Osteoarthritis is the most prevalent arthritic disease and a leading cause of disability. The pathogenesis of osteoarthritis involves multiple etiologies, including variable degree of synovial inflammation. Metformin and pioglitazone could potentially reduce the levels and activity of inflammatory mediators. This may consider as a new therapeutic approach added to the current used drugs in an attempt to decrease the pain, inflammation, and improve daily activity and quality of life in patients with knee osteoarthritis. This study designed to evaluate the clinical utility of using metformin or pioglitazone as anti-inflammatory agents in combination with non-steroidal anti-inflammatory drugs (NSAID) of selective type of cyclooxygenase-2 (COX-2) inhibitor, meloxicam, in the treatment of knee osteoarthritis (OA). Randomized, double blinded clinical study was performed on 98 patients who have symptomatic and radiologic evidence of painful OA of the knee (57 patients only completed the study). Patients were allocated into three groups, group (A); 20 patients treated with meloxicam (15mg/day) alone, group (B); 20 patients treated with metformin (1000mg/day) + meloxicam (15mg/day) and group (C); 17 patients treated with pioglitazone (15mg/day) + meloxicam (15mg/day). The treatment was followed for 12 weeks through measurement of the clinical effects of drugs each 7 days, using the Knee Injury and Osteoarthritis Outcome Score (KOOS) system. The results showed that metformin or pioglitazone, when used in combination with NSAID resulted in significant improvement in the components of KOOS, higher than that produced by meloxicam when used alone. In conclusion, administration of metformin or pioglitazone as adjuvant therapy to NSAID, meloxicam, in OA patients produced very well characterized analgesic and anti-inflammatory activities, and improves the therapeutic profile of meloxicam. Keywords: Metformin, Pioglitazone, Osteoarthritis, Knee injury, KOOS.

Background: There are scarce data on disease characteristics and severity of coronavirus 2019 (COVID-19) among Iraqi patients with rheumatic diseases (RDs). In this study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among patients with RDs.Methods: Between October 2020 and April 2021, rheumatic diseases (RDs) patients with COVID-19 were registered from different centres in Iraq. The patient's demographics, rheumatological history, COVID-19 symptoms, severity, and management, if any, their disease progress and outcome have been assessed. Binary logistic regression analysis was performed to determine predictors of disease severity.Results: 253 patients were included in the study, and most were females. The commonest rheumatic disease was rheumatoid arthritis (RA), followed by systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) (95, 52 and 20 patients respectively). It has been found that 50.6% of patients had mild COVID-19, and 49.4% had moderate disease; 18% of patients required oxygen support, no patient was treated in hospital, and there was no reported death. Patients with moderate COVID-19 had significantly higher age than mild type (p= 0.022); with more BMI (p=0.03), more in the number of comorbidities (p<0.001), more steroids users (p=0.012), higher steroid dose (P=0.034), had longer steroid duration, longer duration of conventional disease-modifying antirheumatic drugs (cDMARDs) (p=0.018), and biologic Diseasemodifying Antirheumatic Drug (bDMARDs) in months (p=0.025). Increasing body mass index (BMI), duration of biological DMARDs use, and an increasing number of comorbidities were significant independent factors that increase the risk of having more severe COVID-19, (p<0.05). Gorial et al.: COVID-19 patients with rheumatic diseases 90Conclusion: COVID-19 infection rheumatic patients tend to have mild-moderate disease course; BMI, duration of biological DMARDs use, and many comorbidities were significant independent factors that increase the risk of having more severe COVID-19.

Objective: Antiphospholipid antibodies (APLAs) have high risk of vascularthrombosis with significant clinical comorbidities. Anticardiolipin antibodies (ACLAs)and Lupus anticoagulant (LA) are important APLAs. The aim of this study was to evaluate the prevalence of APLAs(ACLAs and LA) and their clinical significance among sample of Iraqi patients with systemic lupus erythematosus patients (SLE). Patients and methods: A single center cross sectional study conducted on 50 SLE patients diagnosed according to the 1997 revised American College of Rheumatology (ACR) criteria for SLE from February 2010 to April 2011. Patients' age at SLE diagnosis, disease duration, SLE disease activity index (SLEDAI), renal involvement, cerebral involvement, cardiac involvement, pregnancy events, and thrombotic events were analyzed. Serum samples were extracted and screened for IgG and IgM using an anticardiolipin (ACL) enzyme-linked immunosorbent assay, Lupus anticoagulant (LA), prothrombin time (PT), partial thromboplastic time (PTT), kaolin clotting time (KCT), and KCT index were assessed in all patients. Results: Of 50 SLE patients, the prevalence of positive anticardiolipin antibodies (ACLA) was 10(20%) and positive LA 5 (10%). Abnormal KCT12 (24.5%), Abnormal KCT index 5(10), Abnormal PTT2 (4.1%), and Abnormal PT 2(4%). Thrombotic events, pregnancy events, and cerebral involvement were associated with positive serology (P = 0.000, 0.225, 0.083 respectively). Renal and cardiac involvement were associated with negative serology (P = 0.019, 0.094 respectively). No new thrombotic events were found. Conclusions: Prevalence of positive ACLAs was 20% and positive LA 10%. Thrombotic events, pregnancy events, and cerebral involvement were associated with positive serology while renal and cardiac involvement with negative serology. We suggest screening SLE patients for the presence of APLAsand larger sample with longer follow up for their clinical manifestations.

