Cigarette smoking and risk of adult-onset Still disease: a propensity score matching analysis.

BACKGROUND: Environmental factors play an important role in the pathogenesis of rheumatic diseases. Smoking is thought to be a risk factor for autoimmune rheumatic diseases. AIMS: The purpose of the present study was to assess the association between smoking and adult-onset Still disease (AOSD) and the effect of smoking on outcomes of this disease. METHODS: In this case-control study, patients with AOSD who met the Yamaguchi criteria, were older than 16 years at the disease onset and were in follow-up for at least 12 months were consecutively enrolled in the study. The outcome of AOSD was assessed by acquiring remission on treatment, remission off treatment, time to remission and rate of flare. The smoking status of participants was defined by direct or phone interviews. Individuals who had smoked daily for at least 6 months were defined as a smoker. We performed propensity score matching analyses by using four parameters, including age, sex, educational status and marital status. RESULTS: Propensity score matching resulted in 72 patients with AOSD and 216 matched controls. The number of ever smokers in the AOSD and control groups were 11 (15.3%) and 25 (11.6%) respectively. There was no significant increase in the risk of AOSD in multivariate analysis after adjustment for age, sex, marital status and educational level. There were no significant differences in the outcomes of AOSD between ever and never smokers. CONCLUSIONS: Smoking probably is not a risk factor for AOSD and did not affect the response to treatment.

Outcomes of undifferentiated peripheral inflammatory arthritis in real-world practice. A longitudinal cohort study.

OBJECTIVES: Undifferentiated peripheral inflammatory arthritis (UPIA) may have 3 different courses, including evolution to differentiated arthritis, remaining undifferentiated, and self-limited course. The purpose of this study was to provide a real-world evidence for predictors of outcomes in UPIA in a longitudinal cohort of patients. METHODS: Patients enrolled in the CTDRC-UA cohort were screened for eligibility. Inclusion criteria were: (i) having synovitis in ≥ 1 joint, (ii) not meeting the criteria of any other rheumatic disease, (iii) having at least 2 visits per year, iv) included in the cohort during the period of 2004 to 2021, and (v) having active disease at cohort entry. Two hundred and three patients who met the inclusion criteria were followed up until January 2023. RESULTS: Medication-free remissions occurred in 42 (20.7%) cases. In 24 (11.8%) cases, the disease met the criteria of other rheumatic diseases, of which rheumatoid arthritis (RA) was the most common. In addition, joint damage occurred in 33 (16.3%) cases. Predictors of medication-free remissions were absence of comorbidity, starting a sustained remission at ≤ 6 months, and having no flare. Factors associated with disease evolution to RA were anti-citrullinated peptide antibody (ACPA) positivity, non-adherence to therapy, not going into sustained remission and having flare. Delay in treatment for > 3 months and being ACPA positive were the predictors of joint damage. CONCLUSION: Although the majority of UIPA cases treated with step-up combination therapy with DMARDs do not progress to RA, most require continued treatment and a few achieve medication-free remissions. Key Points • Undifferentiated peripheral inflammatory arthritis (UPIA) can progress to rheumatoid arthritis in 11% of cases; and lack of sustained remission, being anti-citrullinated peptide antibody positive, non-adherence to therapy, and having flare are its predictors. • Medication-free remissions occur in 21% of patients with UPIA; and absence of comorbidity, starting a sustained remission at ≤ 6 months, and having no flare are its predictors. • Initiating treatment in the window of opportunity may lead to a better joint outcome.

Effects of Trigonella foenum graecum (fenugreek) on rheumatoid arthritis: a systematic review.

BACKGROUND: Adjuvant therapies especially medicinal plants have gained lots of attention nowadays and have been consumed all over the world for treating different diseases particularly rheumatoid arthritis (RA). Recent animal studies have indicated the benefits of fenugreek in RA and indicate that it may be a therapeutic candidate in RA; nonetheless, no systematic review is available about fenugreek and RA. This paper systematically reviewed the existing studies about fenugreek and RA and plausible mechanisms. METHODS: Databases including PubMed, Scopus, Web of Science, ProQuest, and the search engine Google Scholar were searched until May 2022 and search alerts were used to receive studies issued after the primary search. There was no restriction in time and/or language. No human and in vitro research was detected; thus, animal investigations were considered. Also, the citations or references of studies were searched for potential studies. Book chapters, review papers, and grey literature (e.g. conference abstracts, dissertations, and patents) were not included. RESULTS: Finally, 11 studies were entered in this systematic review. Animal investigations showed that fenugreek had favorable effects in RA and could control this disease via attenuating inflammation, suppressing oxidative stress, and displaying anti-arthritic activity. CONCLUSION: Current review provides potent evidences about the efficacy of fenugreek in RA and elucidates the significance of more clinical investigations. HighlightsFenugreek had favorable effects in rheumatoid arthritis and could control this disease via attenuating inflammation, suppressing oxidative stress, and displaying anti-arthritic activity.

