Pub Date : 2021-04-01DOI: 10.22631/RR.2021.69997.1117
M. Khasru, A. Siddiq, T. Marzen, M. Rahman, Iffat Islam, Syed Ahmed Refaie, Tamjid Ali, R. Uddin, M. J. Hasan, Radia Naz, F. Haseen, S. Islam, Danny Clegg, J. Rasker
Introduction: Coronavirus disease (COVID-19) started its journey from Wuhan, China and gradually became a pandemic. COVID-19 often affects the respiratory system, but symptoms may include fatigue, myalgia, arthralgia, arthritis, spine-, and bone pain as presenting complaints. In the present systematic search and review, we aim to highlight the musculoskeletal manifestations during COVID-19. Methods: Using PubMed Central and Google Scholar search engines, we used as key words “muscle pain”, “joint pain”, “body ache”, “fatigue”, in Covid-19 patients. Results: After screening, a total of 76 articles were included following inclusion criteria dated between January 1 and July 1, 2020. All articles were published in English comprising 36558 COVID-19 cases. In cross sectional studies, fatigue was found in 55%, myalgia in 26%, and arthralgia in 20%, respectively. In cohort studies, fatigue was found in 35%, myalgia in 15%, and arthralgia in 5%, respectively. Sporadic case reports also mention back pain, bone pain, myositis and arthritis as presenting symptoms of COVID-19.Discussion: Fatigue was the most frequent musculoskeletal (MSK) manifestion of COVID-19 followed by myalgia and joint pain. The frequency of the different MSK manifestations in COVID-19 may vary widely among different geographic regions. Conclusions: MSK like fatigue, myalgia and arthralgia are frequent symptoms in COVID-19 patients and may vary in different countries.
{"title":"Musculoskeletal Manifestations of COVID-19: A Systematic Search and Review","authors":"M. Khasru, A. Siddiq, T. Marzen, M. Rahman, Iffat Islam, Syed Ahmed Refaie, Tamjid Ali, R. Uddin, M. J. Hasan, Radia Naz, F. Haseen, S. Islam, Danny Clegg, J. Rasker","doi":"10.22631/RR.2021.69997.1117","DOIUrl":"https://doi.org/10.22631/RR.2021.69997.1117","url":null,"abstract":"Introduction: Coronavirus disease (COVID-19) started its journey from Wuhan, China and gradually became a pandemic. COVID-19 often affects the respiratory system, but symptoms may include fatigue, myalgia, arthralgia, arthritis, spine-, and bone pain as presenting complaints. In the present systematic search and review, we aim to highlight the musculoskeletal manifestations during COVID-19. Methods: Using PubMed Central and Google Scholar search engines, we used as key words “muscle pain”, “joint pain”, “body ache”, “fatigue”, in Covid-19 patients. Results: After screening, a total of 76 articles were included following inclusion criteria dated between January 1 and July 1, 2020. All articles were published in English comprising 36558 COVID-19 cases. In cross sectional studies, fatigue was found in 55%, myalgia in 26%, and arthralgia in 20%, respectively. In cohort studies, fatigue was found in 35%, myalgia in 15%, and arthralgia in 5%, respectively. Sporadic case reports also mention back pain, bone pain, myositis and arthritis as presenting symptoms of COVID-19.Discussion: Fatigue was the most frequent musculoskeletal (MSK) manifestion of COVID-19 followed by myalgia and joint pain. The frequency of the different MSK manifestations in COVID-19 may vary widely among different geographic regions. Conclusions: MSK like fatigue, myalgia and arthralgia are frequent symptoms in COVID-19 patients and may vary in different countries.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86097335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1121
S. Assar, D. Mohamadzadeh, Sima Golmohammadi, Zhovan Fatahi
36 (11.7%), p value = 0.034). In RH negative individuals, there was a significant difference in the frequency of the A blood group between SLE patients and the controls (2 (13.3%) vs. 10 (37%), p value = 0.037). There is no difference in the frequency of different BGs between SLE patients and healthy people. Moreover, no significant relation between different organ involvement in Lupus patients and BG was found, except for mucosal ulcers. Therefore, ’blood group cannot be used as a predictor of disease status.
