فهرست مطالب kamila hashemzadeh

Sarcoidosis is a granulomatous disorder characterized by non-caseating granulomas in multiple organs and an unknown cause. This chronic inflammatory disease is heterogeneous in terms of manifestations, duration, and severity. Although its aetiology is not well understood, there are indications of the genetic basis and the involvement of specific microorganisms and vitamin D in the development of this disease. Sarcoidosis can affect individuals of any age; however, it is more commonly observed in young adults and middle-aged subjects. The clinical course of the disease is unpredictable; nevertheless, in general, it can manifest as pulmonary, cardiac, cutaneous, ocular, skeletal-muscular, neurological, and renal involvement. Pulmonary involvement occurs in most patients and respiratory failure is the most common cause of death associated with sarcoidosis. Although numerous biomarkers have been evaluated in recent decades for patients with sarcoidosis, the diagnostic method is complex and no single diagnostic test can confirm the disease. Future research should focus on the combination of biomarkers and more refined imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). By utilizing these techniques and markers, it may be possible to design diagnostic and therapeutic approaches. Corticosteroids are considered the mainstay of treatment for most patients. Moreover, novel therapies, including the administration of rituximab and repository corticotropin injection (a combination of adrenocorticotropic hormone analogs and other pituitary peptides [RCI, Acthar® Gel]), have been reported to be effective in some cases.

Recurrent oral ulcers constitute the most common complaint of patients with Behçet’s disease (BD) and recurrent aphthous stomatitis (RAS). Enhanced innate immune response and neutrophilic activity might be a possible etiopathogenesis of BD. This study aimed to determine the significance of salivary HNP 1-3 in BD and RAS patients and detect their correlation with different clinical presentations, disease activity, and characteristics of oral ulcers.This cross-sectional study included 25 BD patients and 25 RAS patients as well as 25 healthy participants. 5 cc of unstimulated saliva were collected and levels of HNP 1-3 were measured by ELISA. Other data were obtained through interviews, examination, and reviews of medical records. SPSS 25.0 was used to analyze the data.Salivary HNP 1-3 levels were not significantly different between the study groups (P=0.282). Duration of oral ulcers did not correlate with HNP 1-3 levels in RAS and BD patients (P>0.05). Also, BD patients with involvements other than oral ulcers were not found to have different levels of HNP 1-3 comparing to those who did not manifest these conditions.The validity of HNP 1-3 to be used as a probable biological marker for evaluation, diagnosis, and estimation of disease activity in patients with BD and RAS is still questionable due to our results.

Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis.

The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI.

While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis. Level of evidence: V

Charcot neuropathic arthropathy is a destructive process that can occur in patients with neuropathy associated with medical diseases such as diabetes. A rare cause of neuropathic arthropathy is congenital insensitivity to pain (CIP) which includes varying degrees of sensory loss and lack of pain perception contributing to absent withdrawal responses. The clinical manifestations of CIP include delayed diagnosis of fractures, joint dislocations, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification, and Charcot arthropathy. We herein report a case of Charcot arthropathy of ankle joints in a 5-year-old girl with CIP due to underlying hereditary sensory and autonomic neuropathy who had recurrent upper and lower limb fractures with acro-osteolysis. She had an inability to perceive pain from the first year of her life. She also had mild developmental delay. Family history was unremarkable. Blood count, liver and thyroid function tests, erythrocyte sedimentation rate, C-reactive protein, blood electrolytes, blood sugar and other laboratory tests were normal. Charcot neuropathic arthropathy in children is rare and can be a part of congenital diseases like CIP. A high degree of suspicion may lead to early detection and can prevent joint and bone destruction and deformities

Health care systems all over the world face numerous challenges as a result of the rapid spread of the COVID-19 virus that has resulted in increased mortality rates. About 40% of ICU-admitted COVID-19 patients were not severely ill at the time of admission. Thus, by using appropriate ICU admission predictors, clinicians can identify potential critical patients early on. It can also result in suitable resource allocation and consideration for these patients. Therefore, the current study was done with the aim of identifying clinical characteristics and laboratory data that could predict ICU admission in cases with COVID-19. This two-center retrospective observational study was done in Imam Reza and Ghaem Hospitals, Mashhad, Iran. Overall, 334 COVID-19 patients who referred to these hospitals from February to May 2020 were enrolled in this study. The participants were separated into two groups according to ICU admission status. All demographic, clinical, and paraclinical information were extracted from the medical records of the patients.  The present study composed of 88 ICU and 246 non-ICU-admitted COVID-19 patients. No significant differences were found in age between the two groups of patients (P=0.154). Multivariate regression analysis revealed that higher levels of CRP (OR=1.01, 95%CI 1.001-1.010, P=0.016), WBC (OR=1.11, 95% CI 1.01-1.22, P=0.03), and HRCT scores (OR=1.08, 95%CI=1.01-1.16, P=0.037) were linked to higher odds of ICU admission. This study suggests that higher levels of CRP, WBC, and LDH, as well as the HRCT score at the time of admission, were potential independent predictors of ICU admission during inpatient treatment in COVID-19 patients.

risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of usingcombined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumaticdiseases, there have been concerns that taking biological agents may have an additive effect on getting infected withCOVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected withSARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.

We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosedwith lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the diseaseand para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scanor polymerase chain reaction (PCR) of COVID-19.

Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) hadsystemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. Noassociation was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was asignificant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless ofthe type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered thechance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of diseasethan those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001),however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19.

This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those takingexclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factorswith the severity of COVID-19.Level of evidence: II

Systemic sclerosis (SSc) is an autoimmune rheumatic disorder characterized by vascular damage, sclerotic skin changes, and multi-system involvement of internal organs. Digital ischemic lesions, nailfold capillary abnormalities, and secondary Raynaud’s phenomenon are common manifestations of microvascular injuries. Recent findings have revealed that macrovascular involvement in SSc more prevalent than previously believed. There have been reports of large vessel involvement, such as the ulnar, femoral, carotid, renal, and pulmonary arteries. We report here a case of a young woman with progressive SSc who complained of lower limb pain, dysphagia secondary to esophageal dysfunction, and urinary incontinence.She had symptoms of Raynaud’s phenomenon, skin sclerosis, sclerodactyly, digital pitting ulcers,nailfoldcapillary abnormalities, and digital ischemia. On special examination, the anti-centromere antibody was detected. She developed bilateral popliteal artery occlusion as a complication of SSc.

Cutaneous Leishmaniasis is the most prevalent type of leishmaniasis. Iran is among the first six countries in the world with the highest annual incidence of cutaneous Leishmaniasis. Non-caseating granulomatous inflammatory cutaneous reaction is the most common pattern of its skin lesions. The current article presents the case of a 36-year-old man with a history of polyarteritis nodosa vasculitis with extensive caseating granulomatous lesions who was diagnosed with cutaneous leishmaniasis. Caseating granulomatous can present in cutaneous Leishmaniasis; thus, it is recommended to consider leishmaniasis in the diagnosis of this histological pattern, especially in autoimmune patients before starting immunosuppressive treatment.

Recently, several infectious agents including Epstein-Barr virus and Escherichia coli have been suggested as possible contributing factors to the pathogenesis of rheumatoid arthritis (RA). This study was designed to compare serum and synovial fluid markers of herpes simplex virus (HSV) and Helicobacter pylori of RA and osteoarthritis (OA) patients.This comparative study was conducted on two hundred OA and RA patients who referred to the Rheumatic Diseases Research Center (RDRC) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2015 to 2016. Synovial fluid was obtained from all individuals. Two years later, participants attended a follow-up session to collect blood samples for serum markers of these two infectious agents.Twenty-five patients (96.15%) in the RA group and 23 individuals (92%) in the OA group had positive serum IgG antibodies for HSV. As for Helicobacter pylori, 13 individuals (50%) in RA and 12 individuals (48%) had positive serum IgG antibodies (p value = 0.66). In addition, 9 (34.6%) and 8 (30.8%) in the RA group and 10 (40%) and 3 (12%) in the OA group had positive serum IgA and IgM antibodies for Helicobacter pylori, respectively (p value = 0.89 and p value = 0.13, respectively). Collected fluid samples were negative for both Helicobacter pylori and HSV1 and 2 DNA particles in all individuals.Based on the results of the current study, there is no difference between RA and OA patients in terms of Herpes simplex virus and Helicobacter pylori infection.

GCA (Giant cell arteritis) is a granulomatous vasculitis of large arteries. Frequently typical cranial symptoms are observed, but sometimes nonspecific extracranial involvements are dominant. Diagnosis of this “occult” or “extracranial” GCA as a medical emergency is crucial to preventing irreversible complications. The current article presents the case of a 52-year-old man with no cranial manifestations who developed acute peritonitis and died. Elevated inflammatory markers without cranial manifestations should cause extracranial GCA to be considered. Delayed diagnosis in GCA, especially the extracranial type, could lead to severe, irreversible complications.

