Review of Anti-Inflammatory Herbal Medicines

Medicinal plants and their secondary metabolites are progressively used in the treatment of diseases as a complementary medicine. Inflammation is a pathologic condition that includes a wide range of diseases such as rheumatic and immune-mediated conditions, diabetes, cardiovascular accident, and etcetera. We introduce some herbs which their anti-inflammatory effects have been evaluated in clinical and experimental studies. Curcuma longa, Zingiber officinale, Rosmarinus officinalis, Borago officinalis, evening primrose, and Devil’s claw are some of the introduced medicinal herbs in this review. Since the treatment of inflammation is not a one-dimensional remedy, this review tries to reach a multidimensional therapeutic approach to inflammation with the help of herbal medicine and modification in lifestyle

Bedtime Single-Dose Prednisolone in Clinically Stable Rheumatoid Arthritis Patients

Introduction. Sign and symptoms of rheumatoid arthritis have circadian rhythms and are more prominent in the morning. Timing of glucocorticoid administration may be important with respect to the natural secretion of endogenous glucocorticoids. Herein, we intended to test the hypothesis that bedtime administration of prednisolone could be more efficient in controlling signs and symptoms in patients with RA. Material and Methods. Sixty patients with stable disease were treated with single dose prednisolone at 8 a.m. for the first three months and thereafter with similar dose at 10 PM for the next three months (before-after method). We compared fatigue scores, morning stiffness and pain scores, Clinical Disease Activity Indices, erythrocyte sedimentation rates, C Reactive Protein, and profile of adverse effects. Results. The mean of morning stiffness, fatigue scores, CRP and CDAI decreased statistically when prednisolone was administrated at 10 p.m. The means of pain scores and ESR were also decreased when the patients took prednisolone at night, without significant statistical difference. Conclusion. Administration of low-dose oral prednisolone could reduce disease activity scores in morning in clinically stable patients with RA. So it could be supposed that administrating bedtime prednisolone may permit the smallest possible dose

Ischemic Toes after Venous Thromboembolism: A Difficult Differential Diagnosis with Good Response to Combination Therapy—A Case Report

The obliteration of the arterial vascular system of toes is considered as a potentially catastrophic event in clinical practices. In most instances, the cessation of arterial blood flow heralds a serious underlying pathology. A definite classification of some cases is somehow difficult and subject to diagnostic challenges. The aim of the present case study is to share and discuss potentially complex and multifactorial mechanisms of some acute vascular events. In this report, we deal with a 46-year-old man with a rather gradual-onset ischemia of his toe who responded favorably to a combination of pulsed glucocorticoid and anticoagulation within a week

Late Onset of Vitamin D-Dependent Rickets Presenting with 8 years of Low Back Pain: A Case Report

Vitamin D (Vit D) is a prohormone that can be activated during a sequential hydroxylation done by two major mitochondrial cytochrome P450 liver and renal enzymes. Vit D-dependent rickets type 1 (VDDR1) is a rare autosomal recessive hereditary disorder resulting from defective renal 1α-OHase presenting with severe rickets, hypocalcemia, and secondary hyperparathyroidism. Although homozygous Vit D hydroxylation deficient patients develop severe rickets symptom and signs before the age of 12 months, heterozygous types have minor symptoms and are extremely rare presenting as late as 14 years after birthday. Here we present a suspicious case of VDDR1 at 21 years old of age with mild symptoms and signs

Pernicious anemia following COVID-19 vaccination: A report of two cases

Since December 2019 and the global epidemic of COVID-19 different countries have focused on vaccines, and one of the inactivated produced vaccines was the Sinopharm COVID-19 vaccine. Some side effects of this vaccine were reported previously, including pain at the vaccination site, fatigue, lethargy, headache, and tenderness, which were more prevalent among individuals <49 years old. Herein, we reported two patients aged 45 and 51 years old. Both patients have different signs and symptoms after receiving the second dose of the vaccine. None had a history of chronic disease. On examination and following labs and other diagnostic investigations, we found megaloblastic anemia due to atrophic gastritis and low intrinsic factor. These cases showed an autoimmune side effect of the Sinopharm COVID-19 vaccine that was previously reported with an exact mechanism but other features called Covid Arm, Guillain-Barré syndrome, and thrombocytopenia. The mechanism of this reaction is unclear yet

Prevalence of amyloid deposition in long standing rheumatoid arthritis in Iranian patients by abdominal subcutaneous fat biopsy and assessment of clinical and laboratory characteristics

