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Abstract Background In recent decades, several studies have shown changes in the intestinal microflora among patients with rheumatoid arthritis (RA). Therapeutic measures using probiotics have shown favorable effects on the recovery of these patients. However, most studies have used probiotic supplements. In this study, we aimed to investigate the effect of probiotic cheese consumption on inflammatory and anti-inflammatory factors, disease severity, and symptoms in these patients. Methods This study is a randomized, double-blind clinical trial, in which forty patients with mild to moderate severity of RA will be randomly allocated to receive either 30 g/day probiotic cheese (n = 20) or only low-salt and low-fat cheese without any added probiotic (n = 20) for 12 weeks. Assessment of anthropometric measures and biochemical indicators, including serum concentrations of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10), will be done at the study baseline and end of the trial. In addition, disease severity and disability will be assessed by DAS-28 and the HAQ-DI questionnaire, respectively. Discussion Diet is the leading environmental factor affecting the gut microbiota. A prebiotic-rich diet and probiotics might be beneficial in this regard. To the best of our knowledge, the effect of probiotic supplements on inflammation in these patients has widely been assessed; however, there is only one study that examined the effect of probiotic-containing food in these patients. Further studies are needed to investigate the effect of probiotic-containing foods on inflammatory markers and symptoms in patients with RA. Trial registration Iranian Registry of Clinical Trials IRCT20201120049449N1 . Registered on 14 February 2021

For downloading the full-text of this article please click here. Background and Objective: Spirituality in job is a new topic but with a limited theoretical-scientific development in organizational literature. The importance of this issue and its impact on work efficiency call for a proper instrument for evaluation purposes. Longevity and incomprehensiveness of some of the questionnaires motivated the authors to provide an Intercultural Translation and psychometric analysis of the standard comprehensive instrument of Spirituality at Work. Methods: In this cross-sectional descriptive study, English version of Spirituality at Work scale, adopted from Val Kinjersk’s study, was used as the main instrument. An attempt was made to complete English-to-Persian translation as well as to provide cultural conformities using the Wild pattern and recursive translation method and retranslation phases, respectively. Afterwards, face validity was performed based on 10 experts’ views and 18 accessible samples and then reliability and validity of the questionnaire were examined and internal correlation was determined in a cross-sectional study on 393 health workers. Construct validity was assessed with a sample size of 268 people through factor analysis. In this study, all the ethical considerations have been observed and no conflict of interest was reported by the authors. Results: To determine construct validity, principal components analysis was performed using Varimax rotation method, in which 70.31% of total variance was explained by two factors. Its face validity was also desirable. In assessing the questionnaire’s reliability using internal consistency method, Cronbach’s alpha coefficient was found to be 96%, which ranged from 78% to 91% for the subscales. There was a high correlation among subscales of this questionnaire (0/82-0/97). Conclusion: The questionnaire had good consistency and the high correlation between the subscales is indicative of a god cultural consistency in translation of the questionnaire. The questionnaire of Spirituality at Work, which aimed at assessing the experience of spirituality in job based on individuals’ experience of spirituality and workplace morale has proper construct validity and face validity.For downloading the full-text of this article please click here. Please cite this article as: Shojaei S, Tavafian SS, Wagner J, Jamshidi AR, Mohammadi-Valadani A. An Intercultural Translation and Psychometric Analysis of 18-item Spirituality at Work Questionnaire. Pizhūhish dar dīn va salāmat. 2020; 5(4): 114-126. https://doi.org/10.22037/jrrh.v5i4.22349

Abstract Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial arthritis. The genetic–environmental factors seem to be involved in the pathogenesis of the disease and the disease debilitates patients during the most productive stages of their lives. The aim of this study was to examine the relationships between two environmental factors, diet and air pollution with disease activity and functional impairment in AS. Methods A case-control study was carried out. Thirty patients with AS and 30 age and sex-matched healthy controls were included. Disease scores including BASMI, BASDAI, BASFI, and BASG were calculated by means of the international Ankylosing Spondylitis Assessment working group consensus recommendations. The food intake was evaluated by semi-quantitative food frequency questionnaire (147 items FFQ). Level of air pollution indices, PM10 and PM2.5 information was obtained from the Tehran air quality control network. Results Total energy and fat intake, some vitamins (A, B1, B2, C) and mineral intake (potassium, calcium, iron, phosphorus, magnesium, zinc, copper and selenium) were significantly higher in patients with AS compared to controls. Fat component consumption especially Saturated Fat of Food was moderately correlated with BASFI score. PM2.5 long term exposure was strongly correlated with BASMI, BASFI and BASDAI scores of patients. Conclusion High-fat diet and long term exposure to air pollution are associated with worse disease outcomes reported in patients with AS. This is an interesting area of investigation in AS pathogenesis and management.

