The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis.

Introduction: Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. Material and methods: Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. Results: Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. Conclusions: These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.

Increased frequency of activated regulatory T cells in patients with lupus nephritis.

BACKGROUND AND OBJECTIVE: Lupus nephritis (LN) is one of the common manifestations of systemic lupus erythematosus (SLE), affecting the quality of life of patients. Abnormality in the adaptive immune response, such as T cell response, plays the main role in the pathogenesis of SLE and LN. In this study, we aimed to evaluate the role of different subpopulations of regulatory T cells (Tregs) and effector T cells (Teff) in LN patients and compare them with SLE patients. MATERIALS AND METHODS: A total of 48 participants were enrolled in this study and divided into 3 groups: (i) patients with SLE; (ii) patients with LN; and (iii) healthy controls (HCs). The frequencies of CD4+ CD25++ CD45RA- Foxp3hi activated Tregs (aTregs), CD4+ CD25+ CD45RA+ Foxp3lo resting Tregs (rTregs), CD4+ CD25+ CD45RA- Foxp3lo non-Tregs, CD4+ CD25+ Foxp3- Teff, and Tregs were analyzed in all subjects using a flow cytometer. RESULTS: LN patients had a significantly increased frequency of aTregs and Tregs compared with SLE patients (standardized mean difference [SMD] = 0.50; 95% CI [-0.26, 1.25]; p > 0.05 and SMD = 0.60; 95% CI [-0.16, 1.36]; p > 0.05, respectively). Patients with LN had a significantly increased frequency of Teff compared with SLE patients (SMD = 0.49; 95% CI [-0.26, 1.24]; p > 0.05). However, an increased ratio of Tregs/Teff was observed in LN patients compared with SLE patients (SMD = -0.25; 95% CI [-0.97, 0.48]; p > 0.05). CONCLUSION: Patients with LN showed immunoregulatory properties, in which both aTregs and Tregs had increased frequencies.

Risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs.

BACKGROUND AND OBJECTIVE: Patients with rheumatic disease taking long-term disease-modifying anti-rheumatic drugs (DMARDs) are expected to have a higher risk of infection due to the alterations in cellular immunity associated with these medications. However, the potential risks associated with these drugs remain unclear. This study aimed to estimate the risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. METHODS: Patients with autoimmune rheumatic disease taking DMARDs with or without long-term (> 6 months) HCQ treatment prior to the COVID-19 outbreak were selected consecutively. The diagnosis of COVID-19 was made based on the history of symptoms suggestive of the disease and/or serum IgG positivity. During statistical analysis, the risk of COVID-19 infection was calculated in rheumatic patients taking DMARDs versus controls, as well as in patients taking HCQ versus those who are not. The ORs and 95% CIs were also calculated. The participants in the control group were selected from individuals without RD. RESULTS: A total of 800 patients with RD and 449 controls were analyzed. COVID-19 infection was detected in 16.8% of rheumatic patients versus 17.6% of controls (OR 0.95; 95% CI 0.7-1.28). The proportions of COVID-19 infection in HCQ users versus non-users were 15.3% and 18.1%, respectively (OR 0.87; 95% CI 0.61-1.26). These results remained unchanged after adjusting for all covariates using logistic regression analysis. CONCLUSION: These findings indicate that rheumatic patients taking DMARDs are not at a higher risk of COVID-19 infection, and that HCQ therapy has no influence on the risk of COVID-19 infection. Key points • The risk of COVID-19 infection is not higher in patients with RD on DMARD therapy. • The prevalence of COVID-19 infection in HCQ users has not significant difference relative to non-users. • Significant percent of RD patients taking DMARDs had asymptomatic infection. • There was a positive association between leflunamide therapy and the risk of COVID-19 infection.

Effects of Rheumatoid Arthritis on the Larynx.

INTRODUCTION: The aim of the present study was to compare the videolaryngostroboscopic findings between patients with rheumatoid arthritis and vocally healthy controls. MATERIALS AND METHODS: This case-control descriptive study was performed on 113 people, including 50 patients with rheumatoid arthritis and 63 controls. The participants were subjected to videolaryngostroboscopic examinations in order to evaluate fundamental frequency, different structural vocal lesions, patterns of glottal closure, subglottal changes, supraglottis appearance, and movement patterns of the arytenoid cartilage. The obtained results were compared between the two research groups. Data analysis was performed in the Statistical Package for the Social Sciences, version 24.0. A p-value less than 0.05 was considered statistically significant. RESULTS: The results revealed a statistically significant difference between the two groups in terms of the complete pattern (P=0.00) and strained state of glottal closure (P=0.00), pattern of subglottal changes (χ2=25.98, df=2; P<0.001), and movement patterns of the arytenoid (χ2=21.16, df=1; P<0.001). Additionally, based on the obtained frequencies, the two groups showed significant differences regarding the normal state of the larynx (P=0.00), hypertrophy of vocal fold (P=0.007), epithelial change (P=0.007), and Reinke's edema (P=0.001). However, the videolaryngostroboscopic examination results revealed no significant difference between the two groups in terms of polyp (P=0.20), nodule (P=0.57), sulcus vocalis (P=0.08), cyst (P=0.45), and atrophy of vocal folds (P=0.45). CONCLUSION: It seems that rheumatoid arthritis affects the patterns of arytenoids movement, some kinds of glottal closure patterns, and subglottal changes. As the results indicated, the occurrence of some laryngeal structural changes was higher in patients with rheumatoid arthritis than in individuals without this disorder.

Isolated thrombocytopenia; A report of a rare presentation of childhood systemic lupus erythematosus (SLE).