{"title":"The association of main blood groups and development of Systemic Lupus Erythematosus and its organ involvements","authors":"S. Assar, D. Mohamadzadeh, Sima Golmohammadi, Zhovan Fatahi","doi":"10.22631/rr.2021.69997.1121","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1121","url":null,"abstract":"36 (11.7%), p value = 0.034). In RH negative individuals, there was a significant difference in the frequency of the A blood group between SLE patients and the controls (2 (13.3%) vs. 10 (37%), p value = 0.037). There is no difference in the frequency of different BGs between SLE patients and healthy people. Moreover, no significant relation between different organ involvement in Lupus patients and BG was found, except for mucosal ulcers. Therefore, ’blood group cannot be used as a predictor of disease status.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77783267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1123
Z. Habibagahi, Leila Azizi
Granulomatosis with polyangiitis ) GPA, also known as Wegener’s ( is an anti-neutrophil cytoplasmic antibody-associated multisystem disease characterized by necrotizing small vessel vasculitis which mainly affects the upper and lower respiratory tracts as well as the kidneys. Involvement of the central nervous system is uncommon in GPA and might be difficult to treat. Pituitary involvement is a rare presentation in GPA. Presented herein is the case of a 28-year-old woman with GPA involving the pituitary gland and other systemic manifestations of the disease.
多血管炎肉芽肿病(Granulomatosis with polyangiitis, GPA),又称韦格纳氏病(Wegener 's),是一种抗中性粒细胞细胞质抗体相关的多系统疾病,以坏死性小血管炎为特征,主要累及上、下呼吸道和肾脏。累及中枢神经系统在GPA中并不常见,可能难以治疗。垂体受累是GPA的罕见表现。本文报告一位28岁女性,其GPA累及脑垂体及其他系统性表现。
{"title":"Pituitary involvement in a case of granulomatosis with polyangiitis: case report and literature review","authors":"Z. Habibagahi, Leila Azizi","doi":"10.22631/rr.2021.69997.1123","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1123","url":null,"abstract":"Granulomatosis with polyangiitis ) GPA, also known as Wegener’s ( is an anti-neutrophil cytoplasmic antibody-associated multisystem disease characterized by necrotizing small vessel vasculitis which mainly affects the upper and lower respiratory tracts as well as the kidneys. Involvement of the central nervous system is uncommon in GPA and might be difficult to treat. Pituitary involvement is a rare presentation in GPA. Presented herein is the case of a 28-year-old woman with GPA involving the pituitary gland and other systemic manifestations of the disease.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86072098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1120
Nasrin Bazgir, E. Shafiei
controlled, cartilage, ligaments, and tendons in some cases, to disability. aim of this study identify inflammatory biomarkers in rheumatoid arthritis patients. This case-control study was performed on 50 rheumatoid arthritis patients who referred to the Rheumatology Clinic of Shahid Khomeini Hospital in Ilam and their healthy counterparts. All patients were examined by a rheumatologist for disease activity based on DAS28 (Disease Activity Score Calculator for Rheumatoid Arthritis) criteria. The results of this study showed that the mean lymphocyte count in the case group was lower than the control group, and there was a statistically significant relationship between lymphocyte level in the two groups. The mean neutrophil count was higher in the case group than in the control group, and this relationship was significant. The mean neutrophil/lymphocyte ratio was higher in patients with rheumatoid arthritis than in controls and in women more than men. Stepwise logistic regression showed that age, sex, DAS28, VitD (Vitamin D), RF (rheumatoid factor), and NLR (neutrophil-to-lymphocyte ratio) significantly predict the incidence of rheumatoid arthritis ( p value < 0.05). Therefore, NLR can be used as a prognostic factor.