Osteoporosis is the most common bone disease in humans. With its related fragility fracture, it represents a major public health problem in our region, with a significant medical and socioeconomic burden. The high prevalence rate of vitamin D deficiency, the increase in life expectancy, the low socioeconomic level and the significant restriction to access to health care in some countries represent the major causes for the increasing prevalence of osteoporosis and incidence of fragility fractures in the Arabic countries. Bone mineral density (BMD) assessment is the gold standard to diagnose osteoporosis. However, a clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, without BMD measurement. Dual energy x-ray absorptiometry (DXA) is the preferred method for screening bone mineral density. For screening site of measurement, DXA of hip and spine is suggested. BMD assessment is recommended in all women 65 years of age and older and men 70 and older regardless of risk factors. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines are aimed to provide to health care professionals in the region of an updated process for the diagnosis and treatment of osteoporosis. It includes risk factors for osteoporosis and the indications for screening, diagnosis of osteoporosis, treatment of osteoporosis in postmenopausal and premenopausal women, and men; in addition to prevention and treatment of glucocorticoid-induced osteoporosis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the sacroiliac joints and spine that may be associated with a variety of extra-spinal lesions. Knowledge acquisition is a complex procedure and depends on patient intelligence, level of education, motivation teaching style and content. Different models have been identified to increase level of knowledge, with educational courses and information booklets among the most common. The aim of the present study is to assess a level of knowledge in sample of Iraqi patients with ankylosing spondylitis, by a self-administered questionnaire. This is a cross-sectional study including 200 Iraqi patients with AS, who have access to the Rheumatology Unit in Baghdad Teaching Hospital. AS Data collection were taking place between November 2017 and September 2018. Socio demographic data were reported including age, residence, marital status, smoking, educational level, occupation and disease diagnosis duration. Patients had undergone an interview with a physician to assess their level of knowledge by a questionnaire, which included 4 knowledge areas: Area A includes general knowledge about AS, comprising etiology, symptoms musculoskeletal and extra musculoskeletal, and laboratory blood tests. Area B includes immuno-genetics test (HLA.B27 antigen) and inheritance. Area C includes general management, including pharmacological treatment and its side effects, physical therapy and exercise (exercise type & proper duration and its role in treatment). Area D includes joints protection, pacing and priorities. The clinical and demographic data analyzed using descriptive statistics. The mean total questionnaire score is 16.28 SD +- 2.49, range (2 – 26). There is no significant statistical association between the mean total score and the gender (P value = 0.14), age (P value 0.93), marital status (P value 0.73), smoking (P value 0.65), residence (P value 0.56), and BMI (P value 0.23), While there is a highly significant statistical relationship between mean total score and the level of education (P value 0.0004), and occupation (P value 0.0026). For Area A, the mean achieved score is 3.63 +- SD 1.61, maximum possible score is 8. For Area B, the mean achieved score is 0.26 +-SD 0.51, the maximum possible score is 2. For Area C, the mean achieved score is 9.53 +- SD 2.42, maximum possible score is 15. Area D, the mean achieved score is 2.87 +- SD 1.06, the maximum possible score is 4. The study showed that AS Iraqi patients have low level of knowledge, unawareness and wrong thoughts about specific aspects of their disease, which may reinforce the recommendation of this study.

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Background: Rheumatoid arthritis is a common chronic and destructive autoimmune arthropathy .Treatment with infliximab gives great improvement to a large numbers of patients with RA ,however, in some patients after prolonged treatment infliximab can induce anti-infliximab antibodies formation and result to loss of infliximab efficacy and active persistent disease.Objective: to investigate the frequency of anti-infliximab antibodies in Iraqi patients with rheumatoid arthritis.Patients and methods: fifty Iraqi RA patients(36 females and 14 males) compared with 50 control( 25 healthy control and 25 case control (patients with RA on other treatment) ) were included in this study from begging of March 2014 till end of September 2014.All patients were diagnosed by full history, complete clinical examination and laboratory test. Anti-infliximab antibodies were meatured using enzymelinked immunosorbent assay in serum of Iraqi patients with RA treated with infliximab more than 3 monthsduration.Results: Antibodies to infliximab were detected in 35(70%) Iraqi RA patients , while the patients without detectable antibodies against infliximab were 15(30%),also there were no anti-infliximab antibodies in the control groups.Conclusion: In this study, nearly three quarter of the Iraqi RA patients treated with infliximab developed anti-infliximab antibodies.