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Aim: The aim of this study was to investigate the effect of dietary education on cardiovascular risk factors in patients with rheumatoid arthritis. Methods: In this randomized clinical trial, 112 patients with rheumatoid arthritis were randomly assigned into two groups, intervention and control. Dietary education was provided for the intervention group in 4 sessions; anthropometric measurements, serum levels of RF, triglycerides, cholesterol, HDL, LDL, and fasting blood sugar were measured before and three months after the intervention. Data were analyzed using SPSS software and appropriate statistical tests. Results: The mean of total cholesterol (p Conclusion: Traditional care for rheumatoid arthritis patients is not enough. Patients need more education in order to improve their situation.

Evaluating the effect of convalescent plasma (CP) on some cytokine storm indices in severe COVID-19 patients. Totally, 62 patients were randomly assigned into two groups for this clinical trial. Patients in the intervention group received one unit (500 mL) plasma on the admission day plus standard drugs while the controls merely received standard treatments. Eventually, primary and secondary outcomes were evaluated. In the CP group, compared with controls, the mean levels of lymphocytes and IL-10 significantly increased while the levels of IL-6, TNF-α, and IFN-γ decreased (p 0.05) while WHO severity scores remarkably improved (p = 0.01), despite the higher frequency of underlying diseases among the CP group (66.7%) vs. controls (33.3%). Although CP has a remarkable immunomodulatory and antiviral potential to improve the cytokine storm and disease severity in COVID-19 patients, it did not considerably affect the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02734-8.

Introduction Osteopenia is commonly seen in people over age 50 that have lower than average bone density but do not have osteoporosis. The diagnostic difference between osteopenia and osteoporosis is the measure of bone mineral density. Tenofovir is an antiviral drug that is approved for the treatment of chronic hepatitis B and to prevent and treat Human Immunodeficiency Viruses (HIV) infection. It may cause to reduce Bone Mineral Density (BMD) in some patients. Objective This study aimed Comparing the Frequency of Osteoporosis and Osteopenia in Chronic Hepatitis B Patients with and without Tenofovir treatment. Materials and methods This study was conducted in 2018 as a cohort study on 209 patients with chronic hepatitis B, who referred to Imam Khomeini Hospital and the Gastroenterologist's Office in Ahvaz. Patients evaluated in two groups including Tenofovir group (receiving Tenofovir for more than 12 months) (n = 139) and control group (candidates for Tenofovir and had no history of taking Tenofovir or other anti-inflammatory drugs) (n = 70). BMD was evaluated in all patients by Dual-Energy X-ray Absorptiometry (DEXA) scan and compared in the two groups. Results The frequency percentage of patients with osteopenia and osteoporosis in the Tenofovir group (60.43%) was significantly more than that of the control group (21.43%) (P 0.05). Among patients with osteopenia, 85.71% of the patients in the hip region and 44.44% of them in the lumber area had decreased bone density. Also, osteoporosis was more reported in hip (90.48%), lumbar (90.48%) and femoral neck (80.95%) respectively. Conclusion A significant reduction in bone density was observed in patients with chronic hepatitis B receiving Tenofovir for more than 12 months in comparison with the control group. Also, the patients who had been taking Tenofovir in longer time, osteoporosis and osteopenia were more reported.

