مریم مبینی

Paget's disease of bone is a metabolic bone disorder characterized by localized areas of increased bone production and cycle with excessive and irregular bone formation. Rapid bone resorption and formation lead to irregular bone tissue. Most cases are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Primary sclerosing cholangitis is a chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and narrowing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree. The association of both diseases with other diseases has been reported, but there are few reports of the association of these two diseases together. This association can present the physician with an important challenge for both diseases because both diseases lead to an increase in alkaline phosphatase. Here, we present a 52-year-old man who was also diagnosed with Paget's disease of the femur on evaluation for abdominal pain and elevated alkaline phosphatase. Zoledronic acid 5 mg was prescribed for the patient. Six months later, the patient did not complain of hip pain. The femur graph remained unchanged and the patient's alkaline phosphatase decreased and reached the normal range. Laboratory findings, imaging, and histology of the patient were explained. It seems that in patients with high alkaline phosphatase and primary biliary cirrhosis, the presence of pain or deformity of bones and joints should be checked with imaging to detect the presence of co-morbidities.

Osteoarthritis is the most common joint disease in humans, the main symptoms of which are joint pain and dryness. On the other hand, the knee is the most common joint affected by osteoarthritis. The main goals in the treatment of this disease are to reduce pain restore function and improve the patient's quality of life. In many parts of the world, non-steroidal anti-inflammatory drugs are used as the first-line treatment for osteoarthritis. However, researchers are still investigating herbal and alternative treatments. Therefore, this research aimed to make a local herbal lipogel that can be effective in improving the symptoms of osteoarthritis.

This study was a double-blind randomized clinical trial study. Seventy patients were randomly selected from those who were referred to the rheumatologist's office and were diagnosed with osteoarthritis and ruled out systemic rheumatism diseases by observing the entry and exit criteria. The patients had been referred to the doctor for the treatment of 1st and 2nd-degree osteoarthritis and after explaining to them the objectives of the study, after obtaining written consent, they entered the study and were divided into two groups receiving lipogel Arthrohil (35 people) and receiving lipogel placebo (35 people) were divided. To prepare plastic base gel, first, 5% low-density polyethylene (LDPE) was added in 95% liquid paraffin and it was indirectly heated at 130°C for three hours. Then we cooled it very quickly to form a plastic base gel. The gel obtained from Plastibase was investigated in terms of physical stability in ambient and refrigerator temperatures, in terms of occurrence of turbidity, syneresis phenomenon, appearance change of consistency, and pH. The extracts of each of the plants Turmeric (2%), Betula (4%), and Marmaki (4%) were added separately to the gel base and mixed until the gel reached the appropriate consistency. Lipogel was used topically for two months twice a day each time in the amount of two knuckles on each joint. The results of the WOMAC and VAS questionnaires were collected before the treatment, at the end of the first month, and the end of the second month after the treatment. The significance level of the tests was considered P<0.05.

The studied patients were in the age range of 40 to 73 years. The prepared herbal lipogel can be used for clinical tests in terms of microbial control and it contained 0.03% of total flavonoid and 0.1027% of total phenol. The stability of herbal lipogel was more than 94%. According to the WOMAC questionnaire, compared to placebo, herbal lipogel significantly reduced pain, joint stiffness, and movement disorder in osteoarthritis patients (P<0.05). The results of the Friedman test, to compare the scores of the VAS questionnaire before the start of the treatment, at the end of the first month, and at the end of the second month showed that after the treatment with herbal lipogel, the amount of pain felt by the patients decreased significantly (P<0.05).

By comparing the scores obtained from the WOMAC and VAS questionnaires in the placebo and herbal lipogel groups, we found that the topical use of herbal lipogel has been effective in increasing the performance and pain control of patients with osteoarthritis, which is due to the antioxidant and anti-inflammatory properties of the compounds. In this lipogel, it seems obvious.

Fibromyalgia is a syndrome characterized by chronic musculoskeletal pain, tenderness, and other physical symptoms. We determined the frequency of Fibromyalgia in hypothyroid patients and the relationship between FM symptoms and hypothyroid status.

