Fortune Journal of Rheumatology is an open access peer reviewed journal and strives to support researchers and discovery by publishing the highest quality scientific and clinical-epidemiological papers on a wide range of Rheumatology in paediatric, adult and musculoskeletal conditions, including topics such as diagnosis, therapy, surgery, imaging and education.
Relapse Rates in Patients with GPA or MPA on Rituximab (RTX) Maintenance Therapy: A Single-Center Experience Observational Study from Saudi Arabia
Introduction: ANCA-associated vasculitis (AAV) is a rare, systematic, small-vessel inflammatory disorder, leading to conditions such as granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). While glucocorticoids and immunosuppressants are effective in inducing remission, maintaining it remains a challenge. Rituximab (RTX) has become the preferred choice for maintenance therapy.<o:p></o:p> Objective: To evaluate the effectiveness of rituximab in maintaining remission by analyzing relapse rates among patients with GPA or MPA while receiving RTX.<o:p></o:p> Methods: An ambispective cohort study was conducted at King Fahad Medical City between 2015 and 2025 which included patients (>14 years old) diagnosed with GPA or MPA. Descriptive statistics were used, and relapse-free survival was estimated using Kaplan–Meier model. The French Vasculitis Study Group Relapse Score (FRS) was incorporated into the study, which includes three variables and a score that ranges from 0 to 3 points: positivity of PR3-ANCA, GFR ≥30 mL/min/1.73 m², and age ≤75 years.<o:p></o:p> Results: A total of 33 patients were included in the analysis; 81.7% had GPA. Ear, nose, and throat involvement was in 72.7% of patients. At 36 months, relapse-free survival was 76.6%. Six patients (18.2%) experienced relapses. The median steroid dose did not differ between patients with or without relapses. Patients with an FRS score of 1-2 had much higher relapse-free survival, but this was not statistically significant (log-rank test p-value = 0.3).<o:p></o:p> Conclusion: Rituximab appears to be an effective maintenance therapy for AAV in this Saudi cohort, with relatively low relapse rates and sustained remission in most patients.<o:p></o:p>
Copyright (c) 2026 Fortune Journal of Rheumatology
Therapeutic Role of Hammam Bukhari (Traditional Steam Bath) in the Management of Rheumatoid Arthritis: A Case Report
Background: Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disorder marked by persistent synovial inflammation, pain, stiffness, and functional impairment. Conventional pharmacological therapies provide symptomatic control but are often associated with adverse effects and incomplete disease control. Unani medicine describes RA under Waja? al Maf??il and advocates a holistic approach, including regimenal therapies. Case presentation: A 48 year old female with an eight year history of RA presented with severe polyarticular pain, prolonged morning stiffness, swelling of small and large joints, and reduced quality of life despite intermittent use of methotrexate and NSAIDs. Clinical examination, laboratory investigations, and radiological findings confirmed active disease. The patient was managed with Hammam Bukhari (traditional steam bath) as a Unani regimenal therapy for 15 consecutive days. Intervention and outcome: Following therapy, there was marked improvement in pain intensity, joint stiffness, swelling, and functional ability. Visual Analog Scale (VAS) scores reduced from 8/10 to 2/10, and the WOMAC score improved from 64 to 22. Morning stiffness decreased substantially, and the patient reported sustained symptomatic relief at two month follow up. Conclusion: This case suggests that Hammam Bukhari may serve as a safe and beneficial complementary modality in the integrative management of rheumatoid arthritis. Larger and well designed clinical studies are warranted to substantiate these findings.
