2.20 Behcet’s disease and miscellaneous rheumatic conditions

Background: Behcet’s disease is an inflammatory, systemic and chronic disorder with unknown etiology affecting multiple systems of body (1). The cause is not clear but seems to be multifactorial, including immune system dysfunction (humoral and cellular immune defects), endothelial cell dysfunction and genetic predisposition (2). White adipose tissue produces variety of proteins in the name of adipocytokines, with important roles in body metabolism. One of these newly identified secreted adipocytokines is visfatin, which is secreted by the visceral fat and its plasma level increases during the obesity. It has insulinmimetic effects in metabolism of cultured cells and activates the insulin receptor (3). Visfatin stimulates inflammatory cells like monocytes and can induces increasing circulating level of IL-6 in mice. It have been considered as a new proinflammatory adipocytokine (4). Previous studies have evaluated visfatin level in immunologic disorders like rheumatoid arthritis and showed it was significantly higher in comparing to control subjects (4,5,6). There was no evaluation in patients with behcet disease yet. Objectives: We have evaluated visfatin level in patients with behcet disease finding inflammatory role of that in pathogenesis and clinical manifestations of behcet disease. Methods: We have evaluated 40 patients with Behcet’s disease fulfilled the International Study Group Criteria for the Diagnosis of Behc¸et’s Disease (ISG) and 40 healthy subjects from healthy candidates referring to behcet clinic of Shiraz medical university as a referral center for these patients in south Iran. Both groups have been matched for age, body mass index (BMI) and sex. Visfatin was checked in both groups using ELISA Kit. Results: There were no significant difference between cases and controls in mean concentration of visfatin level (P = 0.61). Difference in the visfatin level between patients with active and inactive manifestations of Behcet’s disease approximated to the significant levels (6.13 3.20 and 4.25 2.73, respectively; P = 0.07). Conclusion: In view of our study, we have concluded that visfatin levels may affect the clinical manifestations of BD maybe as a proinfalmmatory marker in pathogenesis and active manifestations of Behcet’s disease although more cases should be included in future works

Determination of serum visfatin level in patients with Behcet disease, comparing with normal population

Background: Behcet’s disease is an inflammatory, systemic and chronic disorder with unknown etiology affecting multiple systems of body (1). The cause is not clear but seems to be multifactorial, including immune system dysfunction (humoral and cellular immune defects), endothelial cell dysfunction and genetic predisposition (2). White adipose tissue produces variety of proteins in the name of adipocytokines, with important roles in body metabolism. One of these newly identified secreted adipocytokines is visfatin, which is secreted by the visceral fat and its plasma level increases during the obesity. It has insulinmimetic effects in metabolism of cultured cells and activates the insulin receptor (3). Visfatin stimulates inflammatory cells like monocytes and can induces increasing circulating level of IL-6 in mice. It have been considered as a new proinflammatory adipocytokine (4). Previous studies have evaluated visfatin level in immunologic disorders like rheumatoid arthritis and showed it was significantly higher in comparing to control subjects (4,5,6). There was no evaluation in patients with behcet disease yet. Objectives: We have evaluated visfatin level in patients with behcet disease finding inflammatory role of that in pathogenesis and clinical manifestations of behcet disease. Methods: We have evaluated 40 patients with Behcet’s disease fulfilled the International Study Group Criteria for the Diagnosis of Behc¸et’s Disease (ISG) and 40 healthy subjects from healthy candidates referring to behcet clinic of Shiraz medical university as a referral center for these patients in south Iran. Both groups have been matched for age, body mass index (BMI) and sex. Visfatin was checked in both groups using ELISA Kit. Results: There were no significant difference between cases and controls in mean concentration of visfatin level (P = 0.61). Difference in the visfatin level between patients with active and inactive manifestations of Behcet’s disease approximated to the significant levels (6.13 3.20 and 4.25 2.73, respectively; P = 0.07). Conclusion: In view of our study, we have concluded that visfatin levels may affect the clinical manifestations of BD maybe as a proinfalmmatory marker in pathogenesis and active manifestations of Behcet’s disease although more cases should be included in future works

Assessment of inpatients with idiopathic inflammatory myopathies: A 10-year single unit experience