{"title":"Identification of inflammatory biomarkers in rheumatoid arthritis patients; a case-control study","authors":"Nasrin Bazgir, E. Shafiei","doi":"10.22631/rr.2021.69997.1120","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1120","url":null,"abstract":"controlled, cartilage, ligaments, and tendons in some cases, to disability. aim of this study identify inflammatory biomarkers in rheumatoid arthritis patients. This case-control study was performed on 50 rheumatoid arthritis patients who referred to the Rheumatology Clinic of Shahid Khomeini Hospital in Ilam and their healthy counterparts. All patients were examined by a rheumatologist for disease activity based on DAS28 (Disease Activity Score Calculator for Rheumatoid Arthritis) criteria. The results of this study showed that the mean lymphocyte count in the case group was lower than the control group, and there was a statistically significant relationship between lymphocyte level in the two groups. The mean neutrophil count was higher in the case group than in the control group, and this relationship was significant. The mean neutrophil/lymphocyte ratio was higher in patients with rheumatoid arthritis than in controls and in women more than men. Stepwise logistic regression showed that age, sex, DAS28, VitD (Vitamin D), RF (rheumatoid factor), and NLR (neutrophil-to-lymphocyte ratio) significantly predict the incidence of rheumatoid arthritis ( p value < 0.05). Therefore, NLR can be used as a prognostic factor.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88517694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1119
A. Ahmadzadeh, S. Basiri, F. Farsad, M. Emam, A. Rajaei
The aim of the current study was to investigate the prevalence of Covid-19 in patients with rheumatoid arthritis who used classic disease-modifying anti-rheumatic drugs (DMARDs). In this descriptive study that was performed in Loghman-Hakim Hospital (Tehran, Iran) between 2011 and 2020, patients with RA who were referred to the hospital were assessed based on age, sex, medications, comorbidities, smoking, duration of RA, history of Covid-19 in a first-degree relative, history of Covid-19 in the patient, and Covid-19 symptoms. one years 72.3% Covid-19 prevalence among patients with RA was 10.4%. The prevalence of Covid-19 in patients who used sulfasalazine was significantly higher (14.3%) than in patients who did not take it (8.9 %) (OR = 1.72; 95% CI, p value = 0.011). Hydroxychloroquine utilized drug among Covid-19 patients. However, there was no correlation between the prevalence of Covid-19 and the use of hydroxychloroquine ( p value = 0.779). In RA, self-quarantine lowered the risk of Covid-19 by around 60% (OR = 0.382; 95% CI (0.225 - 0.650)). In these patients, cardiac disease exhibited a significant correlation with Covid-19 prevalence ( p value < 0.001). Covid-19 has no higher prevalence in RA patients taking classic DMARDs than in the general population. The most common medicine among RA patients was hydroxychloroquine, which could be one of the reasons why these people did not develop Covid-19.
{"title":"The prevalence of Covid-19 in patients with Rheumatoid Arthritis receiving classic Disease-Modifying Anti Rheumatic Drugs","authors":"A. Ahmadzadeh, S. Basiri, F. Farsad, M. Emam, A. Rajaei","doi":"10.22631/rr.2021.69997.1119","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1119","url":null,"abstract":"The aim of the current study was to investigate the prevalence of Covid-19 in patients with rheumatoid arthritis who used classic disease-modifying anti-rheumatic drugs (DMARDs). In this descriptive study that was performed in Loghman-Hakim Hospital (Tehran, Iran) between 2011 and 2020, patients with RA who were referred to the hospital were assessed based on age, sex, medications, comorbidities, smoking, duration of RA, history of Covid-19 in a first-degree relative, history of Covid-19 in the patient, and Covid-19 symptoms. one years 72.3% Covid-19 prevalence among patients with RA was 10.4%. The prevalence of Covid-19 in patients who used sulfasalazine was significantly higher (14.3%) than in patients who did not take it (8.9 %) (OR = 1.72; 95% CI, p value = 0.011). Hydroxychloroquine utilized drug among Covid-19 patients. However, there was no correlation between the prevalence of Covid-19 and the use of hydroxychloroquine ( p value = 0.779). In RA, self-quarantine lowered the risk of Covid-19 by around 60% (OR = 0.382; 95% CI (0.225 - 0.650)). In these patients, cardiac disease exhibited a significant correlation with Covid-19 prevalence ( p value < 0.001). Covid-19 has no higher prevalence in RA patients taking classic DMARDs than in the general population. The most common medicine among RA patients was hydroxychloroquine, which could be one of the reasons why these people did not develop Covid-19.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"186 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77720358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1122
A. Ahmadzadeh, samad nazarpour, E. Jandaghi
SLE (Systemic Lupus Erythematosus) is an autoimmune disorder with a range of symptoms and an unclear cause. Infections, which are one of the leading causes of death in SLE patients, are made more possible by immunosuppressive medications. It is yet unclear how Cytomegalovirus (CMV) infection affects SLE. Clinically, differentiating between an infection and a lupus flare-up is critical. For this reason, we discuss the case of a 56-year-old woman who was hospitalized to Loghman Hospital's rheumatic clinic with SLE and CMV infection.