Serum salusin-ß levels in patients with systemic lupus erythematosus.

OBJECTIVE: Endothelial dysfunction (ED) has an important role in the pathogenesis of systemic lupus erythematosus (SLE). Studies on other inflammatory diseases show that salusin-ß with various mechanisms may play a role in the promotion of ED and inflammation. The aim of this study was to measure serum salusin-ß levels in SLE patients and evaluate it as a potential biomarker in assessing SLE activity and predicting organ involvement. METHODS: In a cross-sectional study, 60 patients diagnosed with SLE and 30 age- and sex-matched healthy controls were enrolled. Disease activity of SLE patients was assessed by the systemic lupus erythematosus disease activity index 2000 (SLEDAI-2 K). Serum levels of salusin-ß were measured using a human salusin-ß enzyme-linked immunosorbent assay kit. RESULTS: Serum salusin-ß levels in SLE and control groups were 474.2 ± 117.1 pg/ml and 157.7 ± 88.7 pg/ml, respectively. The difference was significant (P = 0.001). There was no significant correlation between serum salusin-ß levels with age (r = - 0.06, P = 0.632) and SLEDAI (r = - 0.185, P = 0.158). In patients with nephritis and thrombosis, serum salusin-ß was significantly higher. In addition, in patients with serositis, serum salusin-ß was significantly lower. Multiple linear regression analysis showed that serum salusin-ß levels retained a significant association with nephritis and thrombosis after model adjustment for serositis, nephritis, and thrombosis. CONCLUSIONS: Our findings showed that salusin-ß might have a possible role in the pathogenesis of SLE. Salusin-ß may be a potential biomarker for nephritis and thrombosis in SLE. Key Points • Serum salusin-ß levels were significantly higher in SLE patients than the control group. • There was no significant correlation between serum salusin-ß levels with age and SLEDAI. • Serum salusin-ß levels retained a significant association with nephritis and thrombosis.

Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study.

OBJECTIVES: The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients. METHODS: Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5 mg/d for at least 5 years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis. RESULTS: One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108 months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1. CONCLUSION: In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission. Key Points • In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. • Median time to long-term remission was 8 months. • Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

Association between Serum α-Klotho Levels and Behçet Disease.

BACKGROUND: Endothelial dysfunction (ED) has a well-known role in promoting vascular inflammation in Behçet disease (BD). α-klotho is involved in regulation of endothelial function, and its reduction has been reported to be associated with ED. OBJECTIVE: To assess serum α-klotho in patients with BD, compared with healthy control individuals. METHODS: In a cross-sectional study, 55 patients with BD and 30 age- and sex-matched healthy controls were enrolled, and their serum levels of α-klotho were measured. RESULTS: Common clinical symptoms in patients with BD were oral aphthous ulcers, uveitis, and genital ulcers. Median (IQR) serum α-klotho levels in the BD and control groups were 0.30 (0.20-0.70) and 1.00 (0.70-2.52) ng/mL, respectively. The difference was statistically significant (P = .005). No significant correlation was observed between serum α-klotho and age (r = 0.194; P = .14). Serum α-klotho levels in patients with uveitis were significantly lower. CONCLUSION: α-klotho may have a role in the pathogenesis of ED and is a potential biomarker for uveitis in BD.

Effects of Quinoa (Chenopodium quinoa) on inflammatory mediators: a systematic review of preclinical studies.

The aim of the current systematic review was to gather the researches about the effect of quinoa (chenopodium quinoa) on inflammatory parameters interleukin-6 (IL-6), interleukin-1ß (IL-1ß), and tumor necrosis factor-alpha (TNF-α). Search was performed using PubMed, Scopus, WOS, ProQuest, and Google scholar databases without any restriction on language or publication date until July 2022 and search alert services were used to detect novel papers published after the initial search. Only 20 animal and in vitro investigations were eligible for this systematic review. According to in vitro researches and 8 of 14 animal investigations, IL-6, IL-1ß, and TNF-α level decreased remarkably after quinoa administration, which indicates the capability of quinoa in alleviating inflammatory factors. Quinoa is favorable but not yet a confirmed agent for alleviating systemic inflammation in inflammatory diseases.

