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Showing 29 results for Arthritis
Neonatal septic arthritis and osteomyelitis. Evaluation of risk factors
F Nili,
Volume 59, Issue 6 (11-2001)
Abstract
Neonatal septic arthritis and osteomyelitis is not prevalent in first month of the life in new borne children. According to anatomic specifications of bones in this period, the manifestation of disease is different from other periods of life and the disability induced, will be serious and permanent. In this investigation, 31 infants with the diagnosis of septic arthritis and osteomyelitis were studied during 10 years. Hyperbilirubinemia (58.1 percent), emergency cesarean (25.8 percent), umbilical vessel catheterization (26.6 percent), permaturity (12.9 percent), perinatal asphyxia (9.7 percent), scalp laceration (6.5 percent), omphalitis & previous bone fracture (6.5 percent) were the most common findings among predisposing factors. Previous hospital admission was detected in 19 patients (67.3 percent) and multiple bone involvements demonstrated in 12 (38.7 percent). From those who had risk factors, 42.3 percent had multiple bone lesions. Only 5 patients (16.12 percent) had no predisposing factors. The mean age for diagnosis and seeking admission were 23 and 30 days respectively and the mean age of diagnosis at surgery was over 72 hours in 15 (48.38 percent) cases. All with delaying in requesting admission had destructive changes in their joints. Knee and hip were most involved (77.3 percent). The most common microorganisms found in this study were staphylococcus aureus and klebsiella. Of all, 47 percent were gram negative & 53 percent gram positive microorganisms. Existence of risk factors and previous hospital admission in the majority of cases accompanied by microorganisms such as methiciline resistant S.aureus and klebsiella as a causative agents who were also resistant to empirical antibiotics demonstrated the role of nosocomial infections as an important cause of infection.
Blood antioxidant enzyme levels in patients with Rheumatoid Arthritis
Jalali M, Shahram F, Ariaeian N, Zeraati H, Sadeghi Mr, Akhlagy A, Zyaii N, Fatehi F, Chamary M,
Volume 64, Issue 8 (8-2006)
Abstract
Background: Rheumatoid arthritis (RA) is an autoimmune disorder with unknown etiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis. The aim of this study was to analyze the level of activities of catalase, glutathione peroxidas (GSH-Px), Super oxide dismotase (SOD) in patients with RA compared with the healthy subjects.
Methods: In a case-control study sixty rheumatoid arthritis patients 18-75 years old and 60 healthy sex and age-matched controls were selected, Catalase activity was measured by determining the constant rate (k) of hydrogen peroxide decomposition. GSH-Px activity of plasma was measured with spectrophotometer by Glutathione oxide generation due to GSH-Px. SOD activity is measured by degree of inhibition effect of SOD in generating super oxide radicals by xanthine and xanthine oxidase. C-reactive protein and rheumatoid factor values were determined by agglutination and latex tests.
Results: The plasma activity of catalase (p<0.001), GSH-Px (p<0.01), plasma level of hemoglobin and hematocrit (p<0.05) were significantly lower in patients with RA comparing with controls. The reduction in SOD activity was not significant (p>0.05). There was a negative significant relation between C reactive protein and Rheumatoid factor values with the erythrocyte activity of catalase and GSH-Px (p<0.01).
Conclusion: These results suggested that oxidative stress plays a very important role in the inflammation and pathogenesis of RA.
The comparison between monotherapy and combination therapy in Rheumatoid Arthritis
Khalvat A, Rostamian A, Najafizadeh S.r, Meisami A.p,
Volume 64, Issue 11 (10-2006)
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory condition. The condition can affected many tissues throught out the body, but the joints are usually most severely affected. The high incidence of RA, the conventional treatments and the experimental observation have shown by combination therapy, the disease symptoms of the patients reduce. To compare the efficacy and tolerability of single-agent Hydroxychloroquin (HCQ) with combination therapies composed of (HCQ) and Methotrexate (MTX) and (HCQ), (MTX) and Sulfasalazin (SSZ) in active rheumatoid arthritis patients with additive arthritis.
Methods: One hundred and twenty RA patients with active arthritis (male/female: 30/90) who were treated in rheumatology clinic between 2003 and 2005 were enrolled in this trial. Patients treated with (HCQ) alone(200 mg/day)were include in group (I), patients treated with combination of (HCQ) (200 mg/day)and (MTX) (7.5mg/week)in group (II),and patents treated with combination of (HCQ) (200mg/day),(MTX) (7.5mg/week)and (SSZ)(1 gr/day)in group (III), Forty patients (male/female:10/30) in group (I),(II) and (III)were eligible for statistical analysis at the end of study. Changes in variable were compared by the T-test.
Results: The combination of (MTX), (HCQ)and (SSZ) and the combination of (MTX) and (HCQ) were more effective regarding the clinical and laboratory parameters than (HCQ) alone (P<0.05). Moreover the combination of (MTX), (HCQ) and (SSZ) was more effective than the combination of (MTX) and (HCQ) (P<0.05). Combination therapies seem to be more effective and no more toxic than monotherapy in RA patients with additive arthritis.
Conclusion: Combination therapy with methotrexate, hydroxychloroquin and sulfasalazin is more effective than hydroxychloroquin alone or a combination of methotrexate and hydroxychloroquin in RA. We suggest starting combination therapy for the patients with early RA, when the diagnosis has been established.
The effect of stress on prognosis and treatment response in 100 Rheumatoid Arthritis patients
Hussain Khan Z, Mirazimi F, Najafizade S R, Pasha Meisami A,
Volume 65, Issue 5 (8-2007)
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease with several factors that contribute to its manifestation and continuation. One of the factors that initiate RA is emotional stress, which is in direct relationship with the sufficiency or insufficiency of the neuro-endocrine axis. Therefore, any stress that is not resolved in the neuro-endocrine axis might lead to RA and, as the stress continues, it causes the continuation of the disease. The aim of this study is to determine the effect of stress on continuation of RA and to find curative methods and, ultimately, the best method for treatment.

