Comparison of the effect of omega-3 fatty acid supplementation with and without vitamin E in patients with rheumatoid arthritis

To test the hypothesis that an n-3 fatty acids [n-3] plus vitamin E supplementation is more effective than n-3 supplementation alone in improving the clinical, laboratory and inflammatory indices in patients with rheumatoid arthritis [RA]. A total of 55 RA patients [50 female, 5 male; mean age = 47 +/- 11y], in 3 groups, were included a double-blind randomized clinical trial. The groups were assigned to treatments as follows: group 1 [G1], placebo [2 g/d MCT oil + vitamin E placebo]; group 2 [G2], n-3 fatty acids [1/2 g/d EPA/DHA] +vitamin E placebo; group 3 [G3], n-3 fatty acids [1/2 g/d EPA/DHA] + vitamin E [100 IU/d]. Clinical, inflammatory, and laboratory indicators were determined at the baseline and at the end of the 6the and 12th weeks. Intra- and inter-group comparisons of the values obtained were made using repeated measure-ANOVA and ANOVA, respectively [p<0.05]. In G2 and G3, improvements in clinical, biochemical, inflammation, and oxidative indicators, as well as in the score of health status assessment [by interview] were more pronounced than in G1 [P<0.01]. Also, compared to G1, at the end of week 12 there were higher improvements in morning stiffness and the score of health status assessment in G2 and G3 groups [P<0.05]. Combination of n-3 fatty acids with vitamin E improved most of the clinical and laboratory indices in RA patients. However, there were no significant differences between G2 and G3 other than decreased oxidation and ESR

[ prevalence of periarthritis in patients referred to rheumatology center of Shariati hospital [Tehran, 1996-2002]]

Soft tissue involvements are the most common types of rheumatic diseases. The prevalence of periarthritis in a study in the USA was 20-30% of all rheumatic diseases. The aim of this study was to estimate the prevalence, type, topography and treatment in these disorders. This cross-sectional descriptive study was done on 1600 files of patients that were visited in rheumatology center of Shariati Hospital between 1996-2002. The samples were selected randomly and systematically and the data were extracted. The prevalence of periarthritis was estimated 16.25% [260 cases]. Most of the cases with periarthritis were found in the age group of 40-50 years [26.6%] and the mean of age was 46.48 +/- 13.86. About 78.5% of patients were female and 21.5% were male. The most common forms of periarthritis were tendonitis and bursitis [64.6%] and the second rate was neurovascular [23.6%]. The most frequent disease was carpal tunnel syndrome 21.9% and shoulder capsulitis [13.5%]. Right upper limb and wrist [26.2%] were the most frequent sites of involvement and the rate of bilateral carpal tunnel was 42%. The rheumatic disease, as background, were found in 17.3% of patients. Bilateral carpal tunnel syndrome was the most frequent type of bilateral periarthritis which was statisticaly significant [p<0.001]. As the results showed periarthritis diseases are very common, specially carpal tunnel syndrome and shoulder capsulitis. The future studies need to evaluate the response to treatment, job and trauma must be considered because of their importance in etiology. This study can be considered as a basis study for future reserches

[Comparison of the accuracy of diagnostic criteria of behcet's disease in children]

Different criteria for Behcet's diagnosis reveal that there isn't still consensus about the definition of this syndrome. Although a comprehensive study about the accuracy, the sensitivity and specificity of seven different types of diagnostic criteria for Behcet's disease in children, Ras not been performed we planned this study to compare these criteria in the Iranian children with Behcet's disease. Two random samples were selected from the patients less than 16 years of age referring to the Behcet's clinic of rheumatology research center. 177 children had definite diagnosis of Behcet's disease after being visited by the three professors of rheumatology experienced in Behcet's syndrome. Control group were children suspected to have Behcet's disease but it was ruled out. Sensitivity, specificity and accuracy of each of the Behcet's criteria were calculated. Mean age in Behcet's children was 13.6 years and in control group was 12.8 years. In the patients group female to male ratio was 1.1 and in the control group it was 1.3. Sensitivity of different criteria was as follow: Manson and Bames 55.1%, 0' Duffy 60.7%, International criteria 71.9%, Japan criteria 90.4%, Dilsen criteria 79.8%, Iran criteria 93.8%, and Iranian classification tree 94.4%. Specificity of the criteria was as following; M and B 99.5%, O Duffy 99.5%, International 100%, Japan 96.2%, Dilsen 94.6%, Iran 96.2%, classification tree 96.2%. Although some of the researchers believe that current diagnostic criteria of Behcet's diseases due to establishment on the adults clinical data, is not appropriate for children; our study revealed that the current seven Adult BD criteria are reliable and accurate in children too

[Prevalence of hypothyroidism in Shariati Hospital 2003-2004]

