Rheumatology Research Journal
Volume:9 Issue: 1, Winter 2024

Systemic lupus erythematosus (SLE) is one of the most heterogeneous systemic autoimmune diseases physicians manage. Despite therapeutic advances, the morbidity of SLE has remained considerable. All hopes for the future in this regard are pinned on targeting the interferon pathways, drugs that block B-cell function or T-cell function, Janus kinase inhibitors, also known as JAK inhibitors, and approaches involving stem cells or mesenchymal cells. New treatment recommendations clarifying anti-inflammatory and immuno-modulatory drugs emphasized the treat-to-target medical strategy, which combines low disease activity and low glucocorticoid (GC) exposure. Researchers support GCs at the lowest dose. The SLE patients need to take hydroxychloroquine. Biological medicines, including belimumab and anifrolumab, are prescribed based on disease stage and severity. To proceed with personalized therapy choices, we need a deeper understanding of biological pathways and specific disease-perpetuating components. New information from ongoing therapeutic studies and real-world data will assist in further clarifying the underlying multidimensional interrelations, bringing in a new era of precision medicine in lupus erythematosus that will benefit both patients and physicians. In order to determine the most effective therapy plan for lupus nephritis, rheumatologists and nephrologists should engage in close interdisciplinary communication. This review study will examine the most recent steps to deal with and treat this disease and future plans to help SLE patients.

Thyroid disorders have profound effects on body organs. This study was conducted aiming to examine the frequency of skeletal muscle manifestations in patients with thyroid dysfunction. The statistical population of this descriptive study was comprised of 200 patients with thyroid disorders referred to the endocrinology clinic of Rafsanjan University of Medical Sciences from March 21, 2018, to September 23, 2018, who were included in the study by census method. The research checklist included the information obtained from the complete physical evaluation of each patient's organs as well as the demographic characteristics. The Chi-square test and Fisher's exact test were used to analyze the data. The mean age of the examined patients was 39.25±14.43 years. Out of 200 patients, 23 (11.5%) were male and 177 (88.5%) were female. Joint pain was found in 121 people (60.5%), morning stiffness in 45 people (22.5%), limited joint mobility in 44 people (22.0%), adhesive capsulitis in 25 people (12.5%), carpal tunnel syndrome in 24 people (0. 12%), trigger finger disorder in 20 people (10.0%), and 2 patients (1.0%) experienced tarsal tunnel. No musculoskeletal manifestations were reported in 74 individuals (0.37%) suffering from a thyroid disorder. There was a significant relationship between musculoskeletal manifestations accompanying thyroid disorders and gender (p=0.001), level of education (p<0.001), and occupation (p=0.002). The findings of this study indicated the comorbidity of musculoskeletal disorders and thyroid dysfunction. Therefore, patients with thyroid dysfunction should be screened for musculoskeletal complaints and, if necessary, receive appropriate treatment.

Carpal Tunnel Syndrome (CTS) is characterized by median nerve entrapment in the wrist. CTS is diagnosed by clinical symptoms, which are confirmed by electrodiagnostic studies. This study aimed to assess median nerve cross-sectional area and elastography in chronic hemodialysis patients. This case-control study was conducted on end-stage renal failure (ESRD) patients undergoing hemodialysis at Rasool Akram Hospital's Dialysis Unit. The healthy companions of the patients were included as control group. An experienced rheumatologist used a supersonic device with linear array probes and dynamic scanners (5-22 MHz) to perform the sonography. The current study was conducted on both hands. There was no statistically significant difference between 30 patients and 30 healthy individuals regarding age, weight, and body mass index. The cross-sectional area of median nerve in both hands was increased in the dialysis group compared to the control group. However, it was significantly higher in the patient group's right hand than in the control group (P = 0.031). Considering the causes of ESRD and parathormone levels, the cross-sectional area and mean right and left median nerve elastography were not different between the two groups. The results showed that the patient group had a larger right and left median nerve cross-sectional area than the control group. However, the median nerve elastographic indices did not differ between dialysis patients and healthy individuals.