Combination of Trochleoplasty and High Tibial Osteotomy in Patellofemoral Instability Yielding Good Short-Term Results in terms of Pain Relief, Patella Stability and Knee Function
Introduction: In many cases patellofemoral instability (PFI) presents a multifactorial issue that often requires a combination of different surgical procedures. In addition to re-balancing relevant soft tissue structures, osseous pathologies must also be addressed. Although, the combination of trochlear dysplasia, increased external tibial torsion or valgus deformity of the knee is rare, it is usually seen in young adolescents and could thus lead to early onset patellofemoral osteoarthritis or persisting PFI. We hypothesize that the combination of trochleoplasty and high tibial osteotomy (HTO) improves patellar stability and functional scores in patients who present with trochlear dysplasia and a tibial axis deviation (valgus deformity or increased external rotation) of a lower extremity. Methods: 13 consecutive cases were included, where patients who presented with PFI were surgically treated by performing a trochleoplasty in addition to HTO. The following five inclusion criteria had to be met: (1) patients with PFI (2) trochlear dysplasia (Dejour type D), (3) tibial deformity (valgus or increased tibial torsion) of the ipsilateral limb and (4) failure of conservative treatment (5) simultaneous correction femoral and tibial. Preoperative imaging acquired consisted of conventional X-ray studies of the knee (a.p. and lateral) and full weight bearing long leg radiograph a.p. of the lower extremity, as well as a torsional CT scan of the lower extremities and a MRI of the affected knee joint. Surgical procedure consisted of trochleoplasty and HTO (tibial valgus or torsional correction) in addition to soft tissue rebalancing via lateral release. MPFL reconstruction was performed depending on patellar instability, tested intraoperatively. Subjects with previous surgical intervention, follow-up less than 6 months and femoral valgus deformity were excluded from this study. Visual analog scale (VAS), Tegner-score and the Kujala-score were compared pre- and postoperatively. Intra- and postoperative complications were registered. Results: The study group consisted of 7 male and 6 female procedures with a mean of 20.8 years of age. 6 knees received a tibial varisation osteotomy, 7 knees a high tibial torsional osteotomy, 8 knees a primary MPFL-reconstruction. No intraoperative complication occured. During a mean follow-up time of 24.2 months one patient suffered a deep vein thrombosis and consequent pulmonary embolism. One patient who did not undergo primary MPFL-reconstruction suffered a single event of patella re-dislocation, which remained stable after secondary MPFL-reconstruction. 2 patients without primary MPFL-reconstruction received MPFL-reconstruction secondary simultaneous with hardware removal due to patella subluxation after primary surgery. The Tegner score improved from 3.08 to 4.62, the Kujala score from 65.8 to 88.8, while the VAS decreased from 5.62 preoperatively to 1.77 postoperatively. Conclusions: This multi-case study shows that the combined surgical procedure consisting of trochleoplasty and HTO improves patellofemoral stability and knee function while provoking a low rate of intra- and postoperative complications. The rare number of individuals suffering from PFI due to trochlear dysplasia and tibial valgus or increased external rotation deformity can be safely treated in a single surgical setting yielding good clinical results in terms of pain relief, functional scores, and patellar stability, while primary MPFL-reconstruction yields a better patella stability.
Haglund Syndrome in a Professional Basketball Player: Mini Open Excision. A Case Study
Haglund syndrome is a common but challenging condition for athletes, especially those involved in high-impact sports like basketball. It involves a bony enlargement of the posterosuperior calcaneus that irritates the retrocalcaneal bursa and Achilles tendon. This case study details the diagnosis, treatment, and recovery of a professional basketball player treated with a mini open excision technique.
Different Dosing Regimens of Rituximab Biosimilar in Rheumatoid Arthritis: A Comparative Analysis of Disease Activity Control, B-cell Depletion and Adverse Effect Profile
Introduction: Rituximab is an established biologic DMARD for refractory rheumatoid arthritis (RA), but its high cost restricts access in low- and middle-income countries. Biosimilar rituximab (bRTX) provides a more affordable option with proven efficacy and safety. While reduced-dose regimens have shown non-inferiority to the standard regimen in originator RTX, real-world evidence on bRTX in India is limited. This study compares clinical outcomes and B-cell depletion with two bRTX dosing strategies in RA. Methods: We retrospectively analysed bDMARD-naïve RA patients with inadequate response to conventional DMARDs who chose to receive either 1000 mg × 2 or 500 mg × 2 doses of bRTX. Disease activity (DAS28-ESR/CRP), ACR50 responses, and CD19+ B-cell counts were assessed at baseline and 12 months. Between-group comparisons were performed using Student’s t- test. Results: The mean DAS28-CRP decreased from 5.23 ± 0.10 to 3.62 ± 0.44 in the 1000 mg group and from 5.24 ± 0.09 to 3.65 ± 0.59 in the 500 mg group. ACR50 response rates were 84.6% and 78.6% in the standard- and reduced-dose groups, respectively, with no significant difference in disease activity reduction (p > 0.05). CD19+ counts (/uL) fell from 1222 to 127 in the 1000 mg group and from 1223to 134 in the 500 mg group. Conclusion: Both standard and reduced bRTX regimens achieved comparable clinical efficacy and B-cell depletion over 12 months. The 500 mg regimen may represent an economically-viable alternative for RA management in resource-constrained settings.
Copyright (c) 2025 Fortune Journal of Rheumatology
CT and DXA Bone Fragility Evaluation after Bariatric Surgery
Objectives: The objectives were to determine the prevalence of bone fragility 3 years (±6 months) after bariatric surgery via DXA and computed tomography (CT) in patients with obesity; to identify the risk factors for the bone fragility development (bone mineral density [BMD] ≤-2SD or a scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) ≤145 Hounsfield units (HU)) and to compare the results obtained via CT and DXA. Methods: This descriptive study included patients with obesity who underwent bariatric surgery and DXA and CT before and 3 years (±6 months) after bariatric surgery. Results: Among the 44 included patients, 84.1% were women, with a mean age of 53.9 years (±10.7). After 3 years, there was a greater prevalence of osteoporosis (p=0.002), the postsurgery T-scores were significantly lower (p<0.001) than those at baseline. The SBAC-L1 was significantly lower after surgery than before surgery (p=0.008). According to multivariate analysis, no risk factor was significantly associated with the development of bone fragility at 3 years. The correlation between CT and DXA results was positive and moderate to strong (0.53 to 0.63). Conclusion: There was a significantly greater prevalence of osteoporosis and a lower SBAC-L1 3 years after bariatric surgery than before.
