The Potent Inhibitory Effect of ß-D-Mannuronic Acid (M2000) as a Novel NSAID with Immunosuppressive Property on Anti-Cyclic Citrullinated Peptide Antibodies, Rheumatoid Factor and Anti-dsDNA Antibodies in Patients with Rheumatoid Arthritis.

OBJECTIVE: To investigate the inhibitory effect of ß-D-mannuronic acid (M2000) on anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), antidouble strand DNA (anti-dsDNA) and acute phase reactants in rheumatoid arthritis (RA) patients. METHODS: The study included 40 patients with RA who had an inadequate response to conventional therapy (identifier: IRCT2014011213739N2). The patients were permitted to continue the conventional therapy excluding NSAIDs. 21 of them were treated orally by M2000 at a dose of 500 mg twice daily for 12 weeks and the others did not. Serum samples were collected at baseline, 4 weeks and 12 weeks after treatment and were tested for the serum level of anti-CCP and anti-dsDNA antibodies using enzyme linked immunosorbent assay. The serum level of RF and C-reactive proteins (CRP) was determined by the immunoturbidimetric assay, respectively. RESULTS: At baseline, all patients in the M2000 treated group and the control group were positive for anti-CCP, RF. moreover, 4 of 21 (19%) in the M2000 treated group and 2 of the 19 (10.5%) patients in the control group were positive for anti-dsDNA antibodies, respectively. The serum levels of anti-CCP, RF and anti-dsDNA were decreased significantly after M2000 therapy (p<0.001, p<0.001 and p<0.001, respectively). The reduction in the level of anti-CCP was positively correlated with disease activity, swollen joint count and CRP. Furthermore, the level of inflammatory markers ESR and CRP decreased significantly after M2000 therapy (p<0.001 and p<0.004, respectively). CONCLUSION: M2000 shows inhibitory effect on anti-CCP, RF, anti-dsDNA antibodies and acute phase reactants in RA patients.

Treatment of low back pain: Second extended follow up of an original trial (NCT00600197) comparing a multidisciplinary group-based rehabilitation program with oral drug treatment alone up to 30 months.

BACKGROUND: The aim of this study is to investigate the effects of the extended 30-month follow-up of an original trial (NCT00600197) which has been published in the Clinical Journal of Pain. METHODS: Seventy-four percent (146/197) of the participants who had taken part in the original study, including 69 patients in the intervention group and 77 patients in the control group, were followed up to 30 months after intervention. The intervention group continued receiving monthly motivational consultation and booster classes plus oral medication but the other group received just medication. Data on measures from the Short Form 36 (SF-36), Quebec Disability Scale (QDS) and Ronald Morris Disability Questionnaire (RDQ) were collected at 3-, 6-, 12-, 18-, 24- and 30-month follow-ups and analyzed through repeated measures analysis of variance. RESULTS: The two groups were comparable regarding all baseline characteristics (P > 0.05) except for education level and mental health, which were better in the intervention group (P < 0.05). The two groups improved regarding all studied variables over time up to 30 months (P < 0.001). Moreover, the intervention group in comparison with the control group had consistently better outcomes regarding all variables. There were significant differences within each group by time in terms of mental health (P = 0.01) and disability measured through QDS (P = 0.005) and RDQ (P = 0.014). CONCLUSION: The proposed multidisciplinary program could improve mental health and disability up to 30 months in chronic low back pain patients.