Rheumatology Research Journal
Volume:9 Issue: 2, Spring 2024

Several studies have reported the possibility of ocular toxicity with the use of antimalarial drugs by patients with rheumatic diseases. Thus, the present study intended to investigate the prevalence of such toxicity in these patients and the feasibility of the regression of changes after medication discontinuation. The present retrospective study included the medical records of 598 patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and mixed connective tissue disorders (MCTDs) who took chloroquine (CQ) or hydroxychloroquine (HCQ) and underwent routine ophthalmologic examinations. Moreover, if a patient had any ocular abnormality reported by the examining ophthalmologist, he/she was referred to another ophthalmologist to confirm the primary findings. Also, the patients with abnormal ocular findings who discontinued the drugs were re-examined 12 months after the drug discontinuation to evaluate the rate of regression of the ocular changes. According to our findings, 81 out of 598 patients (13.6%) had ocular toxicity in routine ophthalmologic examinations. However, ocular changes were ruled out in 49 (8.2%) patients using a second examination by another ophthalmologist. Therefore, retinopathy was confirmed in 32 out of 598 (5.4%) cases. Moreover, the patients with eye complications were significantly older than those without ocular toxicity (P = 0.03), while no significant relationship was found between ocular toxicity and other variables. Finally, of 32 patients with ocular toxicity, 12 patients were re-examined 12 months after the drug discontinuation, revealing normal findings in 7 (58%) patients, while 5 (42%) had irreversible ocular abnormalities. According to our findings, the prevalence of HCQ- and CQ-induced retinopathy was quite considerable in patients receiving these drugs. Therefore, despite the current controversies, we recommend that all patients receiving antimalarial drugs undergo screening for ocular toxicity.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that can affect many organs, and due to its systemic nature, it seems that some types of surgeries are more prevalent in this disease. This study aimed to investigate the prevalence of different types of surgery in RA patients. This retrospective study using the RA registry was performed on 639 RA patients in the rheumatology clinic of Rafsanjan, Iran, 2022. All patients fulfilled the ACR/EULAR 2010 classification criteria for RA. Demographic information, clinical parameters, laboratory information, surgical history, and surgery time were collected from the medical records. The sample comprises 555 (86.9%) women and 84 (13.1%) men. The average age was 55.08 ± 12.52, and the mean duration of the disease was 7.32 ± 5.94. There was a history of at least one surgery in 252 (39.4%) patients. The prevalence of gastrointestinal, gynecological, orthopedic, eye, ear, nose, and throat, cardiovascular and urological surgeries was 18%, 16.4%, 9.2%, 8.3%, 3.9%, 0.9% and 0.9%, respectively. There were 69.8% of eye surgeries and 57.6% of orthopedic surgeries after disease diagnosis; other surgeries were more prevalent before the diagnosis. The average age (58.16 ± 11.89 vs. 53.07 ± 12.53, P-value < 0.001) and body mass index (29.65 ± 5.68 vs 28.63 ± 5.56, P-value = 0.025) were higher in participants with surgery than those with no surgery. The most prevalent surgeries were gastrointestinal, gynecological, and orthopedic surgeries, and Cardiovascular and urological surgeries were the least. The mean age and body mass index in patients with surgery were significantly higher than those without surgery. Also, physical activity was significantly lower in the participants with surgery.

Therapeutic plasma exchange (TPE) is a type of treatment, which eliminates harmful antibodies, immune complexes, cytokines, and inflammatory products. Due to the lack of sufficient data on indications, effectiveness, and side effects of TPE in patients with rheumatic disease, we evaluated TPE in our center. All consecutive patients registered in university hospitals with definite rheumatologic indications for TPE during 15 years were evaluated. 680 sessions of TPE were performed on 166 patients, aged between 19 and 83 years. The most common underlying causes were collagen vascular diseases (60%) including systemic lupus erythematosus (SLE) (98%), and antiphospholipid antibody syndrome (APS) (1%); and then, primary small vessel vasculitis (SVV) (39.8%). The main indications for TPE in all patients were rapidly progressive glomerulonephritis (RPGN) (69.8%) and pulmonary hemorrhage (39.1%). During 12 months follow-up, in SLE and SVV patients 17 (17.3%) and 20 (30.3%) entered complete remission; 37 (37.3%) and 12 (18.1%) entered partial remission; 44 (44.8%) and 34 (51.5%) had no recovery; and 37(37%) and 19 (28.7%) died, respectively. A total of 18 (10.8%) patients experienced TPE-related adverse events during TPE [hypotension 15 (9%), allergic reaction 1 (0.6%), fever 1 (0.6%), and hypocalcemia 1 (0.6%)]. The most common indication for TPE is SLE and primary vasculitis. The RPGN and pulmonary hemorrhage were the main indications. Although the rate of response to treatment was acceptable according to the fatal nature of these complications, further case-control studies are suggested to assess the effectiveness of TPE.