Scleroderma is an important chronic disease with unknown ethiology and two subtypes: limited type: Skin involvement limited to distal of extremity and face. Diffuse type: Skin involvement is both distal and proximal of extremity, face and thrunk. Thyroid dysfunction is a main problem in these patients but there is no published data of Iranian scleroderma patients This is a cross-sectional study to determine the prevalence of hypothyroidism [clinical, subclinical and autoimmune] in patients with scleroderma 125 patients with scleroderma selected and T3, T4, TSH Anti Tpo Ab and Anti TG Ab measured in them. 33 patients with scleroderma had hypothyroidism. [%26/4]. Two patients with scleroderma had hyperthyroidism. [%1/6].%12/8 had clinical hypothyroidism. And%13/6 had subclinical hypothyroidism,%33/3 of patients with subclinical hypothyroidism and positive autoantibody had limited type. Where as%66/6 of patients with subclinical hypothyroidism and autoantibody had diffuse type,%28/5 of patients with clinical hypothyroidism and positive auto anti body had limited type. Where as%71/4 of patients with clinical hypothyroidism and auto anti body had diffuse type. All of patients with hyper thyroidism had diffuse type and autoantibody positive. It seems hypothyroidism has an increased prevalence in patients with scleroderma and we suggest that thyroid function test must be done in primary evaluation of these patients

[ relationship between triglyceride level - HDL level - tumor necrosis alpha factor and its soluble receptors with lupus erythematosus activity]

Systemic lupus erythematosus [SLE] is a disease with life-threatening complications. Since evidence indicates that measurement of triglyceride [TG] and HDL levels and tumor necrosis alpha factor [TNF- alpha] and its types I and II soluble receptors plays a major role in evaluation of lupus activity, this study was conducted to investigate the relationship between the above mentioned factors and lupus activity in Tehran in 2005. In this cross-sectional study fasting blood samples were obtained from 86 SLE patients who had been entered into the study through convenient sampling and the disease activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]. Scores >/= 6 were considered as active lupus and <6 as dormant lupus. Serum levels of TNF- alpha, sTNFR[1] and sTNFR[2] were measured through ELISA [Bender Medsystem] and blood TG and HDL through routine biochemical tests within 12 hours overnight fasting. The results were analysed by t-test, Mann-Whitney and Pearson correlation tests. 46 people [53.5%] suffered from dormant disease and 40 people [46.5%] from active disease. TG level had significant relationship with disease activity, sTNFR[2] [P=0.001] and TNF-alpha [P=0/01], while HDL level had inverse significant relationship with SLEDAI [P=0.007], TNF [P=0.01], STNFR1 [P=0.001]. There was no significant relation between TG and HDL with STNFR2. Multiple linear analysis of regression showed that three variables [TG, sTNFR[1] and sTNFR[2]] are maintained in the model for prognosis of the disease while TNF-alpha and HDL are omitted. Dislipoproteinemia [elevated TG and reduced HDL] correlates with SLE activity following an increase in TNF-alpha and its soluble receptors. Thus, serum levels of TG, HDL and TNF-alpha and its soluble receptors are connected with lupus activity and are valuable markers for the disease activity

Quality of life in women with different intensity of low back pain

It is widely believed that pain has a profound effect on health related quality of life. This study was conducted to assess quality of life in patients suffering from different density of chronic low back pain. The sample consisted of 101 patients with chronic low back pain attending to the Rheumatology Research Center of Tehran University of Medical Sciences between July and September 2003. All patients were female, married, aged 18 years or over and underwent rheumatologic clinical examination. Data were collected by face-to-face interviews using the Iranian version of the Short Form Health Survey [SF-36]. Relative to mean score of bodily pain, patients were divided into 2 groups: severe pain group [group 1] and mild pain group [group 2]. Then, quality of life scores was compared between these two groups. Independent sample t-test was applied and the results showed that there were significant differences between quality of life scores among people with different intensity of low back pain in all dimensions but the role emotional and social functioning scales. The findings from this study confirm that quality of life in patients with low back pain depending on its intensity may vary

[Back school in low back pain: a single blind randomized trial]

Back school was developed as a preventive measure for reducing low back pain in those who suffer from the disease. Despite diversities in approaches. all back school programmers involve classes in which patients receive theoretical and practical information to know their back and to cope with their limitations. Some studies showed benefits of back school including reduction in pain severity and functional disability in the short and medium terms. The purpose of the present study was to evaluate the short term effect of the multidimensional and interdisciplinary modern back school program in women with chronic low back pain in Tehran, Iran. This was a randomized controlled clinical trial carried out in Teheran, Iran. All 102 eligible women with chronic low back pain were randmly allocated to either back school program [n = 50] or control group [n = 52]. The back school subjects received 5 group sessions of back school education over 12 hours and followed up weekly until 3 months but control group was not offered any education. The two groups underwent physician visits and medication. Outcome variables were the pain severity as well as measures of physical, social and emotional functioning using the SF- 36 questionnaires. The findings indicated a significant improvements in pain, physical, emotional and social functioning scores in the back school group compared to control group. Although pain reduction was reported in both groups after 3 months but the difference was significantly greater for the back school group. Also regression analysis showed that back school program was the best predictor for improving low back pain. The back school program is an effective measure in reducing pain severity in those who suffer from low back pain

How much improvement is expected in ocular lesions of Behcet's disease treated with pulse cyclophospamide?

