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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: Gout is a Common recurrent clinical syndrome characterized by increased serum uric acid and recurrent attacks of acute arthritis. Colchicine is used for Prophylaxis against recurrence of arthritis, but the duration of its administration has mentioned variable. In this study, optimal duration of prophylactic colchicine for prevention of gouty arthritis was assessed. Methods : In a clinical trial 190 patients with gouty arthritis divided randomly to group 1,2and 3 and received colchicine for 3 to 6, 7 to 9 and 10 to 12 months then colchicine discontinued and the patients followed one year for recurrence of arthritis. Result assessed by survival analysis with Kaplan –Meier method. Results: The probability of recurrence of arthritis (in order of duration of colchicine prophylaxis) was 54%, 27.5% and 23%, respectively. The difference between group one and others was statistically significant, but between group 2 and 3 was not statistically significant. Conclusion: The most suitable duration of colchicine prophylaxis that accompanied with lower recurrence rate was 7-9 months, which seems more cost -effective than 10-12 months regimen. Key words: Gout, Colchicine, Arthritis, Recurrence

Objective (s): The aim of this study was to determine the correlation between vaccine therapy and appearance of mutations in hepatitis B surface antigen (HBsAg)-positive chronic hepatitis B virus (HBV) patients. Materials and Methods: 16 patients received the HBV vaccine and another 16 individuals from the control group did not. The surface gene was amplified and directly sequenced from samples prior to vaccination and six months after the third dose. Results: Only one patient lost HBsAg. 48 and 44 amino acid mutations were found before and after vaccine therapy in the vaccine group respectively, 51 of which (55.4%) occurred in immune epitopes: 5 were in B cell, 21 in T helper (Th), and 25 in cytotoxic T-lymphocyte (CTL) epitopes. In the control group, 35 and 41 amino acid substitutions were found before and after therapy, respectively. 32 (42%) of 76 amino acid changes occurred within immune epitopes. There were no differences in age, gender, and duration of chronicity in both patient and control groups in terms of the frequency and the patterns of mutations. Conclusion: In chronic carriers who already had HBsAg variants selected by the host-immune response, any immune stimulation by the vaccine had no effect on the chronic state of these patients or selected any remarkable escape mutants. Newer strategies should be considered based on third generation or the use of DNA vaccines or new adjuvants.

Background: The correct interpretation of bone mineral density (BMD)measurement by dual energy x ray absorptiometry(DEXA) requires a population specific reference range. We collected data on age 20-35 years to obtain reference values of BMD for Isfahani women in order to make a population specific diagnosis of osteoporosis. Methods: In 660 healthy Isfahani women Volunteers (20-35 years) without illness, use of drugs or predisposing conditions to osteoporosis, the BMD (gr/cm²) of lumbar spine and non-dominant femur was measured by lunar DPX –IQ machine. Results: The mean BMD and its standard deviations at each site were calculated and compared with normative data from Caucasian US/North European women. No significant differences were detected between them. Conclusions: Bone mineral density measurements of these 660 healthy Isfahani women can serve as a reference guide for the diagnosis of osteoporosis in Isfahani women. Key words: Bone Mineral Density, Osteoporosis, Normative data, DEXA

Background and Objectives: Iranian chronic HBV carrier’s population has shown a unique pattern of genotype D distri- bution all around the country. The aim of this study was to explore more details of evolutionary history of carriers based on structural surface proteins from different provinces. Materials and Methods: Sera obtained from 360 isolates from 12 Different regions of country were used for amplificationand sequencing of surface proteins. A detailed mutational analysis was undertaken. Results: The total ratio for Missense/Silent nucleotide substitutions was 0.96. Sistan and Kermanshah showed the lowest rate of evolution between provinces (P = 0.055). On the other hand, Khorasan Razavi and Khoozestan contained the highest ratio (P = 0.055). The rest of regions were laid between these two extremes. Azarbayjan and Guilan showed the highest proportion of immune epitope distribution (91.3% and 96%, respectively). Conversely, Sistan and Tehran harbored the least percentage (66.6% and 68.8%, respectively). Kermanshah province contained only 5.2%, whereas Isfahan had 54.5% of B cell epitope distribution. In terms of T helper epitopes, all provinces showed a somehow homogeneity: 22.58% (Fars) to 46.6% (Khuz- estan). On the other hand, distribution of substitutions within the CTL epitopes showed a wide range of variation between 6.6% (Khuzestan) and 63% (Kermanshah). Conclusion: Further to low selection pressure found in Iranian population, the variations between different regions designate random genetic drift within the surface proteins. These finding would have some applications in terms of specific antiviral regimen, design of more efficient vaccine and public health issues.

Primary amyloidosis is the most prevalent form of systemic amyloidosis and clinical sign of this disease is in association with the extent of amyloid deposition in organ systems. Most of the organs, except central nervous system, involved in this disease (heart, kidneys, liver, GI system, spleen, thyroid, adrenals, lymph nodes, bone marrow, lung, synovium, skin, skeletal muscle and tongue). Background: We describe a 43 years Iranian female patient with sign of hardness of skin and joints (scleroderma skin like), nonspecific mechanical pain, shoulder bigness, dysphasia, hoarseness, popular skin lesions, and signs of carpal tunnel syndrome, which hospitalized because of dyspnea. In the skin biopsy and with light microscopy there was epidermal atrophy and in papillary dermis deposition of amorphous eosinophilic material. In congo-red staining amyloidosis was proved. Case Presentation: In spite of this point that the primary amyloidosis is the most prevalent form of systemic amyloidosis, in our country this is the very rare disease and the diagnosis especially in early stages is difficult. In early stages, skin manifestations of disease can confuse with other diseases like hypothyroidism and scleroderma in edematous stage and in our patient waxy form papules was similar to familiar hypercholesterolemia. Because of this presentation we fall in mistake in primary evaluation but the proteinuria cause the suspicious of amyloidosis and finally the diagnosis. Conclusion: Shoulder pad sign, tongue bigness, primary amyloidosis Key words