Shoulder Electromyography (Emg) Evaluation During Latissimus-Dorsi Pulldown Variations Following an Accelerated Shoulder Resistance Training Program
Background: The latissimus dorsi-pulldown exercise is used to strengthen the elbow flexors, shoulder adductors, and shoulder horizontal adductors. Evidence indicates that resistance training injuries commonly occur in the shoulder complex. Objectives: The purpose of this study was to determine peak muscle activation and time to peak activation using shoulder surface electromyography (sEMG) during latissimus-dorsi pulldown variations following an accelerated shoulder resistance training program. Methods: Thirteen males aged 18 to 35 years participated in the study. The participants completed a five-week, three times weekly supervised intervention program for 60 minutes. The intervention program consisted of a standardized rotator cuff impingement rehabilitation protocol and shoulder stabilizing muscle exercises. Each session commenced with a five-minute arm ergometer warm-up performed at 50 watts with 50-70 revolutions per minute (RPM), followed by five minutes of static upper body musculature. Participants performed three sets of eight to 12 repetitions of floor calisthenics exercises at 50-70% maximal voluntary contraction (MVC) and four sets of 25 repetitions of TheraBand exercises. Each session was concluded with stretching for three sets, with each stretch held for 45 seconds. Results: Peak muscle activation of the middle trapezius significantly improved during wide grip anterior (WGA) (p=0.042). Further, the intervention significantly reduced the time to peak activation of the latissimus-dorsi during WGA (p=0.000) and supinated close grip (SCG) (p=0.000). Time to peak activation also significantly reduced of the middle trapezius during WGA (p=0.010). Similarly, time to peak activation of the triceps long head significantly reduced during WGA (p=0.002), wide grip posterior (WGP) (p=0.045) and SCG (p=0.008). Further, this study demonstrated a significant difference using WGA in the latissimus-dorsi at pre-test, in the lower trapezius using WGP at pre- and post-test, in the middle trapezius using WGA during post-test and using VBG during pre-test and in the triceps long head using WGA at pre- and post-test. Conclusion: This study’s findings are essential in shoulder prevention and rehabilitation programs since the various grips of latissimus dorsi-pulldown exercises are varied in their ability to target specific muscles in the shoulder complex that may need focused attention.
Rheumatoid Arthritis – The Immaculate Infection
Rheumatoid arthritis (RA), long considered a purely autoimmune disorder, is increasingly recognized as a disease potentially initiated or modulated by microbial triggers. The provocative phrase “the immaculate infection” underscores the possibility that infection—without overt illness—might be the inciting event in genetically susceptible individuals. This review explores microbial agents implicated in RA, including Porphyromonas gingivalis, Prevotella copri, Epstein-Barr virus, and Mycoplasma species. I discuss mechanisms such as molecular mimicry, citrullination, and dysbiosis, and consider the therapeutic and diagnostic implications of an infectious model for RA.
Immunoglobulin Deficiencies in Rheumatoid Arthritis
Rheumatic diseases are more frequent in patients with immunoglobulin deficiencies than in those with intact humoral immunity. This study investigates the immunoglobulin profiles of 45 rheumatoid arthritis patients and 45 matched controls. Our analysis revealed a higher prevalence of IgE, IgA, and IgG subclass deficiencies in RA patients, especially among those with secondary autoimmune conditions. These immunoglobulin deficits may predispose to autoimmunity via impaired mucosal exclusion, altered cytokine signaling, and defective complement regulation.
Galanin receptor agonists limit osteoclast number in in vitro mouse models
Despite evidence that galanin-like compounds are potential regulators of bone activity, little research has been undertaken to investigate the role of these compounds on osseous cells. The aim of this study was to elucidate the mechanisms by which the galanin receptor agonist’s galanin and galnon regulate osteoclasts. Osteoclasts were cultured from cells isolated from femurs of C57BL/6 mice and grown to 80% confluence, then differentiated via the application of mCSF and RANKL. Cultures were analyzed for osteoclast number via TRAP staining, qPCR and immunocytochemistry. A moderate dose of both galanin-like compounds decreased osteoclast count in vitro . The moderate dose of galanin also reduced expression of inflammatory markers. These results indicate that both galanin and galnon can act to reduce osteoclast count, although they have led to contradictory responses with respect to inflammatory expression. These results may help to better treatment for bone-resorptive diseases such as osteoporosis.
