Tehran University Medical Journal

Background: Osteoarthritis (OA) is a degenerative disease that can cause pain and limited function. One of the non-surgical treatments is intra-articular ozone injection. This study aimed to compare the effect of ultrasound-guided corticosteroid injection with ozone injection in patients with grade 3 osteoarthritis of the knee.
Methods: This randomized, double-blind, clinical trial was carried out in 32 participants with diagnosis of grade 3 knee osteoarthritis were divided into 2 groups randomly. In one group 40 mg triamcinolone (1 cc) injected into the knee joint (under ultrasound-guided in suprapatellar pouch). In another group under sterile conditions, 10cc oxygen-ozone (O2O3), (Ozone generator, Hyper Medozon Comfort, Herrmann Apparatebau GmbH, Kleinwallstadt, Germany) (15 μg/ml) under ultrasound-guided (in suprapatellar pouch), injected into the joint. This study was carried out in Physical Medicine and Rehabilitation, Clinic of Hazrat Rasul Akram and Firoozgar University Hospitals, Tehran, Iran, from September 2017 to August 2018. Outcome instruments were WOMAC, clinical parameters of the knee (knee flexion), ultrasound index (suprapatellar pouch) and pain, visual analog scale, VAS). Measurements were done before, 1 week and 1, 3 months after treatment. All injections were done under ultrasound guide. All patients were trained to perform knee strengthening exercises.
Results: From 32 patients, 7 men and 25 women were enrolled in our study. The mean age of patients, in the steroid group was 58.50 and in the ozone group was 60.06 years. Recovery was significant after treatment in both groups (P<0.05). Our results showed that there was the improvement in VAS criteria in both groups before and after treatment but there was no significant difference between the two groups (P=0.261). There was no significant difference in the WOMAC score between the two groups (P=0.265). The recovery in one month after treatment, was in favor of the ozone group (P=0.008). There was no significant difference in ROM criteria and joint effusion between the two groups (ROM P=0.270, Effusion P=0.630), but in the ozone group, joint effusion was decreased (P=0.009).
Conclusion: Steroid and ozone injections has no superiority to each other in the improvement of pain, function, ROM, and effusion in patients with grade 3 knee osteoarthritis.

Background: Rheumatoid Arthritis patients are evaluated during treatment for various inflammatory factors such as C-reactive protein, Erythrocyte Sedimentation Rate, and Disease Activity Score, and other immune system-related factors. In the follow-up of patients with rheumatoid arthritis, hematologic factors associated with the immune system especially Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio are important. In this study, platelet to lymphocyte ratio and Neutrophil to lymphocyte ratio were compared in two groups of patients with and without ocular complications.
Methods: This cross-sectional study was performed on 246 patients with rheumatoid arthritis who were referred to the rheumatology clinic of Kermanshah from December 2018 to May 2019. This study was carried out in accordance with the approval of the ethics committee (IR.KUMS.REC1397.311) at Kermanshah University of Medical Sciences. Of these patients, 191 had no ocular complications and 55 patients had ocular complications and were matched for age and sex. The blood samples were taken from patients and blood cell count was measured by Sysmex KX-21 hematology analyzer. The Spearman correlation test was used to evaluate the relationship between platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in both groups of patients without ocular complications and with ocular complications. The Disease Activity Score was compared between the two groups using the Mann-Whitney test.

Background: One of the most important issues for patients with osteoarthritis is reducing pain and returning them to normal life. In addition to losing weight and improving daily activities, pain management treatments may be needed. One of these treatments is the injection of hyaluronic acid gel into the knee joint, which has been studied in this study.

Background: Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.
Methods: This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.

Results: Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control. Conclusion: Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

Results: The results showed that, 5083 genes had significant expression differences. Analysis of signaling pathways showed that antigen processing and presentation,  natural killer cell-mediated cytotoxicity, the, IL-17 signaling pathway, Th17 cell differentiation and cytokine-cytokine receptor interaction, as inflammatory pathways, were important in this disease. It was also determined that CH25H (upregulated in RA samples) and GYPE (downregulated in RA samples) genes can distinguish rheumatoid arthritis from osteoarthritis. Conclusion: Since accurate diagnosis helps with better disease treatment, it is very important to obtain new biological diagnostic markers. Overall, our data showed that genes can act as novel biomarkers with potential utility in the diagnosis of RA and OA and can be considered novel molecular biomarkers for the diagnosis of these two diseases.