Study DesignInterventional research with a 6-month follow-up period.PurposeWe aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory.Overview of LiteratureWRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP.MethodsWe included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data.ResultsThe comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p

Background: Cardiac involvement, as one of the life-threatening manifestations of systemic sclerosis (SSc), is chiefly caused by collagen fiber deposition in the myocardium, which subsequently leads to conduction abnormalities. In the present study, we aimed to investigate the prevalence and clinical significance of bundle branch blocks (BBBs) and the fragmented QRS complex (fQRS) in Iranian patients with SSc. Methods: Forty-one patients with SSc were enrolled from the outpatient SSc clinic of Shariati Hospital, Tehran University of Medical Sciences, between October 2016 and February 2017. Twelve-lead ECG was obtained and interpreted for BBBs and the fQRS. To adjust for the confounding effects of non–SSc-related cardiovascular risk factors, we calculated the Framingham risk score to estimate the risk of cardiovascular diseases. The associations between the studied conduction abnormalities and SSc cutaneous subtypes; disease duration; and the Medsger SSc severity scale of cutaneous, pulmonary, and vascular involvements were also analyzed. Results: The study population consisted of 41 Iranian patients with SSc at a mean age of 47.48±11.57 years (82.9% female). The prevalence of BBBs and the fQRS was 26.8% and 36.6%, respectively. The fQRS was associated with the limited cutaneous SSc subtype (OR: 0.100, 95%CI: 0.018–0.553, and P=0.028). BBBs and the fQRS were not associated with either the Framingham risk score or the rest of the clinicodemographic variables. Conclusion: BBBs and the fQRS were more prevalent in our patients with SSc, without any association with the involvement of the other organs. These findings may suggest the independent pathophysiology of cardiac involvement in SSc.

Study DesignPsychometric evaluation design.PurposePsychometric evaluation of a multidisciplinary work-related low back pain predictor questionnaire (MWRLBPPQ) of Iranians patient-care workers based on the social cognitive theory.Overview of LiteratureHealthcare is one of the professions in which work-related musculoskeletal disorders are prevalent. The chronic low back pain experienced by patient caregivers can negatively impact their professional performance, and patient handling in a hospital is the main cause of low back pain in this population.MethodsThis was a cross-sectional study carried out in Qom, Iran from July 2014 to November 2014. A MWRLBPPQ based on nine concepts of the social cognitive theory and existing literature regarding chronic low back pain was developed. Ten patient-care workers first completed the questionnaire as a pilot test, allowing the ambiguities of the instrument to be resolved. Exploratory factor analysis was used to confirm construct validity. This questionnaire was distributed among 452 patient-care workers in hospitals located in different geographically areas in Qom, Iran. Cronbach's Alpha was calculated to assess reliability.ResultsIn all, 452 caregivers of patients with mean age of 37.71 (standard deviation=8.3) years participated in the study. An exploratory factor analysis loaded seven concepts of self-efficacy, knowledge, outcome perception, self-control, emotional coping, and self-efficacy in overcoming impediments and challenges in the environment. All concepts were jointly accounted for 50.08% of variance of behavior change. The Cronbach's alpha coefficient showed favorable internal consistency (alpha=0.83), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the MWRLBPPQ.ConclusionsThe MWRLBPPQ is a reliable and valid theory-based instrument that can be used to predict factors influencing work-related low back pain among workers who lift and transfer patients in hospitals.

The aim of this study was to investigate the effect of β-D-mannuronic acid (M2000) on hematological parameters in patients with active rheumatoid arthritis. This study was conducted on 25 patients with active rheumatoid arthritis (RA) (identifier: IRCT2014011213739N2). M2000 was administered orally for anemic and non-anemic RA patients at a dose of 500 mg twice daily for 12 weeks. The patients were permitted to continue the conventional treatments excluding NSAIDs. Blood samples were collected at baseline, 4 and 12 weeks after drug administration and were tested for hematological parameters. Moreover, serum levels of TNF-α and IL-6 were analysed before and after M2000 therapy compared to healthy controls using enzyme linked immunosorbent assay method. We found a significant increase in the count of red blood cells and also hemoglobin (Hb) concentration (0.9 g/dL) in anemic patients after 12 weeks of M2000 therapy (p

