Evaluation of simple calculated osteoporosis risk estimation (SCORE) in Iranian postmenopausal women

زمینه و هدف: پوکی استخوان به یک مشکل عمومی سلامت در تمام جهان تبدیل شده است. روش جذب دوگانه پرتو ایکس، به عنوان مطمئن ترین روش برای تشخیص به دلیل هزینه بالا و عدم سهولت دسترسی، جهت غربالگری پوکی استخوان توصیه نمی گردد. بر اساس عوامل خطر، ابزارهایی برای غربالگری و سنجش میزان خطر ابتلا به استئوپروز ابداع، که مشهورترین آنها ابزار محاسبه ساده تخمین خطر پوکی استخوان (SCORE) می باشد، این مطالعه با هدف بررسی کارآیی این ابزار در غربالگری زنان یائسه ایرانی برای ابتلا به استئوپروز انجام گردیده است. روش بررسی: در این مطالعه توصیفی-تحلیلی 341 زن یائسه که جهت سنجش تراکم استخوان به مرکز تشخیصی سنجش تراکم استخوان اصفهان مراجعه نموده بودند، مورد پرسش قرار گرفته و فرم پایش پوکی استخوان (SCORE) بر اساس خصوصیات افراد برای آنان تکمیل گردید. نتایج فرم ها و امتیاز بدست آمده با نتایج تراکم استخوان بدست آمده در هر فرد، با هم مقایسه و حساسیت، اختصاصی بودن و ارزش اخباری این روش غربالگری مشخص گردید. یافته ها: از 341 زن یائسه مورد مطالعه، 71 نفر دچار استئوپروز (8/20)، 135 نفر (6/39) دارای تراکم استخوان پایین (استئوپنی) در یک یا هر دو ناحیه مورد بررسی و 135 نفر (6/39) نیز دارای سنجش تراکم استخوان نرمال بودند. ابزار SCORE دارای حساسیت 2/87 و اختصاصی بودن 9/37 برای مشخص کردن زنان دارای تراکم استخوان پایین بود. نتیجه گیری: ابزار SCORE برای غربالگری زنان یائسه ایرانی نیز با حساسیت قابل قبول می تواند مورد استفاده قرار گرفته و برای پایش زنان یائسه ایرانی و ارجاع آنها برای سنجش تراکم استخوان مناسب و قابل اطمینان می باشد

Pamidronate infusion improved two cases of intractable seronegative rheumatoid arthritise

Pamidronate is a bisphosphonate derivative that can inhibit bone resorption by actions on osteoclasts and increase bone density in spite of treatment with steroids. This drug has the anti-inflammatory effect by increase apoptosis of monocytes. 5-10 percent of rheumatoid arthritis patients is seronegative and may be resistant to conventional disease modifying anti rheumatic drugs (DMARDs). Intravenous (IV) pamidronate can be effective in disease control in seronegative rheumatoid arthritis. We report two cases of seronegative and drug resistant rheumatoid arthritis that favorably responds to pamidronate

Intravenous pamidronate for refractory rheumatoid arthritis

Background: Patients with rheumatoid arthritis may be resistant to conventional treatment with disease-modifying antirheumatic drugs (DMARDs). On the other hand, biologic therapy is costly and may be inconvenient for many patients. Pamidronate is a potent bisphosphonate with the capacity of modifying the biological activity of the immune system cells. It may thus be used as an anti-inflammatory agent in patients with inflammatory joint diseases. Materials and Methods: To assess the effectiveness of pamidronate in the management of rheumatoid arthritis, we selected 38 patients with rheumatoid arthritis to enroll in a pilot study to receive pamidronate and conventional treatment with prednisolone and DMARDs in combination. These patients received 60 mg of pamidronate for 3 consecutive months and were followed for 6 months since the first infusion. Results: The mean visual analogue score (VAS) and disease activity score (DAS28) fell steadily until one month after the third infusion. However, no improvements were observed during the 3 months after the last infusion of the drug. All patients, except one, reported decreased pain in response to 3 consecutive pulses of pamidronate and most had improvements in the assessed laboratory and clinical indices. The drug was tolerated well in our patients. Conclusion: Pamidronate infusions had beneficial effects on various clinical and laboratory parameters of patients, but alleviation of symptoms were temporary and did not last for more than 6 months. This treatment option can be a choice for difficult cases of rheumatoid arthritis with severe pain and osteoporosis