Results: The average age of patients was 59.59±11.75 and most of them (74.3%) were women. Most patients (75.71%) with a normal to mild FIB-4 index stage had a normal to mild elastography stage. of patients had normal to mild liver fibrosis. FibroScan grade were not related to the age, gender, body mass index, methotrexate dose and duration of the disease (P>0.05). The average FIB-4 was 1.25±0.6, which was not significantly related to gender, body mass index, disease duration and methotrexate dose but directly related to the age of patients (P<0.001, (CL95%, 0.51-0.53)).The correlation between FIB-4 and FibroScan grade of the patients showed a positive association, which was not statistically significant (P=0.594, r=0.06, CL95%, -0.24-0.4). The FIB-4 in normal to mild grade was 85% rejecting the moderate to severe grade in FibroScan but none of them were statistically significant (P=0.146). Conclusion: Overall, the FIB-4 was incapable of predicting the FibroScan result. On the contrary, this case was also inconclusive and the results of FibroScan did not justify FIB-4 results of the patients. The FIB-4 cannot replace in RA patients. It is recommended to conduct future studies with a larger sample size in RA patients.

Background: This cross-sectional study aims to evaluate the association between patellofemoral joint alignment measurements and patellofemoral cartilage defects using MRI images.
Methods: A retrospective and cross-sectional study was conducted on 530 knee MRI images from Golestan and Imam Khomeini hospitals in Ahvaz, Khuzestan, Iran. The images were obtained from individuals experiencing non-traumatic knee pain and were selected based on their age, with subjects over 30 years of age being included in the study. This survey was conducted over the period from March 2023 to March 2024. The parameters of femoral groove angle (SA), femoral groove depth (SD), lateral patellofemoral angle (LPFA), tibial-trochlear tubercle groove distance (TT-TG), lateral patellar displacement (LPD), patellar inclination angle, and patellar height were evaluated. In addition, the Caton-Deschamps index and the degree of focal cartilage defect (from 0 to III) in the knee joint were evaluated.

Results: Regarding body mass index, 15.7% of the patients studied were underweight, 42.3% were of normal weight, 31.1% were overweight, 10.4% were obese, and 0.6% were extremely obese. There was a significant relationship between body mass index and patellar-lateral articular cartilage defects in the lateral tibia and lateral femur. There was a significant relationship between age and patellar-lateral articular cartilage defects in the lateral femur. There was a significant relationship between lateral patellar articular cartilage defects and lateral patellar dislocation, lateral patellofemoral angle, tibial prominence-skeletal groove distance, and patellar inclination angle. In addition, there was a significant relationship between medial patellar articular cartilage defects and knee groove angle. Conclusion: Patellofemoral misalignment is multivariately associated with knee articular cartilage defect. The results of this study will be of use to medical professionals, and the early diagnosis of knee osteoarthritis can prevent the development of the condition. It is recommended that similar studies and surveys be conducted in other provinces of Iran so that the statistical population is highly vulnerable.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by persistent inflammation, progressive joint destruction, functional disability, and systemic complications. Key inflammatory mediators, such as tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), play critical roles in disease progression and tissue damage. Mesenchymal stem cells (MSCs) have recently gained attention as a therapeutic approach for autoimmune diseases because of their abilities in self-renewal, immune modulation, and tissue repair. Considering the role of pro-inflammatory cytokines in the pathogenesis of RA, this study investigated the effect of autologous bone marrow-derived MSCs (ABMSCs) on the gene expression of TNF-α and IL-17A in patients with refractory RA.
Methods: The study utilized archived RNA from the research team's previous clinical trial. In this study, 13 patients with refractory RA who underwent MSC transplantation (MSCT) at an intravenous dose of 1×10⁶ ABMSCs per kilogram of body weight were evaluated at baseline and at 1, 6, and 12 months post-injection. Between November 2023 and March 2024, archived RNA samples were converted into cDNA at the Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Then, the expression levels of TNF and IL-17A were analyzed using SYBR Green-based real-time PCR.
Results: TNF-α gene expression declined significantly 1 month after MSCT (mean±SEM: 1.00±0.00 at baseline vs. 0.38±0.11 at 1 month, P=0.045). However, no significant differences were observed at 6 months (1.21±0.38) or 12 months (0.61±0.18) compared to baseline (P>0.05). IL-17A gene expression remained statistically unchanged across all time points (baseline: 1.00±0.00; 1 month: 0.87±0.31; 6 months: 1.19±0.42; 12 months: 1.79±0.92; P>0.05).
Conclusion: The results of this study suggest that ABMSCs may exert an anti-inflammatory effect by modulating TNF-α in patients with refractory RA. However, the findings related to IL-17A do not support the hypothesis that ABMSC injection exerts anti-inflammatory effects through modulation of IL-17A gene expression in these patients.