Skin dryness and thickening are hallmarks of systemic sclerosis (SSc) disease. Aquaporins (AQPs) are plasma membrane proteins that transport glycerol and water, resulting in water retention and skin hydration. Expression of AQPs has been evaluated in human normal skin. However, expression of these proteins in SSc dermal fibroblasts has not yet been reported. The aim of this study was to assess the expression profile of AQPs in dermal fibroblasts of SSc patients. Fibroblast cells were extracted from SSc and healthy skin biopsies and characterized using fibroblast surface protein antibody. The SYBR Green Real-time PCR was used to evaluate the mRNA expression of AQP1, 3, 5, 7, 9, and 10 in dermal fibroblasts. Immunoblotting was performed to confirm the results of Real-time PCR. Our data demonstrated that only AQP1, AQP3, and AQP9 were expressed in human skin fibroblasts. Moreover, the expression of AQP3 mRNA and protein were significantly decreased in SSc dermal fibroblasts compare to healthy fibroblasts. AQP3, which involves in skin hydration and wound healing through water and glycerol transmission, is downregulated in SSc fibroblasts. Based on previous studies and our results, it seems that SSc manifestations like skin dryness, abnormal wound healing, and fibrotic lesions may be related to downregulation of AQP3 in SSc fibroblasts. Therefore, induction of AQP3 expression can be a potential treatment to relieve SSc skin thickness in the future.

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Ankylosing Spondylitis (AS) is a chronic rheumatic disease which mainly involves the axial skeleton. It seems that non-HLA genes, as well as HLA-B27 gene, are linked to the etiology of the disease. Recently, it has been documented that KIRs and their HLA ligands are contributed to the Ankylosing Spondylitis. The aim of this study was to evaluate the KIR genes and their HLA ligands in Iranian AS patients and healthy individuals. The present study includes 200 AS patient samples and 200 healthy control samples. KIR genotyping was performed using the polymerase chain reaction sequence-specific primer (PCR-SSP) method to type the presence or absence of the 16 KIR genes, 6 known specific HLA class I ligands and also, two pseudogenes. Two KIR genes (KIR-2DL3 and KIR2DL5), and among the HLA ligands, two HLA ligands (HLA-C2Lys80 and HLA-B27) genes were significantly different between case and control groups. In addition, we found some interesting KIR/HLA compound genotypes, which were associated with AS susceptibility. Our results suggest that the AS patients present more activating and less inhibitory KIR genes with combination of their HLA ligands than healthy controls. Once the balance of signal transduction between activating and inhibitory receptors is disturbed, the ability of NK cells to identify and lyse the targets in immune responses will be compromised. Accordingly, imbalance of activating and inhibitory KIR genes by up-regulating the activation and losing the inhibition of KIRs signaling or combination of both might be one of the important factors which underlying the pathogenesis of AS.

Background: Chronic low back pain is one of the most health problems worldwide. This study aimed to examine the effects of a designed multidisciplinary program on quality of life and disability among chronic low back pain patients up to 18 months. Methods: This study followed the participants in previous randomized controlled trial up to 18 months. Therefore, data at 18- month follow up, were collected through SF-36, Ronald –Morris Disability Questionnaire, and Quebec low back pain Disability Scale and then analyzed in five stages of 0, 3, 6, 12, and 18 months through repeated measure ANOVA. Finding: Repeated measures ANOVA showed that interactions between time and group were different in all subscales of SF-36 scale (all P ≤ 0.05).The disability of patients was decreased over time in intervention group that was significantly different from control group (P < 0.01). Conclusion: The findings of this study suggest that the designed multidisciplinary program could improve quality of life and decrease disability even up to 18 months in chronic low back pain patients.

Background: Increased dietary consumption of the n-3 polyunsaturated fatty acids (PUFA) eicosapetaenoic acid (20: 5n-3; EPA) and docosahexaenoic acid (22: 6n-6; DHA) is associated with their incorporation into circulating phospholipid and increased production of lipid peroxide metabolites. The relationship between peripheral blood mononuclear cell (PBMC) function, n-3 PUFA intake and antioxidant co-supplementation is poorly defined in rheumatoid arthritis (RA) patients. This study was designed to evaluate tumor necrosis factor-α (TNF-α) and interleukin (IL) 6 production by PBMC in RA. Methods: Fifty-five patients (50 female, 5 male; mean age = 47 ± 11 years) were investigated in three groups in a randomized double-blind clinical trial. Patients were randomly assigned to one of these three groups: group 1 (G1) was received placebo (MCT oil, 2 g/d plus vitamin E placebo), the second group (G2) was received n-3 fatty acids (1.2 g/d; EPA/DHA plus vitamin E placebo), and the third group (G3) was received n-3 fatty acids (1.2 g/d; EPA/DHA) plus 100 IU/d vitamin E. Medication dose was intact during the study. Data were compared between groups using analysis of variance (ANOVA). Findings: Fish oil n-3 fatty acids supplementation of diet decreased production of TNF-α (P = 0.007) by stimulated PBMC in G2 and G3 in relation to G1. Also G3 in relation to G2 and G1 showed significant decrease with respect to malonaldehyde (MDA) (P = 0.005). Conclusions: Consumption of omega-3 fatty acids with vitamin E not only decreased production of inflammatory parameters but also decreased lipid per-oxidation in RA patients. Key words: Rheumatoid arthritis, PBMC, N-3 fatty acids, Vitamin E.