Randomized double-blinded controlled trial on the effect of synbiotic supplementation on IL-17/IL-23 pathway and disease activity in patients with axial spondyloarthritis.

BACKGROUND: Interleukin 17 (IL17)-expressing CD4+ T cells and IL-17/IL-23 pathway play a key role in the pathogenesis of axial spondyloarthritis (axSpA). Synbiotics have been suggested due to their immunomodulatory effects in the treatment of autoimmune diseases. This randomized double-blind, placebo-controlled trial was designed to assess the effects of synbiotic supplement on IL-17/IL-23 pathway and disease activity in patients with axSpA. METHODS: Forty-eight axSpA patients were randomly allocated to use one synbiotic capsule or placebo daily for 12 weeks. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and ASAS-endorsed disease activity score-C-reactive protein (ASDAS-CRP). The secondary outcome was proportion of IL17-expressing CD4+ T cells, IL-17 and IL-23 gene expression, and supernatant levels of IL-17 and IL-23, which were measured at the baseline and end of the trial. RESULTS: A total of 48 patients were randomized into the synbiotic and placebo groups. Thirty-eight patients completed the study. Synbiotic supplementation significantly reduced the proportion of IL17-expressing CD4+ T cells (4.88 ± 2.47 vs. 2.16 ± 1.25), gene expression of IL-17 (1.03 ± 0.24 vs. 0.65 ± 0.26) and IL-23 (1.01 ± 0.13 vs. 0.68 ± 0.24) and serum IL-17 (38.22 ± 14.40 vs. 24.38 ± 11.68) and IL-23 (51.77 ± 17.40 vs. 32.16 ± 12.46) compared with baseline. Significant differences between groups were noticed only in the proportion of IL17-expressing CD4+ T cells, and IL-17 and IL-23 gene expression. Synbiotic supplementation did not significantly alter BASDAI and ASDAS-CRP compared with baseline and placebo group at the end of trial. CONCLUSION: Present study indicated beneficial effect of synbiotic supplement on IL-17/IL-23 pathway without improving disease activity in axSpApatients.HighlightsSynbiotic supplementation reduced IL17-expressing CD4+ T cells proportion in axSpA.Synbiotic supplementation decreased IL-17 and IL-23 gene expression in axSpA.Synbiotic supplementation did not change disease activity score in axSpA.

Effects of synbiotic supplementation on regulatory T cells' response in patients with axial spondyloarthritis: a randomized double-masked placebo-controlled trial.

This study was conducted on samples from patients enrolled in a randomized double-masked placebo-controlled trial on the effect of synbiotic supplementation on the IL-17/IL-23 pathway and disease activity in patients with axial spondyloarthritis (axSpA) to investigate the effects of synbiotic supplementation on regulatory T (Treg) cells' response in these patients. Forty-eight axSpA patients were randomized to take one synbiotic capsule or placebo daily for 12 weeks. Treg cell proportion, gene expression of forkhead box protein P3 (Foxp3), microRNA (miRNA)-25, miRNA-106b, miRNA-146a, interleukin (IL)-10, and transforming growth factor (TGF)-ß as well as serum IL-10 and TGF-ß levels were assessed before and after the trial. Thirty-eight patients (19 in each group) completed the trial. The proportion of Treg cells (P < 0.001), the gene expression of FoxP3 (P < 0.001), IL-10 (P = 0.001), TGF-ß (P < 0.001), and miRNA-146a (P < 0.001) and serum IL-10 (P = 0.003) and TGF-ß (P = 0.002) levels significantly increased compared to the baseline in the synbiotic group. Additionally, a significant reduction in the gene expression of miRNA-25 (P < 0.001) and miRNA-106b (P < 0.001) was observed in the synbiotic group. Significant between-group differences were observed in the proportion of Treg cells (P = 0.024) and the gene expression of FoxP3 (P = 0.010), IL-10 (P = 0.002), TGF-ß (P = 0.016), miRNA-25 (P = 0.008), miRNA-106b (P = 0.001), and miRNA-146a (P = 0.010). Differences in the serum levels of IL-10 and TGF-ß between the groups were not significant. As a conclusion, synbiotic supplementation could modulate Treg cells' response in axSpA patients and thus can be promising as an adjunctive therapy. Additional investigations would help in further clarifying the subject.

