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Background: Anti-cyclic citrullinated peptide (CCP) antibodies are highly specific and predictive for rheumatoid arthritis (RA). Recently, existence of anti-CCP in several other inflammatory conditions from psoriatic arthritis to neurodegenerative disorder like Alzheimer's disease (AD) has been reported. We compared the level of anti-CCP titer between the patients with mild cognitive impairment (MCI) and Alzheimer's disease; then, we compared it between the patients with mild rheumatoid arthritis and Alzheimer's disease. Methods: In this cross-sectional study, 40 patients with rheumatoid arthritis, 29 patients with Alzheimer's disease, 30 patients with mild cognitive impairment and 30 healthy controls were enrolled. Anti-CCP titer was measured by solid phase enzyme immunoassay kit. Statistical analysis was performed using one-way analysis of variance and post-hoc Tukey tests. Findings: Level of anti-CCP titer (mean ± SD) was higher significantly in patients with Alzheimer's disease (13.6 ± 1.6) was higher than healthy subjects (4.2 ± 1.1) and patients with mild cognitive impairment (4.8 ± 1.3) (P = 0.0100 for both). Anti-CCP serum level in 32.1% of patients with Alzheimer's disease and 95.5% of patients with mild rheumatoid arthritis was higher than normal range. In addition, the antibody level was significantly higher in patients with rheumatoid arthritis (54.7 ± 4.8) compared to patients with Alzheimer's disease (P = 0.0001). Conclusion: We obviously observed differences in Anti-CCP titer between patients with Alzheimer's disease and those with mild rheumatoid arthritis. It was expected since anti-CCP has a high specificity for rheumatoid arthritis and become positive in early stages of disease with a high predictive value. However, we found that in early stages of cognitive impairment, we could not use this biomarker as a diagnostic test but during disease progression, a significant difference was observed between patients with mild cognitive impairment and those with Alzheimer's disease. It needs more studies to confirm the role of anti-CCP antibody production in patients with Alzheimer's disease.

Background: The role of obesity in clinical curse of rheumatoid arthritis (RA) is not clear. We investigated the association of obesity and adiposity with disease activity and clinical response to combination therapy in RA patients. Materials and Methods: Active RA patients with the disease activity score using 28 joint counts (DAS28) > 2.6 were studied. Height, weight, and waist and hip circumferences were measured and body mass index (BMI) and waist to hip ratio were calculated. Patients were treated with methotrexate (7.5 to 10 mg/week) plus hydroxychloroquine (200 to 400 mg/day) and prednisolone (2.5 to 10 mg/day) and were followed by DAS28 for up to 24 weeks. Results: One hundred and six patients were studied; age = 48.5 ± 13.8 years, 87.7% female, disease duration = 4.4 years [SE = 0.48]. DAS28 was decreased from 4.5 ± 1.6 to 2.9 ± 1.4 (P < 0.001) after 24 weeks of treatment. Only in patients with disease duration of ≤2 years, BMI (r = -0.415, P = 0.005) and waist circumference (r = -0.296, P = 0.05) were correlated with baseline DAS28. Although BMI (r = -0.337, P = 0.025) and waist circumference (r = -0.315, P = 0.038) were correlated with change in DAS28 after therapy, these correlations were disappeared after controlling for baseline DAS28. Conclusion: Obesity and adiposity are associated with less severe disease activity in early stage of RA, but are not associated with response to combination therapy with methotrexate plus hydroxychloroquine in RA patients.

Background: Rheumatoid arthritis (RA) is commonly associated with abnormalities in plasma lipoprotein levels, especially a significantly low level of high density lipoprotein (HDL). Most treatments for RA, particularly biological drugs, decrease atherogenic index. Improvement in lipoprotein profile has been found to be associated with decrease in inflammation in RA patients. This study was designed to survey the relationship between lipid profile and RA activity index. Methods: This cross-sectional study included a total of 200 randomly selected RA patients. After blood sampling, plasma levels of triglyceride (TG), cholesterol, low density lipoprotein (LDL), HDL were measured. The correlations between these indices and disease activity index were then evaluated using disease activity score calculator (DAS28). The collected data was statistically analyzed by SPSS18. Pierson and Spearman correlation coefficients were applied for data analysis. Multiple regression test and factorial model were used to control bias.. Findings: Examination of the relation between LDL levels and RA criteria revealed a direct significant association of 0.13. A significant association of 0.17 was also found between pain intensity (based on visual analogue scale) and LDL levels. Moreover, LDL and tender joints were significantly associated (0.16). There were no statistically significant associations between LDL, joint swelling and erythrocyte sedimentation rate (ESR). HDL levels did not show significant relations with ESR, pain intensity and tender joints (P > 0.05). However, there was a significant reverse association between HDL levels and joint swelling (0.16). Conclusion: This study showed that lipid profile and RA were significantly related in many aspects. This finding was in accordance with the results of other similar studies. Therefore, it seems advisable to check the lipid profile of patients with chronic inflammatory diseases, especially RA, on a regular basis.