In this study we determined the frequency, sensitivity and specificity of anti cyclic citrullinated peptides (anti-CCP) IgG antibody, total rheumatoid factor (RF-T), and RF isotypes in Iranian patients with rheumatoid arthritis (RA) and their association with age, clinical and serological parameters. Anti-CCP and RF-T and RF isotypes level were measured in 418 patients and 399 healthy controls by enzyme-linked immunosurbant assay (ELISA). Additionally, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), visual analog scale (VAS) and disease activity score (DAS28) were evaluated in RA patients. The anti-CCP was positive in 53.1% of RA patients and 4.7% of controls. The frequency of RF-T was 61.87% and 17.66% in RA patients and controls respectively. The prevalence of RF isotypes in RA patients was 46.52% for RF-IgM, 23.47% for RF-IgA and 21.74% for RF-IgG. 31.39% of RA patients were RF-IgM positive without RF-IgA and RF-IgG and 21.9% were positive for all three RF classes. The anti-CCP positive patients showed increased number of swollen joints. On the other hand, RF-T positive patients exhibited a longer disease duration, lower age of onset and also higher ESR, CRP level and increased swollen joints. RF-T titer was significantly higher in RA patients with active disease compared to remission, low and moderate active groups. The sensitivity and specificity were 53.1, 95.3 for anti-CCP antibody and 61.8, 82.3 for RF-T. Our results support that anti-CCP and RF titer maybe valuable in estimation of disease activity and other inflammatory parameters in RA patients.

The aim of this study was to assess the role of HLA-B*27 and it’s subtypes in determining severity and clinical manifestations of ankylosing spondylitis (AS). A total of 163 AS patients were assessed for clinical manifestations and severity using structured questionnaires. HLA-B*27 screening and B*27 sub-typing were performed by PCR. One hundred twenty two patients (74.8%) were B*27 positive. The male to female ratio, peripheral arthritis, steroid use, intense dorsal kyphosis and decrease of cervical slope had a significantly higher frequency in B*27 positive patients compared to B*27 negative ones (p=0.01, 0.001, 0.01, 0.04 and 0.04, respectively). However, the age of diagnosis was significantly lower in B*27 positive patients (p=0.005). Trend in uveitis and some severity markers including: BASMI and ASQoL were toward higher values in B*27 positive group with no significant difference. After controlling confounding variables, significant relationship was found only between B*27 and BASMI (p=0.01). B*27 subtypes in patients were included B*2705: 48.4%, B*2702: 42.6%, B*2704: 5.7% and B*2707: 3.3%. No significant differences were seen for severity markers and clinical manifestations between subtypes; although trend toward lower values of severity markers, less intense dorsal kyphosis and less decrease of cervical slope were observed in B*2704 and B*2707 versus other polymorphisms. Clinical features and severity of AS is influenced by HLA-B*27. Trend toward higher severity markers in B*2705 and B*2702 versus other polymorphisms might be subject of interest for evaluation in other ethnicities with concentration to other novel susceptibility genes co-inherited in each B*27 subtype.

Ankylosing Spondylitis (AS) is an inflammatory arthritis, which affects mainly spine and sacroiliac joints. According to recent studies, ERAP1 is the second most common candidate gene for AS susceptibility after HLA-B27. The aim of this study was to determine the association of ERAP1 gene polymorphisms with AS in Iranian population. The study group comprised 387 Iranian AS patients and 316 healthy controls from Iran. Using Real Time PCR allelic discrimination method, we genotyped four SNPs (rs30187, rs469876, rs13167972 and rs27434) of ERAP1. We found that rs30187 and rs27434 were significantly associated with AS in Iranian population (P=6×10-5, P=7×10-3, respectively). The rs30187 T/T genotype was associated with AS compared with C/C genotype (P=1.5×10-5). The rs27434 G/G genotype was inversely associated with AS (P=5×10-3). Two specific haplotypes including: rs30187/ rs469876/ rs13167972/ rs27434 TAAA and CAGG were associated with increased and decreased risk of AS in Iranian population, respectively. These results indicated that ERAP1 SNPs and haplotypes were associated with AS in Iranian population.