The current study is a cross-sectional descriptive study investigating the prevalence and demographic characteristics of fibromyalgia in hypothyroid patients referred to University clinic in Sari in 1401-1402. Ninety-one hypothyroid patients were included in the study. The sampling method was convenience sampling. The sociodemographic features and the clinical features of hypothyroid patients were recorded. Thyroid tests included T4, TSH, and Anti Tpo Ab. Patients were examined for Fibromyalgia using American College Rheumatology (ACR) criteria for FM 2010 and 1990. For the patients who were classified as FM, the FIQR questionnaire was completed. To analyze the data, descriptive statistics indicators such as central and dispersion indicators and calculation of ratios were used, and to check the relationship between qualitative variables, chi-square test and quantitative variable comparison in different groups were used by t-tests and ANOVA in SPSS-25 software was used.

The mean age and duration of hypothyroidism were 48.35 ± 13.8 and 9.84± 6.6 years respectively. The frequency of fibromyalgia in hypothyroid patients was 7(8%) patients based on ACR 2010 criteria. In patients with hypothyroidism and fibromyalgia, 6 patients (85.7%) were positive for Anti Tpo Ab, while in patients with hypothyroidism without fibromyalgia, 29 patients (34.5%) had this antibody (P=0.007).

It seems that Anti Tpo Ab is more important than thyroid dysfunction, and it is suggested to check this antibody in fibromyalgia patients in addition to thyroid function tests.

Hepatitis B, as a major healthcare problem and a potentially life-threatening infection, is caused by Hepatitis B virus (HBV). Nucleocapsid of HBV is composed of a single polypeptide chain known as core antigen, HBcAg. As a highly immunogenic subviral particle, HBcAg has been used as a carrier platform for heterologous proteins. Anti-HBc antibody, as one of the serological markers for HBV infection, is the best marker for documenting prior exposure to HBV. Here, we produced, purified and characterized HBcAg. pColdI vector, containing a histidine tag, was used for the first time to clone HBcAg gene. The highest level of HBcAg expression was achieved in Tuner strain, followed by BL21 and Rosetta-gami. Histidine-tagged HBcAg was purified using Ni-NTA resin, and its structural and antigenic similarity with natural HBcAg was confirmed by ELISA and western blot. Then, recombinant HBcAg was used to produce anti-HBc polyclonal antibodies in rabbits, and specific anti-HBcAg polyclonal antibodies were purified by the HBcAg-CNBr sepharose column. Specific anti-HBcAg polyclonal antibodies were able to detect recombinant HBcAg up to 0.15 ng/ml in an optimized sandwich ELISA. The results of this study provide valuable information for the production of recombinant HBcAg and specific anti-HBcAg polyclonal antibodies for further research and diagnostic applications.

There is no specific treatment for fibromyalgia. Previous studies suggest that exercise is helpful in controlling the symptoms and psychosocial aspects of the disease. Stretching exercises are emphasized less than aerobic and resistance exercises in these patients. The main reason for re-examining this issue in current study was the contradictory feedback of patients with fibromyalgia to stretching exercises which was observed during recent years in clinical treatments. The aim of this study was to evaluate the effect of stretching exercise on the quality of life of patients and the impact of fibromyalgia.

This study was a per-protocol randomized clinical trial. Forty-nine patients with fibromyalgia diagnosed based on 2010 diagnostic criteria for fibromyalgia who were referred to our sports medicine clinic by a rheumatologist and then a psychiatrist were studied. They were randomly divided into two groups. Twenty-five patients in the intervention group did stretching exercise and received medication while 24 patients in the control group received standard medication for five weeks. SF-36 questionnaire was used to evaluate the quality of life and Revised Fibromyalgia Impact Questionnaire (FIQR) was used to assess the disease state at the beginning of the study and also at weeks 5 and 9.

There are contradictory results about the effect of stretching exercises on fibromyalgia patients. The current study showed no significant differences between the two groups in the mean scores for physical health (P= 0.4), mental health (P= 0.88), and fibromyalgia impact (P= 0.36).

Isolated stretching exercises are not effective in improving fibromyalgia. Further studies are suggested to investigate the effect of more specific stretching exercises on fibromyalgia.

