The efficacy of curcumin supplementation on serum total antioxidant capacity, malondialdehyde, and disease activity in women with rheumatoid arthritis: A randomized, double-blind, placebo-controlled clinical trial.

Oxidative stress plays a crucial role in the physiopathology of rheumatoid arthritis (RA), which is associated with impaired antioxidant defenses. This study aimed to investigate the effects of curcumin supplementation on serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and disease activity in women with RA. In this clinical trial, 48 women with RA were treated with one capsule of curcumin (500 mg daily) or placebo for 8 weeks. Anthropometric measurements and fasting blood samples were collected at baseline and end of the study. Finally, we assessed the Disease Activity Score in 28 joints (DAS-28), dietary intake, and physical activity levels. While curcumin supplementation for 8 weeks significantly increased the serum levels of TAC (p < 0.05), it decreased tender joint counts, swollen joint counts, visual analog scale (VAS) for pain, and DAS-28 compared to the placebo at the end of the study (p < 0.001 for all). MDA levels significantly decreased in the curcumin group (p < 0.05). However, changes in MDA concentration were not significant between groups at the end of the trial (p = 0.145). Curcumin supplementation had a beneficial effect on increasing the serum levels of TAC and decreased DAS-28 in women with RA.

Concomitant uterus agenesia and Marfan syndrome with systemic sclerosis: A rare case report.

It seems that the association of two connective tissue disorders, including Marfan syndrome and systemic sclerosis, the first is associated with the loosening of the subcutaneous tissue and the second with its tightening, is a very interesting and controversial paradox at the same time and need finding possible genetic etiologies.

Hypoparathyroidism as one of the initial presentations of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease and may be associated with many autoimmune conditions. Hypoparathyroidism is a rare disease. The leading cause of hypoparathyroidism is postsurgical hypoparathyroidism. However, hypoparathyroidism as an initial presentation of SLE is still a rare condition. Here, we report a case of SLE presented with hypoparathyroidism and Hashimoto's thyroiditis.

Exposure to greenspace and cancer incidence, prevalence, and mortality: A systematic review and meta-analyses.

We conducted a systematic review and meta-analysis of the available literature on the association between greenspace exposure and all-sites and site-specific cancer incidence, prevalence, and mortality in adults. We searched PubMed, Scopus, and Web of Science for original articles published, without language restriction until September 2021. We assessed the risk of bias in each study and the overall quality of evidence for exposure-outcome pairs that were reported in two or more studies. Out of the 18 included studies, cross-sectional studies were the most common study design (n = 8), and most of the studies were conducted in Europe (n = 8). In terms of risk of bias, the majority of cohorts (four out of six) and case-control studies (three out of four) were of good or very good quality, and cross-sectional studies were mostly (five out of eight) of poor quality. Outcomes (incidence, prevalence, mortality) on different cancer sites were reported: lung cancer (n = 9), prostate cancer (n = 4), breast cancer (n = 4), skin cancer (n = 3), colorectal cancer (n = 2), all-sites cancer (n = 2), brain cancer (n = 1), mouth and throat cancer (n = 1), and esophageal cancer (n = 1). The meta-analyses for the breast, lung, and prostate cancer incidence did not show statistically significant associations (for example for breast cancer: hazard ratio = 0.83; 95% confidence interval: 0.47-1.48). For skin cancer, the available evidence suggests that greenspace could be a potential risk factor. For the other cancers, the evidence was non-conclusive. The overall quality of evidence of all of the exposure-outcome pairs was very low. Given the wide confidence interval of the pooled estimates and very low quality of evidence, the findings should be interpreted with caution. Future large and longitudinal studies are needed to assess the potential association of greenspace exposure with cancers, considering types and quality of greenspace, evaluation of cancer sub-types, and adjustment for a sufficient set of covariates.

