Hadi Karimzadeh

Clinical Patterns of Uveitis in an Iranian Tertiary Eye-care Center

Abstract Purpose: This study aimed to analyze the clinical patterns and etiology of uveitis in Isfahan, Iran. Methods: In this descriptive research, the records of 2016 patients with uveitis referred to a tertiary eye care centers were examined. Age, sex, clinical and anatomical features, and etiology of disease were recorded and analyzed. Results: The mean age of onset of uveitis was 33.76 years and the women/men ratio was 1.2/1.0. Anterior uveitis was the most common (42.9%) type followed by posterior (21.4%), intermediate (19.3%), and pan uveitis (16.31%). Noninfectious causes had more roles (76.5%) in the etiology of uveitis. A total of 43.9% of the patients had unknown etiology (idiopathic). The most common known etiologies were toxoplasmosis, Behçet disease and Fuchs heterochromic iridiocyclitis (FHI), respectively. In 15.6%, there was an underlying systemic disease. Conclusion: There were some differences in the clinical and etiologic pattern of uveitis in Isfahan. Environmental, genetic, and geographical factors may contribute to this difference.

Long-term outcome of biopsy-proven lupus nephritis in Iran

This study was conducted to evaluate the survival of patients with lupus nephritis (LN) in two different lupus clinics in Iran.

Devic's syndrome concomitant with nephritis in a young woman.

We presented a 34-year-old woman with blurred vision and inability to walk due to acute optic neuritis and transverse myelitis, neuromyelitis optica (Devic’s syndrome), for an interesting presentation of this syndrome with proteinuria as the first manifestation of systemic lupus erythematosus.

The effect of Vitamin D supplementation in disease activity of systemic lupus erythematosus patients with Vitamin D deficiency: A randomized clinical trial

Background: The aim of this study was to check the effectiveness of Vitamin D supplementation on the disease activity of Vitamin D-deficient systemic lupus erythematosus (SLE) patients. Materials and Methods: In this randomized, double-blind, placebo-controlled trial, 45 Vitamin D-deficient SLE patients were studied in two groups, namely interventional and placebo groups. The interventional group patients were treated with Vitamin D (50,000 unit/weekly Vitamin D for 12 weeks and then 50,000 unit/monthly for 3 months) and placebo group patients were only administered the placebo. The level of Vitamin D and the level of disease activity using SLE disease activity index (SLEDAI) were measured before and after intervention period in each group, and for intra- and between-groups comparison, we used t-test and repeated measure ANOVA. Results: A total of 90 patients were enrolled in this study. The mean of Vitamin D was increased significantly after therapy in interventional group (17.36 ± 4.26 ng/ml vs. 37.69 ± 5.92 ng/ml, P < 0.001). The mean of Vitamin D had no significant difference before and after intervention in placebo group (16.78 ± 4.39 ng/ml vs. 16.62 ± 4.61 ng/ml, P = 0.53). The mean of disease activity (SLEDAI) was not different significantly before and after Vitamin D administration in interventional group (3.09 vs. 1.62 ± 1.25, P = 0.39). The mean of disease activity (SLEDAI) was not different significantly before and after intervention in placebo group (3.09 vs. 1.98 ± 2.47, P = 0.42). Conclusion: According to our study, it is suggested that using Vitamin D in patients with SLE could not have better outcomes in this regard. However, there are many unknown environmental or biological factors which are associated with the disease activity of SLE and have not been identified yet.

Serum adenosine deaminase in patients with rheumatoid arthritis treated with methotrexate

Objective: Recently, adenosine deaminase (ADA) is introduced as helpful marker in diagnosis, prognosis, and monitoring of treatment in rheumatoid arthritis (RA). The aim of this study was to determine the efficacy of the serum ADA in diagnosis, prognosis, and monitoring of treatment with methotrexate (MTX) in RA. Methods: This was a self-controlled clinical trial conducted in university hospitals of Isfahan, Iran. The serum level of ADA, erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were measured for 70 patients with active RA (Disease Activity Score-28 [DAS28] > 3/2). After three months of MTX treatment and disease remission (DAS28 < 2.6) these markers were measured again. ANCOVA multiregression and paired t-test were used to compare and evaluate the mean level and correlation of ADA, ESR, IgM-RF, and DAS before and after RA remission. Findings: The mean value for ADA activity was significantly higher than the normal one compared with other studies. Significant decreases were seen in values of ADA, ESR, RF, visual analogue scale (VAS), and DAS after remission. Also, the correlation coefficient between the values of ADA with ESR and DAS were statistically significant in baseline. Moreover, the statistically significant correlation between ADA and ESR, VAS, and DAS were seen after remission. No correlation was found in the case of the dosage of MTX with the value of ADA. Conclusion: It was concluded that ADA may be considered useful as a marker in diagnosis, prognosis, and monitoring of treatment with Methotrexate in RA.