Persistent Pyrexia of Unknown Origin and Deep Vein Thrombosis in a Patient with Sjögren’s Syndrome: A Case Report
Background: Sjögren’s Syndrome (SS) is a systemic autoimmune disorder primarily affecting the exocrine glands but often presenting with significant extraglandular manifestations, including systemic vasculitis, hematological abnormalities, and antiphospholipid syndrome (APS). Atypical presentations, such as pyrexia of unknown origin (PUO) or thrombotic events, can delay diagnosis. Case Presentation: We report a 57-year-old male with persistent fever, anemia, and leukocytosis. Initial blood cultures identified Pseudomonas aeruginosa, and antibiotic therapy resulted in temporary improvement. Persistent febrile episodes prompted further evaluation, revealing bilateral hilar lymphadenopathy on HRCT thorax and strong anti-SS-A (Ro-52) antibody positivity, confirming SS. Despite no classical sicca symptoms, systemic inflammation and autoimmune markers led to the diagnosis. One month later, the patient developed deep vein thrombosis (DVT), confirmed by Doppler ultrasound. Positive antiphospholipid antibodies and lupus anticoagulant established APS. The patient was managed with anticoagulation and hydroxychloroquine, achieving clinical stability. Conclusion: This case highlights the diagnostic challenges in atypical SS presentations, emphasizing the need for a high index of suspicion in PUO. Multidisciplinary management addressing systemic inflammation, thrombotic risks, and infections is essential to improving outcomes in SS patients with extraglandular manifestations.
Identification of m7G RNA Methylation Regulators in Osteoarthritis and its Prognostic Markers
Background: Osteoarthritis (OA) is a multifactorial disease that places an increasing burden on modern society. Synovial inflammation plays an important role in osteoarthritis. 7-methylguanosine (m7G) is one of the most common forms of base modification in post-transcriptional regulation. However, the function of m7G RNA methylation regulators in synovial tissue remains unclear, and the expression and predictive value of m7G RNA methylation regulators are rarely reported. So new studies are needed to fill this gap. Methods: Firstly, 40 m7G RNA methylation-related genes were selected from the four pathways and compared with the GSE55457 dataset to obtain gene expression profiles and clinical information. And 25 related genes were obtained. Six differential genes were also selected after the differential analysis of the 25 m7G RNA methylation-related regulators in OA and normal patients. Finally, the areas under the curve (AUC) were used to evaluate the diagnostic efficacy of m7G related genes in distinguishing OA patients from healthy population. Results: We found these genes are mainly involved in RNA metabolism, RNA cap binding, and the formation of RNA cap-binding complexes and the regulation of RNA cap formation had a strong impact on gene regulation. Then we identified 6 differentially expressed genes (DEGs), confirming for the first time that SNUPN and NUDT11 were associated with early diagnosis and prediction of OA. Conclusions: The regulators of m7G RNA methylation play a crucial role in the advancement of OA and hold promise in terms of prognosis. However, the clinical effects of these biomarkers on OA need further study.
Copyright (c) 2024 Fortune Journal of Rheumatology
Numerical Simulation of Pressure Distribution for Structural Design of Diabetic Footwear Insoles
Diabetic foot ulcerations or open wounds that cannot heal on the feet are a serious condition for people who have diabetic mellitus, as they might face lower limb amputation if the wounds are not well cared. Here, we propose braced frame structure insoles with traditional insole material to further reduce the shear stress and contact pressure at the plantar-insole surface to reduce the risk of foot injury. Finite element models (FEMs) are developed to evaluate the structural changes of the developed braced frame structure upon exertion of compressive forces. Also, the effect of different braced frame structures on the shear stress, contact area as well as maximum contact force of the plantar are analysed through a finite element analysis (FEA). The result of the validated FEMs show that the proposed structure reduces the shear stress (~21%) and maximum contact force (~55%) more than traditional diabetic insoles.
A Nomogram for Lateral Lymph Nodes that have Metastatic Cn0 Unifocal Papillary Thyroid Microcarcinoma
Background: The need for lateral neck dissection (LND) for papillary thyroid microcarcinoma (PTMC) can be better understood by identifying risk variables for occult lateral lymph node metastasis (LLNM). This study aimed to create a nomogram to predict the likelihood of LLNM in individuals with cN0 unifocal PTMC. Methods: A total of 9744 patients with cN0 unifocal PTMC who were treated at our facility between February 2013 and April 2020 were included in our retrospective analysis. Risk variables for LLNM were identified using logistic regression analysis, and a nomogram was created based on these risk factors. Results: In the study population, 3.2% had LLNM. Compared to tumors in the lower or middle lobe with a size less than or equal to 7 mm, tumors in the upper lobe had a substantially increased risk of LLNM (odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.80–3.62; p 0.001) and OR = 2.59, 95% CI 1.85–3.62. ETE tumors had a significantly increased probability of developing LLNM (OR = 1.41, 95% CI 1.01–1.99; p = 0.044). One or two central lymph node metastases (CLNMs) or three or more of them (OR = 5.84, 95% CI 3.83-8.93; p 0.001) increased the probability of LLNM compared to those who did not (OR = 2.91, 95% CI 1.93-4.42; p 0.001). The receiver operating characteristic (ROC) curve of a nomogram considering these risk factors showed an area under the curve (AUC) of 0.777, indicating a good level of predictive accuracy. Conclusion: Three or more CLNMs, especially three or more, and upper lobe tumors >7 mm in size were independent risk factors for LLNM in patients with cN0 unifocal PTMC. Based on these variables, the nomogram showed a good predictive value and consistency.