Treatment of rheumatic diseases depends on proper use of medications. The aim of this study was to evaluate the frequency and reasons for discontinuation of drugs in these patients.

A cross-sectional study was performed in patients with inflammatory rheumatic diseases in Sari, Iran 2020-2021 to investigate the frequency and reasons for discontinuation of drugs. Statistical analysis was performed using SPSS V20 and descriptive statistical methods were used to determine the frequency of drug discontinuation and its causes.

The participants (n=251) included 197 patients with rheumatoid arthritis, 31 with systemic lupus, 16 with ankylosing spondylitis, and 7 patients with psoriatic arthritis. The mean age of patients was 52.36±13.4 and mean duration of illness was 8.35±7.31 years. Drug discontinuation was seen in 73 patients (85 cases). The most common reason for drug discontinuation was drug side effects (55.4%). Drug shortage, transient improvement of symptoms, ineffectiveness of the drug, and fear of developing COVID 19 were some of the reasons for discontinuation of drug.

The most common cause of discontinuation of treatment was drug side effects, but in about one third of cases, there are factors that could be corrected to help preventing drug discontinuation and non-adherence to treatment.

Connective tissue diseases, including scleroderma, may be associated with an increased risk of lung cancer. The most common type of lung cancer associated with systemic sclerosis is adenocarcinoma or bronchoalveolar carcinoma, and small cell carcinoma is rare. This reports presents a 54-year-old non-smoker woman with a history of scleroderma who was examined due to aggravation of shortness of breath and cough for the last two months. On radiography and CT scan, a mass was seen in the sub pleural area of the upper right lobe of the right lung, and pathological examination showed small cell carcinoma of the lung. Small cell carcinoma is very rare in non-smokers, therefore, it may be associated with interstitial lung tissue disease in scleroderma.

Eosinophilic fasciitis presents as painful symmetrical stiffness and limb sclerosis with deep fascia inflammation. Unilateral conflict has been rarely reported. In this paper, a young man with unilateral thigh and leg involvement is presented who developed symptoms following strenuous exercise. Clinical, laboratory, imaging, and pathology findings are discussed. Treatment with prednisolone and methotrexate was started.

Disease registry of Coronavirus disease 2019 (COVID-19) as an emerging global health threat could create a suitable research context, identify various aspects of the disease from symptoms to laboratory diagnoses, and determine effectiveness of treatment. The present study aimed to design and implement COVID-19 registry in Sari Imam Khomeini Hospital and investigated preliminary results.

At first stage, to design the disease registry, a strategy committee was established consisting of experts involved in COVID-19. Variables determined by members of the registry strategy committee included demographic findings, patients’ vital signs, comorbidity, laboratory findings, diagnostic test results, disease forms, complications, patients’ prognosis, and medical interventions on admission and at the time of discharge. Then, a web based software was designed in Structured Query Language (SQL) to record the information. The study population included all patients attending Sari Imam Khomeini Hospital with clinical and molecular diagnosis of COVID-19.

Out of 1924 registered patients, 829 (43.1%) were female. The mean age of patients was 53.2±17.5 years. The mean ages of men and women were 53.9±16.8 and 52.7±18.1 years, respectively (P= 0.142).

Outbreak of COVID-19 and paucity of information about the disease call for an accurate, complete, and reliable database including timely information which could be achieved by an integrated disease registry.

Inflammatory rheumatic diseases, in addition to involvement of the joints and different systems, are associated with increased risk of morbidity and mortality. One of the most common causes of death in patients with these diseases is cardiovascular causes which can be due to the nature and pathophysiology of the disease, chronic inflammation, and the drugs used. Despite different pathogenesis and symptoms of rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and gout, the presence of chronic inflammation is a common pathophysiological feature in these diseases. Metabolic syndrome is reported to be associated with some of these conditions. The study of metabolic syndrome in inflammatory rheumatic diseases is important from different perspectives, since it plays a role in development of cardiovascular disease and pro-inflammatory status and also influences the choice of treatment and related monitoring. Here, first, the importance of metabolic syndrome in rheumatic diseases in general is discussed, then each of the above diseases is evaluated separately. It seems that abdominal obesity in patients with rheumatoid arthritis and lupus, and hypertension and obesity in patients with psoriatic arthritis, and hypertriglyceridemia and hypertension in gout are important components of metabolic syndrome that require more care.