The association of anti-CCP1 antibodies with disease activity score 28 (DAS-28) in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is one of the most frequent autoimmune diseases in the world which affect about 1% of people. Measurement of the anti-CCP1 antibody titer in these patients is one of the new tests that is available in our country and in the multiple studies has been shown to be more specific than rheumatoid factor in the diagnosis of RA (97%). This test becomes positive in early stage of disease and it has a high predictive value. The aim of our study was to determine the relationship between anti-CCP1 antibody and disease activity score 28 (DAS-28) in patients with rheumatoid arthritis. Materials and Methods: A cross-sectional study was performed in 90 patients with RA for evaluating the relation between anti-CCP1 antibody titer and DAS-28, patients were selected by consecutive method; serum samples were collected from patients. Anti-CCP1 antibody was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rates (ESR), rheumatoid factor (RF), DAS-28, visual analog scale (VAS) were determined in patients with RA. Statistical analysis performed with t-test and Pearson′s correlations coefficient. Results: Anti-CCP1 level was associated with DAS-28 (P<0.001, r=0.35). The largest linear correlation was between anti-CCP1 antibody levels and VAS; it means that higher titers of anti-CCP1 antibody are associated with more painful joints in our patients. The average of DAS-28 in our positive and negative anti-CCP1 antibody patients was 5.07±1.1 and 3.5±1.5, respectively (P<0.05). Conclusion: There was moderate correlation between anti-CCP1 titer and DAS-28

The salivary alpha-amylase concentration in patients with rheumatoid arthritis: A case–control study

Background: Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. Previous studies have reported an association between stress and salivary alpha-amylase. The aim of this study was to investigate the concentration of salivary alpha-amylase in patients with RA (by elimination of stress factor). Materials and Methods: In this case–control study, we enrolled 50 patients with RA and 48 healthy patients as the control group. The perceived stress scale questionnaire was used to evaluate scores of stress in both case and control groups, and then the participants with high scores of stress were excluded from the study. Moreover, the alpha-amylase activity kit was used for the assessment of the levels of salivary alpha-amylase. In all analyses, the significance level was considered to be < 0.05. Finally, the obtained data were analyzed by SPSS22. Results: Our results indicated a high score of stress in the case group (19.42 ± 5.83 units) compared with the control group (18.02 ± 6.07 units) which was not statistically significant (P 312 alpha-amylase concentrations, were 80% and 46%, respectively. Conclusion: In general, we indicated that the alpha-amylase concentration in patients with RA is higher than the healthy controls, and can be used as a codiagnostic factor

Hepatic Necrosis: A Main Presentation of Systemic Lupus Erythematosus in a Previously Healthy Woman

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause. In this study, we report a case of SLE that was presented with persistent vomiting and liver involvement. To our knowledge, this is the first description of a patient with hepatic necrosis as the initial presentation of SLE in a previously healthy woman without any significant past medical history. In the literature, we found few cases of SLE with liver necrosis. In addition, all the cases found had a past medical history of a missed abortion or other complications of the disease. Therefore, if a young woman presents hepatic necrosis with a background of a previously missed abortion, it is better to perform anti-nuclear antibody (ANA) and anticardiolipin antibody tests as a preventive method for early diagnosis and early treatment

Effects of aerobic exercise on hematologic indices of women with rheumatoid arthritis: A randomized clinical trial

Background: To investigate the effects of moderate aerobic exercise on the hemoglobin, hematocrit, and red blood cell (RBC) mass of women with rheumatoid arthritis (RA). Materials and Methods: This randomized clinical trial was conducted at the Specialized Clinic of Physical Medicine and Rehabilitation, Al-Zahra Hospital of Isfahan, during a 4-month period in 2014. We included patients with RA who did not have any malignancy and hematologic disorder. Two groups - one group receiving aerobic therapy along with medical therapy (N = 16) and the other group receiving medical therapy alone (N = 17) both for a period of 8 weeks. The levels of RBC mass, Hb, and HCT were measured before and after the intervention. The changes in these parameters were compared between the two study groups. Results: There was no significant difference between the two study groups regarding the baseline characteristics. The aerobic exercise resulted in increased RBC mass (P < 0.001), Hb (P < 0.001), and HCT (P < 0.001). However, those who received medical therapy alone did not experience any significant changes in these parameters. We found that the RBC mass (P = 0.581), Hb (P = 0.882), and HCT (P = 0.471) were comparable between the two study groups after 8 weeks of intervention. Conclusion: Although the aerobic exercise results in increased Hb, HCT, and RBC mass in patients with RA, the increase was not significant when compared to that in controls. Thus, the increase in the HB, HCT, and RBC could not be attributable to aerobic exercise

