seyedeh tahereh faezi

Behcet’s disease (BD) is a multisystemic, chronic and progressive disorder with a relatively high prevalence in Iran. Therefore, this study aimed to compare the vestibular function between Iranian BD patients and normal subjects using cervical vestibular- evoked myogenic potentials (cVEMPs) and video head impulse test (vHIT).

In this cross-sectional study, 44 patients with definitive BD in the inactive stage of disease and 30 age and sex matched normal subjects were evaluated via cVEMP and vHIT tests and dizziness handicap inventory (DHI). Then the parameters of the tests were compared between the two groups by statistical methods. Moreover, the effects of DHI scores and other contextual variables on the test results were examined.

In terms of the cVEMP test, the response rate and mean latency of p13 in the left ear were significantly lower, the amplitude of the cVEMP wave in the left ear and the amplitude asymmetry ratio were significantly higher in BD patients compared to normal subjects (p<0.05). Fifteen BD patients had abnormal amplitude and nine patients had abnormal latency of cVEMP responses. In terms of the vHIT test, the mean vestibule-ocular reflex gain of the left posterior semicircular canal and the mean gain asymmetry ratio of lateral canals were significantly higher in BD patients than in the controls (p<0.05).

the vestibular system of some patients with BD is disturbed and the results of this study indicate the presence of unilateral vestibular weakness in BD. So vestibular assessment can be helpful for these patients.

Behçet’s disease (BD) is a chronic multisystem disorder with the principal pathological finding of vasculitis, which may involve vessels of different sizes. The concurrence of small and large vessel involvement in BD patients is undetermined. The current study aims to evaluate small vessel involvement in BD patients with large vessel involvement. The study population comprised 35 BD patients with large vessel involvement (cases) and 35 BD patients without large vessel involvement (controls). Small vessel involvement was evaluated in all patients by capillaroscopy. Capillaroscopic findings were compared between the two groups. According to the capillaroscopic findings, all of our BD patients had small vessel involvement. The most prevalent abnormality was tortuosity (87.1%), followed by enlarged loops (58.6%) and avascular areas (51.4%). Capillaroscopy findings between the case and the control groups were not statistically different. There was a significant association between microbleeding and history of erythema nodosum (P-value = 0.015), tortuosity and a history of skin aphthosis (P-value = 0.015), architectural derangement and history of uveitis (P-Value = 0.029), the number of avascular areas and active oral aphthosis (P-value = 0.021), and architectural derangement and increased ESR (P-value = 0.011). There was no difference in nail fold folder involvement between BD patients with and without large vessel involvement; however, some capillaroscopic features were associated with some disease manifestations.

Behçet’s syndrome (BS) is a systemic vasculitis characterized by skin involvement, uveitis, and arthritis. Azathioprine is an effective therapy among other immunosuppressive drugs for this disease but there is no clear data about all aspects of its side effects in BS patients with ocular manifestations. we want to determine the prevalence and types of adverse effects related with azathioprine in ocular BS patients. the study is  cross-sectional with 165 confirmed diagnosis of BS patients who had ocular involvement. Data were collected retrospectively with medical records of the BS clinic. Of 165 enrolled patients, Adverse events of treatment with azathioprine occurred in 11 patients (6.67%). side effects included: elevated of liver enzymes in four patients (2.43%), hypersensitive reaction in 2 patients (1.21%), leukopenia in 2 patients (1.21%), nausea in 1 patient (0.61%), skin tumor in 1 patient (0.61%), and t pancreatitis and hepatitis in one patient (0.61). azathioprine reduced the rate of adverse effects and resolution of the ocular manifestations in patients with BS and has few side effects so, it is good choice to treat patients with BS.

 Behcet's disease (BD) is a chronic multisystem vasculitis with an unknown etiology. During the past years, several reports are published on the occult hepatitis B infection (OBI), the presence of hepatitis B virus (HBV) DNA in the absence of HBsAg, in rheumatic diseases.

 The current study aimed to, firstly, investigate the prevalence of OBI in patients with BD, and, secondly, its potential association with the clinical and therapeutic status of BD.

 HBV serological markers and HBV DNA were evaluated in 220 consecutive BD patients to detect OBI. Demographic and clinical data of OBI positive and negative groups were compared.

 The mean age of patients was 39.24 (± 10.57), and 134 (62.9%) were male. The mean disease duration was 14.13 (± 8.63) years. No HBsAg positive case was found, but HBV DNA was found in 19 (8.6%) patients. The median viral load value was 475.84 copy/mL. We compared clinical data of 10 OBI positive and 156 OBI negative BD patients with complete and accessible data. There was no difference between the two groups concerning demographic characteristics (age, sex, and disease duration), different clinical manifestations, or types of medications (immunomodulatory, cytotoxic, and corticosteroids).

