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Objective: We aim to investigate the maternal and fetal complications among women with rheumatic diseases (RDs) and evaluate the risk factors for adverse pregnancy outcomes. Methods: In this cohort study, 241 women (comprising 401 pregnancies) who were diagnosed with RDs and sought treatment between 2016 and 2021 were evaluated and followed up for a duration of two years. Clinical backgrounds, pregnancy history, medication usage, immunological characteristics, and pregnancy outcomes were analyzed. Risk assessment for adverse outcomes in RDs was performed using binary logistic regression. Results: The study revealed a 38.2% miscarriage rate and 56.9% live birth rate among 401 pregnancies. Maternal adverse events included gestational hypertension (4.7%), gestational diabetes mellitus (2.7%), and (pre)eclampsia (1.7%). Fetal adverse outcomes consisted of miscarriages in 153 (38.2%), low birth weight in 45 (11.2%), preterm labor in 20 (5%), and fetal heart block in eight (2%). Risk factors associated with adverse fetal outcomes were systemic lupus erythematosus (SLE) (OR 8.24, 95% CI 1.65–41.15), vasculitis (OR 8.06, 95% CI 2.7–24.02), SLE/Sjögren's syndrome (SS) overlap (OR 4.05, 95% CI 1.8–9.11), and history of hypothyroidism (OR 2.81, 95% CI 1.52–5.2). Conclusion: RDs exerted a negative impact on pregnancy outcomes, resulting in complications for both the mother and the fetus. Our study emphasizes the significance of effectively managing RDs during pregnancy, with particular emphasis on SLE, vasculitis, and the overlap of SS with SLE. To improve pregnancy outcomes, a multidisciplinary approach, early identification of high-risk patients, and the implementation of individualized treatment plans are recommended.

Objective: Osteoarthritis (OA) is one of the most prevalent joint disorders in the world that has placed an enormous economic and social burden on governments and healthcare sectors in many countries. Hand OA (HOA) is the most common peripheral arthritis, which is less investigated than knee and hip OA. Due to limited approved drug choices and adverse effects of long-term use of current regimens, we aimed to review the existing evidence that were used as oral herbal medicine to treat HOA.Methods: The PubMed database was searched for both observational and interventional studies that have investigated herbal medicine safety and efficacy in HOA, written in English and published between 2010 and 2022.Results: A total of 5 original articles fulfilled the inclusion criteria, and each article assessed a different herbal regimen. Overall, it seems desirable to add specific herbal treatments to the regimen of HOA patients, specifically in case of early stages of HOA.Conclusion: Currently, the need for a low-risk alternative treatment in HOA patients is felt more than ever. There are reliable references relating to the safety of Korean red ginseng, GCSB-5, XLGB, and GS-GCu in these patients, although their efficacy was limited. Additionally, herbs like curcumin and Boswellia serratahave positively affected patients with knee osteoarthritis. However, there is a lack of strong evidence supporting their effectiveness in hand osteoarthritis (HOA). This emphasizes the potential benefits that these herbs may have for HOA patients.

This study aimed to compare efficacy and safety of test-adalimumab (CinnoRA®, CinnaGen, Iran) to the innovator product (Humira®, AbbVie, USA) in adult patients with active rheumatoid arthritis (RA). In this randomized, double-blind, active-controlled, non-inferiority trial, a total of 136 patients with active RA were randomized to receive 40 mg subcutaneous injections of either CinnoRA® or Humira® every other week, while receiving methotrexate (15 mg/week), folic acid (1 mg/day), and prednisolone (7.5 mg/day) over a period of 24 weeks. Physical examinations, vital sign evaluations, and laboratory tests were conducted in patients at baseline and at 12-week and 24-week visits. The primary endpoint in this study was the proportion of patients achieving moderate and good disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR)-based European League Against Rheumatism (EULAR) response. The secondary endpoints were the proportion of patients achieving American College of Rheumatology (ACR) criteria for 20% (ACR20), 50% (ACR50), and 70% (ACR70) responses along with the disability index of health assessment questionnaire (HAQ), and safety. Patients who were randomized to CinnoRA® or Humira® arms had comparable demographic information, laboratory results, and disease characteristics at baseline. The proportion of patients achieving good and moderate EULAR responses in the CinnoRA® group was non-inferior to the Humira® group at 12 and 24 weeks based on both intention-to-treat (ITT) and per-protocol (PP) populations (all pvalues >0.05). No significant difference was noted in the proportion of patients attaining ACR20, ACR50, and ACR70 responses in the CinnoRA® and Humira® groups (all pvalues >0.05). Further, the difference in HAQ scores and safety outcome measures between treatment arms was not statistically significant. CinnoRA® was shown to be non-inferior to Humira® in terms of efficacy at week 24 with a comparable safety profile to the reference product. IRCT.ir, IRCT2015030321315N1. Registered on 5 April 2015.

Progressive dementia in conjunction with multiple bone fractures in a previously healthy young man led to the investigation of the underlying cause. The differential diagnoses (most importantly hypoparathyroidism) were limited given basal ganglia calcifications on the brain computed tomographic scan. Electronic search of the key words basal ganglia calcification, osteoporosis, and dementiarevealed a rare condition termed Nasu-Hakola diseaseor polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy. This very rare and potentially fatal genetic disease is characterized by pathological fractures, multiple lytic bone lesions, and presenile dementia. We report an Iranian patient with this disease and a review of the literature.