Background: Methotrexate is the most commonly used disease-modifying anti-rheumatic drug (DMARD) and it is considered the first-line treatment in the management of rheumatoid arthritis (RA). MTX treatment outcome regarding response to the drug and adverse effects in RA patients are not universal. Therefore, it would be beneficial if we could predict the response of patients to MTX before starting MTX treatment in order to determine the patient ' s drug-treatment plan. Objectives: The present study aimed to evaluate the impact of MTHFR A1298C SNP (rs1801131) on the clinical outcome of MTX treatment as regards treatment efficacy and toxicity in a cohort of Egyptian rheumatoid arthritis patients. Patients and methods: Fifty rheumatoid arthritis patients were included in the present study. Data about patient related variables such as age and sex, disease related variables such as disease duration as well as treatment related variables such as treatment duration, dose of MTX, its route of administration and concomitant use of other drugs (NSAIDs) were obtained. DAS28 was calculated to all patients to assess drug response. MTHFR A1298C polymorphism was investigated using real time 5 0 nuclease allelic discrimination assay. Results: Multivariate regression analysis for factors predicting MTX drug response showed that MTHFR A1298C SNP and MTX dose were the most significant independent predictors for MTX treatment response (p = .016, OR = 39.113, 95% C.I = 1.970-776.558, p = .003, OR = 1.667, C.I = 1.184-2.348, respectively). Considering clinicopathological variables; longer disease duration, positive anti-CCP, NSAIDs users, higher MTX doses and longer treatment durations were significantly associated with nonresponse to MTX. Regarding MTX drug toxicity, MTHFR 1298 CC genotype, MTX dose and concomitant use of NSAIDs were significantly associated with MTX drug toxicity (MC p = .003, p = .031, p = .029, respectively). Conclusion: Our study proved that MTHFR A1298C SNP can predict clinical outcome of MTX treatment as regards treatment efficacy and toxicity in Egyptian rheumatoid arthritis patients.
Background. The prevalence of functional bowel disorders is on the rise worldwide. Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized mainly by abdominal cramps, flatulence, and abnormal bowel movements. Due to the lack of specific biomarkers and of a specific diagnostic test, IBS is diagnosed according to the Rome IV clinical criteria. The current holistic approach recommends dietary management as the initial therapy for IBS patients with mild and moderate symptoms. Objectives. This review examines the studies on the effect of various types of diets on IBS as well as on the primary dietary therapy in IBS patients. Material and methods. A literature review of published studies was conducted by searching the Medline-PubMed database using the MeSH (Medical Subject Headings) descriptor and the following keyword combinations: "irritable bowel syndrome" and "treatment" (n = 11 articles), "irritable bowel syndrome" and "diet or nutrition" (n = 26 articles), "irritable bowel syndrome" (n = 9 articles), and "gluten", "irritable bowel syndrome" and "lactose" (n = 4 articles). Results. Contradictory results were found in many studies regarding several diets such as diet excluding gas-producing foods, diet low in lactose, gluten-free diet, diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) and the role of fiber, alcohol, caffeine, and natural remedies and their applications in different IBS subtypes. Conclusions. Short-term restriction of FODMAP may be the most effective dietary intervention for reducing IBS symptoms compared to other types of diet.
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