The recent technological advancement has regrettably resulted in the preference of para clinical services over physical examination by physicians. This study is carried out to evaluate a new (remote learning) method for better instruction of physical examination skills to the first-year internal medicine residents as a sample of medical population and using available equipment.Materials &

 This Quasi-Experiment study was carried out on 11 first-year internal medicine residents in 2019. Residents initially were assessed in an Objective Structured Clinical Examination (OSCE) based on a standard checklist. Then, online learning resources in the form of videos from 7 common headlines of internal diseases were provided for one month. Residents were re-evaluated in the next OSCE.

 Comparison of the scores of all stations before and after the intervention showed that intervention has increased the average of total score of residents significantly. It should be noted that in all stations the difference was significant in all station (P<0/001) except the station of chronic bronchitis (P=0.243).

this study showed that using virtual learning resources can be a proper method for enhancing the level of competency in clinical examination of residents.

Systemic sclerosis (SSc) is a relatively common connective tissue disease, which is characterized by inflammation, progressive skin fibrosis, and injuries of small vessels, particularly in the lung and kidney. It seems that Helicobacter pylori (H. pylori) might contribute to the development of SSc as an extra-gastrointestinal autoimmune disease. We investigated the association between H. pylori infections and disease severity in patients with SSc.
Study design: This is a cross-sectional study.

Sampling method in this study was census method in such a way that all patients with SSc referred to Imam Reza Education and Research University Medical Center from May 2015 to August 2016 were included in the study. Finally, 74 patients were selected based on the inclusion criteria.Inclusion criteria were: 1. Definitive SSc based on  American College of Rheumatology/European League Against Rheumatism 2010 (ACR/EULAR) classification for scleroderma, which was diagnosed within the last two years. 2. Not taking any proton pump inhibitors. 3. Not taking any H. pylori treatment with a standard regimen within the recent 2 months. Disease severity was assessed and determined by two rheumatologists based on the Medsger's Disease Severity Scale (MDSS). H. pylori stool antigen was evaluated based on the test which sensitivity and specificity was proven. All obtained data were statistically analyzed by SPSS 16 using Fisher’s exact test Spearman correlation test (RSpearman).

 Forty one  (55.4%) of the 74 patients had positive stool antigens. We found a significant positive association between the severity of disease based on MDSS and titer of H. pylori stool antigen (p ≤0.001).

 This study reveals that H. pylori infection may play a significant role in the severity of organ involvement in SSc.

Recently, saffron (Crocus sativus L. from the Iridaceae family) has been characterized by its antioxidant, anti-inflammatory and analgesic effects. This study aimed to evaluate the effect of saffron on disease activity in patients with rheumatoid arthritis (RA). This is a double-blind, placebo-controlled, randomized clinical trial (RCT) performed on 55 newly- diagnosed RA patients without previous treatment, who were randomly divided into intervention (included 28 cases) and control groups (consisted of 27 individuals). Standard therapy including prednisolone, oral methotrexate, folic acid, vitamin D, calcium, and alendronate, was administered similarly in both groups.  Patients received a 100 mg saffron pill/day (pure saffron powder) or placebo besides the standard protocol. The placebo had the same shape as the saffron pills. Follow up of DAS28ESR disease activity score was done on the 30th, 45th and 90th day of the study. There was no difference between the intervention and control groups regarding to the DAS28ESR at the end of the study. However, a significant decrease in DAS28-ESR was observed in each group compared to the first visit (p=0.001). The results also showed no significant difference in the incidence of side effects in both groups. In summary, patients who received pure saffron pills (100 mg/day) in addition to standard therapy did not have a significant difference in improvement of disease activity from the patients on standard therapy.

