The New Perceptions on Life of Iranian Patients with Ankylosing Spondylitis: A Qualitative Study

Various studies suggest that ankylosing spondylitis (AS) as a chronic inflammatory disease with many disabilities can have impacts on different aspects of patients’ life. Despite many quantitative studies, only few qualitative studies have thus far been published on this subject. For the first time, the present study aims at gaining insight into the life experience of Iranian AS patients. We performed a content analysis through semi-structured interviews with twenty-eight patients diagnosed with AS, including three females and twenty-five males with an average age of 38.5 years, to gain insight into their experiences. Whatever the patients expressed was written and transcribed verbatim. Then, we did analysis of the results after each interview. The detailed information completely extracted from the interviews was classified as sub-themes and main themes. Three main themes were identified by the analysis: (i) “Always with pain” describing the effects were found in regard to pain on patients’ life, (ii) “The perceived limitation” describing many difficulties that people may face in the society as a result of their disease, and (iii) “Fearing the unknown future” which implies to both patients and their families have concerns about the future and what will happen. Our research findings in line with other qualitative studies showed that AS disease puts a heavy and intolerable burden on patients and their family. It seems that the experiences of people living with AS can be useful to meet challenges caused by the disease and it can enhance their coping with the disease

Downregulation of ITM2A Gene Expression in Macrophages of Patients with Ankylosing Spondylitis

Objectives: Ankylosing spondylitis (AS) is a rheumatic disorder that is mostly determined by genetic and environmental factors. Given the known importance of macrophage in AS pathogenesis, we investigated the transcriptional profile of macrophage cells in the disease. Methods and Results: Two approaches of differential expression and subsequently, weighted gene co-expression network analysis was utilized to analyze a publicly available microarray dataset of macrophages. Integral membrane protein 2A (ITM2A) was among the most significant genes with a decreased trend in the common results of both methods. In order to confirm the finding, the expression of ITM2A was evaluated in monocyte-derived (M2-like) and M1 macrophages obtained from 14 AS patients and 14 controls. Macrophages were differentiated from whole-blood separated monocytes by 7 days incubating with macrophage colony-stimulating factor and then macrophages specific markers were verified with the flow cytometer. M1 polarization was induced by IFN-gamma and lipopolysaccharide. Finally, relative gene expression analysis by real-time polymerase chain reaction revealed a significant downregulation of the ITM2A gene in both M2 like and M1 macrophages of the AS group compared to the control. Conclusion: Since ITM2A plays a critical role in osteo- and chondrogenic cellular differentiation, our finding may provide new insights into AS pathogenesis.Peer reviewe

Low back pain education and short term quality of life: a randomized trial

BACKGROUND: Different interventions can reduce the burden of the chronic low back pain. One example is the use of a 'Back School Programme'. This is a brief therapy that uses a health education method to empower participants through a procedure of assessment, education and skill development. This study aimed to evaluate to what extent the programme could improve quality of life in those who suffer from the condition. METHODS: This was a randomized controlled trial. One-hundred and two female patients with low back pain (n = 102) were randomly allocated into two groups, matched in terms of age, weight, education, socioeconomic status, occupation and some aspects of risk behavior. Group 1 (back school group, n = 50) but not group 2 (clinic group, n = 52) received the 'Back School Programme'. Then quality of life using the Short Form Health Survey (SF-36) was assessed at two time points: at baseline and at three months follow-up. The findings were compared both within and between two groups. RESULTS: The 'Back School Programme' was effective in improving patients' quality of life; significant differences were found on all eight subscales of the SF-36 for group 1. In the clinic group (group 2), improvement was observed on three scales (bodily pain, vitality and mental health) but these improvements were less than in group 1. The mean improvement over all eight subscales of the SF-36 was significantly better for the 'Back School Programme' group. CONCLUSION: The 'Back School Programme' is an effective intervention and might improve the quality of life over a period of 3 months in patients who experience chronic low back pain

Association study between KIR polymorphisms and rheumatoid arthritis disease: an updated meta-analysis