Methods: One hundred rheumatoid arthritic patients (80 females and 20 males), having a final diagnosis of RA based on the guidelines of the American College of Rheumatology and onset of disease within the last 12-36 months, were studied as case and control subjects. Data was collected using interviews and questionnaires that reflected their life events with stress as a serious factor in their disease. The patients were divided into two groups: group A with stable stress and group B with unstable stress. The same treatment method was given to both groups. The results of the treatment were evaluated and compared after two years of follow up.

Results: There was significant improvement in the patients in group B with unstable stress over that of the patients in group A with stable stress (P<0.0001).

Conclusion: The present study shows that a considerable number of RA patients suffer from serious stress that affects their clinical path and improvement, and is quite visible in the health indexes and continuity of the disease. The results further showed that stress can play an important role in the initiation and continuation of RA. Therefore, by identifying and making efforts to remove the stress factors using anti-anxiety drugs, the disease can be better controlled.


A 17-year study of septic arthritis in neonates in two University Hospitals
Amini E, Daneshjou Kh, Ghasemi M,
Volume 65, Issue 5 (8-2007)
Abstract
Background: Septic arthritis in neonates can be difficult to diagnose and may be associated with severe morbidity and even mortality. A majority of apparent septic arthritis cases may have a negative culture, thereby creating a dilemma regarding treatment. The present study investigates demographic, laboratory and clinical variables of septic arthritis in neonates hospitalized over a period of 17 years.
Methods: The medical files of all neonates hospitalized in Imam Khomeini and Vali-e-Asr Hospitals in Tehran, Iran, from 1989 to 2005 were assessed and the files of 59 neonates with a diagnosis of septic arthritis were further evaluated. Variables such as age, sex, gestational age, birth weight, history of hospitalization, body temperature, involved joints, blood and joint fluid cultures, ESR, CRP, and WBC count were evaluated in this group of hospitalized patients. Results: Of the 59 neonates, 39 cases were male and 20 cases were female. At the time of hospitalization, 45.8% of the neonates were 20-28 days old and 52.2% were 10-20 days old, and 67.7% and 35.6% of cases had been preterm and had low birth weight, respectively. Histories of hospital admission were found for 30.5% of patients. The two most common joints involved were hip (30.5%) and knee (23.72%). The mean body temperature was 36.6oC. ESR was elevated in all patients (mean 85 mm/h) and CRP was positive in all cases. The WBC count was >15,000/mm3 in 39% of the neonates and was in the range of 10,000-15,000/mm3 for 47.4%. Blood and joint fluid cultures were positive in 51% and 91.5% of cases, respectively. The organisms isolated from joint fluid culture were Klebsiella (54%), S. aureus (37%) and E. coli (9%). Conclusion: Due to the rarity of septic arthritis in neonates and paucity of signs and symptoms, all neonates with a high index of suspicion should be examined carefully with septic arthritis in mind.
Heat shock protein 70 level of synovial fluid in rheumatoid arthritis versus osteoarthritis: a comparative study
Gharibdoost F, Samadi F, Taghipoor R, Akbarian M, Shahram F, Nadji A, Jamshidi A R, Davatchi F,
Volume 65, Issue 7 (10-2007)
Abstract

Background: Heat-shock proteins are part of a strictly controlled biological system that allows organisms to respond to environmental stresses. Different proinflammatory cytokines are present in the synovial tissue of rheumatoid arthritis patients. Such tissues respond to stress and induce heat-shock proteins. In addition, synovial cells are exposed to mechanical stress caused by joint motion. The effects of mechanical stress on the metabolism of the synovial cells may be substantial, even pathogenic. Heat-shock proteins are often implicated in the pathogenesis of rheumatoid arthritis. Here, we compare the levels of heat-shock protein 70 from the synovial fluid of rheumatoid arthritis and osteoarthritis patients.