Background Despite the use of health information technology (HIT) for controlling and managing lupus, its effectiveness has not been well studied. The objective of this study was to investigate the role of HIT in controlling and managing lupus. Methods We searched Scopus, PubMed, Web of Science, and Embase, using "self-management", "self-care" and "Systemic Lupus Erythematosus" keywords. Two researchers selected relevant papers and extracted data using a data collection form. Disagreements were resolved in consultation with the third and fourth researchers. After extraction, the data were analyzed. Results Totally, 23 papers met the inclusion criteria. About 75% of the studies used web and telephone-based technologies. Most services provided with health technologies were ‘Training’ and ‘consulting’. The ‘lifestyle" and ‘Consultation and education’ axes were the most widely used HIT services to control and manage lupus. While, ‘Better management and control of the disease’, ‘Increasing knowledge and awareness of people about lupus’ and ‘Improving behaviors and attitudes toward self-management and self-care’ were also the most important outcomes. ‘Collectiing patient data and information’, 'Providing education and consultation services to patients', 'Measuring patient-reported outcomes', and 'Increasing patients' knowledge and awareness of their disease' were the most important advantages of various technologies. 'Slow internet speed' and 'Challenges and problems related to appearance and usability' and 'Patient concerns about privacy and misuse of their data' were three disadvantages of technologies. Conclusion The findings showed that HIT can improve the management and control of lupus and facilitate self-efficacy, self-care, and self-management in patients. The axes and data elements identified in this study can be the basis for developing and implementing efficient HIT-based systems to improve, control, and manage lupus.

Background: Heart problems are one of the main causes of death in patients with idiopathic inflammatory myopathies, such as polymyositis (PM) and dermatomyositis (DM). Speckle tracking echocardiography (STE) and global longitudinal strain (GLS) are non-invasive, accurate, repeatable, and angle-independent imaging techniques that facilitate a full global and regional evaluation of the left ventricular (LV) function. Objectives: This study aimed to evaluate myocardial dysfunction in DM and PM patients using STE and GLS methods. Methods: The present control-case study was conducted on 30 polymyositis and dermatomyositis patients and 40 healthy people as the control group. Both groups showed no symptoms of cardiovascular diseases. Both groups underwent two-dimensional STE and GLS evaluation. The GLS value was taken as a marker of LV systolic dysfunction. Results: The 2D GLS value of LV was significantly lower in the DM and PM patients, compared to the control group. A mild diastolic dysfunction was observed in seven (23.3%) patients, and 23 (76.7%) patients had a normal state. The patients’ age and duration of the disease were found to be significantly correlated with the left ventricular diastolic dysfunction. No significant difference was observed between the DM and PM patients with the control group in terms of pulmonary artery pressure level. Conclusion: Although the DM and PM patients had normal left ventricular ejection fraction values, there was a significant difference between the patients in these two groups and the control group in terms of LV dysfunction using GLS. Therefore, GLS is a useful variable that can be used to diagnose sustained and subclinical disorders in LV systolic function of DM and PM patients.

Pregnancy in women with systemic lupus erythematosus (SLE) is one of the challenges of recent studies. Women should prevent the onset of relapses with medications before and after pregnancy, and on the other hand, the effect of these medicines considers the health and development of the fetus. In this retrospective study, the effects of anti-phospholipid syndrome and the use of common drugs such as methotrexate, cyclosporine, and azathioprine and their side effects on maternal health and ultimately the development of the fetus have been investigated.This study is a descriptive and retrospective epidemiologic study that was conducted in 2016 to investigate maternal and fetal complications in SLE patients. We prepared forms of data recording, including age, occupation, and other important information and then analyzed them in SPSS version 22.The results showed that the presence of anti-phospholipid syndrome in pregnant women can lead to abnormalities such as preterm, IUGR, abortion, and fetal death (P value 0.0001). It also leads to complications such as nephritis, arthritis, and preeclampsia in the mother (P value 0.003). This study suggests that methotrexate and cyclosporine medications could cause fetal developmental disorders. The P value of cyclosporine was 0.0001 and the P value of methotrexate was 0.001.Anti-phospholipid syndrome in women with SLE who intend to become pregnant can disrupt the development of the embryo. The consumption of methotrexate and cyclosporine medications before and during the pregnancy can have irreparable effects on fetal growth. Key Points • Anti-phospholipid syndrome can disrupt the development of the embryo in women with SLE who intend to become pregnant. • Methotrexate and cyclosporine consumption before and during pregnancy can affect fetal growth. • 7 to 33% of patients whose disease had been suppressed and controlled 6 months before pregnancy seams to relapse during the pregnancy. • Taking medications to control the disease during pregnancy plays an important role in the progression of pregnancy and fetus health.