{"title":"Syndrome of Inappropriate Secretion of Antidiuretic Hormone and Severe Thrombocytopenia in an Immunosuppressive Systemic Lupus Erythematosus Patient: A Case Report","authors":"A. Ahmadzadeh, samad nazarpour, E. Jandaghi","doi":"10.22631/rr.2021.69997.1122","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1122","url":null,"abstract":"SLE (Systemic Lupus Erythematosus) is an autoimmune disorder with a range of symptoms and an unclear cause. Infections, which are one of the leading causes of death in SLE patients, are made more possible by immunosuppressive medications. It is yet unclear how Cytomegalovirus (CMV) infection affects SLE. Clinically, differentiating between an infection and a lupus flare-up is critical. For this reason, we discuss the case of a 56-year-old woman who was hospitalized to Loghman Hospital's rheumatic clinic with SLE and CMV infection.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84842049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.22631/rr.2021.69997.1118
M. Rezaeian, Afsaneh Abbasi, M. Abbasifard
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves vital organs of the body. Studies have shown that abnormal lipids may be involved in the pathogenesis of SLE. Hence, the aim of this study was to evaluate lipid profiles in lupus patients. This retrospective cross-sectional study evaluated 136 SLE patients who were referred to the Rheumatology Clinic of Rafsanjan from October 2015 to September 2018. The data for the SLE disease activity index (SLEDAI) and demographic information of all patients were entered in a researcher-created checklist, and serum lipid profiles were measured in serum samples. The SLEDAI score of patients was 13.8 ± 5.9. Age had a significantly positive correlation with cholesterol ( r = 0.224, p value = 0.009) and LDL ( r = 0.256, p value = 0.003) levels as well as significantly negative correlation with HDL levels ( r = -0.489, p value = 0.023). Lipid profiles of patients with different levels of education showed no significant difference ( p value = 0.174). In recently diagnosed patients, SLEDAI had a significantly positive correlation with cholesterol ( r = 0.489, p value = 0.002) and LDL levels ( r = 0.418, p value = 0.009) as well as a significantly negative correlation with HDL levels ( r = -0.381, p value = 0.037). No significant correlation was observed between TG level and SLEDAI ( p value = 0.114, r = 0.19). There was no significant difference in the SLEDAI score between subjects using lipid-lowering drugs and those without such treatment ( p value = 0841). It seems that abnormal lipid levels are common in patients with SLE, and there is an association between abnormal lipids and SLEDAI.
{"title":"Association between Abnormal Lipid Levels and Systemic Lupus Erythematosus","authors":"M. Rezaeian, Afsaneh Abbasi, M. Abbasifard","doi":"10.22631/rr.2021.69997.1118","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1118","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves vital organs of the body. Studies have shown that abnormal lipids may be involved in the pathogenesis of SLE. Hence, the aim of this study was to evaluate lipid profiles in lupus patients. This retrospective cross-sectional study evaluated 136 SLE patients who were referred to the Rheumatology Clinic of Rafsanjan from October 2015 to September 2018. The data for the SLE disease activity index (SLEDAI) and demographic information of all patients were entered in a researcher-created checklist, and serum lipid profiles were measured in serum samples. The SLEDAI score of patients was 13.8 ± 5.9. Age had a significantly positive correlation with cholesterol ( r = 0.224, p value = 0.009) and LDL ( r = 0.256, p value = 0.003) levels as well as significantly negative correlation with HDL levels ( r = -0.489, p value = 0.023). Lipid profiles of patients with different levels of education showed no significant difference ( p value = 0.174). In recently diagnosed patients, SLEDAI had a significantly positive correlation with cholesterol ( r = 0.489, p value = 0.002) and LDL levels ( r = 0.418, p value = 0.009) as well as a significantly negative correlation with HDL levels ( r = -0.381, p value = 0.037). No significant correlation was observed between TG level and SLEDAI ( p value = 0.114, r = 0.19). There was no significant difference in the SLEDAI score between subjects using lipid-lowering drugs and those without such treatment ( p value = 0841). It seems that abnormal lipid levels are common in patients with SLE, and there is an association between abnormal lipids and SLEDAI.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87538290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.22631/rr.2021.69997.1115