Methods: Synovial fluid samples from 34 rheumatoid arthritis patients and 34 osteoar-thritis patients were analyzed for heat-shock protein 70 by an ELISA method. Statistical analysis was performed using independent T-test and one-way ANOVA. Differences were considered statistically significant at p< 0.05.

Results: The mean value of synovial fluid heat-shock protein 70 levels in rheumatoid arthritis patients was 156.30 ±128.51 and that of osteoarthritis patients was 14.98 ±11.58. The differences were statistically significant at p<0.0001. For seven rheumatoid arthritis patients suffering from mechanical knee pain, synovial fluid analysis revealed non-inflammatory effusion. The mean value of synovial fluid heat-shock protein 70 level in inflammatory synovial fluid of rheumatoid arthritis patients was significantly higher at 191±121.73 and that of non-inflammatory synovial fluid from rheumatoid arthritis patients was 21.93 ±10.06 (p< 0.05).

Conclusion: The level of heat shock protein 70 is higher in inflammatory arthritis than in non-inflammatory arthritis. Considering that patients with rheumatoid arthritis are known to have a hypertrophic synovial-lining layer, and that heat-shock protein 70 is known to protect cells against a variety of toxic conditions as well as apoptotic death, further research is needed to determine if heat-shock protein 70 induction is a sign of significant changes in the cellular and tissue metabolism or is actively participating in the pathogenesis of rheumatoid arthritis.


Evaluation of Rheumatoid Factor using ELISA versus Latex method: a cross sectional study
Khalvat A, Rostamian A, Najafizadeh S R, Movasseghi S,
Volume 65, Issue 11 (2-2008)
Abstract

Background: Rheumatoid factor (RF) is an IgM antibody against the Fc portion of IgG, which together form an immune complex. RF is an important criterion in the diagnosis of early-stage rheumatoid arthritis (RA) and prognosis of RA pathogenesis, as higher levels of RF indicate a higher possibility of more damage. Although 2/3 to 3/4 of patients that undergo ordinary standard tests and have final clinical diagnosis are also positive for RF, a 70-90% prevalence of RF among RA patients can be achieved, depending on the method of detection and the target antibody, IgG or IgM. In this study, we measured the frequency of IgG and IgM RF isotypes using the ELISA and latex agglutination methods and compare these results with those of a hospital control group, tested using standard methods, in order to determine the best method for the measurement of RF.

Methods: Of the patients referred to the Rheumatology Clinic of Imam Khomeini Hospital during 2005-2006, one hundred randomly selected rheumatoid arthritis patients, 75 females and 25 males, with classical or definite rheumatoid arthritis (defined by the criteria of the American College of Rheumatology), with a short disease duration of 12-24 months, underwent testing for RF using the latex method for IgM and ELISA for IgM-IgG. The healthy control group (75 females and 25 males) were tested for RF using the ELISA method for IgM-IgG. The variables were compared using the Pearson's chi-square test.

Results: We found that the measurement of RF among RA patients using did not differ significantly between the two methods. The immune complex in RA is mainly IgM. The positive IgM results in RF patients using two similar methods showed a significant relationship by Pearson's correlation co-efficient (r=0.60, p<0.001). In addition, comparison of the IgM and IgG RF by ELISA showed a weak correlation with low significance (r=0.10, p<0.001). In sum, this study showed a significant difference (r=0.24, p<0.001) between the IgM in RA patients and that in healthy people, who had no IgM or IgG RF.

Conclusion: Approximately 75% of confirmed RA cases had the IgM RF however, we found little advantage in using the one method over the other, nor was the measurement of IgG more useful than IgM as a diagnostic criteria.


Risk factors of knee osteoarthritis, WHO-ILAR-COPCORD study
Dahaghin S, Tehrani-Banihashemi Sa, Frouzanfar Mh, Barghamdi M, Norollahzadeh E, Gholami J, Faezi St, Davatchi F,
Volume 66, Issue 10 (1-2009)
Abstract

Background: To evaluate the association between age, sex, BMI, waist/hip ratio, smoking, religion, ethnicity, education and knee osteoarthritis.