Natural killer (NK) cells play an essential role in the immune response to infections, inflammations, and malignancies. Recent studies suggest that NK cell surface receptors and cytokines are the key points of the disease development and protection. We hypothesized that the interactions between NK cell receptors and targeted cells construct an eventual niche, and this niche has an eventual profile in various autoimmune diseases and cancers. The NK cells preactivated with cytokines, such as interleukin-2 (IL-2), IL-12, IL-15, and IL-18 can have higher cytotoxicity; however, the toxic side effect of IL-2 should be considered. The vicissitudes of NK cell profile and its receptors obey the environmental communications and cell interactions. Our vision around the NK cells as an immune axis remained dual, and we still cannot judge the immune responses based on the NK cell flip-flop. A design of eventual niche to monitor the NK cell and targeted cell interaction is needed to strengthen our ability in diagnosis and treatment approaches based on the NK cells. Here, we have reviewed the shifts in the NK cells and their surface receptors in autoimmune diseases, solid tumors, and leukemia, and also discussed the effective chemokines that affect NK cell activation and proliferation. The main aim of this review is to present a broader vision of the NK cell changes in autoimmune disease and cancers.

Background: Psoriasis is a relatively common inflammatory skin disease characterized by red, scaly plaques in different parts of the body. Although the etiology of the disease is not fully understood, psychological stress is mentioned as a potential factor in developing the disease. Objectives: In this study, in response to the lack of sufficient information obtained from assessing the influence of psoriasis on mental health, an attempt has been made to evaluate the prevalence of mental health problems in a sample of patients with psoriasis. Methods: This study was conducted following an applied, descriptive-correlational study design. A total of 104 patients with psoriasis were selected using the census sampling method. Data were collected using the standardized Symptom Checklist-90 (SCL-90) questionnaire. This self-administering questionnaire contains 90 items. The reliability and validity of the questionnaire were confirmed. Results: The mean score of mental health was 177.51 ± 69.35, which indicates moderate psychiatric disorders. The positive symptom distress index (PSDI) was 0.22 ± 0.08. There was a significant association between all dimensions of mental health and the total score of mental health with gender (P < 0.05). Also, a significant association was found between paranoid ideation and marital status (P = 0.024). There was no significant association between obsessive-compulsive, anxiety, and the total score of mental health with income level (P > 0.05), but there was a significant association between other dimensions of mental health and income level (P < 0.05). Conclusions: Although in the present study, psychiatric disorders in patients with psoriasis were moderate, psychological counseling and psychiatric consultation are key to reduce the consequences of the disease and its progression.

The present systematic review and meta-analysis was conducted to assess the effect of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA). We systematically searched all potential articles in the main databases, including PubMed, Scopus, EMBASE, Web of Sciences (ISI), and Cochrane Center. The search was subsequently updated in December 2020. The initial review and extraction of information were performed independently by two authors to collect the first author and publication year; sample size; mean age of the intervention and control groups; the dose of TCZ, and the follow-up duration. Outcomes of interest include the ACR20, ACR50, ACR70, total complication rate, and the occurrence of remission. Any disagreements between the reviewers were resolved by discussion and re-check of the article and consultation with a third reviewer. After reviewing and culling, 15 clinical trials comparing the clinical efficacy of TCZ and its comparators in the treatment of patients with RA entered the qualitative and quantitative synthesis. Tocilizumab 8 mg was statistically better than 4 mg or placebo for ACR responses. Significant clinical adverse events in patients with RA treated with TCZ, such as abnormal liver function tests (LFTs) and infections, were more frequent than in compara­tor groups. This systematic review and meta-analysis suggest that the combination therapy of TCZ with other drugs such as methotrexate and disease-modifying antirheumatic drugs has been studied for various clinical effects concerning safety and clinically significant adverse events. Although the data are promising, long-term performance and safety data need to be fully identified, as well as the risks and benefits of TCZ, especially appropriate timing, dosage, and regimen.