Rheumatoid arthritis (RA) can affect bone density. Given the significant risk of low bone mass density (BMD) in RA patients, the present study aims to investigate the BMD in these patients. The present cross-sectional study included 415 RA patients from the Rafsanjan Rheumatology Clinic. The patients were included in the study by census based on the inclusion criteria, which included a physician's diagnosis of RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, at least three months of disease history, and age between of 35 and 70 years. The BMD was measured using the dual-energy x-ray absorptiometry method in both the hip and the spine, and the RA severity was determined using the disease activity score-28 (DAS-28) index. The mean age of RA patients was 56.49 ± 11.73 years, with females accounting for 86.7% (300 people). The frequency of osteoporosis was 7.5% (26 people), and osteopenia was 43.6% (151 people) based on hip bone density, and 33% (137 people) and 38.1% (158 people) based on spine density, respectively. Age, fracture history, and DAS-28 score increased the probability of developing osteopenia or osteoporosis based on hip and spine bone density. According to the findings of a study in RA patients, increasing age, history of bone fracture, and DAS-28 score increase the probability of osteopenia or osteoporosis. Therefore, it is advised to pay close attention to the mentioned factors to prevent complications in these patients.

Systemic sclerosis (SSc) is a systemic connective tissue disease with vasculopathy and tissue fibrosis. Mean platelet volume (MPV) indicates the platelet activation and independent risk factor for arterial diseases. Long pentraxin, or pentraxin-3 (PTX3), is a homologous pattern recognition receptor mainly presented in inflammatory diseases with some inhibitory effects on chronic inflammation. This study aimed to evaluate the relationship between clinical and capillaroscopy manifestations of patients with SSc, MPV, and PTX3 levels compared to the control group. This case-control study was conducted on patients who met the SSc diagnostic criteria. Accordingly, clinical manifestations and capillaroscopy data were recorded. Thus, the MPV and PTX3 levels of the patients and the control group were checked. Then, the relationship between the clinical and capillaroscopy results was evaluated. The mean ± SD of MPV in the control group and patients was 10.11 ± 0.96 fL and 9.65 ± 1.13 fL, respectively (Pvalue = 0.043). In addition, the PTX3 level was 3.60 ± 8.98 and 1.79 ± 5.77 ng/ml, respectively (P-value = 0.223). The relationship of these factors with the clinical and capillaroscopy results was insignificant (P-value > 0.05). Based on the results, the MPV level was significantly lower in patients with SSc than controls, while the PTX3 level did not differ between the groups. Moreover, there was no relationship between PTX3 and MPV levels with the capillaroscopy and clinical results. However, further studies with larger sample sizes are recommended.

Adamantiades-Behçet’s disease (ABD) is a chronic, recurrent inflammatory disease with an unclear aetiology. Major and minor clinical signs characterize ABD. Major signs generally comprise oral and genital aphthae and skin and eye manifestations. Minor signs include joint, neurological, and gastrointestinal symptoms and vascular involvement. This work aims to compare the prevalence and clinical manifestations of ABD using available study results from Iran and Germany.This report is based on statistical data from Iran and Germany. A long-term study over 35 years from the Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, and a large German epidemiological study dealing with data from the German Registry for ABD and data on the disease in Europe are the information sources. Additionally, data from recent ABD studies listed in PubMed are used.Although the prevalence of ABD in Iran, with 80 patients per 100,000 inhabitants, is markedly higher than in Germany, with 4.2 patients per 100,000 inhabitants, the male-to-female ratio and age of onset are similar in the two populations. In Iran, the male-to-female ratio is 1.3:1, and the average onset age is 26 ± 11.3 years. In Germany, the male-to-female ratio is 1.4:1, and the average onset age is 27.7 ± 11.6 years. The incidence of the disease is decreasing, both in Iran and other parts of the world.Recurrent oral aphthae were the most common onset manifestation in patients of both Iran (82.7%) and Germany (84.5%), with ocular manifestations more common onset signs in Iran (8.7%) than in Germany (5.1%). Except for recurrent genital ulcers, which were more common in women in both countries, all other clinical signs – except oral aphthae – were more common in male patients in both countries. Minor clinical signs differed.A markedly different prevalence was observed in the study populations of Iran and Germany, with the disease being more common in Iran. However, despite the different origins, demographics and major clinical signs of ABD were similar in both countries. ABD is most frequently detected in young patients.

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

Bone mineral densitometry (BMD) is the most valuable method for assessing bone and calculating fracture risk. Serial or comparative bone densitometry is important in rheumatologists' work on osteoporosis management. The response or lack of response to osteoporosis treatment based on densitometry scans is crucial. This paper examines the timing of scan requests concerning the history of glucocorticoid use, renal or other solid organ transplantation, malignancy, and other situations discussed. We encountered four types of compared scans based on the centers where BMD was performed and the precision of the devices used for this survey: Same Center, Same Device (SSSD), Same Center Different Devices (SCDD), Different Centers Same Devices (DCSD), and Different Centers Different Devices (DCDD). We discussed the principles of comparison and the key indicators.