Immunomodulatory effects of Simvastatin in Toll-like receptor-2 stimulated Rheumatoid arthritis synoviocytes
Fibroblast-like synoviocytes (FLS) are major effector cells in Rheumatoid arthritis (RA). Toll-like receptor-2 (TLR2) activation of FLS plays a key role in RA pathogenesis. Recently, statins have been shown to modulate RA. We investigated the immunomodulatory effects of simvastatin (SMV) in vitro, in FLS cell lines from control and RA subjects, in the presence of TLR2 activation. Normal and RA FLS cultures (1x105 cells/well) were treated with SMV then activated with TLR2 ligand (Pam3CSK4 100μg/ml) for 24-hours. SMV caused dose-dependent cytotoxicity in both cell lines as assessed by Alamar-blue assay and increased ROS production measured by flow cytometry. Gene expression of anti-oxidants including GSR, TXNRD1, PRDX1, SOD2 and MT3 was upregulated. BNIP3 expression was increased 2200-fold in RA-FLS after SMV/TLR2 treatment pointing to apoptosis as a cause of observed cytotoxicity. Apoptosis increased in both cell lines with SMV to 25%. Akt decreased dose- dependently in RA FLS assessed by western blots. IP-1, IP-2 and IP3 decreased with SMV/TLR2 treatment indicating cell survival while IL-6 increased dose-dependently. Thus, SMV induces apoptosis in FLS by upregulating BNIP3 and inhibiting Akt. FLS react to survive by increasing IL-6, decreasing IP-1 and IP-2 and upregulating anti-oxidant genes. SMV has immunomodulatory properties and may be used in RA as adjunctive therapy in combination with other more potent disease-modifying medications.
Fast Algorithm for the Determination of the Optimum Filter for Bone SPECT Image Reconstruction
In SPECT, the reconstructed images are strongly affected by poisson noise, poor spatial resolution and bad contrast due to the radioactivity disintegration and procedures acquisition. In this paper, we propose an algorithm to improve the traditional FBP reconstruction and to choose the most suitable technique for bone SPECT image denoising. The proposed approach is composed of two steps. The first one consists of denoising the acquired sinograms using successively eight currently used filters in nuclear medicine: Wiener, Metz, Hamming, Hann, Shepp-Logan, Parzen, Butterworth and Gaussian combined with Butterworth filters. The second step is a simultaneous reconstruction of the axial slices using a new 3D FBP algorithm for each filter. A comparative study of these filters is tested and evaluated on a dataset containing thirty one bone SPECT image. The results show that the difference between these filters is statistically significantly different from each other (p<0.05) and the 3D FBP with the combination between Butterworth and Gaussian provide the best performance. The selected method is compared to three denoising methods. These methods are tested on a Shepp Logan phantom and bone SPECT images. Experimental results show that the 3D FBP reconstruction with the pre-processing combination (Gaussian (Std=0.3) + Butterworth (fc=0.47, ordre=3)) filter is more accurate and robust compared to other methods. It provides the highest performance in term of contrast, SNR, CNR ensuring a shorter processing time. It accelerates the reconstruction, reduces noise and artifacts while preserving detailed features. This approach could be considered as a valuable candidate to enhance the quality of the reconstructed bone SPECT image.
Validation of Osteoporosis Scores with Urinary N-telopeptide Bone Marker in Assessment Bone Mineral Density in Autoimmune Rheumatic Diseases Patients
Introduction: Osteoporosis is a condition characterised by decreased bone strength. Many tools are used to assess osteoporosis e.g Dual-energy x-ray absorptiometry (DXA) and Fracture Risk Assessment Tool (FRAX). Also, different bone resorption marker can predict osteoporosis e.g Urinary N-telopeptide is a sensitive and specific marker of bone resorption. Objective: assess the validity DXA and FRAX scores in early detection of osteoporosis in autoimmune diseases. Also, serum vitamin D and urinary N-telopeptide as marker for bone resorption in them. Method: A cross sectional observational study where a (180) autoimmune rheumatic patients were assessed by DXA, FRAX scores, serum vitamin D, serum uric acid and Urinary N-telopeptide. Result: The mean age of studied patients (180) was 46±12.6 years old, BMI 33.7 (29.4-37.8), S Uric acid 6 (5-7), S vitamin D 26 (13.3-32), urinary Telopeptide 105 (89-175), Lt femur neck T score -0.9 (-1.5…-0.3), Lt forearm T score -0.8 (-1.7….-0.1), osteoporosis 2 (1-2), FRAX score osteoporosis % 3.7 (2.6-7.5), FRAX score hip fracture % 0.2 (0.1-0.6) and risk hip fracture 1 (1-1). Left femur neck T score and Lumbar T score were significantly correlated with age, S uric acid, percentage of FRAX score osteoporosis and FRAX score hip fracture. Conclusion: If we suspect osteoporosis, it is better to go for urinary N-telopeptide and those who test positive can go for current gold standard DXA scan. Combination of two diagnostic tools; urinary N-telopeptide with osteoporosis scores could help early identification of high risk for fracture in autoimmune diseases.
