring cartilage thickness in the medial femoral condyle. The current study wasconducted at the Radiology Department of Rasole-Akram Hospital, Tehran, Iran, between March and May 2020. The samplesize was 18 people. The mean cartilage thickness of the left medial femoral cartilage was measured by T1 weighted MRI andultrasound from transverse, anterior, middle, and posterior medial femoral regions in nine healthy females with a mean ± stddeviation as indicated below: thickness = 1.6 ± 0.04 m, weight = 55.3 ± 4.3 kg, age = 21.7 ± 0.8 years.Additionally, nine healthy males with thickness = 1.80 ± 0.02 m, weight = 78.6 ± 11.1 kg, age = 22.4 ± 0.7 years were alsoincluded. Pearson and Bland–Altman plots were used for correlations and agreements. Anterior longitudinal ultrasoundthickness measures were significantly positively correlated with MRI anterior (r = 0.93, p = 0.00001), transverse ultrasoundwith MRI anterior (r = 0.87 p = 0.0369), middle longitudinal ultrasound with MRI anterior (r = 0.87 p = 0.00002), and transverseultrasound and MRI middle (r = 0.87 p = 0.00001).Agreement in all aspects was good except between the anterior longitudinal ultrasound and MRI posterior. There was a goodabsolute agreement between corresponding measurements done by ultrasound and MRI. The results suggest that ultrasound maybe a good clinical tool for assessing relative cartilage thickness in medial femoral regions.

Endoplasmic reticulum (ER) stress triggers the unfolded protein response (UPR), which has been correlated with enhancedproduction of inflammatory cytokines. Given the important pathogenic roles of macrophages and inflammatory responses in theetiopathogenesis of Behcet’s disease (BD), this study aimed to assess the mRNA expression pattern of genes involved in theUPR pathway in macrophages from smoker and non-smoker BD patients. This case-control study was conducted between 2015and 2016 in Shariati Hospital, Tehran, Iran. Monocytes were enriched from obtained whole blood samples of 10 smokers and 10non-smoker BD patients as well as 10 healthy individuals. Using macrophage-colony stimulating factor (M-CSF), separatedmonocytes were differentiated into macrophages. After total RNA purification and cDNA synthesis, quantification analysis ofUPR genes, including activating transcription factor (ATF) 4, ATF6, X-box binding protein 1 (XBP1), binding immunoglobulinprotein (BIP), C/EBP homologous protein (CHOP), homocysteine-inducible, endoplasmic reticulum stress-inducible, ubiquitin-like domain member 1 (HERP), and growth arrest and DNA damage-inducible protein (GADD34), was performed using SYBRgreen master mix and real-time PCR. Among the measured genes, HERP mRNA was overexpressed in macrophages from BDpatients in comparison with healthy macrophages. HERP and GADD34 genes were upregulated in smoker BD patients comparedwith non-smoker BD patients as well as healthy subjects. Cigarette smoke can induce UPR gene expression in BD patients. Thealtered UPR gene expression in BD macrophages may contribute to BD pathogenesis.

Vitamin D level varies according to the geographic location. This study was conducted to evaluate Vitamin D level in the serumsamples of Systemic lupus erythematosus (SLE) patients from the Iranian population and determine its association with SLE diseaseactivity index (SLEDAI), sun exposure, smoking, photosensitivity, sun protector cream use, and drug regimen. In this crosssectional study, 200 patients were included. The patient’s data were obtained using a questionnaire. The enzyme-linkedimmunosorbent assay (ELISA) technique was used to determine Vitamin D level in the serum samples of the patients. The studypopulation was comprised of 27 (13.5%) males and 173 (86.5%) females, with a mean age of 38.46 ± 13.24 years. The serumlevel of Vitamin D was 13.62 ± 3.22 ng/ml in the patients. Vitamin D deficiency was observed in 104 (52%) patients. There wasa statistically positive correlation between vitamin D level and duration of sun exposure (CC = 0.57, P = 0.004). A statisticallysignificant negative correlation was seen between vitamin D level and SLEDAI (CC = -0.41, P = 0.013).Vitamin D level was significantly (P = 0.030) lower in the SLE patients with photosensitivity. SLE patients using sunprotector cream had significantly (P = 0.002) lower level of Vitamin D. Patients receiving glucocorticoid drugs hadsignificantly (P = 0.001) lower levels of Vitamin D in comparison to the patients not receiving glucocorticoids. Vitamin D isinvolved in the disease activity of SLE patients. It is important to include vitamin D supplementation in the drug regimen of SLEpatients, especially when it includes glucocorticoids.

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder with multiple system involvements whichcommonly affects the cardiovascular system. Although pericarditis and pericardial effusion are prevalent cardiac manifestationsin SLE, massive pericardial effusion as an initial presentation is unusual. We describe a 47-year-old woman who presented tothe hospital with a headache, dry cough, shortness of breath, and fatigue. According to the clinical, radiologic, echocardiographicand laboratory rheumatologic test findings, SLE was diagnosed and treatment with prednisolone, hydroxychloroquine, andmycophenolate mofetil was initiated. The patient improved clinically, and follow-up echocardiography showed a reduction inthe effusion volume compared with previous tests within the preceding 6 months. In patients with cardiopulmonary symptoms,especially when other organ involvement is seen, screening for autoimmune systemic diseases such as SLE should beconsidered. To achieve rapid recovery and prevent life-threatening complications, early diagnosis and treatment are essential.