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 and conventional disease-modifying antirheumatic drugs (DMARDs) on the incidence of COVID-19 infection in rheumatic patients. Material and methods: In the present cohort-analytical study, 512 patients with rheumatic diseases were enrolled during the COVID-19 pandemic (2020COVID-19 pandemic ( -2021. The incidence of COVID-19 infection was diagnosed according to the definition of the Iranian Ministry of Health. The frequency of COVID-19 infection in patients treated with biological and conventional DMARDs and glucocorticosteroids were compared. Results: Among 512 rheumatic patients, 19.9% were definitely infected with COVID-19, and 23.3% of infected patients were hospitalized. Only one patient with vasculitis died during the two outbreaks. Our study showed that adding biologic DMARDs to conventional DMARDs did not increase the risk of COVID-19 infection. However, unlike biologic DMARDs, in conventional DMARDs, methotrexate increased, and hydroxychloroquine decreased COVID-19 infection. Regression analysis showed that prednisolone at a dosage higher than 10 mg/day increased the risk of COVID-19 infection 5-fold; hydroxychloroquine had a protective impact and reduced the risk of infection by 40%. Conclusions: Biologic DMARDs and the type of selected rheumatic diseases in our study did not influence the susceptibility to COVID-19 infection. Prednisolone raised the coronavirus infection, and hydroxychloroquine played a protective role in the current study. Most of our patients showed good adherence to the health protocols. Further studies after worldwide vaccination are now required to reevaluate the influence of rheumatic diseases and DMARDs on COVID-19 infection.

Background: Pain is one of the most challenging symptoms in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and pain relief is one of the top priorities for improving health-related quality of life. When medication therapy does not significantly reduce pain, chronic opioid consumption becomes more prominent in such patients. This study aimed to evaluate the state of opioid use in RA and SpA patients. Methods: This cross-sectional study was performed on 316 patients with RA and spondyloarthropathies (SpAs) from January to March 2014. The convenience sampling method was used to select the participants, and by obtaining verbal consent, everyone was given 15 minutes to complete a checklist independently. Demographic and opioid use data were evaluated in terms of opioid use and its predictors. In this regard, univariate and multivariate logistic regressions were used to evaluate the predictors of opioid consumption in patients. All analyses were conducted using SPSS 21 and the significance level was set at P<0.05. Findings: About 9.5% of all participants, including 8.8% of RA and 22.6% of SpA cases, were opioid abusers. In the first step of the analysis, it was observed that opioid abuse was significantly higher in men, married participants, urban residents, patients with no biological therapy, and patients with a negative family history of addiction. The most prevalent ways of drug abuse were smoking and ingestion. The results of univariate logistic regression analysis revealed SpA and other factors significantly increase the chance of opioid abuse. Furthermore, multivariate logistic regression analysis showed male gender (OR=10.4) and negative family history of addiction (OR=3.19) significantly affected addiction in RA and SpA patients with a 95% confidence interval. Conclusion: Lack of suitable responsiveness to medication therapy to relieve pain, inconsistent pain evaluation, and shame of asking direct questions about addiction in RA and SpA patients may lead to opioid consumption in some cases. Seronegative SpA may make patients more prone to addiction. However, in this study, male gender and no family history of addiction were related to opioid abuse.

Introduction: Air pollution is one of the environmental factors that influences the pathogenesis of systemic autoimmune diseases, followed by the development and spread of inflammation and increased oxidative damage. Only a few studies have been conducted on the impact of air pollution on disease activity in patients with lupus, which mostly have focused on PM2.5 particles. Materials and Methods: We longitudinally studied 50 patients with lupus bimonthly in a 6-month period in Mashhad; one of the polluted cities of Iran. Disease activity and quality of life were examined according to SLEDAI2K, SLEQOL, and VAS criteria. The outdoor air pollutant was measured by monitoring the average concentration of nitrogen dioxide (NO2), carbon monoxide (CO), some particles less than 10 and 2.5 micrometers in diameter (PM <10, PM <2.5) and the level of temperature and humidity which were taken from the Meteorological Organization of Mashhad. Confounding factors such as medications were investigated by univariate and multivariate statistical analysis, specifically by GEE method. Results: The possible relation among various factors to SLEDAI, SLEQOL and VAS by two different univariate and multivariate analysis were studied. Our analysis indicated that spring season, decreased temperature, increased air pollutants including (PM2.5, and NO2) and increased humidity increase SLEDAI2K. Furthermore, the percent of polluted days directly correlates with Anti-dsDNA and NO2 significantly increases SLEQOL. Conclusion: Based on our findings, air pollution (particularly NO2 and PM2.5) has affected at least some aspects of the disease and the health-related quality of life (HRQL) of lupus patients. Further research is needed to confirm these findings.