Explore the vast range of titles available.

Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that primarily affects young women. SLE has no recognized etiology but it is believed to be triggered by a number of factors, including genetic predisposition, hormonal influences, and environmental conditions. Dysbiosis in the gut microbiota has emerged as a potential mechanism connecting the intestinal microbiome to the breakdown of self‐tolerance and chronic inflammation. This review aims to investigate the role of probiotics in modulating the gut microbiome and their potential therapeutic benefits in managing SLE, providing insights for future research and clinical practice. Methods We conducted a thorough search for papers published up to June 2023 in databases such as PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library. Results The systematic review identified 22 articles examining the effects of probiotics on SLE. These studies—which include in vivo tests, in vitro research, and clinical trials—indicate that probiotics may be effective against inflammation, and improve immunological responses and metabolic profiles in SLE patients. Most in vivo studies were assessed as medium to high quality, while the randomized controlled trial was deemed of high quality. Conclusion According to the findings of our systematic review, probiotics may be used in conjunction with other treatments to manage SLE. Nonetheless, current data is limited, and more randomized controlled trials would be required to fully examine their effectiveness.

Objectives To present the clinical characteristics, disease course, management, and outcomes of COVID-19 infection in patients with Behcet’s disease (BD). Methods In this retrospective cohort study, we retrieved BD patients with definite diagnosis of COVID-19 infection. Demographic data, comorbidities, features related both to BD and COVID-19 infection, treatments, and outcomes were collected. Comparisons between patients with or without hospitalization were performed. All statistical analyzes were performed using SPSS version 25. We considered p  < 0.05 statistically significant. Results We identified 61 episodes of COVID-19 infection in 59 BD patients. The prevalence was 0.69%. The median age was 45 years ( IQR  = 20), and the median disease duration was 162 months ( IQR  = 195). BD features were similar except for higher rate of arterial involvement and positive pathergy test in infected patients. Thirty-five episodes (62.5%) happened in non-active patients; 39% had a comorbid disease. COVID manifestations were the same as the general population. Flu-like symptoms were the most common (85%), followed by fever (66%), ageusia/anosmia (56%), headache (51%), and pulmonary involvement (48%). There was no change in BD symptoms in 74%. Fifteen patients (25.4%) were hospitalized, and one patient (1.7%) died. Receiving glucocorticoids ( p  < 0.03) and cytotoxic drugs ( p  < 0.02) were associated with an increased rate of hospitalization. Conclusion The incidence of COVID-19 infection in BD patients was not higher than general population in Iran. They showed milder form of disease with lower morbidity and mortality rate. Most were on immunosuppressive drugs, or had a comorbidity apart from BD. No significant effect on BD course was shown. Key Points • The incidence of COVID-19 infection in patients with Behcet’s disease is not higher. • They showed milder form of infection with lower morbidity and mortality rate. • No significant effect on Behcet’s disease course was shown with COVID19 infection. • BD patients can be managed according to the guidelines used for general population.

Background/objective Osteoporosis is a global health concern with an increasing prevalence worldwide. Denosumab is an antiresoptive agent that has been demonstrated to be effective and safe in osteoporotic patients. This study aimed to compare the efficacy and safety of the biosimilar denosumab candidate (Arylia) to the originator product (Prolia®) in postmenopausal osteoporotic patients. Methods In this randomized, double-blind, active-controlled, noninferiority trial, postmenopausal osteoporotic patients received 60 mg of subcutaneous Arylia or Prolia® at months 0, 6, and 12 and were followed up for 18 months. The primary endpoint was the noninferiority of the biosimilar product to the reference product in the percentage change of bone mineral density (BMD) in 18 months at the lumbar spine (L 1 -L 4 ), total hip, and femoral neck. The secondary endpoints were safety assessment, the incidence of new vertebral fractures, and the trend of bone turnover markers (BTMs). Results A total of 190 patients were randomized to receive either biosimilar ( n  = 95) or reference ( n  = 95) denosumab. In the per-protocol (PP) analysis, the lower limits of the 95% two-sided confidence intervals of the difference between Arylia and Prolia® in increasing BMD were greater than the predetermined noninferiority margin of − 1.78 at the lumbar spine, total hip, and femoral neck sites (mean differences [95% CIs] of 0.39 [− 1.34 to 2.11], 0.04 [− 1.61 to 1.69], and 0.41 [− 1.58 to 2.40], respectively). The two products were also comparable in terms of safety, new vertebral fractures, and trend of BTMs. Conclusion The efficacy of the biosimilar denosumab was shown to be noninferior to that of the reference denosumab, with a comparable safety profile at 18 months. Trial registration ClinicalTrials.gov, NCT03293108 ; Registration date: 2017–09-19.