The current study aimed at investigating the occurrence and features of olfactory dysfunction in patients with confirmed coronavirus disease 2019 (COVID-19) infection.   Patients with laboratory and clinically confirmed COVID-19 infection were enrolled in this longitudinal study. They were managed in either the inpatient or outpatient setting. The demographic, clinical, and outcome data were retrieved from patients’ medical records. Olfactory dysfunction features, including the onset pattern, duration, and recovery time were investigated. The visual analog scale (VAS) was utilized as a self-rating subjective measurement of olfactory function.   According to the results, the mean age of the patients (n=502) was obtained at 46.8±18.5 years; moreover, 52.4% and 47.6% of cases were female and male, respectively. It was also revealed that 35.4% and 64.5% of the subjects were outpatients and hospitalized, respectively. Based on the findings, 178 (38.4%) subjects had olfactory dysfunction. The mean values of VAS in hyposmic patients were estimated at 2.5±2.5, 8.3 ±2.1, and 9.4±1.6 at the first evaluation, in 2 weeks, and after 1 month of follow-up (p <0.001). The onset of olfactory dysfunction was more suddenly (58.7%). The majority of cases experienced olfactory dysfunction at the same time as other symptoms 72(51.1%). Based on the results, 0.4% of subjects infected with COVID-19 had olfactory dysfunction as an isolated symptom. The olfactory dysfunction was recovered after 2 weeks in 18 (25.3%) anosmic and 37(46.8%) hyposmic patients.   Olfactory dysfunction seemed to be an important symptom of COVID-19 infection. The occurrence of this disturbance as a transient self-limited condition was significantly higher among female subjects.

The current study aimed to assess the correlation between lipoproteins, in particular lipoprotein a [Lp (a)], and inflammatory activity in rheumatoid arthritis (RA). This retrospective case control study was conducted over a period of 6 months and studied two groups, RA patients (n=70) and healthy control subjects (n=52), who were matched by age and gender (P value<0.005). The modified Health Assessment Questionnaire (MHAQ) was employed by self-administration. Fasting lipid profiles including LDL, HDL, total cholesterol, triglycerides, and Lp (a) were assayed, and the findings for the two studied groups were compared using the Student t test. Thirty-two patients in the RA group (45.71%) and 27 subjects in the control group (51.92%) had abnormally high Lp (a) levels (P value=0.57). Mean serum Lp (a) values between the RA and control groups were significantly different (P value=0.79). Serum Lp (a) had no significant correlation with ESR (r=0.27, P value=0.028). No significant correlation was found between Lp (a) level and MHAQ (r=0.11, P value=0.37). Serum Lp (a) was also found to have no significant relationship with other laboratory parameters (CRP and RF) or clinical indices of RA activity (functional class and morning stiffness duration). No correlation was observed between serum Lp (a) and clinical/laboratory indices of RA activity other than a weak one with ESR. It is not recommended to use routine serum Lp (a) measurements to assess RA severity.

Cartilage oligomeric matrix protein (COMP) as a marker of cartilage destruction. We aimed to compare the effect of a mixture of avocado-soybean unsaponifiables versus celecoxib on the serum level of COMP in patients with knee osteoarthritis.

This was a randomized controlled trial and the patients with knee osteoarthritis were recruited from those who attended Imam Reza Hospital, Mashhad, Iran. The patients were divided randomly into two groups; Group 1 (n=30) received avocado+soybean mixture (300 mg daily) and group 2 (n=30) received celecoxib (200 mg/day) for 2 months. At the enrollment and then every month up to 2 months, the patients' venous blood samples were collected to measure serum COMP.

The total number of patients was 60 (male 38%, female 62%) with a mean age 56±7 years. Before treatment, the serum levels of COMP were 14.5±1.4 unit/liter (U/L) and 13.9±1.4 U/L in avocado+soybean mixture and celecoxib groups, respectively (P=0.052). After the first month the serum levels of COMP were 12.3±1.5 U/L and 12.8±1 U/L in avocado+soybean mixture and celecoxib groups, respectively (P

This case control study investigated the serum and synovial fluid adiponectin levels in 33 patients with rheumatoid arthritis (RA) and 26 patients with osteoarthritis (OA) as the control group.
A venous blood sample was collected from each patient in fasting condition to measure plasma adiponectin. At the same time, synovial fluid was aspirated aseptically from the swollen knee joint of all patients and controls. Blood and synovial fluid samples were centrifuged at 5,000 rpm for 5 min, then frozen and stored at -20 °C. For analysis of data, the independent t test, Mann-Whitney test, Kolmogorov-Smirnov test, Pearson’s correlation, and linear regression analysis were utilized.
Serum and synovial fluid adiponectin levels were significantly higher in RA patients than OA subjects (P valueThe present study revealed that adiponectin levels were increased in the serum and synovial fluid of RA patients compared with OA patients, and these levels may have a significant role in the pathogenesis of RA

Systematic lupus erythematosus (SLE) is a chronic and autoimmune disease that involvement of several target organs, at emergency department (ER) it is important to consider SLE as a cause for acute organ involvement. The aims of this study were to determine the cause for emergency visits in SLE Patients, focuses of Vasculitis.