Systematic review of preclinical studies about effects of Coriandrum sativum L. on inflammatory mediators.

This study is designed to systematically review the accessible researches regarding influence of Coriandrum sativum L. on inflammatory mediators including interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Databases Scopus, PubMed, WOS, ProQuest, and a Google Scholar were searched until February 2022 and search alerts were turned on to find papers published following the primary search. There was not any restriction in language and/or date. No human study was gained; thus, animal and in vitro researches were considered. The references of related papers were reviewed to access plausible researches. Twenty-four papers were entered in review. Inflammatory factors IL-1ß, IL-6, and TNF-α considerably had a descending direction following C. sativum consumption. In other words, the pooled direction of influences was consistently lower for inflammatory mediators in 7 of 9 in vitro and 10 of 16 animal investigations. These results demonstrated the potential of C. sativum in reducing IL-1ß, IL-6, and TNF-α. C. sativum is hopeful but not yet a confirmed natural ingredient to reduce systemic inflammation in subjects with inflammation-prone disorders. Additional investigations are required to concentrate on assessing the impact of C. sativum on inflammatory factors that are not exceedingly fluctuating and the clinical consequences of inflammation-linked diseases.

Effects of okra (Abelmoschus esculentus L) on inflammatory mediators: a systematic review of preclinical studies.

The present study aimed to systematically review the available investigations about the effects of okra on important inflammatory mediators including C-reactive protein (CRP), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Electronic databases such as PubMed, Scopus, WOS, ProQuest, and the search engine Google Scholar were searched until August 2021 and search alerts were activated in order to notice papers issued after the initial search. There was no restriction in the date and/or language. No human research was found; therefore, animal and in vitro studies were considered. Also, the citations or references of these studies were assessed to gain possible research. Review papers, book chapters, and grey literature such as conference papers, dissertations, and patents were not considered. Twenty-six papers were considered in the systematic review. The concentrations of inflammatory mediators including CRP, IL-1ß, IL-6, and TNF-α mainly showed a downward trend after treatment with okra. In other words, the pooled direction of impacts was consistently lower for all of the evaluated inflammatory markers in the majority of preclinical (7 of 13 in vitro and 13 of 16 animal) studies. The findings proposed the potential of okra to lower CRP, IL-1ß, IL-6, and TNF-α. Okra is a promising but not yet confirmed natural ingredient to decrease systemic inflammation in patients with inflammation-predisposed diseases. Further research is needed to focus on evaluating the effects of okra on inflammatory mediators with lower variability as well as the clinical outcomes of inflammation-related diseases in order to add sufficient power to the results of this study.

Effects of N-acetylcysteine supplementation on disease activity, oxidative stress, and inflammatory and metabolic parameters in rheumatoid arthritis patients: a randomized double-blind placebo-controlled trial.

Considering the importance of inflammation and oxidative stress in the development of rheumatoid arthritis (RA) as well as anti-inflammatory and antioxidant features of N-acetylcysteine (NAC), this study was conducted to evaluate the effect of NAC supplementation on disease activity, oxidative stress, and inflammatory and metabolic parameters in RA patients. In a randomized double-masked placebo-controlled trial, 74 RA subjects were chosen and randomly divided into two groups to take 600 mg of NAC or placebo twice daily for 3 months. Before and after the study, disease activity was assessed via disease activity score-28 (DAS-28), and serum malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione peroxidase (GPX) activity, nitric oxide (NO), high-sensitivity C-reactive protein (hs-CRP), fasting blood sugar (FBS), lipid profile, and erythrocyte sedimentation rate (ESR) were measured. Seventy patients completed the trial. Compared to baseline, NAC significantly reduced morning stiffness (P < 0.001), DAS-28 (P < 0.001), ESR (P = 0.004), MDA (P < 0.001), NO (P < 0.001), hs-CRP (P = 0.006), FBS (P < 0.001), and low-density lipoprotein cholesterol (LDL-C) (P = 0.023) and significantly increased GPx activity (P = 0.015) and high-density lipoprotein cholesterol (HDL-C) level (P = 0.001). After treatment, remarkable differences were only seen between the two groups in serum NO (P = 0.003), FBS (P = 0.010), and HDL-C (P < 0.001) adjusted for baseline measures. There were no significant changes in morning stiffness, DAS-28, ESR, hs-CRP, MDA, TAC, GPx activity, triglyceride, total cholesterol, and LDL-C levels compared to the placebo group. In conclusion, NAC did not improve RA disease activity, but reduced NO and FBS and increased HDL-C levels. It appears that NAC should not be consumed as a replacement for routine medications prescribed in RA therapy, but it can be used as an adjunctive therapy.