Safety Comparison of Conventional Versus Extended Infusion of Pulse Methylprednisolone in Multiple Sclerosis Exacerbation
Objective: To determine the impact of Intravenous Methylprednisolone (IVMP) administration on the changes in vital signs (Heart Rate (HR), Systolic (SBP), Diastolic Blood Pressure (DBP), and serum potassium level in multiple sclerosis flare. Design: retrospective review study conducted at Hamad General Hospital (HGH). All patients admitted in 2019-2020 with MS flare without any comorbidities were categorized into two groups depending on infusion rate. One group received a conventional IVMP dose over 30 minutes to one hour, while the second group received IVMP over an extended period) (four to six hours). After that, we assessed multiple readings of vital signs and potassium levels through steroid administration time to determine if there was an infusion-related significant difference in adverse events between both groups. Methods: 74 adult patients with MS relapse admitted to Hamad General Hospital (HGH) and satisfied pre-specified inclusion criteria were invited to participate in the study. Results: 74 patients with MS were included in the study; 61 patients (83.6%) received a methylprednisolone dose of 500 mg -1000 mg in a conventional infusion rate, while 12 patients (16.4%) received pulse steroids in an extended duration. Both groups had no significant difference in mean blood pressure before and after IVMP. There was a small but statistically significant increase in mean heart rate in the conventional group immediately after the first and second but not 3rd dose of IVMP compared to baseline 3.5± 8.9 and 4.85± 13.9 P < 0.003. There was a minimal non-significant increase in potassium level in the conventional group (P = 0.17), while there was a non-significant decrease in potassium level in the extended group (P=0.72). Conclusion: IVMP is considered safe and effective in treating MS exacerbation regardless of intravenous infusion duration. There was no significant difference in vital signs among different infusion rates. However, there was a small but statistically significant increase in mean heart rate in the conventional group immediately after the first and second but not 3rd dose of IVMP compared to baseline. No significant difference was observed in potassium levels before and after IVMP. We, therefore, recommend restricting potassium level monitoring to patients with other risk factors of hypokalemia.
Copyright (c) 2023 Fortune Journal of Rheumatology
Association of Interleukin-10 with Severity of Axial Spondyloarthritis in Patients Attending in A Tertiary Care Hospital in Dhaka City
Objective: The aim of the study was to determine the association of interleukin-10 (IL-10) level with severity of axial spondyloarthritis (axSpA). Materials and methods: According to Assessment of Spondyloarthritis International Society (ASAS) criteria, 38 patients with axSpA (clinically diagnosed by Rheumatologist, attending outpatient department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, BSMMU) and 38 healthy controls (resident doctors, laboratory staffs of BSMMU and general people) were enrolled. Blood samples were collected after taking informed written consent and data in a predesigned data collection sheet. Serum IL-10 levels were measured by Enzyme Linked Immunosorbent Assay (ELISA) at Microbiology and Immunology Department, BSMMU. Results: Among 38 patients, 63.2% were male. According to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 14 patients were in mild to moderate group and 24 in severe group. Serum level of IL-10 were significantly higher in patients compared to controls (3.69 pg/ml vs 0.88 pg/ml, P<0.001). Mean IL-10 levels in inactive disease group were comparatively higher than active disease group (P<0.001). Conclusion: Serum level of IL-10 is significantly elevated in axSpA patients and is negatively correlated with disease activity.
