مریم صاحباری

Rheumatoid arthritis is an inflammatory, autoimmune, chronic, and progressive connective tissue disease with an unknown cause that is associated with symptoms such as pain, swelling, tenderness, stiffness, and dryness in the joints and decreased energy, leading to muscle inactivity and atrophy. The aim of this study was to investigate the effect of Pilates exercises on pain and isometric torque of flexor muscles and knee extensors in women with rheumatoid arthritis.

Thirty female patients with rheumatoid arthritis (hip and knee joints) were randomly divided into two groups (15 experimental groups and 15 control groups). Evaluation of the pain performed with visual Analogue Scale (VAS) scale and Kin-com 125A isokinetic dynamometer were used to assess the isometric torque of the muscles. The experimental group performed Pilates exercises for eight weeks and three sessions a week. Paired t-test and analysis of covariance were used to interpret the data in two groups. (P≤0.05).

The findings showed that the pain of the experimental group after eight weeks of Pilates exercises was significantly lower than the control group (P <0.05). Also, the isometric torque of the knee flexor and extensor muscles of the experimental group is significantly better than the control group members (P <0.05).

According to the findings of this study, Pilates exercises can improve the pain and the knee flexor and extensor muscles isometric torque of patients with rheumatoid arthritis.

In recent years, the universal epidemic of obesity, cause more interest in performing further researches about the biology of white adipose tissue. Adipocytes and macrophages within the adipose tissue secreted protein mediators are named as adipokines. Some adipokines such as leptin, resistin, lipokalin and interlukine-18 play an important pro-inflammatory role while adiponectin has mainly anti-inflammatory properties. Resistin as the novel adipocyte–derived peptid induced a significant insulin resistance in the liver tissue as well as contribute in physiologic besides inflammatory and autoimmune process. Serum concentration of this marker is correlated with some inflammatory processes such as Crohn disease and collagen vascular disorders like rheumatoid arthritis and systemic lupus erythematosus. The roles of adipokines in modifing inflammatory processes raise an important question to answer whether inhibition of abnormal adipocytokines production in autoimmune diseases could be a potential biologic target for treatment of this disorder. This review article debates the role of adipokines, specially resistin in inflammatory and autoimmune disorders.

sarcoidosis is a multiorgan granulomatosis disease with unknown origin. Lofgren syndrome is an acute form of it that consists of ankle periarthritis, erythema nodosum and bilateral hilar adenopathy.Patients & in this study we evaluated 100 participants whose sarcoidosis confirmed clinical and paraclinical data. All participants answered to a general questionnaire regarding disease manifestations and epidemiologic data. acute sarcoidosis was more common in females than males (71% vs 29%) and most commonly occured in the age of 40-50 year. Among those patients, 93% had acute course of disease, 91% presented with arthritis. 67% developed erythema nodusom,10% uveitis. and 41% constitutional symptoms. Positive family history of sarcoidosis was found in 2% of them. Moreover a Abnormal chest radiography (para-hilar lymphadenopathy) was found in 94% of patients. ESR was increased in most of patients but the blood cell count remained unchanged. The most common presentations of sarcoidosis in its acute subtype were ankle peri-arthritis and erythema nodosum. The most paraclinical finding was para-hilar lymphadenopathy. Elevated ESR was also significant.

