Zahra Mirfeizi

Background: Systemic lupus erythematosus (SLE) is a long-term autoimmune condition characterized by diverse clinical and laboratory manifestations influenced by genetic, environmental, and socioeconomic factors. This study aimed to characterize the clinical and laboratory profiles of SLE in Iranian patients. Methods: A cross-sectional study was conducted on patients with SLE at a private rheumatology clinic from 2015 to 2023. Data on clinical manifestations and laboratory findings, including immunological indices, systemic inflammation, hematological, metabolic, thyroid, and renal factors, were collected from patient medical records. Results: Of 313 patients (284 females, 29 males; mean age: 43.68 ± 12.39 years for females, 40.20 ± 10.17 years for males), the most prevalent clinical manifestations were joint pain (61.94%) and skin rash (60%). Renal, vascular, serositis, neuropsychiatric, and cardiac manifestations occurred in 33.33%, 17.15%, 9.39%, 7.44%, and 2.91% of patients, respectively. Leukopenia was observed in 24.10%, thrombocytopenia in 10.13%, and all patients were ANA-positive. Gender differences included higher leukopenia in females (25.63% vs. 10.34%; P = 0.041) and elevated LDL in males (25% vs. 9.6%; P = 0.014). Conclusion: This study delineates the clinical and laboratory characteristics of SLE in Iranian patients, revealing patterns consistent with global cohorts but shaped by regional genetic and environmental factors. Comparisons with international studies highlight the influence of ethnicity on disease presentation, emphasizing the need for tailored management and prospective research to address data gaps, such as histopathological and serological details.

Background: Kidney involvement is prevalent in systemic lupus erythematosus (SLE) and is the leading cause of disability and death. Colony-stimulating factor-1 (CSF-1) may be involved in the development of lupus nephritis (LN). This study aimed to evaluate serum CSF-1 levels in SLE patients with and without proteinuria and its correlation with the value of proteinuria. Methods: A total of 75 subjects including 25 newly diagnosed SLE cases without renal involvement evidence, 25 new SLE with biopsy-proven LN, and also, 25 healthy controls were included in the study. Serum CSF-1 level was measured in all participants using a human CSF-1 ELISA kit. Results: Analysis of variance (ANOVA) and post hoc analysis demonstrated significant differences between the three groups including healthy individuals, and SLE subjects with and without nephritis (P=0.006). The mean values of CSF-1 levels were increased among both participants without LN and patients with LN, compared to healthy individuals. However, a statistically significant greater mean concentration of CSF-1 was detected in individuals with LN compared to the healthy group (P=0.004). No significant statistical correlation was found between CSF-1 and 24-hour urine protein. Furthermore, when comparing the activity of SLE, a notable distinction was observed in the SLE disease activity index (SLEDAI) values between individuals with and without proteinuria (P<0.0001). Conclusion: An upward trend in average CSF-1 levels was observed among both patients with and without LN, in comparison to healthy individuals. Significantly enhanced concentrations of CSF-1 were found in subjects with LN compared to healthy individuals.

Background: Rituximab (RTX) is a chimeric antibody that directly targets B cells, which has been suggested as a new treatment option for systemic lupus erythematosus (SLE) resistant to conventional treatments. Objectives: This retrospective study aimed to investigate RTX's effect on treating SLE patients with refractory manifestations. Methods: This study was conducted on SLE patients who were resistant to treatment. The patients demographic characteristics and clinical information were collected from their medical records, and the results were compared before and after RTX therapy. Data were analyzed using SPSS software, and the significance level was less than 0.05 (P < 0.05). Results: Nephritis (26.3%), cutaneous manifestations (23.7%), and arthritis, occasionally secondary to overlap with rheumatoid arthritis (18.4%), were the most common complications that made patients (n = 55) candidates for the RTX biosimilar (Zytax). Ten patients were excluded due to a lack of complete data, and seven patients died immediately after starting Zytax due to disease severity and complications. Improvement in arthritis and cutaneous complications was reported after RTX injection in 57.1% and 44.4% of patients, respectively. Creatinine levels decreased significantly in patients with lupus nephritis after RTX injection compared to before treatment (P = 0.006). Moreover, anti-DNA was significantly different before and after RTX injection (Z = -2.89, P = 0.004). Comparison of C3 (t = 0.63; P = 0.53) and C4 (t = 1.72, P = 0.101) levels before and after RTX injection showed no significant differences. Conclusions: Based on the results, RTX improved nephritis, arthritis, and cutaneous complications in lupus patients.

