[Prevalence of osteopenia and osteoporosis in patients with celiac disease in northeastern Iran]

Celiac disease is an autoimmune disorder which causes malabsorption in genetically susceptible patients who consume gluten. Celiac disease is not limited to the gastrointestinal system, and exhibits different signs and symptoms in other organs. Malabsorption of calcium and vitamin D can cause osteomalacia and secondary hyperparathyroidism. Celiac disease is no longer a rare disease and is more frequent in the Middle East. It is expected that 1% of the in general population has celiac disease. This study aims to determine the prevalence of osteopenia and osteoporosis in Iranian patients with celiac disease. Individuals with intestinal and extra-intestinal problems who had positive serologic tests for anti-tissue transglutaminase or antiendomysial antibody were offered endoscopic duodenal biopsy to confirm their diagnoses of celiac disease. Biopsy-proven celiac disease patients between the ages of 20 to 60 years were enrolled. Exclusion criteria were as follows: 1] the use of drugs such as corticosteroids, anticonvulsants, heparin, cyclosporine, statins, and beta -blockers, 2] the presence of any neoplasm, and 3] any metabolic disorder such as diabetes, hyperthyroidism, Cushing's, and immobility. After obtaining informed consents, we evaluated 76 patients diagnosed with celiac disease. All enrolled patients underwent BMD measurement of the hip, femoral neck, and spine using dual-energy X-ray absorptiometry [bone densitometry with DEXA scan]. A total of 76 patients with celiac disease of ages 20 to 60 years old [mean: 33 years old] underwent bone densitometry. Of these, 66% were female and 33% were male. There were 44 patients [57%] who had normal bone density in the spine, 17 [22.4%] who had osteopenia, and 15 patients [20%] had osteoporosis. In the femoral neck, 38 patients [50%] had normal bone densitometry, 25 [32.9%] had osteopenia, and 12 [15.8%] had osteoporosis. Low bone mineral density [osteoporosis or osteopenia] was seen in 48% of our patients in the femoral neck and 43% in the spine. The prevalence of osteoporosis among celiac disease is much higher than the general population. Of the study patients, 55% had osteopenia in the femoral neck or spine and 36% had osteoporosis in the femoral neck or spine. The prevalence of osteoporosis is elevated enough to justify a recommendation for osteoporosis screening of all patients with celiac disease

[Homocysteine and high sensitivity C-reactive protein in patients with systemic lupus erythematosus, and their relation with diseases activity and cardiovascular risk factors]

Systemic lupus erythematosus [SLE] is an inflammatory multi-system disease with an unknown origin. In patients with lupus disease cardiovascular events is an important cause of mortality and morbidity. This study carried out to measurement of high sensitivity C-reactive protein [HsCRP] and homocysteine in patients with SLE and their relation with diseases activity and cardiovascular risk factors. This case control study carried out on 60 patients [55 females and 5 males] with lupus disease which referred to Clinical Research Center of Rheumatology, Mashhad, Iran and 30 controls [26 females and 4 males] during 2007-08. Information of subjects were gathered using SLEDAI questionare. HsCRP and homocysteine of subjects were measured. The level of low density lipoprotein [LDL], Triglycerid, hypertension and Body mass index [BMI] was assessed. Systemic lupus erythematosus activity was assessed by using SLEDAI so that if the score was higher than 10, lupus was called as active disease. Mean age was 28.8 +/- 10.3 and 33.8 +/- 9.13 years in SLE and control groups respectively. The mean of HsCRP in SLE patients were 3 +/- 2.42 mg/dl versus in controls were 1.58 +/- 2.1. The serum level of homocysteine were 12.3 +/- 1.93 micro mol/L and 24 +/- 8.13 micro mol/L in SLE patients and controls [P<0.001]. Mean disease activity was 15.37. There was no any associtation between homocysteine and HsCRP and disease activity. LDL, Triglycerid, hypertension had significant association with homocystein [P<0.05]. BMI and Triglycerid had significant association with HsCRP [P<0.05]. This study showed that there is no linear significant corrolation between homocysteine, HsCRP and disease activity, but there is significant corrolation between increase of homocysteine and HsCRP and cardiovascular risk factors

Vitamin D receptor gene BSMI polymorphisms in systemic lupus erythematosus and healthy subjects