Eighty one known SLE patients based on “1982 Revised American College Of Rheumatology SLE Criteria “who had visited the emergency department of Imam Reza hospital from June 2012-December 2014 having undergone a thorough physical examination by the emergency service and classified based on demographic and SLE related sign and symptom. We focused on vasculitis and non-vacuities groups.

In total 17.3% were diagnosed as vasculitis. In the vasculitis group cutaneous vasculitis (50%), thromoembolic events (7.1%) and cerebral vasculitis (7.1%) retinal vasculitis (7.1%) and aortic involvement was seen. the first three most common causes for ER visit in SLE patients were 1) SLE flare episode along with polyarthritis, mucosal ulcer and photosensivity. 2) Vasculitis 3) Renal involvement. Mean SLEDAI and SLICC scores were 22.79 (±13.29) and 1.95 (±1.46), respectively. Regarding SLICC parameters and their relevance to vasculitis ocular, renal, gastrointestinal and neuropsychiatric damage and diabetes mellitus were the most prevalent complications among the vasculitis group (p-value = 0.03, 0.01,

IgG4-positive plasma cell infiltration has been observed in patients with other conditions, including retroperitoneal and mediastinal fibrosis, inflammatory pseudotumor of the lungs and liver, Küttner tumors, and interstitial nephritis, indicating that these diseases and conditions collectively constitute a new disease concept known as "IgG4-related disease". The aim of this study was to present a case of a typical IgG4 syndrome.
Case Report: The case presentation involves a 33-year-old man with a soft tissue mass (3 × 4 cm) on the right side of his frontal area which had enlarged over the space of a year. He had not experienced any allergic disorder, weight loss, night sweating, or anorexia, and did not smoke or use illicit drugs. On examination his vital signs were normal. He had no complains of fever, rash or urticaria. The soft, round mass in the right side of the frontal area had no pain and tenderness, redness, or discharge for the year. Other examinations gave normal results. He was then referred to a rheumatologist.
In further laboratory work, high IgG4 level (119.6; normal range: 5.9-86) was detected and in histopathological studies, chronic inflammation, fibrosis, lymphomononuclear and eosinophilic infiltration with a dilated vascular network were reported.

Macrophage Activation Syndrome (MAS) is an aggressive and potentially life threatening disease which can occur in rheumatologic diseases, more in systemic juvenile idiopathic arthritis and less in adult onset Still’s disease. We presented here a 22-yr-old female who was admitted with high fever for 3 weeks before admission. According to physical and laboratory results and after ruling out infections and malignancies, she was diagnosed with adult onset Still disease.Despite treatment initiation and improvement, she became dramatically ill one week later and jaundice was created. In physical and laboratory data, high fever, pancytopenia and impaired liver function tests and increased serum ferritin levels were found. Bone marrow aspiration and biopsy showed active hemophagocytosis. She was diagnosed with Macrophage Activation Syndrome associated with adult onset Still’s disease and managed with high-dose corticosteroids and cyclosporine. After this treatment she completely recovered.

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.

Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. Some environmental factors can induce SLE in genetically susceptible individuals; for example, sun exposure and some viral infections may emerge the disease manifestations. Human T lymphotropic virus type 1 (HTLV-I) can dysregulate the human immune system, and the role of this virus in the pathogenesis of autoimmune diseases is under investigation. There are conflicting data about the role of HTLV-I in the pathogenesis of several autoimmune diseases such as SLE. In this study, we have focused on the correlation between HTLV-I infection and SLE in the northeast of Iran, an endemic area for the virus. One hundred and thirty women with SLE and 915 healthy controls were screened for HTLV-I by enzyme linked immunosorbent assay (ELISA). Western blot method was used for confirmation of the positive results done by ELISA in the patients and the control group. Two (1.5%) of the patients and 23 (2.5%) of the healthy controls were HTLV-I seropositive. There was not a statistical difference between patients and controls in the number of HTLV-I seropositive samples (P=0.49). This cross-sectional case-control study did not find any association between HTLV-I and SLE. With regard to the previous studies, these controversies may stem from differences in ethnic background. Geographical and environmental factors should also be taken into account.