Methods: Eligible subjects were randomly included from participants of Tehran COPCORD study, of whom 480 subjects with knee osteoarthritis were compared to 490 subjects without (case-control study). Using a questionnaire developed by COPCORD group (Asia & Oceania), we enquired about the risk factors of knee osteoarthritis i.e. age, sex, BMI, Waist/Hip ratio, religion, ethnicity, education and smoking. Knee osteoarthritis was defined using ACR criteria. Each knee was unit of analysis using GEE technique to evaluate these associations.

Results: Age (OR 1.096 CI95%: 1.091-1.1 P: 0.00) and sex (OR 2.85 CI95%: 2.49-3.28 P: 0.00) showed significant association with knee osteoarthritis. Overweight (OR 1.81 CI95%: 1.28-2.55 P: 0.00) and obesity (OR 3.3 CI95%: 2.34-4.66 P: 0.00) both showed higher risk for knee osteoarthritis. The association between waist/hip ratio and knee osteoarthritis showed an OR of 5.28, CI95%: 0.89-31.44 P: 0.07. However, this association was only borderline significant. People with different religion or ethnicity and smokers had no extra risks for knee osteoarthritis. Higher education is a protective factor for knee osteoarthritis as people who had university education compared to people with no/primary education showed a lower risk for knee osteoarthritis (OR 0.54 CI95%: 0.38-0.78 P: 0.00).

Conclusions: Our study confirmed that elderly, females, overweight and obese people are at higher risk to develop knee osteoarthritis as found in western societies. Higher education is a protective factor against knee osteoarthritis. Ethnicity, religion and smoking showed no extra risk of knee osteoarthritis.


HLA DR4 subtype relationship with rheumatoid arthritis: a study on Iranian patients
Jamshidi Ar, Tehrani Banihashemi Sa, Salari Ah, Taghipour R,
Volume 66, Issue 11 (2-2009)
Abstract

Background: There are several evidences that genetic factors besides environmental triggers have important role in initiating the rheumatoid arthritis (RA). The aim of this study was to investigate the association of rheumatoid arthritis with different subtypes of HLA DR4 in Iranian patients.

Methods: In an un-matched case control study, 110 rheumatoid arthritis patients (case) and 56 knee osteoarthritis patients (control) of outpatient clinic in Shariati Hospital were entered to the study. After blood sampling from case and control groups, DNA was isolated by using salting-out method and HLA DR4 and its subtypes were detected. Association of HLA DR4 and its subtypes with rheumatoid arthritis, rheumatic factor and clinical manifestations of diseases was evaluated.

Results: Eighty nine (80.9%) of rheumatoid arthritis patients were female and 21 were male. Thirty four of the RA patients (30.9%) and eleven subjects from the control group (19.6%) were HLA DR4 positive (p=0.12). The most frequent subtype of HLA DR4 in RA patients was 0404 and in control group was 0401 (p=0.03). There were not statistically significant association between HLA DR4 and age of disease onset, family history, morning stiffness and rheumatoid factor. Joint swelling and tenderness had association with HLA DR4 (p=0.04 and p=0.03).

Conclusion: Although there were no statistically significant association between rheumatoid arthritis and HLA DR4, but prevalence of this HLA was higher in patients than control. It is possible that in some ethnics, other HLAs may have role in pathogenesis of disease.


The prevalence of symptomatic hand osteoarthritis in Tehran: Community-oriented program for Control of Rheumatic Diseases- COPCORD
Saeideh Dahaghin , Ahmadreza Jamshidi , Seyed Arash Tehrani Banihashemi , Jaleh Gholami , Mohammad Hossein Forouzanfar , Masomeh Akhlaghi , Alireza Khabazi , Elham Noorolahzadeh , Mojgan Barghamdi , Bozorgmehr Arabzadeh , ,
Volume 67, Issue 6 (9-2009)
Abstract
Background: Osteoarthritis is the most common form of arthritis in the world. This study presents the evidence on the prevalence of symptomatic hand osteoarthritis in urban community. To add to the evidence on the prevalence of symptomatic hand osteoarthritis in urban community.
Methods: Inhabitants (age≥15 yrs) in 22 randomly selected districts (Tehran) participated in a Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) evaluating major rheumatic disorders, including osteoarthritis. Eventually, 10, 291 inhabitants completed a Questionnaire (75% response-rate). Trained interviewers asked participants whether they had had any pain, swelling, tenderness, or morning stiffness in the right/ left hand during previous seven days. Participants underwent a complete physical examination if they had any musculoskeletal complaint or extra-articular manifestation of rheumatic disease. Osteoarthritis was defined as presence of palpable nodules (Heberden’s/ Bouchard’s nodes, CMC1’s squaring), pain, tenderness, swelling, or a combination of them on that joint (DIP-PIP-MCP-CMC1). Clinical hand osteoarthritis was positive if at least one joint showed osteoarthritis.
Results: Symptomatic hand osteoarthritis was present in 2.8%(CI 2.3-3.4) (52.6% female, mean age 37.1±16.3). Prevalence was higher in females (4.3% vs. 1.3%, p=0.000) and increased with age (0.1% in people <30 versus 23% in people >70, p=0.000). The most common signs in the DIP, PIP and CMC1 joints were bony enlargement, followed by tenderness and pain on movement.
Conclusions: our study confirms the evidence of high prevalence of symptomatic hand osteoarthritis in an urban community. The prevalence, pattern of hand joints involvement and relationship with age and sex in this study performed in an Eastern community resemble those in Westerners, which calls for further attention by appropriate services.