 This is the first study showing a rather high prevalence of OBI among BD patients. We did not find any correlation between OBI positivity and different clinical manifestations, medications, or HLA-B51. Further studies are needed on a larger group of patients and by molecular HBV evaluation (as well as serologic) regarding this possible association.
 

Systemic lupus erythematosus is an autoimmune disease that involves several systems of the body. Due to the chronic nature of this disease, non-adherence with medication regimen can lead to deterioration of the disease and also misinterpretation of treatment results. The aim of this study was to determine the medication adherence of patients with Systemic lupus erythematosus.

In this descriptive study, medication adherence was investigated in 209 patients with SLE who were attending lupus clinic of one of the hospitals affiliated to Tehran University of Medical Sciences. The samples who had the inclusion criteria were entered into the study in a convenience and continuous manner. Then, they completed a demographic information form and MMAS-8. Data were analyzed by SPSS software using descriptive statistics, chi-square and ANOVA tests.

The results showed that 18.7% of patients had high adherence to medication regimen, so that 94 patients (45.0%) had low adherence and 76 patients (36.4%) had moderate level of adherence to medication. Also, there was no significant relationship between the demographic and clinical variables of patients and their medication adherence.

Due to the low and moderate medication adherence of patients with Systemic lupus erythematosus, it is necessary to take measures to increase the medication adherence among these patients. It is also necessary to provide patient education by nurses and physicians in the clinic and to pay attention to this issue in medical and nursing programs.

Systemic lupus erythematosus (SLE) is an autoimmune, autoinflammatory disorder in which genetic factors have been implicated in the etiopathogenesis of the disease. Elevated levels of vascular endothelial growth factor (VEGF) have been reported in patients with SLE. This study intended to evaluate the association of VEGFA gene rs833061 and rs2010963 single nucleotide polymorphisms (SNPs) with the risk of SLE susceptibility in the Iranian population.

In this case-control study, 400 SLE patients and 400 age-, sex-, and ethnically-matched healthy controls were recruited. Genotyping of VEGFA gene rs833061 and rs2010963 polymorphisms in both SLE and control groups was done through the real-time PCR allelic discrimination technique.

It was detected that none of the alleles nor genotypes of both rs833061 and rs2010963 SNPs had a statistically significant difference between patient and control groups. Moreover, the haplotypes were not associated with the SLE susceptibility. However, rs833061 and rs2010963 polymorphisms were in linkage disequilibrium according to Dꞌ= 95 %, but not according to the r2= 42%. The associations between rs833061 (C vs. T: OR= 0.98, 95% CI= 0.80-1.20, P= 0.87) and rs2010963 (C vs. G: OR= 0.89, 95% CI= 0.73 - 1.09, P= 0.28) with risk of SLE were not significant. The clinical data of the patients, including anti-dsDNA (P= 0.036), anti-SSA (P= 0.039), and anti-SSAB (P= 0.036), were associated with the genotypes of VEGFA gene rs2010963 SNP.

We recognize that VEGFA gene rs833061 and rs2010963 polymorphisms did not affect SLE susceptibility in the Iranian population.

Osteonecrosis is death of bone tissue due to interruption of the blood supply. It can occur in autoimmune disease due to multiple mechanisms. It occurs rarely in some kind of multisystem disease such as Behcet’s disease (BD). The aim of this article is to present a case of BD with multifocal osteonecrosis.

A 26-year-old woman with oral aphthosis, panuveitis, and retinal vasculitis was diagnosed to have BD, and oral treatment of prednisolone (0.5 mg/kg/day) together with azathioprine (2 mg/kg/day) and intravenous (IV) cyclophosphamide (CYC) (0.75 g/m2) was administered for her. Prednisolone was tapered to 15 mg/day after 3 months. Because of unresponsiveness of eye involvement to traditional immunosuppressive therapy, infliximab (5 mg/kg)was started for her and IV CYC was discontinued. 4 months after initial therapy, she complained of her right shoulder pain. Regarding to shoulder pain, magnetic resonance imaging (MRI) showed osteonecrosis of right shoulder. After diagnosis of osteonecrosis, prednisolone was discontinued by herself. 3 months later, she complained of both knees, both hips, and right ankle pain. According to previous diagnosis of osteonecrosis of herright shoulder, MRI was done for all involved joints, which revealed osteonecrosis of all of them. After diagnosis of multifocal osteonecrosis, the following tests were done that all results were normal: anticardiolipin antibody (ACA) [immunoglobulin G (IgG), immunoglobulin M (IgM)], lupus anticoagulant (LA), anti-beta-2 glycoprotein 1 (antiB2GP1) (IgG, IgM), coagulation tests, and lipid profiles.