Background: Limited studies have shown that the administration of Bromocriptine leads to clinical improvement in a number of rheumatic patients. Low price of Bromocriptine and its trivial side effects lead the authors to investigating the effect of Bromocriptine on rheumatoid arthritis (RA) disease activity. Methods: In a randomized controlled double-blinded quasi-experimental study the effectiveness of Bromocriptine in treating rheumatoid arthritis was evaluated. 80 patients were divided in two groups (experiment and placebo. The inclusion criteria were the presence of active rheumatoid arthritis (DAS > 3.2) in spite of medical treatment. In addition to the standard medications, the case group received single oral doses of 5 mg bromocriptine and the control group received placebo tablet and were followed up for three months. Independent T-test was used to compare DAS28 in the two groups. P < 0.05 was considered significant. Finding: The mean ages of the experiment and placebo groups were 46.2 ± 13.0 and 45.9 ± 12.5 respectively. Before the starting pf the intervention in the experiment group, the mean values of PRL and DAS were 11.7 ± 6.9 and 4.2 ± 1.2, and the mean values of PRL and DAS in the placebo group were 11.3 ± 6.2 and 4.6 ± 1.4 respectively (P > 0.05). After the intervention the mean values of serum PRL level and DAS in the experiment group were 10.6 ± 7.1 and 3.7 ± 1.3 respectively, that were different with those of before the intervention (P < 0.05). Conclusion: Our findings suggest that Bromocriptine might be effective in decreasing the rheumatoid arthritis disease activity index, without any concerns about side effects.

Background: We can prevent developing osteoporosis in rheumatoid arthritis (RA) patients with compounds containing calcium and vitamin D. In some of the studies, patients who received more vitamin D had better disease control. Our aim in this study was to observe whether the vitamin D could be effective on the rheumatoid arthritis disease activity or not? Methods: This study was a double blind randomized controlled clinical trial on 117 patients with rheumatoid arthritis. In Intervention group, in addition to drug therapy, vitamin D 50000 units per week were prescribed. Control group also received placebo tablets. In the end of study, results in both groups compared. Data analysis was performed by paired t-test, Student t-test and General linear Model. Finding: There were no significant differences in baseline disease severity, and DAS-28 in both groups. DAS-28 in intervention and control groups was 5.4 ± 1.1 and 5.5 ± 1.3, respectively (P > 0.05). In both groups, all clinical and laboratory parameters after intervention were reduced. The amount of reductions in intervention group was more than the placebo group but it is not significant. Conclusion: According to this research vitamin D can use as an adjuvant therapy for rheumatoid arthritis.

Background: Patients with rheumatoid arthritis may be resistant to conventional treatment with disease-modifying antirheumatic drugs (DMARDs). On the other hand, biologic therapy is costly and may be inconvenient for many patients. Pamidronate is a potent bisphosphonate with the capacity of modifying the biological activity of the immune system cells. It may thus be used as an anti-inflammatory agent in patients with inflammatory joint diseases. Materials and Methods: To assess the effectiveness of pamidronate in the management of rheumatoid arthritis, we selected 38 patients with rheumatoid arthritis to enroll in a pilot study to receive pamidronate and conventional treatment with prednisolone and DMARDs in combination. These patients received 60 mg of pamidronate for 3 consecutive months and were followed for 6 months since the first infusion. Results: The mean visual analogue score (VAS) and disease activity score (DAS28) fell steadily until one month after the third infusion. However, no improvements were observed during the 3 months after the last infusion of the drug. All patients, except one, reported decreased pain in response to 3 consecutive pulses of pamidronate and most had improvements in the assessed laboratory and clinical indices. The drug was tolerated well in our patients. Conclusion: Pamidronate infusions had beneficial effects on various clinical and laboratory parameters of patients, but alleviation of symptoms were temporary and did not last for more than 6 months. This treatment option can be a choice for difficult cases of rheumatoid arthritis with severe pain and osteoporosis.

Background: Patients undergoing renal transplantation consume immunosuppressive drugs to prevent graft rejection. Cardiovascular complications and reduced quality of sleep are among the side effects of these drugs. Studies have indicated that the use of non-therapeutic methods such as exercise is important to reduce these complications. Objective: To evaluate the effect of a period of exercise training, as a non-therapeutic method, on quality and quantity of sleep and lipid profile in renal transplant patients. Methods: 44 renal transplant recipients were selected to participate in the study and randomized into exercise (n=29) and control (n=15) groups. The exercise group participated in a cumulative exercise program 3 days a week for 10 weeks in 60–90-minute exercise sessions. Control group subjects did not participate in any regular exercise activity during this period. Sleep quality of the subjects was evaluated using Pittsburgh Sleep Quality Index (PSQI) questionnaire; the sleep quantity was assessed by recording the duration of convenient nocturnal sleep of the subjects. Physiological sleep-related variables (serum triglyceride [TG], and total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL] cholesterol) were measured before and after 10 weeks of exercise training. Results: In exercise training group, sleep quality of the subjects was improved by 27%; the sleep quantity was increased by 30 minutes (p