Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Because immunological changes can be induced by steroid hormones, it seems that oral contraceptive pills can affect the severity of the disease. In this study, we examined the effect of oral contraceptive pills on rheumatoid arthritis activity in women. Methods: This blinded randomized clinical control trial was performed in the selected rheumatology centers in Tehran, Iran, in 2011. A total of 100 women with rheumatoid arthritis were included (50 in the intervention and 50 in the control groups), and those in the intervention group took oral contraceptive pills intermittently for 8 weeks. Disease activity was measured at 1 and 9 weeks based on DAS-28, which includes the number of tender joints, number of swollen joints, ESR, and GH. Data were analyzed using SPSS-16, and significance level was set at p≤0.05. This study was registered in IRCT (number: 138904224364N1) and all interventions were done after receiving confirmation from the Ethical Committee of Tehran University of Medical Sciences (Code: 250/ 6441). Results: After administering oral contraceptive pills to the intervention group, we found significant differences between the 2 groups in disease activity and severity scores (p=0.04). Intervention group showed lower swollen joints score (p=0.02), lower joint tenderness score (p=0.02), and lower general health score (p=0.001) than the control group. Conclusion: According to the results of this study, oral contraceptive pills can improve rheumatoid arthritis activity and severity. As these pills are used for contraception, women with rheumatoid arthritis can benefit from both effects of these pills.

Peripheral nervous system involvement frequently occurs in systemic lupus erythematosus (SLE) patients. However, chronic inflammatory demyelinating polyneuropathy (CIDP) is an unusual presentation that can develop before, after, or simultaneously with the onset of SLE. This paper reports the case of a 20-year-old man with diabetes mellitus (DM) and CIDP accompanied by SLE. The patient complained of progressive weakness in the bilateral upper and lower extremities that had begun 2 months prior to this visit. He was diagnosed with CIDP and treated with intravenous immunoglobulin (IVIG), but had little improvement. A plasma exchange was then scheduled, but it was not helpful either. The patient developed polyarthritis, oral ulcer, and a worsening of his muscle weakness two weeks later. A neurologic examination revealed 3/5 muscle strength in the upper and lower extremities, absent deep tendon reflex (DTR), and impaired position sense. The patient was diagnosed with SLE because of pancytopenia, lymphopenia, pleuropericardial effusion, proteinuria, high titer anti-nuclear antibody (ANA), and anti-dsDNA. A kidney biopsy revealed stage IV lupus nephritis. The patient received 3 pulses of methyl prednisolone, 6 months of cyclophosphamide, and a high daily dose of prednisolone. His proteinuria improved, and he regained the ability to ambulate with a normal gait after about 2.5 months. To the best of the authors" knowledge, the concurrency of CIDP with SLE and DM has not been previously reported.