Assessment of protein tyrosine phosphatases number 22 polymorphism prevalence among rheumatoid arthritis patients: A study on Iranian patients

Background: It has been proposed that Trp (620) allotype of protein tyrosine phosphatases number 22 (PTPN22) gene can intensify the susceptibility to rheumatoid arthritis (RA) and other autoimmune diseases. Thus, in this study, the prevalence of this polymorphism has been surveyed among RA patients compared with healthy persons. The samples were selected from Isfahan province (one of the most populated area of Iran). Materials and Methods: In this study, 100 patients (case group) and 100 healthy persons (control group) were participated voluntarily. The case group was selected from people who had referred to the rheumatology clinic of AlZahra University Hospital to follow-up their treatment and change their drugs dosage. The control group members, who were living in Isfahan province, mutually had similar age with patients. On a total, 22% of the case group was male and 75% of the control group was female. DNA was extracted from the blood sample of all cases and controls and the PTPN22 single nucleotide polymorphism (SNP) C1858> T gene polymorphism were studied using the polymerase chain reaction-restriction fragment length polymorphism method. Results: PTPN22 SNP C1858> T gene polymorphism was observed in 11 persons (11%) of the case group and 8 persons (8%) of the control group. Conclusion: The results show that the difference was not statistically significant in Isfahan RA population (P = 0.47; OR = 1.42; 95% CI 0.55-3.69). Although, another study on Iranian population had shown that this polymorphism confers susceptibility to RA.

Definition of a population-specific dual energy X-ray absorptiometry reference standard in Isfahani women

Objective:  There are some clues that correct interpretation of bone mineral density (BMD) when measured by dual‐energy X‐ray absorptiometry (DXA) which requires a population specific reference range. We determined reference values of BMD and the prevalence of osteopenia and osteoporosis in postmenopausal Isfahani women.

Agreement of clinical examination and ultrasound methods for detection of joints involvements in rheumatoid arthritis

Background: Rheumatoid arthritis is a chronic autoimmune disease characterized by synovial tissue inflammation and destruction of articular components which if not controlled properly, can cause disability in patients. For this reason, evaluation of disease activity and its control is very important. In recent years using sonography is promising for the evaluation of disease activity. This study aimed to compare “clinical examination” and “ultrasonography” methods in the detection of disease activity in patients with rheumatoid arthritis. Materials and Methods: This cross-sectional study was conducted during 2015 in Al-Zahra Hospital of Isfahan. Based on the American College of Rheumatology 2010 criteria, ninety patients with rheumatoid arthritis who diagnosed by rheumatologist entered into the study. All patients, collaborator by radiologists were subjected to sonography of specific joints structures using two methods, i.e., high-resolution ultrasonography and power Doppler. Results: A total of 2520 joints from ninety patients were examined by physical examination and ultrasonography that 244 joints (9.7%) in physical examination and 348 joints (13.4%) in ultrasonography were involved and the difference between the two groups was statistically significant (P < 0.001). Conclusion: Probably, ultrasonography can diagnose joint involvement better than physical examination in patients with Rheumatoid arthritis.

Prevalence of Chondrocalcinosis in Patients above 50 Years and the Relationship with Osteoarthritis

Background: Some studies showed a relation between chondrocalcinosis and osteoarthritis (OA). Hence, considering the importance of chondrocalcinosis diagnosis andnecessity for its integration with OA, the current study aims at investigating prevalence of chondrocalcinosis in patients above 50 years admitted to Isfahan Al-Zahra Medical Center and its relationship with OA. Materials and Methods: In a cross-sectional study, 600 patients who referred to the radiology units of Al-Zahra Hospital for radiography of different joints were studied during 2013–2014. The patients images were studied for chondrocalcinosis and OA by a radiologist and also examined clinically and results of imaging by an expert rheumatologist. The prevalence of chondrocalcinosis and it relation with OA was determined by Statistical Package for Social Sciences software and using of Chi-square and t-test. Results: 23 patients under study had chondrocalcinosis (3.83%). patients with chondrocalcinosis had higher age average, and they were in age group of 70 years and older, but no significant difference was observed regarding the prevalence of the disease in both genders. Chondrocalcinosis prevalence in terms of body mass index showed significant differences (P = 0.001). All patients with chondrocalcinosis had a history of joint disease and prevalence of chondrocalcinosis in terms of joint disease history showed a significant difference (P < 0.001). Conclusion: Prevalence of chondrocalcinosis is relatively high in the Iranian population of 70 years and older. Hence, more investigation considering to the diagnosis of chondrocalcinosis among patients with OA is very important.

Comparison Study on the Effect of Treatment Decision Based on Renal Biopsy and Clinical Symptoms in the Outcome of Patients with Recurrent Lupus Nephritis

Background: Renal involvement in systemic lupus erythematous is one of the most serious complications. The aim of this study was to compare the effects of treatment decisions based on clinical symptoms and renal biopsy on the outcome of patients with recurrent lupus nephritis. Materials and Methods: This descriptive study was conducted in 2012–13 in the Alzahra hospital on patients with lupus nephritis who had referred to the rheumatology clinic of this center due to lupus nephritis relapse. All lupus nephritis patients were diagnosed with renal biopsy and had gone into remission by treatment but due to the discontinuation of treatment and other causes had relapsed. The patients were divided randomly into two groups of 26, the first group was treated without renal biopsy and based on clinical and laboratory symptoms and the second group was re-biopsied through considering the ethical points. Then their relationship with laboratory findings (BUN, Cr, ANA, ds-DNA, C3, C4, CH50, U/A, cast, and proteinuria), treatment and recurrence outcome were compared between the two groups. Results: The mean of SLEDAI-2K index before initial treatment, after the first round of treatment and after the second round of treatment in single biopsy group and twice biopsy group is not significantly different (P = 0.27). Conclusions: Treatment decisions based on clinical and laboratory findings or re-biopsy of the kidney in patients who relapsed after initial treatment had no significant effect on the recovery of patients. Adoption of a treatment plan in patients with lupus nephritis is recommended based on clinical and laboratory finding and the discretion of the physician and if possible, kidney re-biopsy should be avoided.