Bone infarction should be considered in differential diagnosis of patients with joint pain and without the evidence of arthritis; however, it rarely occurs in patients with BD.

Physical training, especially aerobic exercise combined with mental training by patients with Systemic Lupus Erythematosus (SLE), has numerous benefits, including tissue generation and enhanced anti-inflammatory activity. This study aimed at investigating the effect of ten-week aerobic-cognitive combined training on the serum levels of High Sensitivity C-Reactive Protein (HS-CRP), Anti-cardiolipin antibodies, Immunoglobulin G (IgG), Immunoglobulin M (IgM), and mental status of female SLE patients.

Eight female patients with SLE (with the Mean±SD age of 50±47.04 year and the Mean±SD BMI of 29.57±5.83 kg/m2) were randomly assigned to the experimental (n=5) and control (n=3) groups. The experimental group performed Brailletonik exercise, including aerobic (60-80% of Max HR) and cognitive training for ten weeks. The serum levels of HS-CRP, IgG, IgM, and mental status of the patients were evaluated in both groups before and after the training.

According to the results of 2×2 mixed Analysis of Covariance (ANCOVA), there was no significant effect of training on the serum levels of HS-CRP, IgG, and IgM (P>0.05), but HS-CRP and IgM level decreased in the experimental group by (42%) and (23.5%), respectively. The result of ANCOVA indicated the significant effect of training on mental status (P=0.005).

Physical combined cognitive training could be more effective in improving the mental status compared to a decrease in serum inflammatory factors of SLE patients.

Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10% of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography can detect cardiac involvement in patients suffering from SLE. We decided to determine the echocardiographic features and subsequent early diagnosis of cardiac involvement in patients with SLE utilizing the GLS index via speckle tracking echocardiography. In this cross-sectional study, we compared female patients with SLE of at least 2 years’ duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking echocardiography. After data collection in both groups, the GLS index and the ejection fraction were evaluated. We analyzed and compared the LV echocardiographic parameters of 33 patients with SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years). The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was significantly lower in the case group than in the control group (P=0.006). The LV GLS in the apical 4-chamber view revealed no significant difference between the case and healthy control groups (P=0.2). While there was a significant difference between the case and control groups vis-à-vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed no significant difference between the 2 groups (P=0.96). GLS speckle tracking echocardiography is a noninvasive method with diagnostic and prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and other cardiac involvements in patients with SLE.

Rheumatoid arthritis (RA) is a systemic autoimmune disorder causing irreversible joint damage. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression that degrade or translate inhibition of mRNAs. miRNAs can be used as therapeutic targets and predictive biomarkers in many disordres. This study was undertaken to investigate whether or not the expression of key elements in miRNA biogenesis, Drosha, DGCR8 and Dicer mRNAs is dysregulated in RA patients.
In this case-control study, 50 patients with RA and 50 age- and gender-matched healthy subjects participated. The peripheral blood mononuclear cells (PBMCs) were separated from the whole blood, the total RNA content of the cells was isolated and the first strand cDNA was synthesized. Quantitative analysis was performed through real-time polymerase chain reaction (PCR) using SYBR Green gene expression master mix to detect mRNA level expression of Drosha, DGCR8 and Dicer.
The expression levels of Drosha and DGCR8 were significantly downregulated in patients with RA in comparison with the healthy controls (P value = 0.043, P value = 0.000365, respectively). The expression level of Dicer was downregulated in RA patients when compared to the healthy controls, although the difference in expression was not significant (P value= 0.156). RA patients with a familial history of autoimmune rheumatic disease recorded significant overexpression of all three genes. Moreover, DAS28 was significantly correlated with mRNA exoressiom of Drosha, Dicer and DGCR8.
The data suggests that downregulated expression of Drosha, DGCR8 and Dicer mRNAs may be contributing to the pathogenesis of RA