Subcutaneous calcinosis consists of abnormal calcium deposition in soft tissues and is one of the complications of scleroderma, especially in limited systemic sclerosis. It is one of the criteria of CREST syndrome (calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia). A 44-year-old woman with systemic scleroderma for 20 years was presented with pain in the elbow, fingers and toes, and extensive calcinosis in soft tissue. The patient was treated with immunosuppressive medications due to lung parenchymal involvement and received various drug and surgical treatments for soft tissue calcinosis. In situations of poor response to medication, surgical treatment could be the only option for treating symptomatic lesions.

Background and purpose: Evidence suggest high prevalence of trigger finger (TF) in diabetic patients. Corticosteroid injection in the area of tendon sheath thickening is the first-line treatment of choice for TF. However, some studies indicated low efficacy of this method in diabetic patients. This study aimed at investigating the effectiveness of oral corticosteroids in diabetic patients with TF. In a clinical trial, 50 diabetic patients with trigger finger (n=106 digits) enrolled. The patients were treated with oral prednisolone 5 mg, three times a day for 2 weeks. They were then followed up based on Quinnell grading at 3 and 6 weeks, and 3 months. Data analysis was done in SPSS V17 applying Repeated measures ANOVA. At the end of the three-month follow-up, 84 fingers (79.3%) of patients who took oral prednisolone improved. The reduction of Quinnell grading was significant after medication (p<0.001). Positive correlation was observed between symptoms duration and disease severity at third month (r=0.37, p<0.0001). In addition, there were positive correlations between the number of fingers affected and diabetes mellitus duration (r=0.425, p=0.002), HbA1C (r=0.319, p=0.024), and 2HPP (r=0.29, p=0.041). Current study showed no local side effects of corticosteroids in patients receiving oral prednisolone. Therefore, it could be suggested as an influential treatment for trigger finger in diabetic patients, especially those with less than 6 months onset of symptoms, normal blood glucose control, less severity of the symptoms, and higher number of involved fingers.

Background and Rheumatoid arthritis (RA) is an autoimmune disease that increase the risk of coronary artery diseases. Metabolic syndrome (MetS) is considered as a risk factor for developing coronary artery diseases. There are some concerns about the association between RA and MetS, therefore, this study was done to evaluate the prevalence of MetS in male RA patients.
In a cross sectional study, male RA patients (n= 50) were evaluated regarding demographic and clinical features including disease activity score 28 (DAS28), health assessment questionnaire (HAQ), visual analogue scale (VAS), and laboratory parameters and compared with 50 age-matched controls. MetS was diagnosed according to the 2005 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) definition. The prevalence of MetS was compared in RA patients and controls. Statistical analysis was performed in SPSS V19, and results were considered significant at P The mean ages of RA patients and controls were 49.04±10.2 and 46.12± 9.4 years, respectively (P= 0.139). MetS according to NCEP and IDF criteria was present in 12 (24%) and 18 (36%) of RA patients vs 16 (32%) and 18 (36%) of controls, respectively that was not significantly different. Controls were more likely to have hyperglycemia and hypercholesterolemia, especially higher levels of low density lipoprotein (P According to the present study, prevalence of MetS was similar in RA patients and controls. MetS components should be routinely investigated in male RA patients to reduce the occurrence of MetS and its complications.