Pediatric septic arthritis: a 10- year epidemiologic study in Imam Khomeini Hospital Complex
Ali Zamani , Seyed Reza Raeeskarami , Parvin Akbrai Asbagh, Zohre Oloomi Yazdi , Reza Matloob , Narges Zamani , Mamak Shariat ,
Volume 67, Issue 10 (1-2010)
Abstract

Background : Septic Arthritis is an acute infection of intra-arthicular space. Delay in diagnosis and in appropriate treatment may lead to prolongation of treatment duration and poor outcome. We decided to evaluate clinical aspects of this disease in our department pediatric department, Imam Khomeini Hospital complex, Tehran, Iran during a 10 years period.

Methods : In a retrospective cross-sectional study, 60 patients with age from 1 month to 14 year-old during 1996-2005 were evaluated. The demographics characteristics, clinical observations (signs & symptoms) and paraclinic values were gathered from medical records and analyzed with statistical tests.

Results : Pain and Swelling was seen in all, joint limited motion in 80% ( 50 cases) claudicating in 64% ( 38 cases), fever in 80% ( 48 cases), monoarticular disease in 80% ( 48 cases) and polyarticular one in 20% ( 12 cases) of them. Hip was most Common involved joint 62% ( 37 cases), elevated ESR was seen in all patients. CRP was positive in 85% ( 51 cases). Leuckocytosis was found in 65/8% ( 17 cases) of cases. In infectious cases, Staphylococcus aurous was responsible organism in 65.6% ( 16 cases), klebsiella in 12.4% ( 3 cases), Streptococcus pneumonia in 12.3% ( 3 cases), group b streptococcus in 4.1% ( 1 case), Hemophilus Influenza type b in 4.1% ( 1 case) of study patients. With therapy ESR was normalized in 64% ( 39 cases) and CRP was normalized in all patients.

Conclusions: In general, all children with complaint of fever, pain, and limited joint motion or claudicating should be suspected for septic arthritis.


The sonographic findings of subclinical atherosclerosis in common carotid arteries: Rheumatoid arthritis patients Versus control group
Rahmani M, Najafizadeh Sr, Sharegh H, Rahmat Sadeghi S, Ahmadinejad A,
Volume 68, Issue 6 (9-2010)
Abstract

Background: High Resolution sonography of common carotid artery is a safe method for rapid diagnosis of atherosclerosis in Rheumatoid Arthritis (RA). The purpose of this study was to compare sonographic findings of subclinical atherosclerosis in rheumatoid arthritis patients and control group and comparing the prevalence of atheromatous plaques and Intima- media thickness in arteries of the groups.

Methods: Fifty RA patients and fifty non-RA persons were evaluated in a cross- sectional, Descriptive study. The sonographic findings of common carotid artery of these two groups were compared.

Results: After analysis of the sonographic findings of common carotid arteries of 100 females in our study (50 patients with the mean age of 48.1y/o [23-61] and 50 control group with the mean age of 47y/o [23-61]), the prevalence of RA patients with atheromatous plaques was 32% and in control group was 6%. [OR=7.4, 95%CI=2-27.3, p=0.001]. The mean (SD) of the Intima- Media Thickness (IMT) in RA patients was 7.76 mm (1, 04) while in control group was 6.10 mm (0.95). From 38 RA patients with less or equal 5 joints involvement in hand radiography, 13.2% had atheromatous plaques and the mean (SD) of the IMT was 7.6 (±1.1) mm. From 12 patients with more than 5 joints involvement in radiography, 91.7% had atheromatous plaques and the mean (SD) of the IMT was 8.4 (±0.7) mm. [p=0.012].

Conclusions: Regarding higher prevalence of vascular problems in RA patients, screening and early diagnosis of vascular pathologies could be of value in reducing morbidity and mortality of these patients.


