Rheumatology Research Journal
Volume:5 Issue: 4, Autumn 2020

Systemic sclerosis (scleroderma/SSc) is a rare, connective autoimmune multisystem disease with wide-reaching consequences. SSc is recognized by the presence of serum autoantibodies and fibroproliferative changes in the microvasculature which, in turn, results in too much accumulation of collagen fibres in the skin and internal organs. Gastrointestinal (GI) involvement is highly prevalent among SSc patients (seen in over 90% of cases). Altered GI function and subsequent nutritional disorders are common outcomes of SSc, affecting the quality of life (QoL) and possibly carrying an associated rate of morbidity and mortality. Disease-related malnourishment is also considered to have a detrimental effect on clinical outcomes. There is little information on dietary advice for SSc patients, and as GI complaints are risk factors for bad nutritional status, perceptive assessment seems to be necessary. As the SSc pathogenesis is yet to be explored, recent investigations have aimed to evaluate the effect of diet in terms of triggering or altering the course of the disease. The present review aimed to discuss current knowledge relating to the effect of nutrition on SSc pathogenesis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus which has led to a pandemic. There is no approved treatment for coronavirus disease 2019 (COVID-19). Over time, physicians came to understand that in some severe patients, glucocorticoids could be considered as a second line treatment option. As there are a limited number of reports addressing the use of glucocorticoids (GCs) in patients with moderately severe COVID-19, this article presents the results in patients who referred to our national team and received glucocorticoids as part of their medication. This descriptive and prospective study iincludes 35 clinically-diagnosed moderate to severe COVID-19 cases in outpatient and inpatient settings. Patients received intravenous dexamethasone, oral prednisolone, and pulsed methylprednisolone. Demographic data, clinical signs and symptoms, laboratory and chest CT findings of patients were recorded. On average Men comprised 60% of this group of patients. On admission Lymphocyte counts were depleted in a majority of patients (54.3%). Shortness of breath, O2 sat, and respiratory rate improved 48 to 72 hours after administration of glucocorticoids. Almost all patients had favorable clinical courses were improved during treatment with glucocorticoids, except one who had superimposed bacterial and candida infection. CT scan findings showed bilateral peripheral patchy infiltrations with ground glass opacities as the dominant pattern of lung involvement (60%). One patient was admitted to the intensive care unit. The results of our study showed that the administration of glucocorticoids in the early stages of COVID-19 disease is not only effective, but is also safe and prevents the progression of the disease.

Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread, long-term pain and multiple tender points revealed in physical examination. Previous studies about the relationship between serum vitamin D level and FM have reported paradoxical results. This cross-sectional study aimed to evaluate levels of vitamin D and its relationship with the severity of FM. Based on the American College of Rheumatology (ACS) criteria, 100 female patients with FM were enrolled in this study, and their serum vitamin D levels were screened. Vitamin D deficiency is defined as a level less than 12 ng/mL; insufficiency is defined as a level between 12–29 ng/mL, and sufficiency is a level equal to or greater than 30 ng/mL. Disease severity was evaluated by symptom severity scale (SSS) score and documented using designed questionnaires. Among the 100 female FM patients enrolled in this study, the mean patient age was 35.60 years; 47% of them had vitamin D deficiency, 36% had vitamin D insufficiency, and only 17% had normal vitamin D serum levels. Vitamin D deficiency was reported among 50% of patients with an SSS score between 9 and 12, 49% of patients with an SSS score between 5 and 8, and 14.3% of patients with an SSS score between 1 and 4. There was no significant correlation between patient age and vitamin D level (p-value=0.12). Moreover, no significant correlation was found between patient age and SSS score (p-value=0.36). The current study demonstrated that there was no statistically significant relationship between FM disease activity and vitamin Dserum level.