Background and Osteoporosis is a bone disease that reduces bone strength and increases the risk of fractures. Evidence suggest an association between nephrolithiasis and osteoporosis and decrease in bone density. The aim of this study was to compare bone densitometry in women with kidney stones and women with no history of stones.
A cross-sectional study was conducted in patients referring to medical centers in Sari, Iran 2015-2016. One hundred and twenty eligible women were compared in the two groups of with and without kidney stones based on demographic characteristics, anthropometric, biochemical, and bone densitometry findings. The groups were compared by t-test for quantitative variables and Chi-square test for qualitative variables in SPSS V19.
The mean of age of participants was 53.64±6.8 years and 77 (64.2%) were postmenopausal. There were 39 women with nephrolithiasis and 38 without kidney stones. Family history of kidney stones and urinary calcium excretion in women with kidney stones were significantly higher than that in those without kidney stones (P = 0.002, P = 0.000). The mean values for bone density in lumbar spine in women with and without kidney stones were 0.851±0.17 and 0.946±0.13 (P=0.001). These values in femoral neck and total hip were 0.815±0.13 and 0.748±0.10 (P=0.003) and 0.891±0.13 and 0.965±0.10 (P=0.001), respectively.
It seems that nephrolithiasis and higher urinary calcium excretion are associated with lower bone mass. Therefore, earlier investigations for osteoporosis are suggested in patients with kidney stones and higher urinary calcium excretion.

Tuberculosis is a major concern in patients with rheumatologic disorders under immunosuppressive therapy. In this paper a 67-year old woman is presented with seropositive rheumatoid arthritis and negative screening for latent tuberculosis. She was treated with infliximab since 22 months ago. She developed constitutional and respiratory manifestations and flare of articular symptoms during treatment by immunosuppressive agents. Tuberculosis clinical presentation and investigation tests including imaging, pleural effusion analysis and interferon γ release assay (IGRA) estimation and anti-tuberculosis treatment was initiated and dose of prednisolone was increased. Afterwards, constitutional respiratory and articular signs improved significantly. Beside of initial screening, attention to tuberculosis in patients being treated with biologic drugs should be done at any time.

Sickle cell disease is the most common type of hemoglobinopathies in the world that is caused by abnormal beta globin chain in hemoglobin. The disease is usually diagnosed in the first decade of life. Bone involvement is one of the most common clinical manifestations both in the acute setting (painful vaso-occlusive crises), and/or as a source of chronic disability (such as avascular necrosis). This paper introduces an old patient with advanced skeletal manifestation due to this disorder. A 66-year-old man who was opium abuser was visited by a rheumatologist for lower limbs pain, and fatigue from one year ago. The patient had severe anemia, and X-ray revealed diffuse osteolytic changes without sharp border in pelvis and femur and joint space narrowing. Involvement of thoracolumbar vertebras were seen as codfish vertebra appearance. In peripheral blood smear, sickle cell and target cells accompanied by hypochromia and platelets aggregation were detected. The hemoglobin electrophoresis was compatible with sickle-β thalassemia. In old patients with anemia and osteolytic lesions with unknown reason, evaluation of hemoglobinopathies, especially sickle cell anemia is suggested.

Background and Vitamin D is a steroid hormone. It plays an important role in bone metabolism and neuromuscular function. It is mainly synthesis from converting 7-dehydrocholesterol to cholecalciferol on skin with exposure to sunlight. This study aimed at comparing the serum levels of 25-hydroxyvitamin D after taking parenteral and oral vitamin D in patients with vitamin D insufficiency.
This historical cohort study was done in 400 patients with vitamin D insufficiency attending Rheumatology and Endocrinology clinics in Sari, 2013-2014. The patients were treated either by vitamin D3 (cholecalciferol) orally (control group) or injection (case group).
The patients were 333 females (83%) and 67 males (16.8%). Two hundred forty four patients received intramuscular (IM) and 158 received oral vitamin D3. The mean serum levels of 25 (OH) D before and after the intervention in oral group were 17.16 ± 0.39 and 43.02 ± 0.48 ng/ml, respectively (P Administration of oral or injectable vitamin D led to increase in 25 (OH) D levels, but there were no difference in terms of the effects or compilations. According to the requirements and wishes of the patients either the oral or injectable form could be administered for prevention or treatment.

