Background: The attentive management of rheumatoid arthritis (RA) has attracted particular attention. The German 7-joint Ultrasound (US-7) is the first scoring system that combines bone erosions and soft tissue lesions in a single composite scoring system. This study aimed to assess the correlation between US-7 and DISEASE ACTIVITY SCORE Using 28 Joint Counts ((DAS28)) in clinically active RA patients. The efficacy of a novel ultrasound SCORE-based system, the US-9 SCORE (joints assessed with US-7 plus knees), was also compared with the standard US-7 SCORE.Methods: All the RA patients referred to the outpatient rheumatology clinic of Ghaem Hospital, Mashhad, Iran, during 2019-2020 were included. 28 joints were clinically examined to calculate (DAS28). Nine joints were assessed comprising the German US-7 plus knees using grayscale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS). Retrieved data were analyzed by SPSS software, version 22. The Spearman Correlation test was used to find the correlation between (DAS28) and ultrasonographic findings. The statistical significance level was set at P<0.05. Results: This study was composed of thirty-five RA patients with a mean age of 49.1±12.0 years. US-7 synovitis SCOREs in GSUS and PDUS were significantly correlated with (DAS28) (P=0.02, r=0.38 and P=0.003, r=0.48, respectively). US-9 synovitis SCOREs in GSUS and PDUS were also significantly correlated with (DAS28) (P=0.003, r=0.49 and P=0.006, r=0.45, respectively). The synovitis SCORE measured by GSUS was significantly correlated with the GSUS knee synovial SCORE (P=0.01, r=0.42).Conclusion: Ultrasound assessment of large joints such as knees can be an effective approach to determining RA severity. However, it can be proposed that adding more involved joints into the sonographic assessment does not necessarily provide a better clinical correlation.

Background: Rheumatoid arthritis is a chronic, progressive inflammatory DISEASE that causes pain, stiffness, swelling and destruction of the articular tissues. This study aimed to evaluate the relationship between serum levels of vitamin D and DISEASE severity in patients with rheumatoid arthritis.Methods: In this descriptive-analytic-sectional study was conducted in the city of Qom, Iran, 120 patients were enrolled based on the evaluation and consideration of inclusion and exclusion criteria using convenience sampling method. The ACTIVITY or severity of DISEASE was determined based on the DISEASE ACTIVITY SCORE 28 ((DAS28)) criteria.Findings: 92 patients (76.7%) were women and the mean age of the patients was 48.26 ± 13.28 years. The serum vitamin D level was lower than normal in 19 patients (15.8%). The severity of the DISEASE was reported as severe in 54 patients (45%), average in 51 patients (42.5%) and minor in 15 patients (12.5%). There was no significant relationship between the DISEASE ACTIVITY based on criteria and serum level of vitamin D (P>0.05).Conclusion: According to the frequency and importance and effects of rheumatoid arthritis, more and more accurate and complete studies should be done in this area; then, the health departments can conclude details of preventive and curative approach in the context of the relationship between vitamin D and DISEASE ACTIVITY in patients with rheumatoid arthritis.

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.Findings: 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 and purpose: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune DISEASE characterized by synovitis, inflammation, and joint destruction that if not well controlled can destroy cartilage, bone, ligaments and tendons, and in some cases cause disability. The aim of this study was to evaluate the possible role of the ratio of neutrophil-lymphocyte (NLR) as an inflammatory marker in determining the severity of RA (DISEASE ACTIVITY SCORE 28 [(DAS28)]). Materials and methods: Fifty patients with RA attending the rheumatology clinic in Ilam Shahid Mostafa Khomeini Hospital, Iran, were examined for DISEASE ACTIVITY using physical and laboratory tests. NLR and DISEASE severity were determined based on (DAS28). Results: The DISEASE ACTIVITY, including remission and mild/moderate were seen in 34% ((DAS28)<2. 6) and 66% ((DAS28) 2. 6), respectively. The patients were 86% women and 14% men. Mean ages of patients with mild/moderate and remission RA were 51. 30 and 36. 82 years, respectively. The mean NLR was 1. 80 in patients with remission RA and 1. 93 in those with mild/moderate RA and no significant relationship was found in NLR between these two groups (P=0. 99). There was a significant relationship between (DAS28) and erythrocyte sedimentation rate (ESR) (P=0. 02), and a weak relationship between (DAS28) and age, gender, and medication (P≥, 0. 1). Conclusion: According to the results, perhaps ESR rather than NLR could be a prognostic factor for determining DISEASE ACTIVITY levels in RA patients with (DAS28) <3. 2.