This manuscript describes the establishment and initial results of a patient-driven registry in Tabriz, Iran to collect demographic, clinical, and paraclinical data, treatment and outcomes of patients with vasculitis. The Tabriz University of Medical Sciences Vasculitis Registry (TUOMS-VR), a patient-driven, prospective and web-based disease registry system, is conducted at the Connective Tissue Diseases Research Center, TUOMS located in Tabriz, Iran. The primary objective of this registry is to comprehensively document prospective data of patients diagnosed with systemic or single-organ vasculitis according to the Chapel Hill Consensus Conference nomenclature and definitions. To date, the registry has successfully enrolled 743 patients. The gender distribution within this existing cohort is balanced, with 50.5% male and 49.5% female participants. The most frequently diagnosed condition was Behcet’s disease, representing 56.5% of cases. Polymyalgia rheumatica also emerged as a notable diagnosis, accounting for 13.7% of cases. By providing a comprehensive and prospective documentation of vasculitis cases, the TUOMS-VR aims to enhance vasculitis patients care and outcomes.

This study aimed to investigate the effect of aerobic exercise and garlic supplementation on fatigue and cardiovascular risk factors in women with rheumatoid arthritis (RA). Twenty-eight patients who fulfilled the European League Against Rheumatism- American College of Rheumatology (EULAR-ACR) criteria for RA were assigned to three groups, exercise + placebo (E+P) (n = 6), exercise + garlic supplement 500 mg twice/day (E+G), (n = 11) and garlic supplement 500 mg twice/day (G), (n = 11) for 8 weeks. The training program consisted of working on an ergometer 3 sessions/week with a heart rate equal to 60% of VO2max and gradual overload. The outcomes of this study were a comparison of changes in the mean value of the fatigue assessment questionnaire score (FSI), cholesterol, and low-density lipoprotein (LDL) levels. For data analysis, paired t-tests and ANCOVA were used using SPSS software (P ≤ 0.05). The results of the paired t-test showed that after the intervention, the levels of fatigue decreased in the E+G (P = 0.025) as well as in the G (P = 0.002), while it did not change in the E+P (P = 0.151). Additionally, the amount of cholesterol did not change in any of the study groups, and the amount of LDL decreased only in E+G (p=0.028). Furthermore, ANCOVA analysis showed that, there is no significant difference between the study groups in the levels of fatigue (P = 0.962), cholesterol (P = 0.922) and LDL (P = 0.626) after the intervention. According to the results, aerobic exercise and the consumption of garlic can be effective in reducing fatigue and the risk factors of cardiovascular.

Axial spondyloarthritis (axSpA) represents a chronic inflammatory condition primarily impacting axial joints, characterized by sacroiliitis and spondylitis. In axSpA patients, low back pain (LBP) typically assumes a chronic and inflammatory nature, where diagnostic delays can precipitate disability. However, atypical axSpA presentations pose challenges for early diagnosis and management. In the current study, we detail the case of a 39-year-old male presenting with acute, severe LBP and bilateral sacroiliitis. Initial treatment with non-steroidal anti-inflammatory drugs (NSAIDs), the standard first-line therapy, was discontinued due to severe gastrointestinal bleeding. Following a bone biopsy that excluded alternative etiologies, axSpA was confirmed based on diagnostic criteria. Elevated inflammatory markers, contraindications to NSAIDs, and magnetic resonance imaging findings prompted the initiation of anti-tumor necrosis factor (TNF) therapy. Remarkably, a marked improvement was observed in less than six weeks post anti-TNF therapy commencement. This case underscores the significance of recognizing atypical axSpA presentations and underscores the potential for swift and robust responses to anti-TNF agents. Optimal patient outcomes hinge upon effective disease pattern recognition and treatment selection.

Leprosy is a chronic granulomatous disease in which the musculoskeletal system has been described as the third most commonly affected system. Leprosy infections may manifest with various autoimmune phenomena reminiscent of classic autoimmune diseases. Among the leprosy factors affecting the prognosis of the disease, early diagnosis was reported to be the most effective. A 46-year-old married woman was referred to the hospital with initial articular symptoms. The patient also had deep folds, increased thickness of the skin in the forehead area, and dryness of the skin with a progressive course. The finger deformities and swelling are certainly misleading, but they may constitute an unsuspected inaugural form of leprosy, especially in its lepromatous form. The skin smear and biopsy confirmed leprosy, and treatment consisting of multi-drug therapy, as suggested by the WHO, was prescribed for the patient. According to these findings, it seems that one of the major symptoms of leprosy is musculoskeletal involvement and rheumatological manifestations, which may obscure and mislead diagnostic and treatment plans.

Renal involvement is common in systemic lupus erythematosus (SLE), and even without elevated serum creatinine, there is a high proportion of abnormal urine analysis in these patients. Lupus nephritis (LN) develops early in the course of the disease in 50% of SLE patients, and end stage renal disease (ESRD) occurs in 4.3-10.1%. We performed a keyword-based literature search and included 31 articles published from 2004 to 2023. Ethnic and racial differences may affect LN, including higher incidence of LN in Black, Hispanic and Asian compared with white patients. In addition, male sex, longer disease duration, smoking, low albumin globulin ratio, low complement, anti-double stranded DNA, high anti-Sm is associated with disease progression to LN. High serum creatinine (>1.5 mg/dL) at disease onset is the most commonly reported independent clinical laboratory predictor for ESRD in patients with SLE. Other factors indicating an increased risk for ESRD are higher chronicity index, high systolic blood pressure, black race, male sex, hypocomplementemia, class of LN (III, IV and V) and older age.