Sarcoidosis is a granulomatous disorder characterized by non-caseating granulomas in multiple organs and an unknown cause. This chronic inflammatory disease is heterogeneous in terms of manifestations, duration, and severity. Although its aetiology is not well understood, there are indications of the genetic basis and the involvement of specific microorganisms and vitamin ...

Background: The role of prolotherapy in the healing process of damaged tissues has been confirmed in patients with degenerative joint disease. Hypertonic dextrose has been introduced as the most common solution in prolotherapy for reducing pain and improving mobility in people with knee osteoarthritis (KOA). This study aimed to compare the KOA patients undergoing hypertonic dextrose prolotherapy (DPT) with the placebo in terms of pain intensity and functional level. Methods: This triple-blind study randomized clinical trial (RCT) was conducted on patients with mild to moderate KOA who were referred to the Rheumatic Diseases Research Center (RDRC), Mashhad University of Medical Sciences, Mashhad, Iran, in the year 2021. Patients were randomly assigned to two groups of the DPT ([ ] = 47) and normal saline placebo prolotherapy ([ ] = 50) intra- and peri-articular knee joints. Treatment was monthly for three months. Western Ontario and McMaster Universities’ Arthritis Index (WOMAC) and Anterior Knee Pain Scale (AKPS) were completed before and after intervention (weeks 0, 4, 8, 12, and 16). The variables were compared between the two study groups at a significance level of less than 0.05 ([ ] < 0.05). Results: The WOMAC score improved significantly compared to the baseline in both groups ([ ] < 0.005). An increase in WOMAC score (the last follow-up compared to baseline) was 97.4% and 85.7% in DPT and placebo groups, respectively ([ ]= 0.06). Before the intervention and also after the first injection, the AKPS score in the normal saline group was significantly better than the dextrose group ([ ]= 0.03). The AKPS score did not differ significantly between the two groups ([ ] > 0.05) in the next two visits and two-month follow-ups. Improvement of AKPS score in the last follow-up compared to baseline was reported in 66.7% and 68.4% of patients in the normal saline group and dextrose group, respectively, ([ ]= 0.86). Conclusion: Prolotherapy as intra- and peri-articular injections of hypertonic dextrose could be used to relieve pain and improve functional status in patients with mild to moderate KOA as much as a placebo does. Although no remarkable difference was observed between dextrose and placebo in the outcomes, the rate of improvement (last follow-up compared to the baseline) was relatively higher in the dextrose group than in the normal saline group.

Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI. While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis.

Objectives: Systemic sclerosis (SSc) is an autoimmune, connective tissue disorder of unknown etiology which causes vasculopathy and fibrosis. Raynaud’s phenomenon (RP) is a common complication of SSc, which leads to ischemia and gangrenes. Treatment of RP is a clinical problem and often remains insufficient. This study aimed to evaluate the therapeutic efficacy of local injections of botulinum toxin type A (BTX-A) in improving the symptoms of Raynaud’s phenomenon (RP) secondary to scleroderma.Material and methods: This parallel single-blinded, placebo-controlled clinical trial enrolled 29 patients with scleroderma. Participants received BTX-A in the first, 2nd, 3rd, and 4th dorsal web spaces and the base of the thumb and small finger of the non-dominant hand and 2.5 ml of sterile normal saline in the opposite hand. Pre-injection measurements and post-injection follow-up evaluations at months 1 and 4 were performed. We compared the outcomes using the paired Student’s t-test.Results: The change in pain severity between pre-injection and month 1 follow-up was significantly larger in the BTX-A group (p-value = 0.04). Between pre-injection and month 1 and month 4, the changes in the Raynaud’s condition score (RCS) (p-value = 0.02, 0.004, respectively) and the number of Raynaud’s attacks (p-value = 0.006, 0.001, respectively) were significantly greater in the BTX-A group. No significant difference was found in terms of paresthesia, skin thickening, upper extremity function, ulcer diameter, number of ulcers, or Raynaud’s attack duration between the two groups (p-value > 0.05). In time, the decrease in pain severity, paresthesia, RCS, number of ulcers, and ulcer diameter, and the increase in upper extremity function were significantly greater in the BTX-A group as compared to the placebo group (p < 0.05).Conclusions: Our study showed that local injection of BTX-A is safe and has beneficial therapeutic effects on RP and RP-related digital ulcers in SSc patients.