Cytokine pathways and their signaling disorders can be the cause of onset and pathogenesis of many diseases such as autoimmune diseases and COVID-19 infection. Autoimmune patients may be at higher risk of developing infection due to the impaired immune responses, the use of immunosuppressive drugs, and damage to various organs. Increased secretion of inflammatory cytokines and intolerance of the patient’s immune system to COVID-19 infection are the leading causes of hospitalization of these patients. The content used in this paper has been taken from English language articles (2005–2020) retrieved from the PubMed database and Google Scholar search engine using “COVID-19,” “Autoimmune disease,” “Therapeutic,” “Pathogenesis,” and “Pathway” keywords. The emergence of COVID-19 and its association with autoimmune disorders is a major challenge in the management of these diseases. The results showed that the use of corticosteroids in the treatment of autoimmune diseases can make diagnosis and treatment of COVID-19 more challenging by preventing the fever. Due to the common pathogenesis of COVID-19 and autoimmune diseases, the use of autoimmune drugs as a possible treatment option could help control the virus. Key Points • Inflammatory cytokines play an essential role in the pathogenesis of COVID-19 • ACE2 dysfunctions are related to the with COVID-19 and autoimmune diseases • The use autoimmune diseases drugs can be useful in treating COVID-19

Using genetic markers and miRs work strongly beside other sensitive biomarkers in lupus management during sensitive period of pregnancy. PubMed and Google Scholar databases were searched from 2000 to 2017 using the terms “lupus,” “lupus pregnancy,” “biomarkers,” “micro-RNA,” “polymorphisms,” “anti-phospholipid antibodies,” and “cluster differentiation markers.” Complement is a valuable biomarker in lupus pregnancy. However, the complement profile has ambiguous meaning because decreased levels of C3 and C4 reflect inflammation and because they are also prognostic biomarkers for abortion. Furthermore, increased C3 and C4 levels indicate hepatic protein synthesis in hepatocytes. Anti-phospholipid (APL) antibodies are present in 25% to 50% of lupus patients, and can lead to thrombotic and obstetric complications in some pregnancies and increase the risk of abortion, especially in a pregnant woman in the active phase of lupus. Several studies have associated APL with HELLP syndrome. However, other pregnancy complications have not been associated with APL. Autoantibodies against the major vault protein and anti-double strand DNA antibodies are valuable biomarkers in evaluating lupus activity. The expression pattern of micro-RNAs (miRs) differs in various diseases. Current studies have demonstrated the potential of miRs as diagnostic and prognostic biomarkers in various diseases; for example, the level of miR-126 is higher in lupus. Mir-223-3p and miR-451 are informative biomarkers in estimating disease activity. TWEAK, BAFF, and APOL1 genes, and their polymorphisms are informative in estimating disease activity, especially renal effects, and in monitoring higher-risk pregnant women. Further studies of these genes and their relevant polymorphisms are needed.

Background A new form of hepatitis B virus (HBV) infection, occult hepatitis B infection (OBI), has been identified and reported among patients with rheumatic diseases. Aim of the work To determine the incidence of HBV infection and OBI in patients with rheumatic diseases referred to major hospitals in the city of Ahvaz in Iran. Patients and methods 136 patients with rheumatic diseases were included. Serological assays for HBV markers (HBsAg, HBcAb and HBsAb) were performed by enzyme-linked immunosorbent assay. All the sera were tested for HBV DNA using nested PCR and real-time PCR. All samples were negative for anti-HCV and anti-HIV antibodies. Results The mean age of the patients was 43.5 ± 12.02 years with a F:M 2.24:1. 2 (1.47%) cases with undifferentiated connective tissue disease tested positive for both HBsAg and HBV DNA. Quantitative HBV real-time PCR was carried out for the 134 negative HBsAg samples and only 1 (0.74%) patient was positive for OBI. The results of sequencing and alignment showed that the detected HBV DNAs belonged to the D genotype, ayw2 s ubtype. The nucleic acid sequence of OBI case revealed substitution changes in amino acids in the positions of the 171-4 of HBsAg gene. Conclusion A moderate rate of HBV infection and low detection of OBI is found in patients with rheumatic diseases in southwest Iran. The amino acid substitutions and mutation have been observed at the position of 171-4 in the S gene region of HBV DNA which may affect the detection of HBsAg by commercial immunoassay methods.