Effects of curcumin supplementation on metabolic parameters, inflammatory factors and obesity values in women with rheumatoid arthritis: A randomized, double-blind, placebo-controlled clinical trial.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to cartilage damage with mostly accompanied by metabolic disorders. This study aimed to investigate the effects of curcumin supplementation on metabolic parameters (lipid profile and glycemic indices), inflammatory factors, visfatin levels, and obesity values in women with RA. This randomized, double-blind, placebo-controlled clinical trial was conducted on 48 women with RA. The patients were treated with curcumin (500 mg once a day) or placebo for 8 weeks. Fasting blood samples, anthropometric measurements, dietary intakes, and physical activity levels of subjects were collected at baseline and the end of the study. Curcumin supplementation significantly decreased homeostatic model assessment for insulin resistance (HOMA-IR), erythrocyte sedimentation rate, serum levels of high-sensitivity C-reactive protein and triglycerides, weight, body mass index, and waist circumference of patients compared with the placebo at the end of the study (p < .05 for all). HOMA-IR and triglyceride levels significantly increased within the placebo group. Changes in fasting blood sugar, insulin, other lipids profile, and visfatin levels were not significant in any of the groups (p > .05). These results support the consumption of curcumin, as a part of an integrated approach to modulate metabolic factors, inflammation, and adiposity in women with RA.

Stachys schtschegleevii tea, matrix metalloproteinase, and disease severity in female rheumatoid arthritis patients: a randomized controlled clinical trial.

BACKGROUND: Stachys schtschegleevii (SSC) is a herbal medicine used to treat infections. To date, this is the first study aimed to investigate the effects of SSC tea on disease activity score (DAS), serum inflammatory biomarkers and matrix metalloproteinases (MMP-1 and MMP-3) among women with rheumatoid arthritis (RA). METHODS: This pilot, triple-blind, randomized controlled clinical trial was conducted among forty-four women (age: 30-65 years) diagnosed with moderately active RA. Subjects were randomly assigned (1:1 ratio) into either SSC group (2.4 g/day SSC + 2.4 g/day black tea, n=22) or placebo (2.4 g/day black tea, n=22) for 8 weeks. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-1 beta (IL-1ß), and MMPs were measured using ELISA. According to the American College of Rheumatology guideline considering hs-CRP, DAS28 was assessed. RESULTS: Both study groups had respondent rates above 94.9%. The SSC intervention caused significant reductions in the number and the percent changes of the tender joints (SSC: -74.39% vs. placebo: -57.15%, mean differences= -0.77; P<0.05) and DAS28 [SSC: -32.44% vs. placebo: -22.32%, mean differences= -0.41, P<0.05). Unlike the intervention within SSC group that showed significant reductions in the mean serum levels of hs-CRP, IL-1ß, and MMP-3, SSC caused significant MMP-3 reductions (SSC: -20.59% vs. placebo: 1.29%, P<0.05). CONCLUSION: The SSC intervention showed an appropriate clinical efficacy for female RA patients, accompanying remarkable reductions in the number of tender and swollen joints, DAS28, and serum levels of MMP-3. This can provide additional insights to the interventional studies controlling RA-related pathological and inflammatory outcomes. Trial registration Prospectively registered at the Iranian Registry of Clinical Trials (IRCT), linked to the WHO Registry Network ( https://en.irct.ir/trial/11602 , IRCT registration number: IRCT2015032011335N5, Registration date:2015-05-12). Key Points • Stachys schtschegleevii improved clinical outcomes and attenuated disease severity in RA patients. • Stachys schtschegleevii ameliorated serum level of MMP-3 in RA patients.

Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents.

BACKGROUND: Despite successful clinical outcomes of biologic medications in patients with chronic rheumatic diseases, some considerable adverse effects such as infections remain a major concern. Possibility of tuberculosis (TB) reactivation over treatment with anti-tumor necrotizing factor (TNF) alpha agents has necessitated a screening test before initiation of treatment. However, screening over the course of treatment is not recommended in those patients with negative baseline screening tests. This study aimed to evaluate the efficacy of tuberculin skin test (TST) before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and the necessity of repeating this test over the course of treatment. METHODS: In this prospective study, patients with chronic rheumatologic diseases receiving anti-TNF-alpha agents were studied in a two-year period. TST was performed before treatment and those with positive results were excluded from the study. Thereafter, treatment with anti-TNF-alpha agents was initiated with the indicated dose. TST was repeated before administration of biologic treatment until TST became positive or 16 weeks after the initiation of treatment with anti-TNF-alpha. RESULTS: A total of 51 cases were studied, of whom one patient (1.9%) was excluded due to positive TST before treatment. All participants received infliximab and the TST test became positive in one patient (2%) 2 weeks after receiving the first dose. Also, the results of further tests at weeks 6, 10, and 14 were all negative for the remaining patients. CONCLUSION: Due to the possibility of TST conversion after administration of anti-TNF-alpha therapy, it is important to consider TB monitoring in patients under treatment with these agents using available methods such as TST.