Background and Fibromyalgia (FM) is a chronic pain condition with non-articular origin that is defined by generalized pain, fatigue and sleep disturbance. The aim of this study was to evaluate the reliability and validity of Persian version of Revised Fibromyalgia Impact Question­naire (FIQR) in Iranian patients with FM.
The FIQR was translated into Persian and adminis­tered to 44 female patients with primary FM. All patients filled out the questionnaire along with the Persian version of the Hospital Anxiety and Depression Scale (HADS) and short form-36 (SF-36). One week later, FM patients filled out the FIQR at their second visit. Reliability was analyzed by internal consistency Cronbach’s α coefficient and intra-class correlation coefficient. Construct validity was evalu­ated by Spearman’s and Pearson’s correlation coefficient. Statistical analysis was performed in SPSS ver. 19.
From 69 female patients with primary FM who had HADS score less than 15, 44 were selected. The total scores of the FIQR in first and second visits were 52.85±20.2 and 53.62±18.3, respectively. Evaluation of construct validity with SF-36 and HADS showed a significant correlation at the 0.01 level. The intraclass correlation coefficient (ICC) was CI95%=0.929 (0.896-0.956) and Cronbach’s α was 0.93 for FIQR in the first visit. The correlation between first and second total scores was 0.82 (P=0.001).
The Persian version of FIQR showed adequate reliability and validity.

Background and Fibromyalgia syndrome is a chronic bone and skeleton disorder with an unknown aetiology that is characterized by widespread muscle and soft tissue pain. The aim of this research was to analyse the psychological disorders (axis one) in Fibromyalgia patients and frequencies of affective disorders, anxiety disorders and psychoses among them. In a descriptive study 61 patients (aged 16 to 67) suffering from Fibromyalgia were studied who were attending Imam Khomeini Hospital and Tooba clinic in Sari. Demographic questionnaire was applied and a structured SCID interview was conducted for identifying Axis One in DSM-IV-TR. The subjects were 98.4% female and 1.6% men. The frequencies of affective disorders and anxiety disorders were 34.4% and 65.65%, respectively. Among the subjects 30.3% were found with prominent anxiety disorder, 3.03% had dysthymia disorders, and 21.2% had pervasive anxiety. There were 18.8% with acute sensitivity, 16% phobic and 8% who suffered from stress after trauma. Psychotic disorders were not observed in Fibromyalgia patients. High frequencies of affective and anxiety disorders in Fibromyalgia patients calls for more researches in this field. On the other hand, these disorders could be cured, so, physicians should make an accurate diagnose of psychological disorders and provide appropriate treatment.

Statins are a group of drugs that prevent cholesterol building and reduce its concentration in blood by inhibiting the hydroxymethylglutaryl-coenzyme  reductase (HMG Ço r). There is evidence showing other properties including anti-inflammatory, anti-oxidant and anti-thrombotic effects of these agents. Some anti-osteoporotic effects have recently been added to these properties. However, these drugs have some side effects that mimic rheumatologic disorders such as lupus and myopathy. Ïn this review article, we are going to review the role of statins in rheumatologic disorders.

Heterotopic Ossification is bone formation outside the skeletal system. Endosulfan is a pesticide in organochlorines family and endosulfan poisoning can make neurologic toxicity with loss of consciousness, diffuse convulsion and status epilepticus. There are some reports about heterotopic ossification due to neurologic and poisoning events, but there is not any report of it after endosulfan poisoning in the literature.Case report: A 44 year old man, presented with pelvic pain and difficulties in walking. There was a history of status epilepticus and coma 4 months ago due to endosulfan poisoning. There was some heterotopic bone formation around hip joints in radiography. Because of high mortality and morbidity due to endusolfan toxicity and absence of any antidote, it is recommended that its availability be restricted and its toxicity be treated immediately specially for convulsion.

