Background and aimMuch evidence has emerged documenting the involvement of the renin-angiotensin system (RAS) in inflammatory processes. The objective of this study was to evaluate the effects of blocking RAS with azilsartan (Azil) on the clinical efficacy of etanercept (Etan) in patients with active rheumatoid arthritis (RA).Patients and methodsForty-two patients diagnosed with active RA and poorly responding to methotrexate were enrolled in this pilot clinical study. They were randomly allocated into two groups, and treated with either Etan (50 mg/week) and placebo or the same dose of Etan with Azil (20 mg/day) for 90 days. The clinical outcome was evaluated using the Disease Activity Score-28 joint (DAS-28), simplified disease activity index (SDAI), clinical disease activity index (CDAI) and the health assessment questionnaire disease index (HAQ-DI). Blood samples were obtained for the assessment of C-reactive protein and erythrocyte sedimentation rate at baseline and after 90 days.ResultsThe markers of pain and disease activity, C-reactive protein and erythrocyte sedimentation rate were significantly improved when Azil was used, as an adjuvant with Etan, compared with the use of Etan and placebo.ConclusionBlocking RAS with azilsartan may improve the effects of etanercept on the clinical markers of pain and disease severity of patients with active RA not responding to methotrexate.
Background Systemic lupus erythematosus is a chronic autoimmune disease affecting many organ systems with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. Cytokines, like interferon-α and interleukin-6, are important components of immune response regulation and their imbalance play an important role in the pathogenesis of the disease. Objectives To compare the serum levels of interferon-α and interleukin-6 in systemic lupus erythematosus patients and the apparently healthy subjects, and to find out the correlation between the serum levels of the two cytokines and the disease activity according to systemic lupus erythematosus disease activity index. Methods A cross-sectional analytic study conducted on 37 systemic lupus erythematosus patients. The patients were investigated for the serum level of the two cytokines, and the results were compared with those of 31 apparently healthy subjects. Then, the disease activity was measured in the patients according to systemic lupus erythematosus disease activity index and arranged into groups of different disease activity, and their corresponding cytokine levels were compared. Results The serum levels of interferon-α and interleukin-6, in systemic lupus erythematosus patients were signi cantly higher than those of the healthy subjects (37.26 ± 27.58 IU/ml), (18.09 ± 21.02 pg/ml) respectively in the patients, and (13.29 ± 23.63 IU/ml), (7.10 ± 19.80 pg/ml) respectively in the healthy subjects, with p-values of (< 0.001) and (0.031) respectively. Eight (21.6%) of systemic lupus erythematosus patients had inactive disease, 9 (24.3%) had mild to moderately active disease, and 20 (54.1%) had highly active disease. There were a signi cant positive correlation between the serum levels of interleukin-6 and systemic lupus erythematosus disease activity, with p-value of (0.016), while there were no signi cant correlation between the serum levels of interferon-α and disease activity, with p-value of (0.734). Conclusions The serum levels of both cytokines in systemic lupus erythematosus patients are signi cantly higher than their levels in the serum of healthy subjects, and interleukin-6 is significantly correlated with the systemic lupus erythematosus disease activity.
Background: Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing, early recognition and proper management of arthropathy is mandatory. Objectives: To find out the frequency of peripheral arthropathy and pattern of joint involvement in inflammatory bowel diseases. Patients and Methods: Forty-eight patients with a definite diagnosis of inflammatory bowel disease (IBD) (41 ulcerative colitis and 7 crohn's disease) have been assessed for peripheral joint involvement and enthesopathy. Patients clinically assessed for bowel conditions, peripheral arthritis, enthesitis and pattern of joint involvement (monoarticular, pauciarticular or polyarticular). Blood test for full blood count, ESR, CRP, RF, Serum electrolytes and serum albumin done for the assessment of disease activity. Radiological assessment of the symptomatic peripheral joints was done by conventional x-ray. Results: Five (10.4%) cases had peripheral arthritis, 4(80%) were pauciarticular, arthralgia and enthesopathy accounted in 10(20.8%) and 2(4.2%) cases respectively. Peripheral arthritis was more among female patients 4(21.05%) with P-value (0.051). All patients with peripheral arthritis were in active state of inflammatory bowel disease. Patients with ulcerative colitis who had extensive colonic involvement were more likely to develop peripheral arthritis with frequency of 2(50%) for left side colitis, 1(25%) for extensive colitis and 1(25%) for pan colitis, While crohn's disease with colonic localization was more likely to develop peripheral arthritis 1(100%) for ileocolitis. Conclusion:The commonest musculoskeletal manifestations of IBD were arthralgia, followed by arthritis and the least was enthesopathy. The most common pattern of peripheral arthritis was pauciarticular and mostly involved the lower limb joints. It was more common in female patients and occurred independent to the duration of inflammatory bowel disease. Keywords: peripheral arthritis (PA), chronic inflammatory bowel diseases (IBD).
Background Lupus nephritis is one of the most serious manifestations of Systemic lupus erythematosis and it is a major cause of morbidity and mortality. Objectives To find out the relation between Histopathologyical classes of Lupus nephritis with renal, extra renal clinical manifestation and laboratory data. Patients and Methods A cross-sectional study performed on 45 patients with biopsy proven lupus nephritis, which they were collected from April 2012 to April 2013. Results The current study shows female predominance 32 (71.1%) compared with 13 (28.9%) male. Class IV 15 (33.3%) was the most common type followed by class III 9 (20.9%). The new onset hypertension was the commonest clinical renal presentation 32 (71.1%) and the musculoskeletal manifestation 37 (82.2%) was the most common extra renal manifestation. The correlation between classes of Lupus nephritis with clinical and laboratory data were significant for hypertension, 24 hrs urinary protein excretion, S. Creatinine, S. Albumin, Anti-Sm and Anti-dsDNA positivity and low complement levels (C3, C4). Conclusion Class IV is the commonest class of Lupus nephritis. Female preponderance becomes less pronounce in lupus nephritis compared to prevalence SLE.
To investigate the effect of smoking on rheumatoid arthritis as a causative factor, sero-positivity and activity. Materials and Methods: This case control study which is carried out in the rheumatology division of Suliamaniya teaching hospital & clinic from 15th August 2009 to 15th June 2010, Ninety_ two patients 73(79%) females and 19(21%) males who fulfilled the American College of Rheumatology diagnostic criteria for diagnosis of adult rheumatoid arthritis were included compared to 92 controls. Detail history of smoking taken and disease activity assessed according to DAS28j(Disease activity score of 28 joints). Results: All forty six smoker patients had active disease , 38(82.6%) had highly active disease according to DAS28j,these results are statistically significant (P-value =0.04), and 42(91.3%) of them had rheumatoid factor which means the positive relation between smoking and seropositivity also (P-value =0.000). Conclusion: Majority of smokers demonstrated highly active disease according to DAS28j measurement for disease activity , and the relation of smoking with seropositivity found to be positive.
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