Z. Mirfeizi, M. Firoozabadi, M. Jokar, K. Hashemzadeh, Elham Ghalenavi
Giant cell arteritis (GCA) is a granulomatous vasculitis of medium and large arteries, frequently presenting with typical cranial symptoms, but sometimes nonspecific extracranial involvements are dominant. Diagnosis of this “occult” or “extracranial” GCA as a medical emergency is crucial to preventing irreversible complications [1, 2]. GCA vasculitis involves largeto medium-sized arteries, especially the aorta and proximal branches. Its classic presentations as a cranial arteritis comprise temporal headache, visual disturbance, and jaw claudication [2, 3]. In recent years, interest in attaining knowledge about cases with non-classic manifestations and involvement of extracranial arteries has increased [1]. Because of the nonspecific manifestations of extracranial GCA, it seems that actual incidence prevalence, which is reported as only 1.632.8 per 100,000 people, has been underestimated [1]. Common symptoms of extracranial GCA include fever, anorexia, malaise, weight loss, polymyalgia, and muscle weakness. Some vascular manifestations are more specific but less common, such as Raynaud’s phenomenon, digital ischemia, decreased pulse, limb claudication, arterial bruits, and signs of cerebral ischemia. In comparison with cranial GCA, extracranial GCA is more prevalent in women, and the onset of disease occurs at younger ages. Moreover, there is a longer delay in diagnosis. Therefore, in patients over 50 years of age with constitutional raised inflammatory markers, a diagnosis of extracranial GCA must be considered [1]. High risk for developing aneurysms and dissection of the aorta (especially thoracic segment) necessitates prompt diagnosis and treatment [3]. Because of the non-specific signs, symptoms, and blood tests and the difficulties in biopsying affected arteries, extracranial GCA is often diagnosed based on imaging. Acute aortic pathology as the first clinical presentation with a high mortality rate (44-80%) raises suspicion of previously established extracranial involvement. The gold standard for diagnosing extracranial GCA used to be conventional angiography, but that has been replaced with non-invasive methods [3]. Despite the lack of a specific laboratory marker, acute phase reactants (platelets, erythrocyte sedimentation rate, and/or C reactive protein) are raised in most patients. Normal values, however, in the presence of strong clinical suspicion would not rule out the diagnosis [3]. In patients with typical cranial presentation, duplex ultrasonography of the temporal artery is a proper diagnostic modality. In addition, diagnosing patients with predominant extracranial manifestations and atypical ones may be aided by other imaging techniques, such as CT (computed tomography), MRI (magnetic resonance imaging), CT-angiography, and PET (positron emission tomography). The widespread use of these new imaging techniques may lead to the identification of clinically silent large vessel involvement, and this will probably raise the rate of inc