Background and Aims Systemic sclerosis (SSc) is an uncommon autoimmune connective tissue disease distinguished by fibrosis and vascular abnormalities, often leading to gastrointestinal problems. This review explores the potential of probiotics in managing SSc‐related gastrointestinal issues and modulating immune responses, highlighting the need for innovative treatments to improve patient well‐being. Methods We performed an extensive literature search up to October 2023 in databases, including Web of Science, PubMed/MEDLINE, and Scopus. Result This review detected four articles that investigated the impact of probiotics on SSc. These studies, comprising non‐randomized observational studies and randomized clinical trials, provide preliminary insights suggesting that probiotics may be efficacious in modulating the immune response and, consequently, in improving gastrointestinal symptoms in SSc patients. Conclusion The comprehensive review suggests that probiotics may aid in managing gastrointestinal symptoms and modulating immune responses in SSc. However, it is essential to acknowledge the limited existing evidence, underscoring the need for more rigorous randomized controlled trials to thoroughly assess their effectiveness.

We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.

[...]the relationship between these variables and SLE disease activity was investigated. [...]no study has been conducted on this issue in the Iranian population. Other variables include demographic data (age and sex), past medical history (nervous system, renal, cutaneous, musculoskeletal, serological, hematological, and visceral manifestations, fever, vasculitis, and serositis), drug history (prednisolone, hydroxychloroquine, and immunosuppressant use), laboratory data (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], antinuclear antibodies (ANA), dsDNA, ANA profile (including anti-Ro, anti-La, and anti-Sm [Smith]), decreased complement (C) 3 and C4 levels, antiphospholipid antibodies (anticardiolipin immunoglobulin [Ig] G, anti-|32-glycoprotein IgG, lupus anticoagulant, anticardiolipin IgM, and anti-|32-glycoprotein IgM), leukopenia, lymphopenia, thrombocytopenia, liver function tests, and proteinuria were gathered by completing a prepared checklist through interview and patients' hospital files. Serum BAFF The median (interquartile range [IQR]) s-BAFF level in the active, inactive, and control group was 8.2 (3.7), 6 (7.1), and 3 (3.7) ng/mL, respectively (p<0.001). [...]a subsequent two-by-two comparison demonstrated that the median s-BAFF in active lupus patients was significantly higher than that of inactive SLE patients (p<0.001) and the control group (p<0.001).

Vasculitides are a heterogeneous group of more than 20 diseases defined by inflammation and destruction of blood vessels. We aimed to study the demographic characteristics of the primary vasculitides in the North East of Iran. We retrospectively studied the medical records of patients diagnosed with any kind of vasculitis at the Clinic and Department of Rheumatology of the Imam Reza Hospital, Mashhad, Iran between January 1, 2002, and December 31, 2012. Patients were classified according to the American College of Rheumatology 1990 criteria for the classification of vasculitis and the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. A total of 721 patients (51.5% male, 48.5% female) with a diagnosis of primary vasculitis was identified. The frequency distributions of vasculitic disorders were as follows: Behcet's disease, 63.6%; cutaneous leukocytoclastic angiitis, 8.2%; granulomatosis with polyangiitis (Wegener's), 6.8%; Takayasu's arteritis. 6%; giant cell arteritis, 4%; polyarteritis nodosa, 2.1%; microscopic polyangiitis, 0.6%; eosinophilic granulomatosis with polyangiitis (Churg-Strauss), 1.8%; cryoglobulinemic vasculitis, 0.3%; and IgA vasculitis (Henoch-Schonlein purpura), 3.5%. In our population, the most common forms of vasculitis are Behcet's disease, cutaneous leukocytoclastic angiitis, and granulomatosis with polyangiitis (Wegener's).