Effect of Nigella sativa oil extracts on inflammatory and oxidative stress markers in Behcet's disease: A randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: Behcet's disease (BD) is a chronic inflammatory disorder characterized by recurrent oral and genital aphthous ulcers, uveitis and skin lesions. Oxidative stress and inflammation have important role in the pathogenesis of BD. The aim of this study was to assess the effect of Nigella sativa (NS) oil administration on malondialdehyde (MDA), total anti-oxidant capacity (TAC), tumor necrosis factor-α (TNF-α), IL-10 and high sensitivity C-reactive protein (hs- CRP) levels in patients with BD. MATERIALS AND METHODS: In this randomized, double-blind and placebo-controlled clinical trial, 96 BD patients were randomly assigned to NS or placebo groups. Study groups received 1000 mg/day NS oil and placebo soft gels for 8 weeks. Serum levels of TNF-α, IL-10, hs-CRP, MDA and TAC were measured before and after treatment. RESULTS: Eighty-nine individuals completed the study. Significant decreases in the serum levels of MDA and increases in the serum levels of TAC were found in the NS group. However, differences in the changes of MDA and TAC in the NS and placebo groups were not significant. Pre- and post-intervention changes of TNF-α, IL-10 and hs-CRP levels in the NS group were non-significant. CONCLUSION: NS 1000 mg per day is probably not effective in reducing the inflammatory and oxidative markers in BD.

Clinical characteristics and long-term outcome of Takayasu arteritis in Iran: a multicentre study

Background/aim: This study aimed to evaluate the demographic, clinical, angiographic and prognostic characteristics of Takayasu arteritis (TA) in Iran. Materials and methods: A total of 75 patients with TA based on the American College of Rheumatology 1990 criteria for TA classification referred to the Rheumatology Centres, were followed-up from 1989 to 2019. Demographic, clinical, angiographic and prognostic characteristics were collected at baseline and last visit. Results: The mean age was 31.9 ± 9.8 years at the disease onset. Female to male ratio was 14. The median latency in diagnosis was 24 months. Pulse discrepancy in the arms, blood pressure discrepancy in the arms, limb claudication, hypertension and constitutional symptoms were the most common clinical features. The most common angiographic type at the time of diagnosis was Type I (42.7%). The most frequent arterial lesion was stenosis (89.4%). Subclavian, carotid and aortic arteries were the most commonly involved arteries. New lesions developed in 28.6% of patients during the 5.25-year follow-up. Vasculitis-induced chronic damage was observed in all patients. Disease activity decreased and vascular damage remained stable throughout the follow-up period. Conclusions: The clinical features and angiographic type of TA in Iran are different from most Asian countries. Differences in angiographic and clinical features may lead to delayed diagnosis. The issue of delay in diagnosis should create awareness among health care providers that TA is not a very rare disease in Iranians and failure to pay attention to warning symptoms may delay the diagnosis.

Relationship between Helicobacter pylori cytotoxin-associated gene A protein with clinical outcomes in patients with rheumatoid arthritis.

INTRODUCTION: The Helicobacter pylori(H. pylori) infection leads to intensification of symptoms and calenture of autoimmune diseases. This study aimed to evaluate the relationship between H. pylori infection and clinical outcomes in rheumatoid arthritis (RA) patients. METHODOLOGY: This study was performed on 100 RA patients. Blood samples were collected for measuring Anti-H. pylori IgG antibodies and cytotoxin-associated gene A (CagA) protein. Fresh fecal samples were also collected and the fecal H. pylori antigen was extracted. Clinical condition as well as severity and type of RA symptoms in both groups of H. pylori positive and H. pylori negative were also compared. RESULTS: Serum levels of rheumatoid factor (RF), ESR, CRP, anti-cyclic citrullinated peptide (Anti-CCP), and anti-mutated citrullinated vimentin (Anti-MCV) were significantly higher in H. pylori positive patients than in H. pylori negative patients (P < 0.05). Serum RF, ESR, CRP and Anti-MCV levels were significantly higher in CagA positive patients than in CagA negative patients (P < 0.05). There were no significant differences in DAS-28 scores between H. pylori positive and H. pylori negative patients (P = 0.064) as well as between patients with positive and negative fecal H. pylori antigen (P = 0.237). However, DAS-28 score was significantly higher in CagA positive patients than in CagA negative patients (P < 0.001). Furthermore, mean VAS score was significantly higher in H. pylori positive patients (P = 0.031) and CagA positive patients (P = 0.004); however, there were no significant differences in VAS scores between patients with positive and negative fecal H. pylori antigen (P = 0.310). CONCLUSION: Follow-up and examination of RA patients in terms of infection with serum and fecal H. pylori organism and CagA seems necessary that will contribute to better and further control and treatment of the patients.