This study was designed to describe COVID-19 infection in rheumatic patients and to investigate possible risk factors for hospital admission and death related to COVID-19 infection considering the type of rheumatic disease and medications used to treat it. In this observational cross-sectional study, patients under follow-up in Kermanshah rheumatology units were investigated in a 6-month period between February 18 and August 22, 2020. Confirmed COVID-19 cases were collected. The following data were obtained: age, sex, rheumatic disease diagnosis, rheumatic disease medication (glucocorticoids, csDMARDs, ts/bDMARDs). Rheumatic patients were divided into two groups of hospitalized and non-hospitalized. The data from the two groups were compared. In total, 221 patients were enrolled in this study. Of these, 38 patients (17.19%) were hospitalized, and 9 patients (4.07%) died. No significant difference was observed between hospitalized and non-hospitalized patients except for vasculitis and prior use of Janus kinase inhibitors (Tofacitinib). A greater rate of hospitalized patients had vasculitis (6 (15.79%) vs. 1 (0.55%), p < 0.0001 ). A greater rate of them were on Tofacitinib therapy (2 (1.09%) vs. 0, p value = 0.03). A greater rate of patients who died used Tofacitinib (2 (22.22%) vs. 0, p value = 0.001) and Mycophenolate Mofetil (4 (44.44%) vs. 23 (10.85%), p value = 0.014). Hospitalization and mortality rates in rheumatic patients are comparable to the general population. A higher risk for hospitalization was observed only in vasculitis patients and users of Tofacitinib, and a higher risk for mortality was seen only in users of Mycophenolate Mofetil and Tofacitinib, though this finding should be interpreted with caution due to the small size of these subgroups. In conclusion, most rheumatic patients do not seem to be at higher risk for severe COVID-19.

It is thought that an excessive motor cortical facilitation is involved in the physiopathology of chronic pain in fibromyalgia. Studies have shown that transcranial direct current stimulation (tDCS) changes motor cortex excitability according to the stimulation polarity. Based on these effects, it is conceivable to hypothesize that tDCS, which can modulate brain activity, may induce pain relief in patients with fibromyalgia. Fifty older women with fibromyalgia were included in this randomized, doubleblind, single-center placebo controlled trial study. Patients received sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) and the cathode over the contralateral supraorbital area (2 mA for 20 minutes for 10 sessions). Pain intensity was evaluated using the visual analog scale for pain. Assessments were done before treatment and 30 days after the last session of stimulations. The mean age of participants was 58.20 years (SD = 7.80) with an age range from 55 to 74 years.Results showed no statistically significant baseline difference among patients in demographics and clinical characteristics. Comparing visual pain analogue between the sham and treatment groups revealed a statistically significant difference (p value < 0.001) for VAS immediately after intervention and 1 month post intervention between the sham and treatment groups. Analysis of data also showed a significant reduction in pain immediately after intervention and one month post-intervention in the treatment group compared to the sham group. Anodal tDCS is an effective non-invasive technique for pain reduction in elderly women with FM. The clinical improvements observed in the current study may have considerable impacts on pain experienced by elderly women with FM.

Multiple myeloma can have different clinical manifestations, and not all patients present with a classic CRAB component. The acronym CRAB stands for the following traits of multiple myeloma: C = Calcium (elevated), R = Renal failure, A = Anemia, B = Bone lesions (bone pain). We describe a 53-year-old man who was referred to our hospital with a complaint of a rapidly progressive purpura/petechiae on the lower limb and abdomen, and multiple lytic lesions in the skull and spine, and multiple fractures. We documented an increased presence of plasmacytes in bone marrow aspiration and multiple lytic bone lesions, which led to a diagnosis of multiple myeloma. Although multiple myeloma presenting with purpura/petechiae is uncommon, it must always be considered as a differential diagnosis with this clinical finding.

Amyloidosis is a rare condition that develops when an irregular protein called amyloid accumulates in the organs and interferes with their normal function. In conjunction with other disorders such as rheumatoid arthritis (RA) and psoriasis, amyloidosis may occur due to a chronic inflammatory process. With treatment of the underlying disease, amyloidosis can be addressed. Certain forms of amyloidosis can lead to life-threatening organ failure. In fact, it can involve the heart, kidneys, and nervous system. As the signs and symptoms can imitate those of more common illnesses, amyloidosis is sometimes ignored. Early diagnosis may help minimize additional injury to organs. Precise diagnosis is important because based on the individual case, care differs greatly. Herein, we present a patient who was referred to our hospital with some manifestations of RA and psoriatic arthritis (PsA) that were compatible with amyloidosis and discuss the treatment of this patient.