Systemic lupus erythematous (SLE) is a multifactorial autoimmune disorder which affects many organs and displays various symptoms. Genetic components contribute to the incidence and development of SLE. A rare functional variant within the tyrosine kinase 2 (TYK2) gene (rs34536443) is a common genetic candidate for several autoimmune diseases, including SLE. This case control study was performed to investigate the possible association of TYK2 single nucleotide polymorphism (SNP) with a predisposition for and clinical features of SLE in the Iranian population.
Genotyping was conducted on 600 patients with SLE and 600 sex-, age- and ethnicity-matched control subjects from the Iranian population. Patient and control samples were genotyped for one SNP (rs34536443) by applying allelic discrimination real-time PCR.
Statistical analysis of the allele distribution revealed no significant association (OR = 0.67, CI: 0.38-1.17, P value = 0.163) between the rs34536443 C allele and susceptibility to SLE. The CC genotype was not detected in either the patients or controls. Moreover, the CG genotypes showed no significant association with the risk of SLE (OR = 0.66, CI: 0.37-1.72, P value = 0.15).
These findings suggest that TYK2 rs34536443 is not associated with SLE susceptibility in the Iranian population. Further investigation is required to examine the mechanisms by which polymorphisms in this gene lead to SLE development

We evaluated the effects of implementing Team- Based Learning (TBL) on student engagement, accountability, satisfaction, and preference for lecture or team-based learning. Moreover, we assessed the effect of TBL on knowledge retention and application over time through short answer questions based on clinical scenarios addressing history taking and diagnosis skills in medical students.
The study was conducted in a quasi-experimental design. The study population were all of the third-year medical students (n=84) participating in a course of rheumatology in Shariati Hospital, which is a teaching hospital affiliated to Tehran University of Medical Sciences. We compared TBL with the conventional lecture-based method. The assessments were performed after implementation of TBL by the Classroom Engagement Survey (CES) and Team-Based Learning Student Assessment Instrument (TBL-SAI). The assessment for application of knowledge was conducted in 3 time-points through short answer questions on rheumatic diseases. The comparison of results was made by Student’s t-test and repeated-measures analysis of variance (RMANOVA) using SPSS software, version 16.
The CES scores indicated a high level of engagement in TBL (Mean±SD=26.7±3.70, p=0.0001) but not in the lecture-based sessions (Mean±SD=23.80±4.35, p=0.09). The total mean score (SD) for TBL-SAI was 159.68 (14.14) for TBL sessions indicating a favorable outcome (p=0.0001). The student scores obtained from the short answer questions showed that over time the students’ scores had declined significantly less for the TBL sessions in comparison to the lecture-based sessions, F (2, 166)=4.624, p=0.011.
The results indicated higher student engagement, satisfaction and long term learning by TBL.

This study evaluated the effect of cognitive-behavioral therapy (CBT) compared with other treatments on improving the quality of life in rheumatoid arthritis (RA) patients. This study was carried out in a rheumatologic referral clinic at an academic hospital. RA patients were categorized in three subgroups: cognitive behavioral therapy group, educational therapy group, and conventional treatment as the control group. Quality of life was assessed with the Arthritis Impact Measurement Scales (AIMS-2) questionnaire. The CBT subgroup (n=30) received cognitive-behavioral treatment with 7 two-hour sessions twice a week; the educational therapy group (n=30) received education about nutrition and osteoporosis, while controls (n=30) received conventional RA medical treatment. Outcomes were gathered in 14 domains of AIMS-2 including activity, walking, pain, self-care, social activity, depression, and anxiety. The 90 studied patients comprised 72 female patients (80.0%) with a mean age of 41.7 years. The degree of improvement in physical activity (p=0.2), hand/finger function (p=0.18), arm function (p=0.28), social activity (p=0.6), satisfaction (p=0.05), household tasks (p=0.9), health perception (p=0.3), self-care ability (p=0.59) showed no significant difference between the three subgroups. Moreover, CBT was effective in improving mood, ability to walking and bend, working, reducing pain and tension, and these effects were independent of age, gender, or education. Additionally, education about nutrition in RA patients improved their ability to work and their mood, and it effectively reduced tension. Based on the findings, CBT is a recommended modality adjunct to RA medical treatment. CBT is specifically beneficial for patients with depressed mood, problems in walking, bending or working, and in subjects who are suffering psychosocial tension.

Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement. Patients with SLE feature a lower tendency to develop erosive arthritis in comparison with rheumatoid arthritis (RA); however, in some arthritis cases it may be difficult to differentiate SLE from RA. Anti-cyclic citrullinated peptide (Anti-CCP) antibodies are highly-specific for RA. The current study evaluated the relationship between anti-CCP and arthritis in SLE patients. In this study, anti-CCP antibodies were tested in 300 patients with SLE. The INOVA Diagnostics QUANTA Lite™ CCP IgG ELISA and the Axis-Shield Diagnostics Diastat™ anti-CCP ELISA test were applied. Patients were divided into two groups: those with and those without arthritis. Patients with chronic arthritis (>6 weeks) had radiography done on the involved joints. Chi square and Fisher’s exact tests were applied to compare the two subsets. Anti-CCP antibodies were detected in 4.7% of all patients (CI: 2.6-7.8). Anti-CCP was positive in 6.4% of patients with arthritis and 2.3% of patients without arthritis (P=0.09). From seven patients with chronic arthritis, one had both positive anti-CCP and erosions. In the studied Iranian SLE patients, anti-CCP levels were higher in patients with arthritis than in those without arthritis. This study did not show any association of anti-CCP with erosion in SLE patients with arthritis. Ethnic and geographical variance may have influenced the results. More studies on chronic arthritis in SLE are needed to confirm this hypothesis.

Systemic lupus erythematosus (SLE) is a chronic multisystem disorder. Lupus nephritis (LN) is a common serious complication of SLE. LN needs prolonged care and complex therapeutic modalities. This study assessed the characteristics of Persian SLE patients with LN (LN subgroup) and an SLE subpopulation without LN (non-LN subgroup). Furthermore, the association of LN with extrarenal manifestations of SLE was studied. This study assessed 2355 SLE patients from the electronic database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS). The clinical and laboratory data of enrolled patients was retrieved. The chi-square test was used to compare extrarenal manifestations of the LN and non-LN subgroups. Odds ratios (OR) were used to present the strength of associations. The LN subgroup included 1604 cases (68.1%) with a mean age at SLE onset of 24.6±12.5 years and a female-to-male ratio of 8.7/1. Class IV nephritis was the most common type of LN (53.1%). The comparison of extrarenal manifestations revealed statistically significant differences between LN and non-LN subgroups. Major organ involvement including cardiopulmonary, hematologic, musculoskeletal and neuropsychiatric features was significantly more common in LN patients. On the contrary, discoid rash was significantly more common in the non-LN subgroup. This study revealed that LN is positively associated with musculoskeletal, mucocutaneous, and neuropsychiatric features of SLE.

We aimed to evaluate the safety and efficacy of ANGIPARS™ in a phase 2 clinical trial.
This study was performed as a phase 2 clinical trial without a control group between May 2007 and September 2008 in the Iranian Rheumatology Research Center on a group of volunteer patients that were diagnosed with scleroderma. Patients with the diagnosis of diffuse or limited scleroderma without the involvement ofinternal organs were given 100 mg ANGIPARSTM capsules three times a day for 6 months, followed by 2 capsules a day for a further 3 months. Follow-up continued for a year. At the baseline, modified Rodnan score, pain severity and number of pitting ulcers, number of perioral folds, finger to palm distance, and open- mouth area were assessed in each patient. The measurements were repeated on a monthly basis and their change from the baseline was calculated. Possible adverse effects were monitored at regular monthly intervals through a complete set of laboratory tests and clinical examination.
Eleven patients including 10 females were recruited. The mean age was 39 years (SD = 10.2). No significant changes and no abnormality in laboratory measures were found during the study. Repeated measure analysis revealed a significant reduction in the modified Rodnan score (Mean reduction= 38%, P value ANGIPARSTM is efficient and safe for the treatment of the skin manifestations of scleroderma. Conducting a phase III placebo controlled randomized trial is recommended.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which mostly affects women of reproductive age. We evaluated the impact of pregnancy on maternal/fetal health, the pattern of organ involvements and the fare-up risk.
In a retrospective study we studied the thirty-year medical records of patients between 1976-2005. Maternal, neonatal and infantile health data was retrieved. Incidence of flare-ups, pattern of organ involvements and the outcome of pregnancy was analyzed.
We studied 155 pregnancies in 129 SLE patients. Mean age of patients was 27.0 ± 5.5 years (range, 16-44). Thirty one cases (20.2%) experienced flares in the course of pregnancy. During pregnancy, SLE disease activity index (SLEDAI) score increased in 92 (59.3%) patients (median increase = 6 scores). On the other hand, 38 cases (24.5%) SLEDAI score remained unaltered and in 25 cases (16.1%) SLEDAI score decreased (median decrease = 1). Mean SLEDAI during pregnancy were significantly higher than preconceptional scores (P-value = 0.002).Term delivery was more common in quiescent SLE (54.2% vs. 34.6%, P-value = 0.04). Number of therapeutic abortions was higher in active SLE (38.5% vs. 10.2% P-value = 0.003).
In this study increased SLEDAI and flare-up episodes were observed during pregnancy. However the majority of cases did not face major fetal or maternal complications.

Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. SLE as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups. Our SLE registry is one of the largest series in Asia-Pacific region.