Background: The burden of the patients with idiopathic inflammatory myopathies (IIM) including their admissions, diagnostic and therapeutic cares is similar to other severe diseases. Aim of the work: To evaluate the different aspects of the disease in IIM patients in our region. Patients and methods: All of patients with a diagnosis of IIM admitted to the wards in Shiraz University of Medical Sciences between 2001 and 2011 were evaluated. Results: There were 117 (70.5%) female and 49 (29.5%) male patients. The mean age of the patients was 38.5 ± 16.8 years (range: 4–78 years). Among all admissions, proximal muscle weakness was the most frequent presenting symptom, however, 23 (13.9%) of patients did not report any limb weaknesses. The present study showed evidence of involvement of different systems including, pulmonary, gastrointestinal and cardiac. 35 (21.1%) patients came with polyarthralgia, 58 (34.9%) with dysphagia and regurgitation, and 8 (4.8%) with arthritis. Unexplained fever was noted in 33 (19.9%), myalgia in 25 (15%) and cough and dyspnea in 28 (16.8%) patients. Elevated serum creatine kinase and lactate dehydrogenase were detected in 105 (63.25%) and 153 (92.17%) patients respectively. Electromyogram findings were seen in 113 (91.8%). 35% of the patients had recurrent admissions and mean duration of their admissions was 10 days. During the study period, 8 (4.8%) patients died, mostly with respiratory and then cardiac and infectious complications. Conclusion: IIMs cause various complications and morbidities, with recurrent admissions due to disease flare-up and respiratory and infectious complications. Further prospective studies are recommended to elucidate the predisposing risk factors. Keywords: Hospital admission, Idiopathic inflammatory myopathy, Dermatomyositis, Polymyositis, Mortalit

Determination of serum visfatin levels in patients with Behcet’s disease: a case–control study

Abstract Aim of the work: Behc¸et’s disease (BD) is an inflammatory, systemic and chronic disorder with unknown etiology affecting multiple systems. Visfatin is a new adipokine with insulinmimetic properties and pro-inflammatory function. The serum visfatin levels were evaluated in BD patients to investigate its role in the pathogenesis and clinical manifestations of the disease. Patients and methods: Forty BD patients were recruited from the Behc¸et’s disease clinic at Shiraz University of Medical Sciences in southern Iran and 40 healthy control subjects of matching age, sex and body mass index (BMI) were also included. Serum visfatin level was measured using ELISA. Results: The 40 BD patients included 16 males and 24 females. Seventeen had active clinical manifestations; 16 with oral ulcer, 5 with genital ulcer, 6 with arthritis and 2 with uveitis. The mean age of the BD patients was 34.95 ± 9.6 years and mean BMI was 23.98 ± 4.44. There were no significant differences between cases (5.05 ± 3.05 ng/ml) and controls (4.72 ± 2.84 ng/ml) in the visfatin level (p = 0.61). The difference in the visfatin level between patients with active and inactive manifestations did not reach statistical significance (6.13 ± 3.20 and 4.25 ± 2.73, respectively; p = 0.07). There was no significant difference according to the gender of the patients or the presence of clinical manifestations

Reporting items for capillaroscopy in clinical research on musculoskeletal diseases: A systematic review and international Delphi consensus

Objectives: The level of detail included when describing nailfold videocapillaroscopy (NVC) methods varies among research studies, making interpretation and comparison of results challenging. The overarching objective of the present study was to seek consensus on the reporting standards in NVC methodology for clinical research in rheumatic diseases and to propose a pragmatic reporting checklist. Methods: Based on the items derived from a systematic review focused on this topic, a three-step web-based Delphi consensus on minimum reporting standards in NVC was performed among members of the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium. Results: A total of 319 articles were selected by the systematic review, and 46 items were proposed in the Delphi process. This Delphi exercise was completed by 80 participants from 31 countries, including Australia and countries within Asia, Europe, North America and South America. Agreement was reached on items covering three main areas: Patient preparation before NVC (15 items), device description (5 items) and examination details (13 items). Conclusion: Based on the available evidence, the description of NVC methods was highly heterogeneous in the identified studies and differed markedly on several items. A reporting checklist of 33 items, based on practical suggestions made (using a Delphi process) by international participants, has been developed to provide guidance to improve and standardize the NVC methodology to be applied in future clinical research studies