Rheumatology Research Journal
Volume:2 Issue: 2, Spring 2017

Spondyloarthropathy is recognized as far back as the Permian, 300 million years before present, increased in prevalence over geologic and modern time and is now essentially trans-mammalian in distribution. Four aspects allow spondyloarthropathy to be studied across phylogenetic lines and through time: Stability of disease characteristics and its spectrum, occurrence sufficiently early in life to for remains to be identified, absence of bias in skeletal preservation and lack of significant effect on organismal survival. Identified in mammal-like reptiles, dinosaurs and other more recent reptiles, it is with mammals that the disease became endemic. It strongly penetrated some early mammal lineages which were short-lived, in contrast to its geometric increase in population penetrance over geologic time. Prevalence increased seven fold in horses, rhinoceros and non-human primates and its current occurrence is independent of captive or free-ranging status. In addition to inflicting musculoskeletal morbidity, the disease is associated with behavior changes, some possibly related to interferon modulation. Spondyloarthropathy is considered a disease and rightly so, given its impact on mobility, health and behavior. However, it seems paradoxical that a phenomenon which has such negative effects would persist, let alone increase in population penetrance.

Systemic lupus erythematosus (SLE) is a chronic multisystem disorder. Lupus nephritis (LN) is a common serious complication of SLE. LN needs prolonged care and complex therapeutic modalities. This study assessed the characteristics of Persian SLE patients with LN (LN subgroup) and an SLE subpopulation without LN (non-LN subgroup). Furthermore, the association of LN with extrarenal manifestations of SLE was studied. This study assessed 2355 SLE patients from the electronic database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS). The clinical and laboratory data of enrolled patients was retrieved. The chi-square test was used to compare extrarenal manifestations of the LN and non-LN subgroups. Odds ratios (OR) were used to present the strength of associations. The LN subgroup included 1604 cases (68.1%) with a mean age at SLE onset of 24.6±12.5 years and a female-to-male ratio of 8.7/1. Class IV nephritis was the most common type of LN (53.1%). The comparison of extrarenal manifestations revealed statistically significant differences between LN and non-LN subgroups. Major organ involvement including cardiopulmonary, hematologic, musculoskeletal and neuropsychiatric features was significantly more common in LN patients. On the contrary, discoid rash was significantly more common in the non-LN subgroup. This study revealed that LN is positively associated with musculoskeletal, mucocutaneous, and neuropsychiatric features of SLE.

Rheumatoid arthritis has a non-homogeneous pattern around the world. The current study aimed to describe the clinical manifestations and disease activity of rheumatoid arthritis patients in southeastern Iran. In this descriptive, cross-sectional study with convenience sampling, data regarding the demographics, painful joints, number of swollen and tender joints, ESR, disease activity, and therapeutic regimen of 500 patients with rheumatoid arthritis who referred to the Rheumatology Clinic of Ali Ebn Abitaleb Hospital between October 2012 and October 2013 was collected using a data form. After collection, the data was analyzed using SPSS version 16. Of the 500 studied cases, 437 cases (87.4%) were female and 63 cases (12.6%) were male. Average patient age was 48.78 ± 13.97 years, and the mean duration of the disease was 7.28 ± 7.14 years. The mean value of disease activity score-28 (DAS-28) was 3.54 ± 1.38. The DAS-28 in 30.25% of cases was below 2.6, while in 14.7% of cases it was greater than 5.1. The knee (49.6%) and the wrist (36.6%) were the most prevalent painful joints, and 375 patients complained of morning stiffness. The most frequent therapeutic regimens were prednisolone (81%), methotrexate (62.4%), hydroxychloroquine(60.8%), sulfasalazine (24%), and non-steroidal anti-inflammatory drugs (NSAIDs) (22.2%). Based on the results of this study, the mean value of DAS-28 of 3.54 ± 1.38 implies disease activity in most cases in southeastern Iran. This indicates that changing therapy regimens is necessary.

Musculoskeletal disorders are prevalent and expensive diseases. This study was conducted to estimate and compare the costs of illness of three musculoskeletal conditions. Patients with rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia syndrome (FMS) who referred to a rheumatologist completed questionnaires about their socio-demographic condition, clinical status, and the costs of their disease (direct costs included visits, laboratory tests, imaging, and medications; indirect costs included absence from paid work, functional inability, and paid and nonpaid household help) in the preceding year. Statistical analyses were performed by descriptive analysis, and one way ANOVA and chi-square test were used for the comparison of three groups using SPSS ver 20. A p-value .

Sacroiliac joint involvement is not specific to seronegative spondyloarthropathies (SpA). There are some rare reports of conditions which mimic sacroiliitis. This paper reports a case of follicular thyroid carcinoma in a patient who had been referred to a rheumatology clinic with hip pain. Sacroiliac joint involvement was her presenting feature before she was correctly diagnosed. The patient was a female, 63 years of age, who referred to a rheumatologist because of unilateral hip pain. Patrick's test on her right side was positive, and the range of motion of her right hip was restricted. Imaging studies included conventional hip radiography and magnetic resonance imaging (MRI) revealed sacroiliitis with surrounding destructive lesion. In review of systems and physical examination, a thyroid nodule was found. Computed tomography (CT)-guided needle biopsy of her hip and fine needle aspiration (FNA) of the thyroid nodule established follicular thyroid carcinoma. In approach to sacroiliitis, rare differential diagnoses (besides SpA) and mimickers of sacroiliitis such as neoplastic lesions should also be considered to avoid misdiagnosis.

Peripheral nervous system involvement frequently occurs in systemic lupus erythematosus (SLE) patients. However, chronic inflammatory demyelinating polyneuropathy (CIDP) is an unusual presentation that can develop before, after, or simultaneously with the onset of SLE. This paper reports the case of a 20-year-old man with diabetes mellitus (DM) and CIDP accompanied by SLE. The patient complained of progressive weakness in the bilateral upper and lower extremities that had begun 2 months prior to this visit. He was diagnosed with CIDP and treated with intravenous immunoglobulin (IVIG), but had little improvement. A plasma exchange was then scheduled, but it was not helpful either. The patient developed polyarthritis, oral ulcer, and a worsening of his muscle weakness two weeks later. A neurologic examination revealed 3/5 muscle strength in the upper and lower extremities, absent deep tendon reflex (DTR), and impaired position sense. The patient was diagnosed with SLE because of pancytopenia, lymphopenia, pleuropericardial effusion, proteinuria, high titer anti-nuclear antibody (ANA), and anti-dsDNA. A kidney biopsy revealed stage IV lupus nephritis. The patient received 3 pulses of methyl prednisolone, 6 months of cyclophosphamide, and a high daily dose of prednisolone. His proteinuria improved, and he regained the ability to ambulate with a normal gait after about 2.5 months. To the best of the authors’ knowledge, the concurrency of CIDP with SLE and DM has not been previously reported.