Correlation of quantified MRI, physical exam and knee radiography in patients with knee osteoarthritis
Yegane A, Mottaghi A, Moghimi J,
Volume 69, Issue 3 (6-2011)
Abstract
Background: Unlike quantified MRI, no correlation has been stated between radiologic findings and the clinical signs in patients with knee osteoarthritis. This study evaluates the relationship between quantified clinical signs including pain, restriction of movement, stiffness and structural changes with MRI and plain radiography findings. Methods: Eighty patients with knee osteoarthritis were successively recruited in the study in Rasole Akram Hospital from 2009 to 2010. Upon physical examination, quantified scales of pain and joint stiffness and limitation of movement were recorded and quantified findings of MRI and plain x-ray were reported during the paraclinical study. All the gathered data including the demographic characteristics of the participants were read to the statistical software. Results: In MRI study, pain was significantly correlated with knee effusion (P=0.008), osteophytes (P=0.006), meniscal degeneration (P=0.036) and subchondral cysts (P=0.044) as was joint stiffness correlated with chondral lesions (P=0.020) and meniscal degeneration (P=0.026). On the other hand, there were no relationship between pain and joint stiffness or limitation of movement in radiologic studies but significant relationships existed between radiologic findings with bone marrow inflammation (P=0.015), chondral lesions (P=0.022) and subchondral cysts (P=0.014). Conclusion: As shown in this study, MRI findings including chondral lesions, subchondral cysts and bone marrow inflammation were correlated with radiologic findings and osteophytes, subchondral cysts, joint effusion and meniscal degeneration were correlated with pain as were meniscal degenerations and chondral lesions were with joint stiffness. On the other hand, clinical findings (pain, stiffness and limitation of movement) had no correlation with radiologic findings.
Staphylococcal superantigens in synovial fluid of 62 patients with arthritis
Noorbakhsh S, Talebi-Taher M, Tabatabaei A,
Volume 70, Issue 1 (4-2012)
Abstract

Background: Determining the etiologic causes of septic arthritis is of the most importance. Goal of this study was to investigate presence of staphylococcal enterotoxins A, B, C and Toxic Shock Staphylococcal toxin-1 in the synovial fluid of patients with arthritis.

Methods: This cross-sectional study was performed in the Pediatric and Orthopedic Wards of Hazrat Rasoul Hospital in Tehran, Iran during 2008- 2010. Gram stains, conventional cultures, direct detection of soluble bacterial antigens were used to detect H. influenza, S. pneumonia, group B streptococci, and N. meningitidis while Latex particle agglutination test was used for staphylococcal supper antigens (by enzyme immunoassays) upon synovial fluid tapping of 62 individuals (5 mo to 16 yrs, mean=113.8 yrs). P<0.05 was considered statistically significant.

Results: Positive SF cultures (n=11): 5 positive cases of S. aureus 5 S. pneumonia 1 H. influenza, and 1 Klebsiella. Positive gram stains: 10% and positive LPA: 4%. Staphylococcal arthritis was diagnosed in 7 (39%) cases upon positive culture or positive gram stain. The most common type was TSST-1 (47%) and the least common was enterotoxin B (18%). Isolation of S. aureus (positive culture) was correlated to presence of enterotoxin A in synovial fluid but not to enterotoxins B, C or TSST-1.

Conclusion: Staph. aureus had a prominent role in arthritis. 47% of cases with negative culture for S. aureus had at least one type of staphylococcal super antigens in the synovial fluid. Searching for antigens of usual organisms or staphylococcal supper antigens could be helpful for diagnosis and


Intra-articular hyaluronic acid injections Vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain
Hashemi Sm, Madadi F, Razavi S, Nikooseresht M, Hassanzadeh Kiyabi F, Nasiripour S,
Volume 70, Issue 2 (5-2012)
Abstract

Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections.

Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology (ACR) for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid (Synocrom Forte® 1%) weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score (KOOS) self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis.

Results: The mean age of the patients was 60.68.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups (P<0.001).

Conclusion: It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA.


Prevalence and risk factors of osteoporosis in postmenopausal women with rheumatoid arthritis: a brief report
Aghaei M, Sedighi S, Behnam Pour N, Hezar Khani Sh, Jamshir M, Agh A, Shojaa M,
Volume 70, Issue 7 (10-2012)
Abstract

Background: Low bone mass is a serious health problem mostly seen in postmeno-pausal women with rheumatoid arthritis. The purpose of this study was to determine the prevalence of osteoporosis and some related risk factors in postmenopausal women with rheumatoid arthritis.
Methods: The data for this descriptive analytical study was extracted from the medical records of 98 postmenopausal women with rheumatoid arthritis who had attended the 5th of Azar Teaching Hospital affiliated to Gorgan University of Medical Sciences, in Iran, in 2009.
Results: The mean durations of menopause and rheumatoid arthritis were 9.39 and 5.13 years, respectively. The overall prevalence of osteoporosis was 13.3%. We found a significant correlation between age, disease duration, and duration of menopause with bone mineral density (P<0.05).
Conclusion: Our results indicate a high prevalence of osteoporosis at the lumbar spine of postmenopausal women with rheumatoid arthritis.