Efficacy and Safety of Mycophenolate Mofetil Versus Intravenous Pulse Cyclophosphamide as Induction Therapy in Proliferative Lupus Nephritis.

INTRODUCTION: Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that can lead to end-stage renal disease and death. The aim of this study was to compare the efficacy and safety of mycophenolate mofetil (MMF) and cyclophosphamide as induction therapy and subsequently as maintenance therapy for lupus nephritis. MATERIALS AND METHODS: In this retrospective case-control study, 67 patients with proliferative lupus nephritis who were treated with MMF (n = 45) and pulse of intravenous cyclophosphamide (n = 22) were included. Remission of the kidney disease, mortality, and adverse events were evaluated and compared between the two groups. RESULTS: The 45 patients treated with MMF had a mean age of 33.8 ± 10.6 years and 17.1% of them were males. The 22 patients treated with pulse of intravenous cyclophosphamide had a mean age of  38.1 ± 11.1 years and 18.2% of them were males. Complete and partial kidney remission occurred in 40% and 42.2% of the patients treated with MMF and in 31.8% and 59.1% of the patients treated with cyclophosphamide, respectively. No significant differences were observed in complete and partial remission between the two groups. No mortality was reported in the studied patients. There were no significant differences in the frequency of adverse events between the two groups. CONCLUSIONS: The efficacy of MMF in long-term treatment of lupus nephritis was comparable to that of cyclophosphamide, and there is no significant differences in the rate of side effects between the two regimens.

Kinetics of biogas production and chemical oxygen demand removal from compost leachate in an anaerobic migrating blanket reactor.

In this study, laboratory anaerobic migrating blanket reactor (AMBR) with four units was used to reduce and remove COD leachate of composting process; it was also used to determine the kinetic coefficients of COD removal and biogas and methane gas production in several different OLRs. The maximum concentration of organic matter entering the reactor was 100,000 mg/L and the reactor was under operation for 319 days. The results showed that the COD removal efficiency of AMBR in all concentrations of substrate entering the reactor was above 80%. First-order model and Stover-Kincannon were used to investigate the kinetics of COD removal via AMBR biological process; in addition, the two models of Modified Stover-Kincannon and Van der Meer and Heertjes were used to check the kinetic constants of biogas and methane gas production. The results obtained from the models showed that the experimental data on COD removal were more consistent with the results obtained from Stover-Kincannon model (R2 = 0.999) rather than with the First-order model (R2 = 0.926). Kinetic constants calculated via Stover-Kincannon model were as follows: saturation value constant (KB) and maximum utilization rate constants (Umax), respectively, were 208,600 mg/L d and 172,400 mg/L d. We investigated the linear relationship between the experimental data and the values predicted by the models; as compared with the values predicted by the First-order model, the values predicted by Stover-Kincannon model were closer to the values measured via experiments. Based on the results of the evaluation of kinetic coefficients of Stover-Kincannon model, with the migration of the leachate flow from unit 1 to unit 4, Umax value has fallen significantly. The values of maximum specific biogas production rate (Gmax) and proportionality constant (GB) obtained from the Stover-Kincannon model, respectively, were 35,714 ml/L d and 42.85 (dimensionless) and value of kinetic constant of Van der Meer and Heertjes (ksg) was 0.0473 ml CH4/mg COD.

Effect of Organic Loading Rates on biodegradation of linear alkyl benzene sulfonate, oil and grease in greywater by Integrated Fixed-film Activated Sludge (IFAS).