Assessment of Knowledge, Attitudes, and Practice (KAP) Among Dentists toward Carpal Tunnel Syndrome in Shiraz, Iran
Background: Carpal tunnel syndrome (CTS) is a common workplace musculoskeletal disorder, and dentists are a high-risk group due to their work conditions. This study aims to obtain a full understanding of knowledge, attitude, and practice (KAP) of CTS among Dentists in Shiraz, Iran. Methods: Between Jun, 2019 and Dec 2019; A researcher-made questionnaire was developed for this cross-sectional pilot study in order to evaluate the KAP of dentists regarding CTS. Participants were recruited to fill out the questionnaire. The participants were recruited using convenient sampling from dentists working. A 51 dentists have completed the survey. Ethical approval to conduct this study was obtained. Results: About 31 (60.8%) respondents were female and 20(39.2%) were male. 54.9%. of the participants were aged below 33 years. 66.7%. of dentists had less than 10 years of work experience. No statistically significant correlation was observed between age, and number of years of work experience and KAP scores. But there was significant correlation between gender and knowledge (p =0.04). The mean scores of knowledges were 3.7 ±1.3 which was low to average regarding the prevention and treatment of CTS. The mean scores of attitudes and practice were 10.9 ±3.2 and 7.9 ± 2.1, respectively. Which represent a positive attitude and practice towards regarding the prevention and treatment of CTS. There was a significant correlation between attitude and practice among dentists with p =0.001. Conclusion: Most dentists in this study had low to average knowledge, high attitudes, and high practice scores of the prevention and treatment of CTS.
The exact prevalence of animal bites in Malaysia, especially domestic animal, is largely unknown. Cat bites is a common problem seen due to a large number of cat lover all across Malaysia. Cat possesses very sharp teeth that can lead to deep infections up to the bone. Statistics have shown that animal bites accounts for significant 1-2 % of emergency hospital visits. Therefore, knowledge of the exact prevalence and common pathogens brought upon this animal bites, namely cat bites are important in overall management of this common problem to prevent serious infection.
Joint Pain Management: Focusing on Osteoarthritis
Joint pain can be classified as either mechanical which is activity related or inflammatory in nature. Osteoarthritis (OA) is the most common cause of mechanical joint pain. It is due to the inefficient repair process of synovial joints and not a disease, as commonly thought. Sometimes this process fails and patients presents with symptoms of pain and functional impairment. As joint pain classification is based on signs and symptoms; x-rays are usually not needed.
Musculoskeletal Manifestations among Egyptian HCV Patients Receiving Direct Antivirals (DAAS) Therapy
Introduction: Hepatitis C is a worldwide problem; the treatment of chronic HCV has been revolutionized with the introduction of the oral Direct-Acting Antiviral (DAA) drugs. The efficacy in eradication of extrahepatic and hepatic manifestation leads to its widely spread of these medications, but there is musculoskeletal side effect reported with its use. Objectives: Assess musculoskeletal manifestation in HCV patients receiving Direct Antivirals Therapy (DAATs) attending Rheumatology & Immunology Unit in internal medicine department in Mansoura university Hospital. Result: Majority of studied patients (n=200) were 64% females and 36% were male. The most frequent involved joint was the knee 55% (110), while the least affected joint was the wrist 6% (12) and the shoulder joint 8%. It was observed that bone pain (71.1%) especially at shoulder joint (64.3%) and back (60.7%) were associated with Sofosbuvir+ Daclatasvir but were statistically insignificant. Arthralgia was presenting manifestation in 63% with patients received Sofosbuvir +Daclatasvir and dominated in the wrist joint (66.7%), knee joint (65.5%), shoulder joint (62.5%) but it was statistically insignificant. Back pain was evident in patients treated by DAAs for 12 weeks (27.7%) than those received it for 24 weeks (11.8%) and it was statistically significant p* = 0.050. Conclusion: Musculoskeletal disorders reported mainly with sofosbuvir and daclatasvir especially for 12-week duration and the most affected age group (more than 55year).
Copyright (c) 2022 Fortune Journal of Rheumatology
Correlation Analysis between Netosis Biomarkers and Peripheral Immune Cells in a Preclinical Model of Ischemic Stroke
Neutrophil Extracellular Trap Formation (NETosis) facilitates thrombosis and contributes to reperfusion resistance - a major challenge encountered during the treatment of acute ischemic stroke. The effect of acute stroke on plasma NETosis biomarkers remains unclear. In this study, young adult C57BL/6 Wildtype (WT) mice were subjected to acute brain Ischemia-Reperfusion (IR) injury. The IR-subjected mice exhibited a drastic increase in plasma citrullinated histone 3 (CitH3) and Neutrophil Elastase (NE) on day 1 (p<0.05) while Deoxyribonucleic Acid (DNA) and Myeloperoxidase (MPO) reached their peak levels on day 3. IR-subjected mice also showed a significant increase in peripheral neutrophils and decline in peripheral leukocytes, lymphocytes, and monocytes on day 1 and day 2 (p<0.05). The ratios of neutrophil to lymphocyte, neutrophil to leukocyte, and lymphocyte to monocyte dramatically increased on day 1 (p<0.05). Plasma NE, CitH3 and MPO were positively correlated with peripheral neutrophil and the ratio of neutrophil to lymphocyte, but inversely correlated with peripheral lymphocyte (p<0.05). Our data suggest that there are time dependent changes in plasma NETosis biomarkers, reducing these biomarkers before their peak may offer potential therapeutic options to reduce cerebral infarction and prevent functional deterioration after acute ischemic stroke.