Abstract Background Currently published studies investigating association between the killer cell immunoglobulin-like receptor (KIR) gene polymorphisms and rheumatoid arthritis (RA) reported inconsistent and contradictory results. Hence, we aim to carry out this comprehensive meta-analysis of all eligible studies meeting the inclusion criteria to achieve precise and comprehensive relationships between genetic variations in KIR gene cluster and risk of RA. Methods Databases of Medline/PubMed and Scopus were searched to investigate case-control studies prior to May 2018. The associations between KIR gene polymorphisms and RA susceptibility were analyzed by computing the odds ratio (OR) and 95% confidence interval (95% CI) for each study. Results A total of 11 comparative case-control studies involving 1847 RA patients and 2409 healthy individuals were included in this meta-analysis. Four significant associations of 2DL3 (OR = 0.591, 95% CI = 0.351–0.994; P = 0.047), 2DL5 (OR = 0.716, 95% CI = 0.601–0.853; P < 0.001), 2DS5 (OR = 0.623, 95% CI = 0.393–0.988; P = 0.045), and 3DL3 (OR = 0.324, 95% CI = 0.129–0.814; P = 0.016) genes with decreased RA risk were discovered in this meta-analysis. Although, other KIR receptors including 2DL1, 2DL2, 2DL4, 3DL1, 3DL2, 3DS1, 2DS1-2DS4, and two pseudo gens of 2DP1 and 3DP1 displayed no significant association with predisposition to RA. Conclusions These findings provide reliable evidence that 2DL3, 2DL5, 3DL3, and 2DS5 might have a potential protective role for RA

ASSESSMENT OF ANTIOXIDANT NUTRIENT INTAKE AND MALONDIADEHYDE PLASMA LEVEL IN RHEUMATOID ARTHRITIS

Abstract &nbsp;&nbsp; BACKGROUND: Elevated free radical generation in inflamed joints and impaired antioxidant systems have been implicated in rheumatoid arthritis (RA). The present study was performed to evaluate dietary nutrient intake and plasma oxidant status in RA patients. &nbsp;&nbsp; METHODS: This case-control study comprised 75 RA patients and equal number of age- and gender-matched controls. Nutrient intake was estimated by using a semi-quantitative food frequency questionnaire. Blood samples were obtained from each group, and as an indicator of oxidant status, plasma concentrations of malondiadehyde (MDA) were measured. &nbsp;&nbsp; RESULTS: The mean calorie intake of RA patients was lower than that of the healthy controls. Energy-adjusted intake of fat, vitamin A and &szlig;-carotene were significantly lower in patients than in control .Plasma MDA concentration was significantly higher in RA patients than in controls (4.9&plusmn;1.8 vs 2.1&plusmn;0.6 nmoles/ml respectively, P &lt; 0.01). &nbsp;&nbsp; CONCLUSION: These results suggest proper antioxidant nutrient intake management may reduce free radical generation and improve antioxidant status in RA patients. &nbsp; &nbsp;&nbsp; Keywords: rheumatoid arthritis, antioxidant, malondialdehyde.</p

Analysis of the genetic component of systemic sclerosis in Iranian and Turkish populations through a genome-wide association study