Background and Rheumatoid arthritis is a chronic inflammatory disease characterized by articular destruction and systemic complications. The aim of this study was to investigate the effect of bromocriptine on clinical and laboratory findings of rheumatoid arthritis. Ïn this randomized double-blind placebo-controlled cross-over clinical trial, 10 patients with rheumatoid arthritis were recruited. Âlthough these patients had consumed modifying anti rheumatoid drugs (DMÂRDs) and prednisolone, they did not show a satisfying response to the drugs. The patients randomly received bromocriptine or placebo for three months and after two weeks as a washout period during which none of the treatments were done, the second course of treatment was started with the alternative drug. Serum level of prolactin, erythrocyte sedimentation rate and clinical criteria of disease activity including the number of swollen and tendered joints, morning stiffness and consumption of analgesics were measured at the beginning and at the end of each course of the treatment. Âmong the patients enrolled in the study, two did not continue because of the side effects of bromocriptine. Ïn comparison with the placebo, bromocriptine was significantly more effective in reducing the severity of disease (P<0.05) and the use of analgesics (P<0.05). However, no clear decrease was observed in prolactin level and other clinical parameters.Çonclusion: This study showed relative improvement in the laboratory and clinical findings of rheumatoid arthritis with bromocriptine. Thus, more studies on this and other prolactin inhibitors in rheumatoid arthritis are recommended.

Background and

Based on the high prevalence of diabetes mellitus and hypothyroidism and different disorders from their coincidence, the present study was designed to determine the correlation between type 2 diabetes mellitus and hypothyroidism.

Ïn this case-control study, 103 type 2 diabetic patients were compared with 103 healthy subjects. Âge, gender and family history of thyroid disease were matched between the two groups. For all patients, anti-thyroid peroxidase antibody (Ânti-TPÔ), FBS, Triglyceride, Çholesterol, HDL and LDL were measured. Descriptive analysis, T-test and X2 were used for data analysis.

Ïn each group, 14 (%13.59) cases were men and 89 (%86.4) cases were women. The prevalence of hypothyroidism in the case group and the control group were %17.5 and %26.2, respectively, which was not statistically significant (P>0.05). Twenty eight percent of hypothyroid patients in diabetic group and 55% in the control group had autoimmune hypothyroidism (P<0.05).Çonclusion: The results of this study showed that the prevalence of hypothyroidism in type 2 diabetic patients is as high as normal population. Because of the interaction between diabetic mellitus and hypothyroidism, screening of hypothyroidism and suitable treatment in diabetic patients is recommended.

Background and Rheumatoid arthritis (RA) is an autoimmune-inflammatory disease that may lead to joint destruction and disability. The purpose of this study was to evaluate the influence of life style، reproduction، and some external factors on the development of rheumatoid arthritis. This is a case-control study، comprised of 184 cases and 184 controls. Possible etiological factors were collected by questionnaire. All variables were analyzed by T test and X2 (SPSS version 17) and P value <0. 05 was considered significant. Odds Ratio (OR) for possible environmental factors was calculated. There were no difference in age، smoking، asthma or allergy history، trauma، vaccination، parent death before puberty and living in city between RA patients and controls. Divorce was significantly more common in RA (P= 0. 04) and the level of education was inversely associated with RA (P= 0. 03) and OR=1. 69 (CI=1. 12 - 2. 55)، exposure to domestic animals and having more than three children were more common in RA but these differences were not statistically significant. In most of the RA patients، the onset of the disease was winter (P= 0. 02). Divorce and low education levels were associated with RA. Because of higher prevalence of RA in winter، more studies on the association of winter environmental factors and RA are recommended.

There are many studies about statins showing that these drugs have some anti-inflammatory and immunomodulatory effects and might reduce inflammatory markers in rheumatoid arthritis. The aim of this study is to evaluate atorvastatin effect on clinical and laboratory markers in rheumatoid arthritis. Patients and This study is a randomized, double-blind, clinical trial carried out from March 2005 to July 2006. 66 patients with active rheumatoid arthritis who had been referred to rheumatology clinic in Hazrat Rasool-e-Akram Hospital were selected and divided into two groups to receive atorvastatin or placebo in a double-blind manner. The two groups were similar in terms of disease duration and activity and anti-rheumatoid therapy. 32 patients received atorvastatin and 34 patients received placebo. Patient's data were recorded in the first visit and at the end of the 4th and 24th weeks of therapy. The mean age of the subjets was 51.84 years in atorvastatin group and 47 years in placebo group. Mean duration of the disease was 7.06 years in atorvastatin group and 7.8 years in placebo group. Except for morning stiffness in placebo group, no significant difference was seen in clinical and laboratory findings. This study showed no significant decrease in inflammatory markers in rheumatoid arthritis treated with atorvastatin.