Presumed Giant Cell Arteritis presenting as Sequential Bilateral 6th Nerve Palsies: Case Report and Review of Literature
Giant CELL ARTERITIS (GCA) is a systemic autoimmune disease that classically presents with jaw claudication, temporal headache and transient visual loss, affecting mostly people above the age of 50 years. However, diplopia due to cranial nerve 6 palsy (CN VI) has been rarely reported in GCA. Moreover, bilateral CN VI palsies, occurring in a sequential fashion in GCA is exceedingly rare. We report a case of a 70-year-old man who was admitted to our hospital twice within the span of one month with persistent binocular diplopia due to sequential, bilateral, CN VI palsies (right followed by left CN VI palsy) with associated eye pain, temporal headache, malaise and joint pain. The inflammatory markers including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated at both admissions. He was treated with intravenous steroids with a complete resolution of his binocular diplopia, eye pain and temporal headache. Despite a negative biopsy of the temporal artery for evidence of inflammation, he was diagnosed with GCA by rheumatology, considering the fact that GCA pathology may have a patchy distribution, and a negative biopsy does not rule it out absolutely. This case underscores the importance of recognizing GCA as a differential diagnosis in patients presenting with binocular diplopia.
Acknowledgement to Authors, Reviewers and Editors of Fortune Journal of Rheumatology in 2020
Abstract not available in the source database.
Madelung Disease-a Challenge in Clinical Practice
Multiple Symmetric Lipomatosis (MSL) or Madelung’s disease is a rare disorder of the lipid metabolism characterized by symmetric growth of sometimes massive unencapsulated fatty deposits (lipomas) in anatomical regions ranging from typical sites such as neck, occipital area, upper arms, face, abdomen and back to the more unusual involvement of the scrotum and the tongue. In this article we present the diagnostic and therapeutic challenges in a patient developing an acute oligoarticular attack of gout generating important functional incapacity, alcoholic liver disease potentially evolving to liver cirrhosis, heart and kidney failure, bilateral parotid gland region swelling and Madelung disease. The recognition and screening for potential complications related to the Madelung disease is of great practical importance because treatment priorities should be stratified accordingly.
A Systematic Review of Vaccinations in Methotrexate Users
With several COVID-19 vaccines now available, many questions regarding immunization within patients on immune modifying agents have been surfacing. One critical question is what effect methotrexate (MTX), a known inhibitor of antibody formation, may have on vaccine response during the pandemic. In particular, does holding methotrexate during the vaccination period have improved outcomes on vaccine response? A systematic review was conducted of previous randomized controlled trials and clinical trials of vaccine studies for methotrexate use. Studies were limited to the adult population and to those with autoimmune rheumatic conditions. 29 studies were included for review. There was heterogeneity in vaccinations used including pneumococcal, influenza (H1N1, H3N2, and various B strains), tetanus toxoid, hepatitis A, and varicella zoster. Measurement of vaccine response was non-uniform among the studies. Methotrexate dosing in some studies was not reported, and in many studies was variable. 82.8% of the studies demonstrated methotrexate users were able to meet the study defined vaccine response in the majority of methotrexate users in at least 1 endpoint. Two studies examined vaccine disruption for influenza vaccines and demonstrated improved vaccine response to methotrexate users who discontinued therapy. Dosing of methotrexate was identified in 3 studies as having an impact on vaccine response. Based off review of previous vaccine literature, a temporary hold of methotrexate in the post vaccination period may be a reasonable option to try boost the immune response to a novel vaccine.
Copyright (c) 2021 Fortune Journal of Rheumatology
Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study
Aim: To evaluate the ultrasonographic findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS). Method: The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest. Results: Forty-eight women and 12 men with a mean age of 42.1 ± 11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51 ± 0.70mm in affected sides compared to 1.81 ± 0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6 ± 0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45 ± 19.3 months (range, 3-74 months). Conclusion: Our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.
Granulomatous Mastitis: Manifestation of Primary Sarcoidosis Masquerading as Tubercular Mastitis
Sarcoidosis is a multisystem disease of unknown etiology that affects young to middle aged adults, characterized by granuloma formation in various tissues, most commonly the lungs, lymphatics, skin and eyes. Involvement of the breast in sarcoidosis is rare. The breast is involved in less than 1% of cases and can be defined into three subsets, including granulomas localized to the breast, referred to as breast sarcoidosis. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. It may present with systemic findings such as erythema nodosum, arthritis, and uveitis, and unlike typical sarcoidosis, commonly manifests during pregnancy. We report a case of breast Sarcoidosis in a 35-year-old lady presenting as recurrent breast abscess with polyarthralgia. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease, and sarcoid-like reactions to cancer. She was started anti tubercular therapy but responded poorly. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated. The patient received treatment with corticosteroid and immunosuppressive, methotrexate and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.