WOS: 000459631600018PubMed ID: 30247649Objectives. SSc is an autoimmune disease characterized by alteration of the immune response, vasculopathy and fibrosis. Most genetic studies on SSc have been performed in European-ancestry populations. The aim of this study was to analyse the genetic component of SSc in Middle Eastern patients from Iran and Turkey through a genome-wide association study. Methods. This study analysed data from a total of 834 patients diagnosed with SSc and 1455 healthy controls from Iran and Turkey. DNA was genotyped using high-throughput genotyping platforms. The data generated were imputed using the Michigan Imputation Server, and the Haplotype Reference Consortium as a reference panel. A meta-analysis combining both case-control sets was conducted by the inverse variance method. Results. The highest peak of association belonged to the HLA region in both the Iranian and Turkish populations. Strong and independent associations between the classical alleles HLA-DRB1*11:04 [P = 2.10 x 10(-24), odds ratio (OR) = 3.14] and DPB1*13:01 (P = 5.37 x 10(-14), OR = 5.75) and SSc were observed in the Iranian population. HLA-DRB1*11:04 (P = 4.90 x 10(-11), OR = 2.93) was the only independent signal associated in the Turkish cohort. An omnibus test yielded HLA-DRB1 58 and HLA-DPB1 76 as relevant amino acid positions for this disease. Concerning the meta-analysis, we also identified two associations close to the genome-wide significance level outside the HLA region, corresponding to IRF5-TNPO3 rs17424921-C (P = 1.34 x 10(-7), OR = 1.68) and NFKB1 rs4648133-C (P = 3.11 x 10(-7), OR = 1.47). Conclusion. We identified significant associations in the HLA region and suggestive associations in IRF5-TNPO3 and NFKB1 loci in Iranian and Turkish patients affected by SSc through a genome-wide association study and an extensive HLA analysis.Spanish Ministry of Economy and Competitiveness [SAF2015-66761-P]; Cooperative Research Thematic Network (RETICS) program, from the Instituto de Salud Carlos III (ISCIII, Health Ministry, Madrid, Spain) [RD16/0012/0004]This work was supported by the Spanish Ministry of Economy and Competitiveness [SAF2015-66761-P to J.M. and SAF2015-66761-P to D.G.S.] and The Cooperative Research Thematic Network (RETICS) program, from the Instituto de Salud Carlos III (ISCIII, Health Ministry, Madrid, Spain) [RD16/0012/0004]

A case of ankylosing spondylitis presenting with fever of unknown origin diagnosed as aortitis: A case report

Key Clinical Message Clinicians should be aware of rare manifestations of AS, while considering a low threshold for screening vascular involvement in an axial SpA/nrxSpA/AS presenting with unexplained fevers and significant constitutional symptoms and elevated markers. Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease from the spondyloarthritis complex, which usually affects young men and primarily involves sacroiliac joints and the spine. It can also present with non‐joint involvement, such as cardiovascular manifestations. Aortitis is a rare yet critical cardiovascular complication associated with AS, which can lead to life‐threatening outcomes when undiagnosed. Here we report a 34‐year‐old man with intermittent fevers and significant weight loss, myalgia, and arthralgia for 1 year before being referred to our hospital due to undefinable causes despite multiple diagnostic efforts. The patient presented with elevated inflammatory markers and involvement of sacroiliac joints in favor of the AS. A positron emission tomography scan was also done to rule out underlying malignancy, which led to the detection of inflammation in ascending aorta, compatible with aortitis. The patient was treated with nonsteroidal anti‐inflammatory drugs, prednisolone, and infliximab, and his signs and symptoms significantly improved. Our case reports a rare but substantial complication of AS, in a young patient without a history of prolonged disease presenting with unspecific manifestations. The implantation of a thorough examination of AS patients, including cardiac examinations, could contribute to faster and more efficient diagnosis and treatment

Evaluation of the association of single nucleotide polymorphisms in DDP4 and CDK5RAP2 genes with rheumatoid arthritis susceptibility in Iranian population

Background: Rheumatoid arthritis (RA) is known as a chronic autoimmune inflammatory disorder, which is characterized mainly by the progressive inflammation and destruction of the joints. In the pathogenesis of RA, a variety of cell types such as lymphocyte, dendritic cells, osteoclasts and synovial fibroblasts are involved. Genetic proneness has been implicated in the pathogenesis of RA. The aim of this study was to evaluate the association of single nucleotide polymorphisms (SNPs) in DPP4 and CDK5RAP2 genes and risk of RA in Iranian population. Methods: For genotyping, 623 RA patients and 412 healthy subjects were recruited. Genetic analysis of DPP4 gene rs12617656 and CDK5RAP2 gene rs12379034 polymorphisms was conducted using TaqMan allelic discrimination (for rs12617656) and ARMS-PCR (for rs12379034) methods. Results: Experiments demonstrated that alleles and genotypes of both SNPs were represented equally in RA patients and controls. Statistical analysis revealed that none of the rs12617656 and rs12379034 SNPs had significant differences in prevalence of both alleles and genotypes between RA patients and healthy controls. Conclusions: It appears that gene polymorphisms of DPP4 and CDK5RAP2 are not involved in the pathogenesis of RA in Iranian population. Keywords: Rheumatoid arthritis, Gene polymorphism, Inflammation, Autoimmunity, DPP4, CDK5RAP