Background: Single-nucleotide polymorphism (SNP) rs2476601 within protein tyrosine phosphatase non-receptor type 22 gene (PTPN22) has been shown to be a risk factor for different autoimmune diseases. This study explored the association of 1858 C/T SNP with rheumatoid arthritis (RA) and celiac disease (CD) in a region covering south-west of Iran. Methods: Totally, 52 patients with CD, 120 patients with RA, and 120 healthy subjects were selected. The samples were genotyped for the rs2476601 in PTPN22 gene using the tetra-amplification refractory mutation system polymerase chain reaction. Results: The frequency of +1858T risk allele was significantly increased in both RA (P=0.021, OR=2.56, 95%CI=1.19-5.47) and CD (P=0.002, OR=3.87, 95%CI=1.68-8.95) patients, as compared to the control group. However, no association was found between the +1858C/T PTPN22 gene SNP and the anti-cyclic citrullinated peptide and rheumatoid factor positivity in RA patients. Conclusions: PTPN22 gene could play a crucial role in people’s susceptibility to certain autoimmune diseases.

Background: Depression is a major disabling factor around the world. Most of the mental disorders immediately affect the inner mood and cognitive aspect of individuals. Therefore, hiding the depression can delay the early diagnosis and, consequently, a proper treatment in the patients. Objectives: We designed the study to determine the association between rheumatoid diseases and depression. Methods: This is a descriptive - analytic study which was performed on 354 patients referred to Rheumatology Clinic of Ahvaz, a province in south west of Iran in 2016. Then demographic information, depression, quality of life and social support were completed based on standardized questionnaires filled by the patients. Results: The prevalence of depression in rheumatoid arthritis (RA), systemic lupus erythematous (SLE) and systemic sclerosis (SSc) patients was 61.63%, 73.52% and 60%, respectively. There is a meaningful relationship between depression, age and duration of disease in SSc patients. There is a significant relationship between depression and gender in SLE and RA patients. There is a significant relationship between depression and the degree of education of SLE patients. There is a meaningful relationship between depression and quality of life, social support and corticosteroid consumption. Conclusions: The prevalence of depression is very high in all three diseases, which is equal in terms of quality of life, social support and corticosteroid usage in all three diseases. Psychiatric disorders such as depression are common in rheumatic patients.

Background Rheumatoid arthritis (RA) is a chronic and multi-systemic disease with an unknown origin that is associated with inflammation and impairment of the immune system. Cardiovascular disease is the most common cause of death in patients with rheumatoid arthritis. Objectives This study was conducted to evaluate cardiovascular parameters in patients with rheumatoid arthritis. Methods In this descriptive study, 112 patients with rheumatoid arthritis, who had been diagnosed for at least six months, were studied. A questionnaire containing demographic data by the researcher using the interview was completed and measuring the cardiovascular parameters was done. Data were analyzed using SPSS software and appropriate statistical tests. Results Based on the body mass index mean (27.98), the patients under study were overweight; in addition, serum levels of glucose 107.55 ± 38.47, total cholesterol 209.90 ± 37.90, LDL 129.28 ± 30.60 and systolic 145.75 ± 16.23, and diastolic 78.46 ± 11.91, blood pressure in these patients did not have normal distribution. Conclusions The risk of cardiovascular disorders in patients with rheumatoid arthritis is considerable due to the increase in body mass index, glucose, total cholesterol, LDL, and blood pressure; therefore, screening of at-risk people is recommended.

