Vitamin E and Autoimmune Diseases: A Narrative Review

Autoimmune diseases are characterized by the attack of the immune system to normal tissues. Patients with autoimmune diseases usually have the deficiency of dietary factors  that may be related to the etiology of these conditions. Given the role of vitamin E as a physiologic stabilizer of lysosomal membranes, its deficiency can initiate the process of autoimmune diseases or accelerate its progress. It is supposed that vitamin E could reduce oxidative stress, which is an important factor in the pathogenesis of autoimmune diseases. The literature review is indicative of a decrease in the serum levels of vitamin E in almost all autoimmune diseases. Furthermore, there is evidence regarding the possible therapeutic value of vitamin E in the management of autoimmune diseases. Owing to the anti-inflammatory and protective effect of vitamin E against free radicals, and also its important effect on cytokines levels, this vitamin may play a powerful role in the prevention and treatment of rheumatoid arthritis, as well as joint inflammation and damage. Moreover, increased vitamin E intake might decrease the incidence and severity of certain autoimmune diseases through the regulation of the immune system

ABO and Rh blood groups in patients with lupus and rheumatoid arthritis

Background: Systemic lupus erythematous (SLE) and rheumatoid arthritis (RA) are autoimmune diseases in which the antigen-antibody system plays an important role. As blood group and Rh are determined by the presence or absence of antigens on the surface of red blood cells (RBCs), we aimed to determine the distribution of ABO and Rh blood groups in SLE and RA patients and its association with disease manifestations. Methods: This short communication is based on a study that was conducted on 434 SLE and 828 RA patients. We evaluated the distribution of ABO and Rh blood groups in RA and SLE patients. Results: This study projected that in lupus patients, Coombs-positive autoimmune hemolytic anemia and arthritis were more common among the B blood type and Rh-positive group, respectively. Furthermore, there was no relation between ABO and Rh blood group and rheumatoid factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) seropositivity. Moreover, there was no difference in distribution of blood groups in RA and SLE patients. Conclusion: The higher frequency of blood group B in hemolytic anemia, and positive Rh in arthritis in lupus patients, develop the hypothesis of probable role of ABO blood group antigen in some manifestations of lupus. Keywords: Rheumatoid arthritis (RA); Systemic lupus erythematosus (SLE); ABO blood group, Rh blood group

Does periodontitis play a causal role in the Systemic lupus erythematosus? A systematic review

Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease, with a relatively unclear etiology. Some evidence confirmed the effects of chronic infections on the development of autoimmune conditions. The association between periodontitis and rheumatoid arthritis as an autoimmune disease is assessed in several studies, which guides the readers to the possible role of periodontitis and oral dysbiosis in other autoimmune diseases, such as SLE. This study aimed to determine the relationship between SLE and periodontitis. Methods: For the purpose of the study, the articles focused mainly on the relationship between SLE and periodontitis published up to 2019 were searched in three databases, including Google Scholar, PubMed, and Scopus. Moreover, some articles were found using manual search. Finally, 18 studies were selected after the detailed evaluation of the full-text versions. Results: The majority of the entered studies confirmed a high prevalence of periodontitis diseases (PD) and the destruction of periodontal tissues in patients with SLE, which was estimated between 60% and 93.8%. This finding can be attributed to the differences in genetic and environmental backgrounds. The relationship between chronic periodontitis (CP) and SLE depends on the common multiple factors. Periodontal and inflammatory diseases have a common origin, and both of them have several components of the immune system. Conclusion: In general, two main predisposing factors of SLE and periodontitis diseases are similar genetic vulnerability and environmental background. On the other hand, it should not be neglected to consider the role of immune dysfunction and immunosuppressive treatment in the initiation and development of CP

Evaluation of the Anti-inflammatory Effects of Atorvastatin on Patients with Rheumatoid Arthritis: A Randomized Clinical Trial

Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disorder with unknown etiology. Atorvastatin is a lipid-lowering agent that affects the inflammatory processes. Objective: This study aimed to determine the anti-inflammatory effects of atorvastatin on the Disease Activity Index and high-density lipoprotein (HDL) concentrations in RA patients. Methods: This clinical trial was performed on 38 RA patients, who were referred to the Imam Reza and Ghaem Medical Centers of Mashhad, Iran between 2013 and 2014. Patients were divided into two groups: 1) the intervention group, which received 40 mg of atorvastatin, and 2) the control group. Response to treatment and the clinical status of patients were evaluated using the Disease Activity Score (DAS-28) and Visual Analogue Scale (VAS) at weeks zero, four, eight, and twelve, based on the 2010 ACR/EULAR Criteria by two rheumatologists. Disease activity and laboratory parameters, including erythrocyte sedimentation rate (ESR), high-sensitivity Creactive protein (hs-CRP), DAS-ESR, DAS- hs-CRP, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and liver function test (LFT) were measured in both groups. Results: There was a significant difference in the mean number of swollen joints (p<0.011), ESR (p <0.005), DAS-ESR (P<0.043), LDL (0.036), and HDL (0.016) between the two groups. The changes in trend showed no significant difference in the mean number of tender joints (p =0.38), VAS (p =0.715), CRP (p =0.07), DAS-hs- CRP (p=0.431), total cholesterol (p=0.285), or TG (p =0.331) between the two groups. However, the Disease Activity Index decreased by 48.4% in the intervention group, compared to 35.5% in the control group. Conclusion: As the results indicated, atorvastatin has a positive effect on the course of RA. In fact, atorvastatin, as an anti-inflammatory agent, could significantly influence inflammation in RA patients. Therefore, adding a lipid-lowering agent to standard medications in RA may be warranted and could decrease disease activity. Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (Website: http://www.irct.ir, Irct ID: IRCT2015122425648N2). Funding: The authors received no financial support for the research, authorship, and/or publication of this articl