BACKGROUND: The study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA), and the assessment of its correlation with the clinical and laboratory findings and data. METHOD: A total number of 220 patients (167 female and 53 male) with a minimum five-year history of RA were selected. Congo red staining method was used for staining the specimens obtained by abdominal subcutaneous fat biopsy (ASFB) method. All of the specimens were examined for apple-green birefringence under polarized light microscope. Clinical and laboratory characteristics of the patients were assessed. Chi-square test and unpaired student's t-test were run for intergroup comparisons. RESULTS: Amyloid deposition test yielded positive results in 15 out of the 220 cases (6.8%) examined by the ASFB technique. Thirteen patients were found to have minimal amyloid deposits. Of all the clinically significant cases, 8 (53%) presented with proteinuria, and 7 cases (46.6%) had severe constipation. CONCLUSION: The prevalence of fat amyloid deposits in Iranian patients with RA is low. In up to half of the study group the deposits were subclinical. Follow up studies are required to determine whether this subclinical amyloidosis can develop into full-blown clinically significant amyloidosis

Plasma exchange in progressive systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune systemic disease of unknown etiology. Present treatment modalities have limited impact on clinical/ laboratory outcomes. For the first time in our center, we used plasma exchange (PEx) in a rather young woman with recent onset but progressive SSc. She is a 39-year-old woman with a recent history of skin stiffness, Raynaud’s phenomenon, nail fold capillary changes and newly diagnosis of SSc presented to us due to worsening her clinical symptoms even after initiation of routine remedies such as low dose oral prednisolone, Ca-channel blockers, azathioprine and pentoxyfylline. After obtaining written consent, interdisciplinary discussion with experts in this field and agreement we started a series of plasma exchange with FFP replacement for her. A dramatic clinical response was observed in respect to Raynaud’s phenomenon, skin stiffness, tendon rub after three sessions of PEx. Her modified Rodnan skin score (MRSS) dropped from 36 (before commencement of therapy) to 28 in day 4 and 18 in day 20 after 15 sessions of PEx. In conclusion PEx could significantly modify the course of SSc as observed in our case study. Elimination of culprit immune mediators/cytokines/autoantibodies could be the possible mechanism of action of PEx. </p

Hidden aspects of inflammation in radiographic knee osteoarthritis

Primary osteoarthritis (OA) is known historically to be a non inflammatory condition but recent observations indicate that a low grade inflammation is encountered in pathophysiology of OA's symptoms and progression. We enrolled 150 female patients aged between 50-70 years old diagnosed as OA. Exclusion criteria were any recent infection, trauma, and proved rheumatologic disease. Bilateral standing knee joint radiography was taken and all were categorized according to Kellgren and Lawrence scale. Markers of inflammation consisting of ESR (1st hour), CRP, Anti-CCP and IgM RF were measured in harvested blood samples. Laboratory results from the patients with low radiographic knee OA (grade I and II) were compared to those in high grade patients (grade III and IV). The mean serum level of ESR in low and high grade groups was 12.85±18.65 and 13.65±15.25 respectively (p = 0.77(. As for the anti-CCP, the values of 13.87±43.75 and 23.42±58.87 were obtained for low and high grades respectively (p = 0.26). The differences between the positivity of RF (p = 0.51) and CRP (p = 0.56) in both groups was also not statistically significant. But inflammation score was significantly higher in high grade group than low grade group (p = 0.03). We conclude that although the differences weren't remarkable but severity of inflammation in higher radiographic grades should be taken into consideration of OA's progression.</em

Adult - onset Still's disease : A review

Objective: This article is an attempt to review recent literature regarding pathogenesis and clinical and laboratory findings in adult-onset Still′s disease (AOSD). Materials and methods: A search was conducted in PubMed and Ovid for English language publications, using individual or linked search terms "adult-onset Still′s disease," "adult Still′s disease," "Still′s disease," "AOSD," and other related terms, from 1996 to 2009, and the clinically relevant articles were subsequently selected. Results: More than 1000 titles were reviewed by the authors, and the most important concepts were selected from 143 full-text articles. Conclusion: Adult-onset Still′s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology and pathogenesis, usually presenting with high spiking fever accompanied by systemic manifestations. The disease is an entity with heterogeneous pathology; and diverse suggested etiologies, clinical manifestations and prognoses. There is no single diagnostic test for AOSD; rather, the diagnosis is based on a set of criteria, the most important of which are indeed clinical, but they also include paraclinical ones. Treatment aims at both minimizing inflammation and halting disease progression. For the former, nonsteroidal anti-inflammatory drugs have limited efficacy; so glucocorticoids in conjunction with disease-modifying antirheumatic drugs are also used. Novel therapeutic approaches such as anti-tumor necrosis factor blockade and monoclonal antibodies are promising