{"title":"Extracranial as Silent Giant Cell Arteritis: Case Report","authors":"Z. Mirfeizi, M. Firoozabadi, M. Jokar, K. Hashemzadeh, Elham Ghalenavi","doi":"10.22631/rr.2021.69997.1115","DOIUrl":"https://doi.org/10.22631/rr.2021.69997.1115","url":null,"abstract":"Giant cell arteritis (GCA) is a granulomatous vasculitis of medium and large arteries, frequently presenting with typical cranial symptoms, but sometimes nonspecific extracranial involvements are dominant. Diagnosis of this “occult” or “extracranial” GCA as a medical emergency is crucial to preventing irreversible complications [1, 2]. GCA vasculitis involves largeto medium-sized arteries, especially the aorta and proximal branches. Its classic presentations as a cranial arteritis comprise temporal headache, visual disturbance, and jaw claudication [2, 3]. In recent years, interest in attaining knowledge about cases with non-classic manifestations and involvement of extracranial arteries has increased [1]. Because of the nonspecific manifestations of extracranial GCA, it seems that actual incidence prevalence, which is reported as only 1.632.8 per 100,000 people, has been underestimated [1]. Common symptoms of extracranial GCA include fever, anorexia, malaise, weight loss, polymyalgia, and muscle weakness. Some vascular manifestations are more specific but less common, such as Raynaud’s phenomenon, digital ischemia, decreased pulse, limb claudication, arterial bruits, and signs of cerebral ischemia. In comparison with cranial GCA, extracranial GCA is more prevalent in women, and the onset of disease occurs at younger ages. Moreover, there is a longer delay in diagnosis. Therefore, in patients over 50 years of age with constitutional raised inflammatory markers, a diagnosis of extracranial GCA must be considered [1]. High risk for developing aneurysms and dissection of the aorta (especially thoracic segment) necessitates prompt diagnosis and treatment [3]. Because of the non-specific signs, symptoms, and blood tests and the difficulties in biopsying affected arteries, extracranial GCA is often diagnosed based on imaging. Acute aortic pathology as the first clinical presentation with a high mortality rate (44-80%) raises suspicion of previously established extracranial involvement. The gold standard for diagnosing extracranial GCA used to be conventional angiography, but that has been replaced with non-invasive methods [3]. Despite the lack of a specific laboratory marker, acute phase reactants (platelets, erythrocyte sedimentation rate, and/or C reactive protein) are raised in most patients. Normal values, however, in the presence of strong clinical suspicion would not rule out the diagnosis [3]. In patients with typical cranial presentation, duplex ultrasonography of the temporal artery is a proper diagnostic modality. In addition, diagnosing patients with predominant extracranial manifestations and atypical ones may be aided by other imaging techniques, such as CT (computed tomography), MRI (magnetic resonance imaging), CT-angiography, and PET (positron emission tomography). The widespread use of these new imaging techniques may lead to the identification of clinically silent large vessel involvement, and this will probably raise the rate of inc","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75103473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.22631/RR.2021.69997.1116
M. Sahebari, Behzad Aminzadeh, Omid Shahpari, Ramin Moghaddam, Morteza Safikhan
Paget’s disease (osteitis deformans) of bone is a focal skeletal disorder that can be mono- or polyostotic. Paget's disease might be asymptomatic as with normal biomarkers, or it can be symptomatic such as bony enlargement or deformity. The diagnosis can be made by laboratory findings and specific findings in radiology or radionuclide scan, and it is sometimes confirmed by bone biopsy.In this report, we present the case of a 37-year-old man whose initial symptoms indicated sacroiliitis, which led to the suspicion of ankylosing spondylitis. Following other diagnostic evaluations and based on imaging features and bone biopsy, active Paget’s bone disease without abnormal biochemical markers was diagnosed. The laboratory diagnosis tests were normal. Other biomarkers including procollagen type I N-terminal propeptide (PINP), serum C-telopeptide (CTx), urinary N-telopeptide (NTx), and urinary hydroxyproline, are not routinely checked.The patient also showed a coincidence of unilateral idiopathic gynecomastia. A single dose of 5 mg of zoledronic acid intravenously was prescribed, and the patient was followed for six months. Paget's bone disease can occur without any change in biochemical markers. In such cases, the response to treatment can becontrolled by improving the clinical picture or evaluating the correct imaging findings.