Evaluation of differences in HLA-DR4 gene and its subtypes prevalence among healthy people and RA patients in Isfahan province population

Background: There are a lot of evidences showing that genetic play an important role in RA disease. Inheritance of some subgroups of HLA-DR4 gene increases the propensity to RA disease. In this paper, the impact of HLA-DR4 gene and its subtypes or subgroups, be consistence on RA patient who lived in Isfahan province, has been evaluated. Materials and Methods: In this survey, two groups of people (100 patients in case group and 100 normal persons in control group) have been selected. These two groups were similar in age and gender. Statistical population has been considered among people who visited Al Zahra rheumatology clinic. The participants were from Isfahan province and accepted to participate to the study voluntarily. The prevalence of HLA-DR4 and its 0401-0404 subtypes were evaluated between two groups; DNA was extracted from blood samples and studied using PCR SSCP method. Results: It was found that 35% of RA patients had HLA-DR4 gene, of which 14 persons had 0401, 10 persons had 0404, and 11 persons had other subtypes, whereas 30 people in control group had HLA-DR4 gene, of which 10 people had 0401, 20 people had 0404, and nobody had other subtypes. Conclusion: The observed differences between prevalence of HLA-DR4 gene between the case and control group were not statistically significant (P = 0.45; OR = 1.256; 95% CI = 0.69-2.27), but a relation was between HLA-DR4 0404 subtypes and RA (P = 0.02; OR = 0.44; 95% CI = 0.196-0.992)

Purified protein derivative test and its booster phenomenon in patients with rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a common disease in the community, with various complications. An appropriate solution is immunosuppressive drugs, which may lead to weakening of the cellular immune system and body unresponsiveness to tuberculosis (TB). As TB sensitivity is determined by the amount of induration created in the Purified Protein Derivative (PPD) test, this study aims to evaluate the immune response to the PPD test and its booster in RA patients. Materials and Methods: This cross-sectional study was performed on rheumatoid arthritis patients referred to Alzahra Hospital, Isfahan, treated with ‹20 mg glucocorticoid daily or 7.5 mg Methotrexate (MTX) weekly. The sampling method was simple and accessible. The PPD test was performed in patients using the Mantoux method after 72 hours, and seven days later, the results were interpreted in 72 hours after the PPD booster injection. Induration ≥5 mm was considered to be positive. The data was analyzed using the SPSS software. Results: Nineteen patients had positive results in the initial and reminder tests and 81 patients had negative results in both tests. Six patients (6.9%) with negative results in the initial test changed to positive in the reminder test. There was no positive result in the initial test and negative result in the reminder one. The frequency distribution of the reminder test, based on the initial test was significant (P < 0.001). Also, the McNemar test showed that the changes in the reminder test based on the initial test had a significant difference (P = 0.031). Conclusion: It seems that in the endemic and developing areas, the PPD booster is applicable for diagnosing latent tuberculosis in patients with rheumatoid arthritis

Effects of a selected exercises program on quality of life in elderly women

Introduction: Osteoporosis is the most common type of bone disease that affects the skeletal system especially in older people. In elderly population, reduction in bone mineral density (osteoporosis) is often associated with a reduced health-related Quality of Life. The present study aimed to investigate the effect of a selected exercises program on quality of life in elderly women with osteoporosis. Materials and Methods: Twenty- seven women with osteoporosis (Mean age ± SD, 58 ± 6 years) who were referred to Isfahan osteoporosis diagnostic center divided into two groups: intervention (n = 14) and control (n = 13) groups. The experimental group received the following intervention: balance, strength training and range of motion exercises for 8- weeks (three sessions per week) .Control group did not receive any intervention. Quality of life was measured using the QUALEFFO-41 questionnaire just before and after exercise program. Independent and paired sample t-test were used to analyze the data. Results: In experimental group, a significant difference (P 0/05) in household activities and ADLs. Also, no significant difference was observed in control group (P > 0/05). Although, in pre test, the observed difference was not statically significant between control and experimental groups (P > 0/05), but significant difference was found in post test (P < 0/05). Conclusion: It seems that an exercise program could improve health-related quality of life in elderly women with osteoporosis, therefore this exercise program can be considered as an appropriate treatment regimen for such patients. Keywords: Elderly woman, Osteoporosis, Quality of life, QUALEFFO-41 questionnaire, Regular exercises progra