Behcet''s disease (BD) is an autoimmune disease، which can affect multiple systems in the human body. Recently، the effects of serum heat shock protein (HSP27) level and antibodies against it have been demonstrated in Behcet''s etiology and pathogenesis. This study aimed to determine the serum levels of HSP27 and high-sensitivity C-reactive protein (hs-CRP) in BD، and their relationship with uveitis in these patients In the current cross-sectional study، the sample size was calculated as 94 individuals. The subjects were divided into three groups: patients with Behcet’s uveitis (BD+U)، BD patients without uveitis (BD-U)، and those with idiopathic uveitis. The serum levels of HSP27 and hs-CRP were compared among the three groups. The serum HSP27 level was measured، using ELISA technique. The mean serum HSP27 level was 28. 81±7. 593، 31. 78±6. 841، and 24. 07±7. 095 in BD-U، BD+U، and idiopathic uveitis patients، respectively. These results indicated that there was a significant difference between the three groups regarding serum HSP27 level (F=8. 118) (P=0. 001). According to the results، there was a significant difference in HSP27 level in BD+U and idiopathic groups; therefore، serum HSP27 level can be a sensitive marker for the diagnosis of Behçet''s uveitis Acknowledgment: This study was supported by Rheumatic Diseases Research Center and Mashhad University of Medical Sciences، further more there was not any conflict of interest in doing this research

Rheumatoid arthritis (RA) is an autoimmune disease with unknown origin. Several etiologic factors have been attributed to the pathogenesis of RA, which is substantially derived by inflammatory factor. Trace elements (TE) including selenium, zinc and copper are components of several fundamental enzymes in the oxidative pathways which play crucial role in the prevention of cellular oxidative stress induced by superoxides and free radicals. The current study aimed to assess the relationship between serum values of the trace elements and RA disease activity. On this purpose, searching of available electronic databanks by relative keywords and without any time limitation performed. The serum levels of selenium, zinc, and zinc/copper ratio in patients with RA were lower than those values in age- and sex-matched healthy control individuals; but zinc had a positive correlation with serum levels of albumin and negative relation with disease duration. Furthermore, copper was positively correlated to disease activity and there was no association between serum level of copper and age or gender. There was a relationship between lower values of selenium and number of affected joints in RA. It can be concluded that there is a relationship between serum values of trace elements and RA development and disease activity.

Vitamin D has immunomodulatory function. Polymorphisms of the gene encoding the vitamin D receptor detected by BsmI may be source of diversity in its action. An association between vitamin D receptor gene BsmI polymorphisms and lupus nephritis has been reported. This study was performed to evaluate vitamin D receptor gene BsmI polymorphisms in lupus nephritis.

Twenty nine patients with lupus nephritis enrolled in this study. Vitamin D receptor gene typing was performed based on polymerase chain reaction-restriction fragment length polymorphism.

Vitamin D receptor genotyping of BsmI polymorphisms was 20.6% for BB, 51.7% for Bb, and 27.5% for bb without statistically significant difference (P = 0.090). In 21 patients that renal biopsy was done, the Bb genotype was the most (42.8%). There was not any correlation between renal histology and vitamin D receptor gene BsmI polymorphisms (P = 0.068).

There was no relationship between vitamin D receptor gene BsmI polymorphisms and lupus nephritis.

Systemic Lupus Erytematosus (SLE) is a chronic and relapsing disorder affecting several organs. To compare serum ferritin level between patients with systemic lupus erythematosus, rheumatoid arthritis, and osteoarthritis This cross-sectional study was conducted on 60 patients with SLE (divided into two groups with low and high disease activity), 20 patients with osteoarthritis (OA), and 20 patients with rheumatoid arthritis (RA). After having received informed consent, the blood and urine samples were collected from all patients to be tested for iron, TIBC, and serum ferritin levels and also to calculate the lupus disease activity. Patients with iron deficiency anemia were excluded. Data were analyzes by independent t- test, ANOVA, logistic regression and correlation tests. There was no significant difference between three study groups regarding the sex however, the age and duration of disease showed significant differences among 3 groups (p< 0.001). High serum ferritin level was seen in 61.7% of SLE, 15% of RA, and 5% of OA patients (p< 0.001). Increase in ESR levels demonstrated significant differences among study groups (p< 0/001). In patients with SLE, no significant correlation between serum ferritin and the decreased serum complement level and increased anti dsDNA titer was observed. Both serum ferritin and CRP levels increased in patients with serositis (p=0.019) and neurological complication (p=0.04). Serum ferritin level was significantly higher in patients with SLE compared to those with OA and RA. There was no significant difference between serum ferritin level and SLE activity.