In this study, performance of Integrated Fixed-film Activated Sludge (IFAS) system in treatment of Linear Alkylbenzene Sulfonate (LAS), and oil & grease in synthetic greywater and effect of Organic Loading Rates (OLRs) on removal efficiency within a period of 105 days were investigated. Present study was carried out in a pilot scale under such conditions as temperature of 30 ± 1 °C, dissolved oxygen of 2.32 ± 0.91 mg/l, pH of 8.01 ± 0.95 and OLRs of 0.11-1.3gCOD/L.d. Also, Scanning Electron Microscopy (SEM) images were employed to specify rate of the biofilm formed on the media inside the reactor IFAS. The best removal efficiency for COD, LAS and oil and grease were respectively obtained as 92.52%, 94.24% and 90.07% in OLR 0.44gCOD/L.d. The assessment of loading rate indicated that with increased OLR to 0.44gCOD/L.d, removal efficiency of COD, oil and grease was increased while with increased OLR, removal efficiency was decreased. In doing so, based on the statistical test ANOVA, such a difference between removal efficiencies in diverse OLRs was significant for COD (p = 0.003), oil and grease (p = 0.01). However, in terms of LAS, with increased value of OLR to 0.44gCOD/L.d, the removal efficiency was increased and then with higher OLRs, removal efficiency was slightly decreased that is insignificant (p = 0.35) based on the statistical test ANOVA. The SEM images also showed that the biofilm formed on the media inside IFAS reactor plays a considerable role in adsorption and biodegradation of LAS, and oil & grease in greywater. The linear relation between inlet COD values and rate of removed LAS indicated that the ratio of inlet COD (mg/L) to removed LAS (mg/L) was 0.4. Therefore, use of IFAS system for biodegradation of LAS, oil and grease in greywater can be an applicable option.

Effects of Elaeagnus angustifolia L. on Lipid Profile and Atherogenic Indices in Obese Females: A Randomized Controlled Clinical Trial.

In the present randomized double-blinded placebo-controlled study, the effect of Elaeagnus angustifolia L. (EA) whole fruit and medulla powders on anthropometric indices, serum lipid profile, and atherogenic indices in females with knee osteoarthritis (OA) was investigated. Ninety females with mild to moderate knee osteoarthritis were randomly assigned to one of three groups-medulla powder, whole fruit powder, or placebo. The subjects received 15 g/day of medulla powder of EA, whole fruit powder of EA, or placebo. Lipid profile, weight, and dietary intake were measured at baseline and at the end of the study. Body mass index and atherogenic indices were calculated. Statistical analysis was performed using SPSS version 13.0, and Paired t tests, analysis of variance (ANOVA), analysis of covariance (ANCOVA), and the Tukey post hoc test were used to compare within-group and between-group values. After 8 weeks of supplementations, compared with the baseline, significant reductions in total cholesterol (TC), low density lipoprotein/high density lipoprotein (LDL/HDL), and TC/HDL ratios were observed in the two supplemented groups; however, the reduction of these values was not statistically significant in the placebo group. There were significant differences between the patients who received medulla powder and placebo group in the case of changes in TC/HDL and LDL/HDL ratios (p < .001). However, no significant differences were found between the two supplemented groups in the case of changes in studied values (p > .05). Generally, whole fruit and medulla powders of Elaeagnus angustifolia L. had positive effects, especially in decreasing total cholesterol and atherogenic indices in females with knee OA.

Renal involvement in Behcet's disease.

There are conflicting reports about the renal involvement in Behcet's disease (BD). In this study we aimed to study the frequency and type of renal involvement in a group of patients with BD in Azerbaijan province that is one of the prevalent areas of BD in Iran. All cases of BD were prospectively followed between June 2004 and January 2007, and evaluated for renal dys-function (serum creatinine > 1.7 mg/dL), glomerular hematuria and proteinuria. Those patients with proteinuria > 500 mg/day and serum creatinine level > 2 mg/dL, underwent renal biopsy. From a total number of 100 patients, six patients (6%) had obvious renal involvements. Four patients had glomerular hematuria and proteinuria. Renal biopsy in two of them revealed measangial proliferative glumerulonephritis with IgA deposit in one of them and membranoproliferative glumerolonephritis in another one. Two remaining patients had serum creatinine > 2 mg/dL without any hematuria or proteinuria. Serologic study for viral agents and collagen vascular disease were negative in all patients with renal involvements. In conclusion, renal involvement in BD is not infrequent, although in most cases it is mild in nature and may be missed.