{"title":"Asymptomatic active Paget bone disease: a case report","authors":"M. Sahebari, Behzad Aminzadeh, Omid Shahpari, Ramin Moghaddam, Morteza Safikhan","doi":"10.22631/RR.2021.69997.1116","DOIUrl":"https://doi.org/10.22631/RR.2021.69997.1116","url":null,"abstract":"Paget’s disease (osteitis deformans) of bone is a focal skeletal disorder that can be mono- or polyostotic. Paget's disease might be asymptomatic as with normal biomarkers, or it can be symptomatic such as bony enlargement or deformity. The diagnosis can be made by laboratory findings and specific findings in radiology or radionuclide scan, and it is sometimes confirmed by bone biopsy.In this report, we present the case of a 37-year-old man whose initial symptoms indicated sacroiliitis, which led to the suspicion of ankylosing spondylitis. Following other diagnostic evaluations and based on imaging features and bone biopsy, active Paget’s bone disease without abnormal biochemical markers was diagnosed. The laboratory diagnosis tests were normal. Other biomarkers including procollagen type I N-terminal propeptide (PINP), serum C-telopeptide (CTx), urinary N-telopeptide (NTx), and urinary hydroxyproline, are not routinely checked.The patient also showed a coincidence of unilateral idiopathic gynecomastia. A single dose of 5 mg of zoledronic acid intravenously was prescribed, and the patient was followed for six months. Paget's bone disease can occur without any change in biochemical markers. In such cases, the response to treatment can becontrolled by improving the clinical picture or evaluating the correct imaging findings.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90133471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.22631/RR.2021.69997.1114
M. Sahebari, Sepideh Sabah Mashhadi, Mahsa Ghandehari Ferdows, H. Rafatpanah, K. Hashemzadeh, H. Heidari, Yahya Shahrokhi, Mandana Khodashahi
Recently, several infectious agents including Epstein-Barr virus and Escherichia coli have been suggested as possible contributing factors to the pathogenesis of rheumatoid arthritis (RA). This study was designed to compare serum and synovial fluid markers of herpes simplex virus (HSV) and Helicobacter pylori of RA and osteoarthritis (OA) patients.This comparative study was conducted on two hundred OA and RA patients who referred to the Rheumatic Diseases Research Center (RDRC) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2015 to 2016. Synovial fluid was obtained from all individuals. Two years later, participants attended a follow-up session to collect blood samples for serum markers of these two infectious agents.Twenty-five patients (96.15%) in the RA group and 23 individuals (92%) in the OA group had positive serum IgG antibodies for HSV. As for Helicobacter pylori, 13 individuals (50%) in RA and 12 individuals (48%) had positive serum IgG antibodies (p value = 0.66). In addition, 9 (34.6%) and 8 (30.8%) in the RA group and 10 (40%) and 3 (12%) in the OA group had positive serum IgA and IgM antibodies for Helicobacter pylori, respectively (p value = 0.89 and p value = 0.13, respectively). Collected fluid samples were negative for both Helicobacter pylori and HSV1 and 2 DNA particles in all individuals.Based on the results of the current study, there is no difference between RA and OA patients in terms of Herpes simplex virus and Helicobacter pylori infection.
{"title":"Comparison of serum and synovial fluid markers of Herpes simplex virus and Helicobacter pylori infection between rheumatoid arthritis and osteoarthritis patients: A Retrospective Case-Control Study","authors":"M. Sahebari, Sepideh Sabah Mashhadi, Mahsa Ghandehari Ferdows, H. Rafatpanah, K. Hashemzadeh, H. Heidari, Yahya Shahrokhi, Mandana Khodashahi","doi":"10.22631/RR.2021.69997.1114","DOIUrl":"https://doi.org/10.22631/RR.2021.69997.1114","url":null,"abstract":"Recently, several infectious agents including Epstein-Barr virus and Escherichia coli have been suggested as possible contributing factors to the pathogenesis of rheumatoid arthritis (RA). This study was designed to compare serum and synovial fluid markers of herpes simplex virus (HSV) and Helicobacter pylori of RA and osteoarthritis (OA) patients.This comparative study was conducted on two hundred OA and RA patients who referred to the Rheumatic Diseases Research Center (RDRC) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2015 to 2016. Synovial fluid was obtained from all individuals. Two years later, participants attended a follow-up session to collect blood samples for serum markers of these two infectious agents.Twenty-five patients (96.15%) in the RA group and 23 individuals (92%) in the OA group had positive serum IgG antibodies for HSV. As for Helicobacter pylori, 13 individuals (50%) in RA and 12 individuals (48%) had positive serum IgG antibodies (p value = 0.66). In addition, 9 (34.6%) and 8 (30.8%) in the RA group and 10 (40%) and 3 (12%) in the OA group had positive serum IgA and IgM antibodies for Helicobacter pylori, respectively (p value = 0.89 and p value = 0.13, respectively). Collected fluid samples were negative for both Helicobacter pylori and HSV1 and 2 DNA particles in all individuals.Based on the results of the current study, there is no difference between RA and OA patients in terms of Herpes simplex virus and Helicobacter pylori infection.","PeriodicalId":87314,"journal":{"name":"Journal of rheumatology research","volume":"139 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86568858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}