The natural history of ocular lesions in Behcet's disease is toward severe loss of vision/blindness in few years, whereas cytotoxic drugs have changed the outcome. Several open labeled cohort studies showed pulse cyclophosphamide [PCP] to be the best choice. Since one third of these patients are resistant to PCP it is important to know how much improve ment one can expect from the responders. To address this question, we selected patients who improved or maintained their baseline visual acuity after treatment. From a cohort of 528 patients [1056 eyes], 753 eyes were selected. At the beginning of the study PCP was given for one month as 0.75 to 1 g in perfusion, and then followed every 2 to 3 months. Prednisolone was also given as 0.5 mg/kg/daily and then tapered upon controlling inflammation. The mean +/- SD number of pulses was 11.5 +/- 8.5/month with follow-up of 20.6 +/- 19.8 months. Different disease activity indices such as visual acuity, posterior uveitis, retinal vasculitis, total inflammatory activity index [TIAI], total adjusted disease activity index [TADAI] were calculated at baseline and at last evaluation. The mean visual acuity improved from 2.4 to 4.4. The mean indices for posterior uveitis, retinal vasculitis, TIAI and TADAI improved from 2.2 to 1, 2.7 to 1.4, 19.3 to 9, and 27.2 to 20.5 respectively. The P value was less than 0.001 for all comparisons. Pulse cyclophosphamide is able to improve ocular lesions of Behcet's disease; therefore it may be used as a first choice, especially in retinal vasculitis

Patient's Knowledge, Perception and Belief about the Reasons of Low Back Pain

Patients with chronic low back pain [LBP] hold various knowledge, perceptions and beliefs about their pain which are based on prior learning and social conditions. Since LBP is a bio- psycho-social phenomenon and there are not any reports about awareness and attitude of Iranian patients' views regarding it, this descriptive study was employed to earn this information P to apply its results in health education planning. For data gathering, deeply interviewing with 24 patients were performed. Volunteer patients were from Rheumatology Research Center of Tehran University of Medical Science from July 1st to Sep 1st 2003 who had inclusive criteria such as: 18 years old or more, suffering from LBP more than 90 d and not having experience of surgical operation in last two years. Interviews were individually held at rheumatic disease center which was convenient to the participants and were being continued to earn data saturation regarding patient's knowledge, perception and belief about LBP. The findings showed that the most popular risky behavior for LBP was hard manual activities, also this study revealed that knowledge of the patients about LBP and its risk factors was little and LBP was not understood by the majority of patients [74%].Only a few people [11%] believed risk factors and risky behaviors could deteriorate it. From this study it can be concluded that health educators should emphasize on perception and attitude of the patients regarding LBP for changing behavior and complying of recommended body mechanics

Comparison of validity of microlymphocytotoxicity and flow cytometry methods with PCR for HLA-B27 antigen typing

The Human Major Histocompatibility Complex [MHC] plays a crucial role in transplantation, transfusion, paternity test and assessment of susceptibility to some diseases associated with HLA-B27. Three of the most fashionable methods for determination of HLA antigens in clinical and research laboratories are microlymphocytotoxicity [MLCT], flowcytometry and polymerase chain reaction [PCR].The purpose of this study was to compare the sensitivity, specificity, and positive and negative predictive values of MLCT and flowcytometry methods with PCR as a gold standard method in determination of HLA-B27 antigen. In the present study, all three above-mentioned techniques have been used for 36 patients suffering from ankylosing spondylitis and 31 healthy volunteers. Specific antisera and monoclonal antibodies against HLA-B27, and allele specific PCR have been used in MLCT, flowcytometry and PCR methods respectively. The results show that sensitivity, specificity, positive and negative predictive values of MLCT method as compared with PCR technique were 83.3%, 100%, 100% and 88.1% respectively. Moreover, sensitivity, specificity, positive and negative predictive values of flowcytometry compared to the PCR technique were 100%, 94.6%, 93.8% and 100% respectively. Based on the results, the flowcytometry method in determination of HLA-B27 is more valid than MLCT in this regard, particularly in research programs. The similarity between the results of our study and those studies done in Europe suggests the probability of resemblance between HLA-B27 subtypes in Europe and in Iran