Aim: The aim of this study was to evaluate the relationship between Interleukin-6 (IL-6) serum level and the severity and activity of Rheumatoid Arthritis (RA). Methods: In this cross-sectional study, 120 RA patients referred to the rheumatology clinic, the patients were diagnosed by rheumatologists according to ACR / EULAR 2010 criteria. Based on DAS28 score the patients were divided into 4 groups: Remission, Mild, Moderate and Severe. Each group contained 30 patients. Serum levels of Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), anti-Cyclic Citrullinated Peptide (anti-CCP) and Rheumatoid Factor (RF) and serum levels of IL-6, were measured. The relationship between these factors was measured and compared to the relationship between IL-6 and these factors, and the activity of the disease was evaluated based on DAS-28. Results: This study showed that the serum level of IL-6 has a significant relationship with RA activity according to DAS-28 (P value Conclusion: Generally the findings of this study indicate that serum level of IL-6 plays an important role in the severity and activity of RA disease and can be considered as a determining factor in evaluating the severity of RA in RA patients and it is a good guide for a step up or down of treatment.

Background: The process of antigen presentation to immune cells is an undeniable contributor to the pathogenesis of autoimmune diseases. Different studies have indicated several factors that are related to autoimmunity. Human Leukocyte Antigens (HLAs) are among such factors, which have a key role in autoimmunity because of their involvement in antigen presentation process. Methods: Relevant English language literature was searched and retrieved from Google Scholar search engine and PubMed database (1996-2018). The following keywords were used: "Human leukocyte antigen", "Behcet’s syndrome", "Rheumatoid arthritis", "Systemic lupus erythematosus", "Type 1 diabetes", "Celiac Disease" and "Autoimmunity". Results: There is a strong association between HLA alleles and autoimmune diseases. For instance, HLA-B alleles and Behcet’s syndrome are strongly correlated, and systemic lupus erythematosus and Type 1 diabetes are related to HLA-DQA1 and HLA-DQB1, respectively. Conclusion: Association between numerous HLA alleles and autoimmune diseases may justify and rationalize their use as biomarkers as well as possible diagnostic laboratory parameters.

This study evaluated the effect of cinnamon on disease activity, serum levels of some inflammatory markers, and cardiovascular risk factors in women with rheumatoid arthritis (RA).In this randomized double-blind clinical trial, 36 women with RA were randomly divided to 2 groups, receiving 4 capsules of either 500 mg cinnamon powder or placebo daily for 8 weeks. Fasting blood sugar (FBS), lipid profile, liver enzymes, serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), erythrocyte sedimentation rate (ESR), blood pressure, and clinical symptoms were determined at baseline and end of the week 8.At the end of the study, there was a significant decrease of serum levels of CRP (p0.001) and TNF-α (p0.001) in the cinnamon group as compared to the placebo group. Diastolic blood pressure was also significantly lower in the intervention group compared with the control group (p = 0.017). Compared with placebo, cinnamon intake significantly reduced the Disease Activity Score (DAS-28) (p0.001), Visual Analogue Scale (VAS) (p0.001), and tender (TJC) (p0.001) and swollen joints (SJC) (p0.001) counts. No significant changes were observed for FBS, lipid profile, liver enzymes, or ESR.Cinnamon supplementation can be a safe and potential adjunct treatment to improve inflammation and clinical symptoms in patients with RA.

Background: Rheumatoid arthritis is a widespread autoimmune disease and inflammation and bone destruction are two main issues in rheumatoid arthritis. Objective: To discussing metformin effects on rheumatoid arthritis complications. Methods: : We conducted a narrative literature search including clinical trials, experimental studies on laboratory animals and cell lines. Our search covered Medline, PubMed and Google Scholar databases from 1999 until 2018. We used the terms” Metformin; Rheumatoid arthritis; Cardiovascular disease; Cancer; Osteoblastogenesis. Discussion: Inflammatory pro-cytokines such as Interlukin-6 play important roles in T. helper 17 cell lineage differentiation. Interlukin-6 and Tumor Necrosis Factor-α activate Janus kinase receptors signal through signaling transducer and activator of transcription signaling pathway which plays important role in inflammation, bone destruction and cancer in rheumatoid arthritis patients. Interlukin-6 and Tumor Necrosis Factor-α synergistically activate signaling transducer and activator of transcription and Nuclear Factor-kβ pathways and both cytokines increase the chance of cancer development in rheumatoid arthritis patients. Metformin is AMPK activators that can suppress mTOR, STAT3 and HIF-1 so AMPK activation plays important role in suppressing inflammation and osteoclastogenesis and decreasing cancer. Conclusion: Metformin effect on AMPK and mTOR pathways gives the capability to change Treg/Th17 balance and decrease Th17 differentiation and inflammation, osteoclastogenesis and cancers in RA patients. Metformin can be useful in protecting bones especially in first stages of RA and it can decrease inflammation, CVD and cancer in RA patients so Metformin beside DAMARs can be useful in increasing RA patients’ life quality with less harm and cost.