BACKGROUND: Systemic lupus erythematosus (SLE) has various presentations in children. Hematologic abnormalities is common in childhood onset of SLE, however, isolated thrombocytopenia is relatively rare. Thus, we present a child with isolated thrombocytopenia as a rare presentation of SLE. CASE PRESENTATION: A 12-year-old boy with chief complaints of loss of appetite, weight loss, decreased platelet count (8000/µL) and lymph node enlargement was referred to our hospital. Biopsy of lymph node showed reactive lymphadenopathy. Investigations regarding infectious disease was negative. Platelet count remained low after low dose steroidned therapy. Antinuclear antibody (ANA) and anti-double stranded DNA antibody screening tests were positive with titer of 1/62 and 1/54, respectively. Therefore, juvenile SLE was considered as the final diagnosis and raising the dose of prednisolone to 2mg/kg/day was associated with increasing platelet count to 40000/µL and a week later to 96000/µL. CONCLUSION: The findings of this study indicate that in cases with isolated thrombocytopenia refractory to conventional dose of steroids, SLE should be considered. This study justifies serum ANA and anti DNA assessment in children with thrombocytopenia.

Three cases of alkaptonuria in one family in Mazandaran Province, Iran.

BACKGROUND: Alkaptonuria is a rare genetic disease leading to the accumulation of homogentesic acid in joint and ear cartilage, sclera and some other tissues causing significant morbidity in these patients. In this paper, we report three cases of Alkaptonuria among the family or household members. CASE PRESENTATION: A 51-year-old man with mechanical low back and knee pain was referred to Rheumatology Clinic of Babol University of Medical Sciences. The physical examination showed thoracic kyphosis and limitation of motion in thoraco-lumbar spine, severe knee osteoarthritis and blue-black discoloration of ear cartilages. There was intervertebral disc calcification in plain radiography, and mitral valve calcification in echocardiography. His urine sample was tested positive in Benedict's test. The diagnosis was confirmed by qualitative assessment of homogentesic acid (HGA) that was highly positive. In addition, we found two more cases of Alkaptonuria in his family. CONCLUSION: Although alkaptonuria is a rare disease, but it may be found in cluster among the family members.

Comparison of sensitivity and specificity of anti-CCP and anti-MCV antibodies in an Iranian cohort of patients with rheumatoid arthritis.

UNLABELLED: Background : Anti-CCP is a test commonly used for the diagnosis of rheumatoid arthritis. The aim of this study was to determine the diagnostic values of ACCP compared to anti-MCV in rheumatoid arthritis patients in north of Iran. METHODS: The serum samples of 150 RA patients and 75 controls, with the mean age of 49.6+11.8 and 48.8+12 years respectively, were tested using the commercially available ELISA kits for ACCP and anti-MCV. Sensitivity, Specificity were determined and Roc curve were used for comparison between these two groups. RESULTS: The sensitivity of ACCP versus anti-MCV was 85% and 81%, respectively. Specificity was 96% and 95%, respectively. In the RA patients, ACCP was positive in 127 (84.7%) and anti MCV in 121 (80.7%) cases. In the control group, these parameters were positive in 3 (4%) and 4 (5.3%) (p<0.0001 and p<0.0001, respectively). The correlation coefficient for ACCP and anti-MCV was calculated at 0.63 (p<0.001). The area under the curve for ACCP was 0.941±0.015 (p<0.001), anti-MCV was 0.902±0.02 (p<0.001). The measure of agreement (Kappa) for these variables was 0.81. In these patients, there was no correlation between DAS28 and the positivity of these tests. CONCLUSION: It was concluded, compared to ACCP, anti-MCV has approximately the same accuracy for the diagnosis of rheumatoid arthritis and it does not have additional value.

Squamous cell carcinoma of lung with unusual site of metastasis.

BACKGROUND: Lung cancer ranks among the most common and most lethal malignancies worldwide. Once vascular or lymphatic invasions occur, metastatic dissemination to distant sites is common. Bone, liver, adrenals, and brain are the most frequent sites of the distant disease. In this study we present a case of squamous cell carcinoma of lung with metastasis of the left knee bursa. CASE PRESENTATION: A smoker man presented with cough and hemoptysis and squamous cell carcinoma of lung was diagnosed. Fourteen months later he developed pain and swelling of left knee. The biopsy and pathologic examination of the left knee bursa showed involvement of the bursa. CONCLUSION: Squamous cell carcinoma of lung can metastasize in the unusual sites of the body.

Takayasu arteritis in a young female.

BACKGROUND: Takayasu arteritis is a granulomatous vasculitis which mainly involves the large arterial vessels. The disease is rare and it is more common in females aged between 15-30 years old. In this paper, we report a case of takayasu arteritis in Babol, north of Iran. CASE PRESENTATION: A 22 - year old female was admitted to the Department of Infectious Diseases of Rouhani Teaching Hospital due to anemia, high erythrocyte sedimentation rate (ESR), low grade fever and weight loss in the early summer of 2011. Her problems started four years ago and was hospitalized in another hospital and after full investigation, no diagnosis was found. Physical exam showed a vascular problem, then MRI angiography was done and showed an involvement of right carotid, abdominal aorta and right iliac arteries and the diagnosis of Takayasu Arthritis was confirmed. Prednisolone was administered, her fever subsided and ESR, CRP and hemoglobin were normalized. CONCLUSION: Takayasu arteritis should be considered in the differential diagnosis of patient with protracted low grade fever, anemia and dramatically elevated ESR in young female in order to prevent late complications of the disease.