Previous studies have found an association between HLA‐B*1502 allele and lamotrigine‐induced Stevens‐Johnson syndrome (SJS)/ toxic epidermal necrosis (TEN) spectrum in Han Chinese populations. This study aims to investigate the association between HLA‐B*1502 and lamotrigine‐ or phenytoin‐ induced SJS/TEN in an Iranian population. The medical records of twenty‐eight lamotrigine‐induced SJS/TEN patients and twenty‐five lamotrigine‐tolerant controls as well as eight phenytoin‐induced SJS/TEN and twelve phenytoin‐tolerant controls were extracted between March 2013 and March 2019 from the university hospitals in Mashhad, Iran. The presence of HLA‐B*1502 allele was determined using real‐time polymerase chain reaction (PCR). Among lamotrigine‐induced patients with SJS/TEN, 11 (39.3%) patients tested positive for the HLA‐B*1502 while only 3 (12.0%) of the lamotrigine‐tolerant controls tested positive for this allele. The risk of lamotrigine‐induced SJS/TEN was significantly higher in patients with HLA‐B*1502, with an odds ratio (OR) of 4.74 [95% confidence interval (CI) 1.14–19.73, p = 0.032]. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HLA‐B*1502 for lamotrigine‐induced SJS/TEN was 39.29%, 88.00%, 78.57% and 56.41%, respectively. The HLA‐B*1502 allele was present in 2 (25.0%) of phenytoin‐induced SJS/TEN cases and 5 (41.7%) of the phenytoin‐tolerant controls tested positive for HLA‐B*1502 allele. The risk of phenytoin‐induced SJS/TEN was not higher in the patients with HLA‐B*1502 (OR = 0.467 [95% confidence interval (CI) 0.065‐3.34, p = 0.642]). Lamotrigine‐induced SJS/TEN is associated with HLA‐B*1502 allele in an Iranian population but this is not the case for phenytoin‐induced SJS/TEN.
43Recently, several infectious agents including Epstein-Barr virus and Escherichia coli have been suggested as possible contributing factors to the pathogenesis of rheumatoid arthritis (RA). This study was designed to compare serum and synovial fluid markers of herpes simplex virus (HSV) and Helicobacter pylori of RA and osteoarthritis (OA) patients. This comparative study was conducted on two hundred OA and RA patients who referred to the Rheumatic Diseases Research Center (RDRC) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2015 to 2016. Synovial fluid was obtained from all individuals. Two years later, participants attended a follow-up session to collect blood samples for serum markers of these two infectious agents. Twenty-five patients (96.15%) in the RA group and 23 individuals (92%) in the OA group had positive serum IgG antibodies for HSV. As for Helicobacter pylori, 13 individuals (50%) in RA and 12 individuals (48%) had positive serum IgG antibodies (p value = 0.66). In addition, 9 (34.6%) and 8 (30.8%) in the RA group and 10 (40%) and 3 (12%) in the OA group had positive serum IgA and IgM antibodies for Helicobacter pylori, respectively (p value = 0.89 and p value = 0.13, respectively). Collected fluid samples were negative for both Helicobacter pylori and HSV1 and 2 DNA particles in all individuals. Based on the results of the current study, there is no difference between RA and OA patients in terms of Herpes simplex virus and Helicobacter pylori infection.
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