Epidemiologic investigation of juvenile rheumatoid arthritis: a ten-year study
Abdolreza Malek, Yahya Aghighi , Behnam Parvisy Parvisy , Seyed Reza Raeeskarami , Vahid Ziaee ,
Volume 72, Issue 3 (6-2014)
Abstract
Background: Juvenile Rheumatoid Arthritis (JRA) is the most common chronic pediat-ric rheumatologic disease. There is a wide range of variation in disease subgroup distri-bution and evolution according to different populations, environments and genetic pre-disposition. This study was designed to evaluate epidemiologic characteristics of JRA in Iran. Methods: A cross-sectional studies was performed on children suffering from JRA ac-cording to American College of Rheumatology during 10 year (2002-2011). Patients' data was recorded in hospital questionnaires Patients' age at the first presentation and time of diagnosis, sex, ethnicity, early clinical and constitutional presentations, joint in-volvement pattern and presence of associated diseases were evaluated. Results: In this study, 171 children (91 boys and 80 girls) were enrolled. The mean age of patients was 5.2±3.5 years at the time of presentation and 5.7±3.6 years when the diagnosis was confirmed. The most common type of disease was polyarticular arthritis (41.9%). The prevalence of pauciarticular and systemic onset subtype were 31.6% and 19.3%, respectively. According to ethnicity, the most common incidence was seen in Fars and Turk populations respectively. The most common constitutional presentation was fever. Fever and morning stiffness was significantly higher in polyarticular pa-tients. Extra articular manifestation was seen in 40.4% patients. Among extra-articular manifestations, skin involvement was seen more than others. There was no correlation between sex and type of chronic arthritis. Uveitis was detected in 5.8% of our cases. The mean age was significantly higher in polyarticular group (6.04 year) in comparison to pauciarticular and systemic group (4.4 year in both groups) (P= 0.005). There was no correlation between sex and type of chronic arthritis. Conclusion: The prevalence of JRA subgroups was different in Iran comparing with western countries and polyarticular disease was the most common subgroup in this study. Uveitis was less common in this study in comparison to studies in other coun-tries. There is no sex predilection in each subgroup of JRA.
The prevalence of metabolic syndrome in psoriatic arthritis patients, a hospital‐based cross-sectional study on Iranian population
Fatemeh Shirani , Siamak Khaleghi , Mehrdad Nikfam , Ali Pourmojarab,
Volume 74, Issue 8 (11-2016)
Abstract

Background: Psoriasis is a T-cell mediated chronic inflammatory disorder with multiple skin, nails and joints involvement. The reported prevalence of psoriatic arthritis varies from 5 to 42 cases per 100 psoriasis patients. Insulin resistance is believed to be central to the pathogenesis of metabolic syndrome, a constellation of major risk factors for cardiovascular diseases, including atherogenic dyslipidemia, truncal adiposity, hypertension and hyperglycemia. The association of psoriasis and psoriatic arthritis with metabolic syndrome is increasingly being reported. Although the literature relating psoriatic arthritis to metabolic syndrome is accumulating, there is still a paucity of evidence, especially from Asia. Here, we examined the prevalence of metabolic syndrome and its components in patients with psoriatic arthritis.

Methods: The study was performed among outpatients attending the specialty clinic and rheumatology ward of Rasoul-e-Akram general hospital between January 2014 and April 2015. A consecutive sample of 80 patients diagnosed as having psoriatic arthritis was studied. Age, gender, body mass index, blood pressure and waist circumference, and history of smoking of patients were measured and asked at the enrolment visit. Venous samples were taken after 8 h of overnight fasting for the estimation of serum lipid profile, glucose and uric acid levels. Also an ultrasonographic examination was done for detection of non-alcoholic fatty liver disease.

Results: 46 patients (57.5%) were male and 34 patients (42.5%) were female. Mean age of the participants was 43 years (SD: 11.3). The prevalence of abnormal components of metabolic syndrome was 53.8% for BMI, 48.8% for TG level, 50% for HDL, 46.3 for LDL, 45% for Cholesterol, 23.8% for FBS, 46% for waist circumflex in men and 47.7% in women and 42.5 for uric acid. 40% of the patients had abnormal SBP and 41.2% had abnormal DBP. Thirty percent of the participants were current smokers and 43.8 had NAFLD on ultrasonographic examination.

