Arman Ahmadzadeh

The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial

Objective: Previous studies have shown that the bioflavonoid quercetin has anti-inflammatory and anti-nociceptive effects. We investigated the effect of quercetin supplementation on inflammation, disease severity, and clinical symptoms in women with rheumatoid arthritis (RA). Methods: The present study was a randomized, double-blind, placebo-controlled clinical trial in which 50 women with RA were allocated into a quercetin (500 mg/day) or placebo group for 8 weeks. Plasma levels of high-sensitivity tumor necrosis factor-α (hs-TNFα), erythrocyte sedimentation rate (ESR), clinical symptoms including early morning stiffness (EMS), morning and after-activity pain, and tender (TSC) and swollen joint counts (SJC) were determined. Disease activity and functional disability were assessed by Disease Activity Score 28 (DAS-28), physician global assessment (PGA), and a health assessment questionnaire (HAQ) at the beginning and end of the study. Results: Quercetin supplementation for 8 weeks significantly reduced EMS, morning pain, and after-activity pain (p < 0.05). DAS-28 and HAQ scores decreased in the quercetin group compared to placebo and the number of patients with active disease significantly decreased in the quercetin group. Plasma hs-TNFα level was significantly reduced in the quercetin group compared to placebo (p < 0.05). There were no significant differences in TJC and SJC between groups but TJC significantly decreased in the quercetin group after the intervention. Supplementation had an effect on ESR but it was not significant (p > 0.05). Conclusions: Five hundred milligrams per day quercetin supplementation for 8 weeks resulted in significant improvements in clinical symptoms, disease activity, hs-TNFα, and HAQ in women with RA.

Correlating Whole-Body Bone Mineral Densitometry Measurements to Those From Local Anatomical Sites.

Background: Using the same cutoff points for whole-body measurements as for site-specific measurements will result in underestimation of osteoporosis. Objectives: We assessed the correlation between densitometry measurements for the whole body with those for the femur, lumbar spine, and forearm to evaluate the possibility of replacing site-specific values with whole-body measurements. Patients and Methods: In this cross-sectional study, we evaluated all patients referred to a single rheumatology clinic for bone mineral density measurements from 2009 to 2010. All patients who had bone mineral density measurements taken from the hip, lumbar spine, forearm, and whole body were enrolled in the study. Standard bone mineral density measurements were performed using a dual energy X-ray absorptiometry device (Hologic Delphi A; Hologic, Bedford, MA, USA). Bone mineral density, Z-score, and T-score were measured for all patients and all body regions. Results: The mean age of the 152 participating patients was 56.7 ± 12.6 years, and 97.4% were female. Pearson correlation coefficients of the whole-body bone mineral density values compared with site-specific values in patients over age 50 were 0.66 – 0.75. Using T-score cutoff points of -1 and -2.5 for osteopenia and osteoporosis, whole-body measurements underestimated the percentage of abnormal patients compared with the site-specific measurements (all P < 0.001). Using receiver operating characteristic (ROC) analysis, the whole-body bone mineral density showed respective areas under the curve of 0.96 and 0.84 for the diagnosis of abnormal hip bone mineral density and osteoporosis. Conclusion: Using the same cutoff points for whole-body measurements as for site-specific measurements will result in overestimation or especially underestimation of osteopenia and osteoporosis diagnosis. Choosing new and appropriate cutoff points for whole-body densitometric measurements when we want to substitutes this assessment instead of site specific measurements seems mandatory and will decrease the rate of false diagnoses of densitometric deficiencies in these anatomical sites.

Autologous Fat Grafting in the Treatment of Facial Scleroderma

Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations of systemic sclerosis are extremely disabling and treatment options are limited. In this study, we aimed to assess the safety and efficacy of autologous fat grafting in the face of patients with systemic sclerosis. We enrolled 16 SSc patients suffering from facial sclerosis and limited mouth opening capacity. Autologous fat injection ranging from 15 to 40 ml was administered per patient, based on their face morphology. The patients were evaluated at baseline and 3 months after fat injection. Evaluations included mouth opening capacity, mouth handicap in systemic sclerosis (MHISS), Rodnan skin sclerosis score, skin biophysical properties using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT), volumizing and aesthetic effects based on pre- and posttreatment photographs, possible side effects, and global patient satisfaction. Clinical assessment showed autologous fat transfer significantly improved mouth opening capacity and the MHISS and Rodnan score of patients with facial scleroderma (p value <.001). The aesthetic and/or functional results of fat injection were satisfying to about 80% of the patients. The changes in CRRT values were not significant. Our findings support the possible therapeutic role of autologous fat grafting in improving facial scleroderma both in aesthetic and in functional aspects. This trial is registered with IRCT20180209038677N1.

Association of CD26/dipeptidyl peptidase IV mRNA level in peripheral blood mononuclear cells with disease activity and bone erosion in rheumatoid arthritis

Dipeptidyl peptidase IV (DPP-IV, CD26) plays many roles in the pathogenesis of several autoimmune and inflammatory diseases. The current study evaluated the association of DPP-IV enzymatic activity and its gene expression with disease activity and bone erosion in rheumatoid arthritis. Blood samples were collected from 20 rheumatoid arthritis patients and 40 healthy volunteers. Patients were divided into four subgroups using DAS28 index. CD26 gene expression levels were analyzed in peripheral blood mononuclear cells by quantitative reverse transcription-polymerase chain reaction. Additionally, the enzymatic activity of this molecule in serum was determined using Gly-Pro-p-nitroanilide as substrate. Digital radiography was applied to obtain images for bone erosion assessment. No significant difference in serum DPP-IV activity level was seen between patients and controls (p = 0.140). However, patients exhibited an increase in CD26 mRNA expression (1.68 times) when compared to controls (p = 0.001). Moreover, a strong positive correlation between CD26 gene expression and DAS28 index as well as bone erosion in the hands was observed (r = 0.71, p = 0.002 and r = 0.61, p = 0.049, respectively). This study demonstrated that CD26 mRNA expression in rheumatoid arthritis patients is associated with disease activity and bone erosion, suggesting a potential role for this molecule in the immunopathology of rheumatoid arthritis and bone erosion.

Evaluation of safety, efficacy and post‐cessation efficacy durability of tocilizumab in patients with active rheumatoid arthritis

To evaluate safety and efficacy of tocilizumab (TCZ) in a post‐approval pilot study among selected Iranian patients with moderate to severe rheumatoid arthritis (RA) and inadequate responses to disease‐modifying antirheumatic drugs (DMARDs).