Chronic polyarticular presentation is not a common manifestation of gout and it may be confused especially with rheumatoid arthritis (RA). To evaluate the characteristics of patients with chronic polyarticular gout, important clues for differentiation from RA and its correlation with cardiovascular disease. This was a descriptive study on patients with chronic polyarticular gout who, for the first time, were admitted to Ghaem Hospital, Mashhad University of Medical Sciences during1998-2006. Diagnosis was based on international criteria of gout. Patients with arthritis in less than four joints were excluded from the study. Eighteen patients were enrolled. In 8 patients (44.4%), the joint involvements were similar to RA and in two patients crystals of calcium pyrophosphate in synovial fluid (12.5%) also found. One patient had a pseudotumor on the tophus, and two with Achill’s tendinitis. Among patients, 61% suffered from cardiovascular disease. In these patients 39% had chronic renal failure, 22.2% had diabetes, and 50% had hypertriglyceridemia. It seems that chronic polyarticular gout is a kind of polyarthropathy that requires more attention to diagnosis.

Soluble FAS (sFAS) is an apoptosis "programmed cell death" marker and results from shedding of FAS molecules during activation of FAS mediated apoptosis. There are several important reasons that Apoptosis is deregulated in active systemic lupus erythematosus and FAS is over expressed by T-cells; although the role of its soluble form (sFas) is unclear. We have investigated the correlation between serum levels of sFAS and active organ damages in lupus patients.Our study was performed on 114 systemic lupus erythematosus patients, compared with 50 randomly selected sex-, age- and race-matched healthy controls. The patients were randomly selected in different phases of disease activity. All the physical examinations and laboratory parameters were collected for determination of the SLEDAI index. sFAS, Anti-dsDNA, C3, and C4 levels were determined using a commercially available ELISA kit. There was a significant difference between serum levels of sFAS in the case and control groups (P = 0.001). We found a significant correlation coefficient between the sFAS and SLEDAI2K variables (P = 0.001, r= 0.494). It was a significant statistical difference between serum levels of sFAS in patients with rising in amount of proteinuria more than 0.5 g/l in 24h urine sample collection and without it (P = 0.04), and central nervous system (CNS) damage versus normal CNS patients (P = 0.006). It was not difference between sFAS and cardiac damage (P = 0.05) but it was near significant difference. We found a correlation between sFAS serum levels and central nervous system involvement and rising in amounts of proteinuria in systemic lupus erythematosus patients.

Primary amyloidosis is the most common form of systemic Amyloidosis. Amyloidosis is the results of fibril formation due to plasma cell dyscrasia or rarely monoclonal gammopathy of uncertain significance (MGUS). Clinical manifestations are proteinuria, cardiomyopathy, peripheral neuropathy, large tongue and shoulder fat pad enlargement and hepatosplenomegaly.

The presented patient is a 42-year old woman with clinical features of a dull epigastric and left upper abdominal pain from one year ago. Her family history and past medical history was normal except for an exertional dyspnea. In the physical examination, paleness, large tongue with indentations around it and hepatosplenomegaly were obvious, during admission, she had rectorrhagia, polipectomy led to severe hemorrhage. Echocardiography performed and revealed the typical sign of sparkling pattern with restrictive cardiomyopathy.

In bone marrow evaluation plasma cells were 8%. Serum protein electrophoresis showed that monoclonal gammopathy near 2 grams in weights and all data confirm monoclonal gammopathy of uncertain significance. Duodenal biopsy verified an amyloid deposition which was confirmed by Congo red coloration. There were no data to support secondary amyloidosis in our wide investigation and patient was treated with the diagnosis of primary amyloidosis due to monoclonal gammopathy of uncertain significance.

Primary amyloidosis secondary to monoclonal gammopathy of uncertain significance is a rare disease which should be mentioned in chronic multiorgan disorders.