At present, some clinical presentations and serological parameters such as products of complement activation and elevation of autoantibodies (e.g. dsDNA antibodies), erythrocyte sedimentation rate (ESR), levels of C-reactive protein (CRP), or cytokines such as IL-2/IL-2 receptor, IL-6 and IL-10 are used as indirect serological markers with variable degrees of significance. To date, no specific serological parameter is available to assess disease activity in SLE. Soluble serum thrombomodulin is a new marker of endothelial cell injury and vasculitis. The objective of this study was to determine in vivo soluble thrombomodulin as a marker of disease activity in SLE pa-tients and compare serum thrombomodulin in SEL patients with and without renal involvement and inactive SLE patients. Sixty-four patients fulfilling ACR criteria with proven SLE with differ-ent disease activities were tested for serum levels of Thrombomodulin and dsDNA by ELISA. C3, C4 and FANA were also measured by standard laboratory tests. The clinical disease activity was evaluated by the Systemic Lupus Erythematosus Activity Index (SLEDAI). Elevated soluble thrombomodulin had significant correlations with an increased ANA level (P= 0.037), decrease level of C3 (P =0.017), increase of SLEDAI (P=0.003) and strongly associated with renal in-volvement in SLE. Thrombomodulin level and Anti dsDNA in active patients with and without re-nal disease were higher than inactive patients. In SLE, serum thrombomodulin seems to be impor-tant marker for evaluation of disease activity.

Isolated hematuria and its association with proteinuria, and urinary cast and systemic lupus erythematosus (SLE) disease activity, and decision for renal biopsy is a dilemma for physician in SLE patients. The aim of this study was to investigate 1. whether isolated hematuria is associated with active SLE, 2. to determine duration between hematuria and proteinuria and urinary cast, and 3. to determine renal histological type in SLE patients with isolated hematuria. All episodes of isolated hematuria between 1981 and 1997 were identified from Lupus Unit, Rheumatology Research Center database. Isolated hematuria was defined as >5 RBC/hpf in the absence of urinary infection and other renal manifestations. Relation of hematuria was assessed with proteinuria and urinary cast and SLE disease activity. Needle renal biopsy was done in 19 SLE patents with isolated hematuria. 4.42% (31/700) of our cohort had at least one episode of isolated hematuria. Out of 31 patients in whom the isolated hematuria was the first documented renal manifestation, 11 patients (35.48%) developed another renal manifestation (25.8% proteinuria and 9.67% casts). 54.54% (6/11) of patients developed proteinuria and urinary cast within 3 months. The mean time for development of a second renal manifestation for the patients with isolated hematuria was 19.9 months. Renal needle biopsy was performed for 19 patients (5.78% type IV, 63.15% type III and 21.50% type II). The results of the present study indicate that isolated hematuria is not rare in SLE patients. Also, there was no significant relationship between isolated hematuria and anti ds-DNA, C3, C4 and major organ involvement in patients with SLE. Our study suggests that SLE patients who have isolated hematuria should undergo renal biopsy and that isolated hematuria should be considered a manifestation of active renal SLE.

The human leukocyte antigen-B27 is one of the class I molecules of the major histocompatibility complex which is strongly associated with ankylosing spondylitis (AS). The strength of the disease association with B27 varies markedly among racial and ethnic populations. It is an allele family, which constitutes about 31 subtypes, with a considerable geographic and ethnic difference in distribution. It is important to know whether certain subtypes show any preferential association with AS. Because there is no report regarding HLA-B27 subtypes in Iranian patients with AS, the factthe main there are rarelystudies (if any); purpose of the present study was to assess the frequency of subtypes of human leukocyte antigen (HLA)-B27 in patients with ankylosing spondylitis in Iranian population One hundred and nineteen AS patients (82 HLA-B27 positive and 37 HLA-B27 negative) were selected for this study. HLA-B27 positive patients were selected screened for B*27 subtyping were performed by polymerase chain reaction amplification with sequence-specific primers (PCR-SSP) for B*27 subtyping.. The results of present study revealed that onlythat only two subtypes were detected in Iranian patients, including: B*2705 (52 patients, 63.4%) and B*2702 (30 patients, 36.6%). Our results showed a restricted number of HLA-B27 subtypes associated with AS in Iran and an elevated frequency of the B*2705 allele in these patients similar to other Euro-Caucasoid (Aryan) groups in the world.