Conclusion: 51.3% of patients had metabolic syndrome according to the adult treatment panel III criteria for adult Asian patients.

Comparing new diagnostic criteria of 2010 ACR/EULAR with 1987 ACR criteria in rheumatoid arthritis
Fatemeh Shirani , Farhang Soltany-Bajestani ,
Volume 74, Issue 10 (1-2017)
Abstract

Background: Rheumatoid Arthritis (RA) is a chronic inflammatory disease presenting with inflammation, tenderness and destruction of the synovial joints, resulting in severe disability and early death due to complication of disease. Previous diagnostic criteria are not useful for identifying patients who need early treatment. Thus, new diagnostic criteria for faster diagnosis of disease are introduced in 2010. The aim of this study was to compared 1987 ACR (American College of Rheumatology) criteria and 2010 ACR/EULAR (European League Against Rheumatism) classification criteria for diagnosis of rheumatoid arthritis.

Methods: In this Cohort prospective study, patients with early arthritis were evaluated   according to the old and new diagnostic criteria and followed-up every two monthly for one year (2012-2013) in Hazrat-e Rasool University Hospital, Tehran. Inclusion criteria of this study were age more than 18 year and indefinite diagnosis of arthritis. For all of patients physical examination by expert rheumatologist was done and lab data include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-cyclic citrullinated peptide (Anti-CCP) and rheumatoid factor was requested. The sensitivity, specificity, positive and negative predictive values were then determined for each diagnostic criteria.

Results: In this study 104 patients including 28 males (26.9%) and 76 females (73.1%) with the mean age of 44.2±13.7 years were included. At the end of one year follow-up, 82 were diagnosed to have RA while other 22 patients were not categorized as RA. Sensitivity for ESR, CRP, Anti-CCP and rheumatoid factor in 2010 ACR/EULAR criteria was 52%, 19%, 48%, 28% and specificity for them was 45%, 71%, 27%, 79% respectively. Number of small and large joint arthritis were more in patients with Rheumatoid Arthritis (RA) rather than other arthritis (P=0.0001). Sensitivity and specificity for small joints involvement was 87% and 54% and for large joints involvement was 81% and 59%. The sensitivity, specificity, positive and negative predictive values for 2010 ACR/EULAR criteria were 65%, 40%, 81%, and 23%, respectively. The sensitivity, specificity, positive and negative predictive values for 1987 ACR criteria were 51%, 62%, 83%, and 25% respectively.

Conclusion: In comparison to the old diagnostic criteria, the new one has higher sensitivity and lower specificity.

Association between obesity types and anthropometric indices with rheumatoid arthritis disease
Mahshad Ali Karoosi , Farideh Shishehbor , Karim Mola , Meysam Alipour ,
Volume 77, Issue 5 (8-2019)
Abstract
Background: Obesity is one of the causes of onset and exacerbation of rheumatoid arthritis. However, limited studies have examined the association between body composition and severity of disease. The aim of this study was to evaluate the association between severity of rheumatoid arthritis with various types of obesity and the comparison of anthropometric indices between patients with rheumatoid arthritis and healthy subjects.
Methods: This case-control study was conducted on 95 patients (48.8±10.4 years) with rheumatoid arthritis as a case group and 95 healthy people (46±9.3 years) as a control group carried in Golestan Hospital, Ahvaz, Iran, from April 2016 to February 2017. Weight, height, waist circumference (WC), hip circumference (HC) and body fat percentage (BFP) were measured. The anthropometric indices were calculated. The disease severity was calculated according to disease activity score 28 (DAS28).
Results: There was no significant difference between two groups regarding their gender ratio (1:1), age (P=0.16) and height (P=0.58). The weight, body mass index (BMI), body fat (BF), WC, HC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and other obesity indices include a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body surface area (BSA) and Conicity index (CI) in patients with rheumatoid arthritis are significantly higher than healthy subjects (P<0.05). No difference in fat free mass was observed between two groups. Waist to height ratio and BAI compared with other indicators had the highest correlation with the DAS28 score. In addition, prevalence of obesity by waist circumference (82% vs. 61%), obesity by BMI (47% vs. 33%), and obesity by BFP (91% vs. 83%) was higher in patients with rheumatoid arthritis than healthy subjects. The risk of rheumatoid arthritis in people with central obesity by waist circumference (OR=2.92, 95% CI 1.50-5.70) was greater than obesity defined by BMI (OR=1.77, 95% CI 0.98-3.18) or BFP (OR=2.37, 95% CI 1.01-5.53).
Conclusion: The results of present study indicate association of rheumatoid arthritis disease severity with obesity types (especially central obesity) and anthropometric indices.
 

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