Vitamin D receptor [VDR] gene polymorphisms cause functional differences in immunomodulatory action of vitamin D. An association between VDR gene BSMI polymorphisms and systemic lupus erythematosus [SLE] has been documented. To compare the VDR gene BSMI polymorphisms in patients with SLE and healthy controls. This was a case-control study conducted in the city of Mashhad [Iran]. Sixty patients with lupus from two outpatient rheumatology clinics and 45 non-relative healthy controls of the same sex were selected using the census procedure. VDR gene typing was performed based on polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. The results were analyzed using chi square test while a P < 0.05 was considered as significant. The distribution of VDR genotyping of BSMI polymorphisms in patients with SLE were 23.3% for BB, 60% for Bb and 16.7% for bb. Similarly, the values found for healthy group were 33.3%, 46.7%, and 20% for BB, Bb, and bb, respectively. There was no statistically significant difference between two groups. No significant difference in relative frequency of VDR gene BSMI polymorphisms in SLE patients and healthy individuals was established

[ effect of laterally elevated wedged insoles in comparison with neutrally wedged insoles on the symptoms of patients with medial knee osteoarthritis]

Knee osteoarthritis is a common condition having an increased prevalence with age. Non-pharmacological interventions are frequently and widely used and strongly recommended in the management of patients with osteoarthritis. Lateral-wedged insoles have been shown to help clinical pain associated with medial compartment osteoarthritis. Yet, it has been shown ineffective in some studies. This study was done to compare the effect of laterally elevated wedged insoles with neutrally wedged insole an the symptom of patients with medial knee osteoarthritis. This double - blind clinical - trial study was done in Rheumatology ward of Imam Reza Hospital in the years 2004 - 2005. 118 patients were randomly divided into 2 groups. Case group [57 patients] received laterally wedged insoles and control group [61 patients] received neutrally wedged insoles for two months. Edinburg knee functional scale was used. At the end of month 2, Patients were asked about the severity of knee pain within the last 2 days and the amount of anti-inflammatory drugs taking within the 2 weeks ago and another Edinburg knee functional scale completed. Analysis of data was performed with SPSS version 11.5. The results were compared by using student's t test, chi-square and Mann Whitney tests. Of the 150 patients enrolled, 118 [49 female and 8 male in laterally wedged insole group and 52 female and 9 male in neutrally wedged insole group] completed the study. There was good baseline balance between the groups, in respect of self reported knee pain, Edinburg knee functional scale and anti-inflammatory drugs taking by the patients. At the end of the study there was statistically significant difference in severity of knee pain in each of the groups from baseline. [p<0.001 in laterally wedged insole group and p=0.012 in neutrally wedged insole]. However there was statistically significant difference in severity of knee pain between the groups [p<0.001]. Edinburg knee functional scale had statistically significant difference from baseline in laterally wedged insole group [p<0.001], while there was no statistically significant difference in neutrally wedged insole group [p=0.645]. There also was statistically significant difference from baseline in laterally wedged insole group on taking anti-inflammatory drugs [p=0.001], but not in neutrally wedged insole group [p=0.941]. Laterally elevated wedged insole was shown to be more effective in reduction of symptoms in osteoarthritic patients

[Evaluation of the relationship between skeletal status and radiomorphometric indices of the mandible observed in panoramic radiography in women]

Since the age-related skeletal osteopenia has attracted much attention in recent studies and also because osteoporosis is the most common metabolic bone disease and the panoramic radiography is widely used for routine examinations, the relationship between radiomorphometric indices of mandibular bone [Panoramic Mandibular Index, PMI; the height of mandibular Inferior Cortex, IC [mm] and Mandibular Cortical Index, MCI] in panoramic radiography and skeletal status in femoral neck and lumbar spine [L[2]-L[4]] was evaluated in women referring to radiology department of Mashhad dental school. In this cross sectional analytical study, radiomorphometric indices of mandibular bone of 67 women over 35 years old referring to radiology department of Mashhad dental school were recorded. Women with a history of bone metabolism affecting diseases or drugs were excluded from our study. All the cases had a panoramic radiography in their orders. All of the patients were then referred to Toos Bone Densitometry Center for bone densitometry in left femoral neck and lumbar spine [L[2]-L[4]], using DEXA[1] technique with Osteocore apparatus. The patients were divided into three categories of normal, osteopenic and osteoporotic in each skeletal region according to their T-score. The data were analyzed by ANOVA and Pearson's correlation coefficient. Comparing average of bone mineral density between C[1] and C[3] subgroups of MCI, in postmenopausal females in femoral neck, a significant difference was detected [P-Value=0.04]. The average of PMI in the three different skeletal categories, was not different according to skeletal region and menstruation status [P-Value>0.05]. The results of this study showed that the use of radiomorphometric indices of mandible [especially MCI] can help to determine skeletal status of patients but is not enough for precise evaluation of patients' skeletal status