Introduction During the SARS-CoV-2 virus pandemic, immunosuppressive agents in treating chronic disease have become a concern, and rheumatic patients are not an exception. The controversies about the deteriorating effects of such medications led this study to evaluate the influence of biologic...

Background/objective: Osteoporosis is a global health concern with an increasing prevalence worldwide. Denosumab is an antiresoptive agent that has been demonstrated to be effective and safe in osteoporotic patients. This study aimed to compare the efficacy and safety of the biosimilar denosumab candidate (Arylia) to the originator product (Prolia®) in postmenopausal osteoporotic patients. Methods: In this randomized, double-blind, active-controlled, noninferiority trial, postmenopausal osteoporotic patients received 60 mg of subcutaneous Arylia or Prolia® at months 0, 6, and 12 and were followed up for 18 months. The primary endpoint was the noninferiority of the biosimilar product to the reference product in the percentage change of bone mineral density (BMD) in 18 months at the lumbar spine (L₁-L₄), total hip, and femoral neck. The secondary endpoints were safety assessment, the incidence of new vertebral fractures, and the trend of bone turnover markers (BTMs). Results: A total of 190 patients were randomized to receive either biosimilar (n = 95) or reference (n = 95) denosumab. In the per-protocol (PP) analysis, the lower limits of the 95% two-sided confidence intervals of the difference between Arylia and Prolia® in increasing BMD were greater than the predetermined noninferiority margin of − 1.78 at the lumbar spine, total hip, and femoral neck sites (mean differences [95% CIs] of 0.39 [− 1.34 to 2.11], 0.04 [− 1.61 to 1.69], and 0.41 [− 1.58 to 2.40], respectively). The two products were also comparable in terms of safety, new vertebral fractures, and trend of BTMs. Conclusion: The efficacy of the biosimilar denosumab was shown to be noninferior to that of the reference denosumab, with a comparable safety profile at 18 months. Trial registration: ClinicalTrials.gov, NCT03293108; Registration date: 2017–09-19.

Objectives To present the clinical characteristics, disease course, management, and outcomes of COVID-19 infection in patients with Behcet’s disease (BD). Methods In this retrospective cohort study, we retrieved BD patients with definite diagnosis of COVID-19 infection. Demographic data, comorbidities, features related both to BD and COVID-19 infection, treatments, and outcomes were collected. Comparisons between patients with or without hospitalization were performed. All statistical analyzes were performed using SPSS version 25. We considered p < 0.05 statistically significant. Results We identified 61 episodes of COVID-19 infection in 59 BD patients. The prevalence was 0.69%. The median age was 45 years (IQR = 20), and the median disease duration was 162 months (IQR = 195). BD features were similar except for higher rate of arterial involvement and positive pathergy test in infected patients. Thirty-five episodes (62.5%) happened in non-active patients; 39% had a comorbid disease. COVID manifestations were the same as the general population. Flu-like symptoms were the most common (85%), followed by fever (66%), ageusia/anosmia (56%), headache (51%), and pulmonary involvement (48%). There was no change in BD symptoms in 74%. Fifteen patients (25.4%) were hospitalized, and one patient (1.7%) died. Receiving glucocorticoids (p < 0.03) and cytotoxic drugs (p < 0.02) were associated with an increased rate of hospitalization. Conclusion The incidence of COVID-19 infection in BD patients was not higher than general population in Iran. They showed milder form of disease with lower morbidity and mortality rate. Most were on immunosuppressive drugs, or had a comorbidity apart from BD. No significant effect on BD course was shown. Key Points • The incidence of COVID-19 infection in patients with Behcet’s disease is not higher. • They showed milder form of infection with lower morbidity and mortality rate. • No significant effect on Behcet’s disease course was shown with COVID19 infection. • BD patients can be managed according to the guidelines used for general population.