Effects of nanocurcumin supplementation on T-helper 17 cells inflammatory response in patients with Behcet's disease: a randomized controlled trial.

OBJECTIVE: Present research was performed to assess the effects of nanocurcumin supplementation on T-helper 17 (Th17) cells inflammatory response in patients with Behcet's disease (BD). METHODS: In this randomized double-blind, placebo-controlled trial, 36 BD subjects were randomly placed into two groups to take 80 mg/day nanocurcumin or placebo for eight weeks. Disease activity, frequency of Th17 cells and expression of related parameters including retinoic acid-related orphan receptor γ (RORγt) transcription factor messenger RNA (mRNA), related microRNAs (miRNAs) such as miRNA-155, miRNA-181, and miRNA-326 as well as proinflammatory cytokines including interleukin (IL)-17 and IL-23 were evaluated. RESULTS: Thirty-two patients (17 in the nanocurcumin and 15 in the placebo groups) completed the trial. Number of Th17 cells decreased significantly in the nanocurcumin group compared to baseline (p = .012) and placebo (p = .047). Moreover, RORγt, IL-17, IL-23, miRNA-155, miRNA-181, and miRNA-326 mRNA expression decreased significantly in the nanocurcumin group compared with baseline (p = .004, p = .009, p < .001, p < .001, p < .001, p < .001, respectively) and placebo (p = .002, p = .021, p = .006, p = .035, p < .001, p = .017, respectively). Significant reductions in IL-17 and IL-23 were seen in nanocurcumin group compared with baseline (p = .017 and p = .015) and placebo (p = .047 and p = .048, respectively). Significant reduction in disease activity was observed in nanocurcumin group compared with placebo group (p = .035). CONCLUSION: Nanocurcumin supplementation had favorable effects in improving inflammatory factors and disease activity in BD patients. Additional studies are warranted to suggest nanocurcumin as a safe complementary therapy in BD.HighlightsNanocurcumin supplementation decreased Th17 cells frequency significantly compared with baseline and placebo group.Nanocurcumin supplementation decreased mRNA expression of RORγt, IL-17, IL-23, miRNA-155, miRNA-181, and miRNA-326 significantly compared to baseline and placebo group.Nanocurcumin supplementation decreased cell supernatant IL-17 and IL-23 significantly compared to baseline and placebo group.Nanocurcumin supplementation decreased disease activity significantly compared to placebo group.

Cigarette smoking and risk of palindromic rheumatism: A propensity score matching analysis.

Present study was conducted to investigate smoking status in palindromic rheumatism (PR) patients compared to healthy individuals as well as to assess the effect of smoking on clinical features and outcomes of PR. One hundred and forty-six patients with diagnosis of PR and 346 healthy controls were included in this study. Demographic, clinical, and laboratory characteristics and the smoking history of PR patients at the cohort entry were obtained from patients' records. Demographic and smoking history of the control group were obtained by direct interview. In order to reduce heterogeneity between the studied groups, propensity score matching (PSM) analyses was performed. Matching was achieved by considering age, gender, educational status, and marital status. After PSM, we carried out a multivariate analysis with PR as the main outcome variable, ever smoking as the main predictor variable and age, gender, educational status, and marital status as covariates. PSM resulted in 123 PR patients and 246 matched controls. Multivariate analysis did not show a significant increase in the risk of PR in ever smokers. Seventy-six patients were anti-citrullinated protein/peptide antibody positive (ACPA-positive). Multivariate logistic regression showed a significant increase in the risk of PR in ACPA-positive ever smokers. Except lower sustained remission rate in ever smokers, no significant differences were observed in clinical manifestations and outcomes of PR between ever and never smokers. In conclusion, smoking is a risk factor for ACPA-positive PR.

Nanocurcumin supplementation ameliorates Behcet's disease by modulating regulatory T cells: A randomized, double-blind, placebo-controlled trial.