Brain Single Photon Emission Computed Tomography Scan (SPECT) and Functional MRI in Systemic Lupus Erythematosus Patients with Cognitive Dysfunction: A Systematic Review

Objective(s): Systemic lupus erythematosus (SLE) is an autoimmune diseasewith a wide range of clinical manifestations. Cognitive dysfunction is one of themanifestations that could present prior to the emergence of any other neuropsychiatricinvolvements in SLE. Cognitive dysfunction is a subtle condition occurring with ahigh frequency. However, there is no data on the correlation of cognitive dysfunctionwith central nervous system (CNS) imaging findings, in particular single-photonemission computed tomography scan (SPECT) and functional MRI. We decided toperform a systematic review of brain SPECT and fMRI in SLE patients with cognitivedysfunction.Methods: PubMed, Scopus, and Google Scholar databases were searched untilApril 2017 with the following keywords: “SLE OR systemic lupus erythematousOR lupus” AND “functional MRI OR functional magnetic resonance imaging ORfMRI OR SPECT or SCAN”. A total of 1,767articles were found. Two rheumatologistsreviewed the articles and finally 14 articles were selected for the final systematicreview.Results: The fMRI and SPECT imaging techniques could provide valuable informationregarding the SLE patients with cognitive dysfunction at the early stages of thedisease.Conclusion: Brain SPECT scan and fMRI are used as functional imaging tools inSLE. Both of these diagnostic modalities are sensitive in reflecting the subtle braindamages in SLE patients with cognitive dysfunction. Brain fMRI and SPECT scancould be significantly beneficial in the diagnosis and initial management of cognitivedysfunction in SLE. Nevertheless, prospective studies could be useful in confirmingthe application of these diagnostic modalities in the clinical setting

Comparison of the efficacy and safety of methotrexate alone or in combination with leflunomide in the treatment of juvenile idiopathic arthritis: a double-blind, placebo-controlled, randomized trial

Objectives Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder in children. Alt-hough methotrexate (MTX) is the first line disease-modifying antirheumatic drug for JIA, many pa-tients do not respond well or cannot tolerate MTX. The aim of this study was to compare the effect of combination therapy of MTX and leflunomide (LFN) with MTX in patients who do not respond to MTX. Material and methods Eighteen patients (2–20 years old) with polyarticular, oligoarticular or extended oligoarticular sub-types of JIA who did not respond to conventional JIA therapy participated in this double-blind, pla-cebo-controlled, randomized trial. The intervention group received LFN and MTX for 3 months while the control group received oral placebo and MTX at a similar dose to the intervention group. Re-sponse to treatment was assessed every 4 weeks using the American College of Rheumatology Pe-diatric criteria (ACRPed) scale. Results Clinical criteria, including number of active joints and restricted joints, physician and patient global assessment, Childhood Health Assessment Questionnaire (CHAQ38) score, and serum erythrocyte sedimentation ratelevel, did not differ significantly between groups at baseline and at the end of the 4th and 8th weeks of treatment. Only the CHAQ38 score was significantly higher in the intervention group at the end of the 12th week of treatment. Analysis of the effect of treatment on study parameters revealed that only the global patient assessment score differed significantly between groups (p = 0.003). Conclusions The results of this study showed that combining LFN with MTX does not improve clinical outcomes of JIA and may increase side effects in patients who do not respond to MTX

A comparative analysis of clinical, para-clinical, and laboratory factors in ICU and Non-ICU admitted COVID-19 patients: identifying predictive markers for ICU admission

Introduction: Health care systems all over the world face numerous challenges as a result of the rapid spread of the COVID-19 virus that has resulted in increased mortality rates. About 40% of ICU-admitted COVID-19 patients were not severely ill at the time of admission. Thus, by using appropriate ICU admission predictors, clinicians can identify potential critical patients early on. It can also result in suitable resource allocation and consideration for these patients. Therefore, the current study was done with the aim of identifying clinical characteristics and laboratory data that could predict ICU admission in cases with COVID-19.Methods: This two-center retrospective observational study was done in Imam Reza and Ghaem Hospitals, Mashhad, Iran. Overall, 334 COVID-19 patients who referred to these hospitals from February to May 2020 were enrolled in this study. The participants were separated into two groups according to ICU admission status. All demographic, clinical, and paraclinical information were extracted from the medical records of the patients. Results: The present study composed of 88 ICU and 246 non-ICU-admitted COVID-19 patients. No significant differences were found in age between the two groups of patients (P=0.154). Multivariate regression analysis revealed that higher levels of CRP (OR=1.01, 95%CI 1.001-1.010, P=0.016), WBC (OR=1.11, 95% CI 1.01-1.22, P=0.03), and HRCT scores (OR=1.08, 95%CI=1.01-1.16, P=0.037) were linked to higher odds of ICU admission.Conclusion: This study suggests that higher levels of CRP, WBC, and LDH, as well as the HRCT score at the time of admission, were potential independent predictors of ICU admission during inpatient treatment in COVID-19 patients