Background: Rheumatoid arthritis (RA) is a chronic, systemic, and inflammatory disease that can cause swelling and damage the cartilage and bone around the joints. Some factors such as polymorphic variations of the HLA-DRB1 and MTHFR genes have been identified as potential markers of susceptibility, severity, or protection in RA. In this disorder, hands and feet are the most affected parts of the body. The risk of RA is almost three times higher in women than in men, and the onset of RA is more common between 40 and 60 years of age, but the disease may occur at any age. Objectives: To study the possible association between the MTHFR C677T polymorphism and RA risk in the Khuzestan province. Patients and Methods: The study included 240 persons (120 patients with RA and 120 healthy controls). Genomic DNA was isolated and genotyping was performed by restriction-fragment-length-polymorphism (PCR-RFLP)-based assays. Results: Our results showed significant differences between the groups with respect to MTHFR C677T genotype (P = 0.015) and allele frequencies (0.004). Statistical analysis showed that there is no relation between gender, age, and RA risk. However, we found that there is a significant association between ethnicity and the risk of RA (P 0.05). Conclusions: Our findings suggest that there is an association between the MTHFR C677T polymorphism and susceptibility for the development of RA.

Separate occurrence of thyroid and parathyroid carcinoma in patients is extremely rare, and to the best of our knowledge, only 7 patients with documented parathyroid and papillary thyroid carcinomas have been described formerly in published reports. We report a patient with an extremely unusual clinical presentation of Hürthle cell carcinoma in thyroid and parathyroid carcinoma. The patient displayed a rare presentation of life-threatening hypercalcaemia after total para-thyroidectomy and failed to respond to standard therapy. Our review of available literature yielded insufficient evidence in managing such. When a patient with thyroid cancer is diagnosed, checking for serum calcium is advised. This is considered a useful method for detecting possible incidental parathyroid lesion and screening the probable concealed parathyroid pathology.

BACKGROUND: Rheumatoid arthritis is a symmetric peripheral polyarthritis of unknown etiology that, untreated or if unresponsive the therapy, typically leads to deformity and destruction of joints due to erosion of cartilage and bone. Omega-3 fatty acids have been shown to reduce morning stiffness, the number of tender joints and swollen joints in patients with rheumatoid arthritis. This study is designed for evaluation of omega-3 effects on disease activity and remission of rheumatoid arthritis in DMARDs treated patients and on weight changes and reduction of analgesic drugs consumption versus placebo.METHODS: Sixty patients with active rheumatoid arthritis (49 female and 11 male) underwent rheumatologist examination and disease activity score were calculated. Then patients were enrolled in this 12 week, double blind, randomized, placebo- controlled study. The patients in both groups continued their pre study standard treatment. The patients were visited every 4 weeks, 4 times and data were recorded.RESULTS: Significant improvement in the patient's global evaluation and in the physician's assessment of disease was observed in those taking omega-3. The proportions of patients who improved and of those who were able to reduce their concomitant analgesic medication were significantly greater with omega-3 consumption. There were no weight changes.CONCLUSION: Daily supplementation with omega-3 results has significant clinical benefit and may reduce the need for concomitant analgesic consumption without weight changes.