Introduction During the SARS-CoV-2 virus pandemic, immunosuppressive agents in treating chronic disease have become a concern, and rheumatic patients are not an exception. The controversies about the deteriorating effects of such medications led this study to evaluate the influence of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) on the incidence of COVID-19 infection in rheumatic patients. Material and methods In the present cohort-analytical study, 512 patients with rheumatic diseases were enrolled during the COVID-19 pandemic (2020–2021). The incidence of COVID-19 infection was diagnosed according to the definition of the Iranian Ministry of Health. The frequency of COVID-19 infection in patients treated with biological and conventional DMARDs and glucocorticosteroids were compared. Results Among 512 rheumatic patients, 19.9% were definitely infected with COVID-19, and 23.3% of infected patients were hospitalized. Only one patient with vasculitis died during the two outbreaks. Our study showed that adding biologic DMARDs to conventional DMARDs did not increase the risk of COVID-19 infection. However, unlike biologic DMARDs, in conventional DMARDs, methotrexate increased, and hydroxychloroquine decreased COVID-19 infection. Regression analysis showed that prednisolone at a dosage higher than 10 mg/day increased the risk of COVID-19 infection 5-fold; hydroxychloroquine had a protective impact and reduced the risk of infection by 40%. Conclusions Biologic DMARDs and the type of selected rheumatic diseases in our study did not influence the susceptibility to COVID-19 infection. Prednisolone raised the coronavirus infection, and hydroxychloroquine played a protective role in the current study. Most of our patients showed good adherence to the health protocols. Further studies after worldwide vaccination are now required to reevaluate the influence of rheumatic diseases and DMARDs on COVID-19 infection.

Genetic and environmental factors are involved in the pathogenesis of systemic lupus erythematosus (SLE). Autoreactive lymphocytes are cleared through apoptosis and any disturbance in the apoptosis or clearance of apoptotic cells may disturb tolerance and lead to autoimmunity. Vitamin D has anti-proliferative effects and controls cell cycle progression. In this study we investigated the effects of vitamin D on cell cycle and apoptosis induction in lupus patients. Isolated peripheral blood mononuclear cells (PBMCs) from 25 SLE patients were cultured in the presence of 50 nM of 1,25(OH)2D3; then one part of the cells were stained with FITC labeled Annexin V and PI and were analyzed for apoptosis determination. For gene expression assessment of FasL, Bcl-2 and Bax, RNA was extracted from one another part of the cells, cDNA was synthesized and gene expression analysis was performed using Real time PCR. An additional part of the cells were treated with PI and the cell cycle was analyzed using flowcytometer. The mean number of early apoptotic cells in vitamin D treated cells decreased significantly (18.48±7.9%) compared to untreated cells (22.02±9.4%) (P=0.008). Cell cycle analysis showed a significant increase in G1 phase in vitamin D treated cells (67.33±5.2%) compared to non treated ones (60.77±5.7%) (P =0.02). Vitamin D up-regulated the expression levels of Bcl-2 by (18.87 fold increase), and down-regulated expression of Bax (23%) and FasL (25%). Vitamin D has regulatory effects on cell cycle progression, apoptosis and apoptosis related molecules in lupus patients.

Other organs that can be involved include eyes, skin, muscles, liver and joints.2 Though T cells play a significant role in the development of sarcoidosis, researches have shown that the humoral immune response can contribute to the disease.3,4 Aggregation of B cells and plasmatic hypergammaglobulinemia are seen in pulmonary lesions, while positive effects of monoclonal antibodies (anti-CD20) have been reported in patients.4,5 B cells are commonly known as a positive immune stimulant in inflammation. B cellactivating factors (BAFFs), which are a family of tumor necrosis factors, play a vital role in the growth and function of B cells, so that their inhibition dramatically reduces the number of B cells in the follicular and marginal regions.6 Also, increasing the expression of BAFF in mice causes the development of reactive cells, as well as the production of autoimmune antibodies.7 The active form of the disease means that T cells and macrophages are still active, and granuloma tissues are associated with an ongoing illness. [...]the inactive form of the disease is when the disease does not find any progress.8 Factors such as angiotensin-converting enzyme (ACE) and lysosomal that are produced by the epithelial and giant cells can be indicative of the activation and progression of the disease.9 In this study, we aimed to determine the relationship between the severity of sarcoidosis and serum BAFF concentrations. Inclusion criteria were patients who had a history of sarcoidosis based on pathological, clinical and laboratory criteria, while exclusion criteria were a history of steroid therapy due to other internal diseases, pregnancy, renal failure, liver and heart failure, patient dissatisfaction with the continuation of the study, cancer and history of chemotherapy, other rheumatologic diseases, immunodeficiency, coagulation disorders, smokers, alcoholics and malnourished patients.