Rheumatology Research Journal
Volume:6 Issue: 2, Spring 2021

Coronavirus disease (COVID-19) started its journey around the world from Wuhan, China and gradually became a pandemic.COVID-19 often affects the respiratory system, but symptoms may include fatigue, myalgia, arthralgia, arthritis, and spine andbone pain as presenting complaints. In the present systematic search and review, we aim to highlight the musculoskeletalmanifestations during COVID-19.PubMed Central and Google Scholar search engines were searched for the key words “muscle pain”, “joint pain”, “body ache”,and “fatigue”, in Covid-19 patients.After screening, a total of 76 articles dated between January 1 and July 1, 2020 met the inclusion criteria and were included inthe study. All articles were published in English comprising 36,558 COVID-19 cases. In cross-sectional studies, fatigue wasfound in 55%, myalgia in 26%, and arthralgia in 20% of cases, respectively. In cohort studies, fatigue was found in 35%, myalgiain 15%, and arthralgia in 5%, respectively. Sporadic case reports also mention back pain, bone pain, myositis, and arthritis aspresenting symptoms of COVID-19.Fatigue was the most frequent musculoskeletal (MSK) manifestation of COVID-19 followed by myalgia and joint pain. Thefrequency of the different MSK manifestations in COVID-19 may vary widely among different geographic regions.MSK like fatigue, myalgia and arthralgia are frequent symptoms in COVID-19 patients and may vary in different countries.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves vital organs of the body. Studies have shownthat abnormal lipids may be involved in the pathogenesis of SLE. Hence, the aim of this study was to evaluate lipid profiles inlupus patients. This retrospective cross-sectional study evaluated 136 SLE patients who were referred to the RheumatologyClinic of Rafsanjan from October 2015 to September 2018. The data for the SLE disease activity index (SLEDAI) anddemographic information of all patients were entered in a researcher-created checklist, and serum lipid profiles were measuredin serum samples. The SLEDAI score of patients was 13.8 ± 5.9. Age had a significantly positive correlation with cholesterol(r = 0.224, p value = 0.009) and LDL (r = 0.256, p value = 0.003) levels as well as significantly negative correlation with HDLlevels (r = -0.489, p value = 0.023). Lipid profiles of patients with different levels of education showed no significant difference(p value = 0.174). In recently diagnosed patients, SLEDAI had a significantly positive correlation with cholesterol (r = 0.489,p value = 0.002) and LDL levels (r = 0.418, p value = 0.009) as well as a significantly negative correlation with HDL levels (r= -0.381, p value = 0.037). No significant correlation was observed between TG level and SLEDAI (p value = 0.114, r = 0.19).There was no significant difference in the SLEDAI score between subjects using lipid-lowering drugs and those without suchtreatment (p value = 0841). It seems that abnormal lipid levels are common in patients with SLE, and there is an associationbetween abnormal lipids and SLEDAI.

