reza mansouri tabar

Methotrexate is an important drug for treatment of rheumatoid arthritis (RA) but is associated with adverse side effects on liver. In this study we evaluated the effect of silymarin on methotrexate induced hepatotoxicity and its analgesic effects in the patients taking this drug.

This study inclouded 58 patients with RA. Patients who had been treated with 2.5 mg methotrexate three times a week for six months were randomly divided into two groups of A and B. Group A received methotrexate and group B treated with 280 mg of silymarin tablets daily (two doses for 2 months) in addition to methotrexate. At baseline (before tests) and after two months, both groups completed the VAS (Visual Analogue Scale) questionnaire and Cr (Creatinine), BUN (Blood Urea Nitrogen), ESR (Erythrocyte Sedimentation Rate), Hemoglobin, WBC (white blood cell), PLT (Platelet) and the liver tests including ALT (Alanine Transaminase) and AST (Aspartate Aminotransferase) were evaluated. We used t-test for data analysis.

In the group B, ALT, AST and ESR, Cr and BUN decreased significantly. Also clinical signs of pain which were indicative of pain intensity were decreased.

Use of silymarin in the patients with RA reduced liver enzymes, liver toxicity and renal complications, which may be due to its antioxidant and cell membrane stabilization properties.

Pressure ulcers are localized damage to the skin and/or underlying tissue that usually occurs over a bony prominence as a result of pressure. The patient was a 60-year-old male who was admitted to the intensive care unit for 1 month due to decreased consciousness in February 2019. He had a Grade 4 pressure ulcer in the sacrum area measuring 15 cm × 15 cm with 4 cm deep and exudate secretion and discoloration of the ulcer to yellow (ancestral tissue) and necrotic tissue around the ulcer. The ulcer was first bandaged with the daily silver sulfate ointment, but no healing process was achieved. After the patient was conscious and transferred to the inpatient ward, the necrotic tissue was debrided and washed with normal saline every day. Then, the ulcer was coated with 2 g of sucralfate tablets (4 tablets of 500 mg) dissolved in 5 cc of distilled water and mixed with 15 g of silver sulfadiazine ointment and was finally bandaged with sterile gauze. The Pressure Ulcer Scale for Healing instrument was used to evaluate the ulcer healing process. After 40 days, the patient’s ulcer changed to a Grade 2 pressure ulcer measuring about 5 cm × 5 cm with pink color (granular tissue enclosed by epithelial tissue) on the skin.