Background: Vitamin D plays an important role in regulating the immune system and recent studies have suggested a relation between serum vitamin D levels and autoimmune DISEASEs including Rheumatoid Arthritis (RA).Objective: The aim of this study was to investigate the association of serum vitamin D level and severity of RA.Methods: This cross-sectional study was conducted on 153 patients with RA who were not taking vitamin D supplementation referred to Booali Sina Hospital in Qazvin, during 2012. DISEASE and pain severity were assessed by the DISEASE ACTIVITY SCORE 28 ((DAS28)) and the Visual Analogues Scale (VAS), respectively. Serum levels of vitamin D and Erythrocyte Sedimentation Rate (ESR) were determined for all the participants. Data were analyzed using independent T-test, Chi-square test and Pearson correlation coefficient.Findings: Vitamin D deficiency was found in 105 (68.6%) patients. According to (DAS28) SCOREs, 86 (56.2%), 33 (21.5%) and 34 (22.2%) patients were categorized as low, moderate and high DISEASE ACTIVITY, respectively. A significant negative correlation was found between serum vitamin D levels and DISEASE severity according to (DAS28). Similarly, a significant negative correlation was found between pain intensity according to VAS SCOREs and serum ESR levels.Conclusion: With regards to the results, vitamin D deficiency is prevalent among patients with RA. Furthermore, there is a negative correlation between vitamin D and the DISEASE severity.

Background: In some studies Anti-mutated citrullinated vimentin antibodies (Anti-MCV) was known as a specific marker to diagnose and evaluate the process of rheumatoid arthritis (RA). In this study our aim was to evaluate the relationship between the DISEASE ACTIVITY SCORE ((DAS28)) and serum titer of Anti-MCV in patients with rheumatoid arthritis.Methods: This study was a clinical trial in which 80 patients with RA were enrolled. All patients were treated for 3 months. ESR, Anti-MCV and (DAS28) were measured before and after the treatment. Data was analyzed be Paired t-test and c2.Findings: Anti-MCV titer was decreased significantly after treatment (P<0.001). Pearson test showed a significant correlation between (DAS28) and Anti-MCV titer (P<0.05).Conclusion: Our findings suggested that Anti-MCV should be one of the serelogic tests for evaluating (DAS28) in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune DISEASE, which can lead to joint destruction and disability. Pannus formation due to chronic synovitis is the hallmark of RA. Oxidative stress as a consequence of immune cell activation and DISEASE-modifying anti-rheumatic drugs can prevent inflammation and tissue destruction. Silymarin, an antioxidant extract from Silybum marianum, has been traditionally used for the treatment of liver DISEASEs for decades. In the present non-randomized single-arm clinical trial (NRSACT) study we evaluated the effects of silymarin tablet (Livergol® ) on inflammatory markers in stable RA patients. DISEASE ACTIVITY SCORE (DAS-28) was measured before and after adding silymarin to standard drug regimen used for controlling inflammation in RA patients. Silymarin significantly reduced the (DAS28) related symptoms in 44 RA patients after 90 days (3. 02± 0. 98 versus 2. 3± 0. 74, p<0. 001). The exact mechanism of therapeutic effects of silymarin in RA patients is not clear but it could be as the results of its anti-inflammatory and anti-oxidative properties. Conducting the study on larger number of patients and also measuring cytokines levels including TNF-α and IL-1β may clarify the underlying mechanisms of the anti-inflammatory effects of silymarin in RA patients.

Background and Aim: Rheumatoid arthritis is a systemic and chronic DISEASE. In this study, we examined the serum levels of vitamin D, calcium and phosphorus in this DISEASE and its relationship with clinical symptoms based on the patient's DISEASE ACTIVITY SCORE 28 ((DAS28)). Methods: This prospective cross-sectional study was performed on patients with rheumatoid arthritis referred to the rheumatology clinic of a military hospital in Tehran, Iran. The diagnosis was made by a rheumatologist according to the criteria of the American Rheumatological Association. After admission, the severity of rheumatoid arthritis was assessed according to (DAS28) criteria, which is based on the number of painful joints, number of swollen joints, erythrocyte sedimentation rate (ESR) test and Visual Analogue Scale (VAS). Serum levels of vitamin D, calcium and phosphorus were also measured in all of these patients. Results: one hundred patients were present in this study, of which 22 were male (22%) and 78 were female (78%). The mean age of patients was 53. 7±, 11 years (range: 26-76 years). The mean SCORE of DISEASE severity among patients was 14. 4±, 1. 2 (range 1. 4-7. 6). 12% of patients had passive DISEASE, 8% had low-ACTIVITY DISEASE, 62% had moderate ACTIVITY and 18% had severe ACTIVITY. There was a significant difference between the severity of the DISEASE and serum levels of vitamin D, calcium and phosphorus. Patients with higher DISEASE severity had lower levels of calcium and vitamin D while higher levels of phosphorus (p <0. 05). Conclusion: In patients with active rheumatoid arthritis, serum levels of vitamin D are low, so it is recommended to investigate the effect of this vitamin on improving the severity of the DISEASE in these patients so that the final decision to increase this vitamin to the treatment regimen can be made.