Current research was designed to assess the effects of nanocurcumin supplementation on regulatory T (Treg) cells frequency and function in Behçet's disease (BD). In this randomized double-masked, placebo-controlled trial, 36 BD subjects were randomly put into two groups to take one 80 mg nanocurcumin capsule or placebo daily for 8 weeks. Before and after trial, disease activity, Treg cells frequency and expression of related immunologic parameters including forkhead box protein P3 (Foxp3) transcription factor messenger RNA (mRNA) and microRNAs (miRNAs) such as miRNA-25 and miRNA-106b as well as cytokines including transforming growth factor (TGF)-ß and interleukin (IL)-10 were studied. Thirty-two patients (17 in the nanocurcumin and 15 in the placebo groups) completed the trial. Treg cells frequency increased significantly in the nanocurcumin group compared with baseline (P < 0.001) and placebo group (P < 0.001). Moreover, FoxP3, TGF-ß, IL-10, miRNA-25, and miRNA-106b mRNA expression levels increased considerably in the nanocurcumin group compared to baseline (P < 0.001) and placebo group (P < 0.001, P < 0.001, P = 0.025, P = 0.011, and P < 0.001, respectively). Significant increases in serum TGF-ß and IL-10 were seen in nanocurcumin group compared with baseline (P < 0.001) and placebo group (P = 0.001 and P < 0.001, respectively). Significant decrease in disease activity was found in nanocurcumin group compared with placebo group (P = 0.044). Our study provided a promising view for desirable effects of nanocurcumin supplementation in improving immunological parameters and disease activity in BD.

Relationship between chest CT scan findings with SOFA score, CRP, comorbidity, and mortality in ICU patients with COVID-19.

OBJECTIVE: This study aimed to investigate the relationship between chest computed tomography (CT) scan findings with sequential organ failure assessment (SOFA) score, C-reactive protein (CRP), comorbidity, and mortality in intensive care unit (ICU) patients with coronavirus disease 19 (COVID-19). METHOD: Adult patients (≥18 years old) with COVID-19 who were consecutively admitted to the Imam-Reza Hospital, Tabriz, East-Azerbaijan Province, North-West of Iran between March 2020 and August 2020 were screened and total of 168 patients were included. Demographic, clinical, and mortality data were gathered. Severity of disease was evaluated using the SOFA score system. CRP levels were measured and chest CT scans were performed. RESULTS: Most of patients had multifocal and bilateral ground glass opacity (GGO) pattern in chest CT scan. There were significant correlations between SOFA score on admission with multifocal and bilateral GGO (P = .010 and P = .011, respectively). Significant relationships were observed between unilateral and bilateral GGO patterns with CRP (P = .049 and P = .046, respectively). There was significant relationship between GGO patterns with comorbidities including overweight/obesity, heart failure, cardiovascular diseases, and malignancy (P < .05). No significant relationships were observed between chest CT scan results with mortality (P > .05). CONCLUSION: Multifocal bilateral GGO was the most common pattern. Although chest CT scan characteristics were significantly related with SOFA score, CRP, and comorbidity in ICU patients with COVID-19, a relationship with mortality was not significant.

Factors associated with COVID-19 and its outcome in patients with rheumatoid arthritis.

OBJECTIVE: We assessed the factors associated with COVID-19, clinical manifestations, and a 30-day-prognosis of COVID-19 in a cohort of rheumatoid arthritis (RA) patients compared with the index population. METHODS: In a cross-sectional study, RA patients were followed in rheumatology clinics of Tabriz University of Medical Sciences, and a group of patients diagnosed with COVID-19 from index population were recruited. Outcomes of COVID-19 were assessed by the hospitalization rate and need to intensive care unit (ICU) and mortality. During a period of 12 weeks, 128 RA patients diagnosed with COVID-19, 760 RA control group, and 92 COVID-19 patients from index population were enrolled. RESULTS: Being female, obese, and diabetic, having pulmonary disease and chronic kidney disease (CKD), and treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. Dyspnea, anosmia, and taste loss were more common in RA patients compared with the index population. Admission in hospital, need to ICU care, and mortality occurred in 38, 11.9, and 8.6 percent of RA patients, respectively. Although hospitalization rate in RA patients was more than the index population, there were no significant differences in need to ICU care and mortality between the two groups. CONCLUSIONS: Treatment with prednisolone and TNFis and having comorbidities including obesity, diabetes, pulmonary disease, and CKD increase the risk of COVID-19 in RA patients. Although some differences exist in the clinical manifestations of COVID-19 in RA patients and index population, prognosis of COVID-19 in RA patients is not any worse. Key Points • Being female, obese and diabetic, having pulmonary disease, chronic kidney disease (CKD), treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. • Dyspnea, anosmia and taste loss were more common in RA patients compared with the index population. • Although COVID-19 related hospitalization was higher in RA patients than in the index population, there was no significant differences in the need to ICU care and mortality between the two groups.