The aim of the current study was to investigate the prevalence of Covid-19 in patients with rheumatoid arthritis who used classic disease-modifying anti-rheumatic drugs (DMARDs).In this descriptive study that was performed in Loghman-Hakim Hospital (Tehran, Iran) between 2011 and 2020, patients with RA who were referred to the hospital were assessed based on age, sex,medications, comorbidities, smoking, duration of RA, history of Covid-19 in a first-degree relative, history of Covid-19 in thepatient, and Covid-19 symptoms.Of one thousand patients with RA, the mean age was 53.84 years old, and 72.3% were female. Covid-19 prevalence among patients with RA was 10.4%. The prevalence of Covid-19 in patients who used sulfasalazine was significantly higher (14.3%)than in patients who did not take it (8.9 %) (OR = 1.72; 95% CI,pvalue= 0.011). Hydroxychloroquine was the most generally utilized drug among Covid-19 patients. However, there was no correlation between theprevalence of Covid-19 and the use of hydroxychloroquine (pvalue= 0.779). In RA, self-quarantine lowered the risk of Covid-19 by around 60% (OR = 0.382; 95%CI (0.225-0.650)). In these patients, cardiac disease exhibited a significant correlation withCovid-19 prevalence (pvalue<0.001).Covid-19 has no higher prevalence in RA patients taking classic DMARDs than in the general population. The most common medicine among RA patients was hydroxychloroquine, which could be one of the reasons why these people did not develop Covid-19.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by synovial involvement, inflammation, andjoint destruction that, if not properly controlled, can damage cartilage, bone, ligaments, and tendons and, in some cases, lead todisability. The aim of this study was to identify inflammatory biomarkers in rheumatoid arthritis patients.This case-control study was performed on 50 rheumatoid arthritis patients who referred to the Rheumatology Clinic of ShahidMostafa Khomeini Hospital in Ilam and their healthy counterparts. All patients were examined by a rheumatologist for diseaseactivity based on DAS28 (Disease Activity Score Calculator for Rheumatoid Arthritis) criteria.The results of this study showed that the mean lymphocyte count in the case group was lower than the control group, and therewas a statistically significant relationship between lymphocyte level in the two groups. The mean neutrophil count was higher inthe case group than in the control group, and this relationship was significant. The mean neutrophil/lymphocyte ratio was higherin patients with rheumatoid arthritis than in controls and in women more than men. Stepwise logistic regression also showed thatage, sex, DAS28, VitD (Vitamin D), RF (rheumatoid factor), and NLR (neutrophil-to-lymphocyte ratio) significantly predict theincidence of rheumatoid arthritis (p value < 0.05). Therefore, NLR can be used as a prognostic factor.

Systemic lupus erythematosus (SLE) is one of the most common systemic inflammatory diseases and can damage various organs.This study aimed to compare the frequency of major blood groups and their relationships with SLE organ involvement in lupuspatients and a control group. In this case-control study, 326 patients with SLE who attended rheumatology clinics of Kermanshahand 335 healthy individuals were included (age: cases = 36.77±11.43, controls = 36.2±12.72, p value = 0.053; female sex:cases=332 (98.8%), controls = 335 (100%), p value = 0.059). Blood groups (BGs) of the patients and the controls were provided.Organ involvement was assessed using patients’ records, periodic follow-up tests, and clinical examinations.In general, without considering RH, there was no significant difference in the distribution of O, A, B, and AB blood groups betweenthe SLE patients and the controls. There was no relation among different organ involvements in SLE patients and BGs except formucosal skin lesions which were significantly higher in the AB blood group (p value < 0.05). In RH positive individuals, therewas a significant difference in the frequency of the AB blood group between SLE patients and the controls (23 (7.4%) vs. 36(11.7%), p value = 0.034). In RH negative individuals, there was a significant difference in the frequency of the A blood groupbetween SLE patients and the controls (2 (13.3%) vs. 10 (37%), p value = 0.037).There is no difference in the frequency of different BGs between SLE patients and healthy people. Moreover, no significant relationbetween different organ involvement in Lupus patients and BG was found, except for mucosal ulcers. Therefore, ’blood groupcannot be used as a predictor of disease status.

SLE (Systemic Lupus Erythematosus) is an autoimmune disorder with a range of symptoms and an unclear cause. Infections,which are one of the leading causes of death in SLE patients, are made more possible by immunosuppressive medications. It isyet unclear how Cytomegalovirus (CMV) infection affects SLE. Clinically, differentiating between an infection and a lupusflare-up is critical. For this reason, we discuss the case of a 56-year-old woman who was hospitalized to Loghman Hospital'srheumatic clinic with SLE and CMV infection.

Granulomatosis with polyangiitis )GPA, also known as Wegener’s( is an anti-neutrophil cytoplasmic antibody-associatedmultisystem disease characterized by necrotizing small vessel vasculitis which mainly affects the upper and lower respiratorytracts as well as the kidneys. Involvement of the central nervous system is uncommon in GPA and might be difficult to treat.Pituitary involvement is a rare presentation in GPA. Presented herein is the case of a 28-year-old woman with GPA involving thepituitary gland and other systemic manifestations of the disease.