Background: There are some discrepancy in association between activity of rheumatoid arthritis (RA) and periodontitis. The aim of this study was to evaluate the periodontal status of outpatients with RA. Methods: The study was conducted in 2013-14 in a rheumatology clinic in Sari, north of Iran on 74 patients with RA. Evaluation of RA disease activity was according to disease activity score 28 (DAS28). Periodontitis was evaluated by probing depth (PD), gingival index (GI), clinical attachment level (CAL index), plaque index (PI), and panoramic X-ray. Statistical analysis included independent ttest and Mann-Whitney U test for quantitative, and chi square and OR for qualitative variables and evaluation of RA activity and periodontitis severity. Results: The mean±SD of age and disease duration were 47.01±8.1 and 8.93±8.6 years, respectively and the mean±SD number of teeth was 20.70±6.8. Twenty-seven (36.5%) patients had moderate to severe disease. Forty-seven cases (63.5%) were found with periodontitis and 14 (12.2%) were identified to have moderate to severe periodontitis, unrelated to disease activity (p=0.22). For active/inactive periodontitis OR =1.33 (95% CI: 0.46 - 3.87) was computed. There was no association between RA disease activity and number of teeth, CAL, PI, PD, and GI, (p>0.05). Conclusion: About 60% of RA patients suffered from periodontitis, but there was not any significant relation between RA disease activity and severity of periodontitis. Periodontitis may interfere with management and follow up of RA, so periodic periodontal examination is suggested in these patients.

Expression of T cell immunoglobulin and mucin-domain containing-3 (Tim-3) and programmed cell death-1 (PD-1) was studied on CD4 T cells of patients with rheumatoid arthritis (RA). Association of Tim-3 and PD-1 expression with disease activity of RA patients was also addressed. A total of 37 RA patients and 31 sex- and age-matched healthy controls were included in this study. Disease activity of RA patients was determined by Disease Activity Score of 28 joints scoring system (DAS28). A three-color flow cytometry method was applied to determine the frequency of Tim-3/PD-1/CD4 T cells. To measure the cytokine production, peripheral blood mononuclear cells (PBMCs) were stimulated with PMA/ionomycin. Concentrations of IL-17, IL-10, IFN-γ, and TNF-α were measured in culture supernatants by ELISA. The frequency of PD-1/CD4 and Tim-3/PD-1/CD4 T cells was significantly higher in patients with RA compared to that in controls (p = 0.0013 and p = 0.050, respectively). The percentage of Tim-3/CD4 T cells was similar in patients and controls (p = 0.4498). The RA patients have produced significant higher levels of TNF-α, IL-17, and IFN-γ than those of healthy controls (p = 0.0121, p = 0.0417, and p = 0.0478, respectively). Interestingly, an inverse correlation was found between the frequency of Tim-3/CD4 cells and DAS28 of RA patients (r = - 0.4696, p = 0.0493). Similarly, the percentage of Tim-3/PD-1/CD4 T cells was also revealed an inverse correlation with DAS28 (r = - 0.5268, p = 0.0493). Moreover, significant positive correlations were detected between the concentrations of TNF-α (r = 0.6418, p = 0.0023) and IL-17 (r = 0.4683, p = 0.0373) with disease activity of RA patients. Our results indicate that Tim-3 and PD-1 are involved in immune dysregulation mechanisms of rheumatoid arthritis and could be considered as useful biomarkers for determination of disease activity and progression.

Introduction / objectives: The cause of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome 2 (SARS-CoV-2). There are evidences of involvement of immune system in pathogenesis of this disease. We investigated the presence of various vasculitis-associated auto-antibodies and complement levels in a series of patients with COVID-19 infection admitted to our hospital.Methods: Forty patients with severe or critical type of COVID 19 were evaluated for symptoms, signs and laboratory tests of vasculitis syndromes including rheumatoid factor (RF), anti-nuclear antibody (ANA), anti dsDNA, c and p anti-neutrophilic cytoplasmic antibody (c ANCA and p ANCA) and complement levels. Descriptive statistics methods were used to describe the clinical / laboratory findings.Results: Forty patients with severe to critical illness were enrolled in the study. The mean age of the patients was 48.5 ± 9.8 years. All patients had pulmonary involvement in lung CT scan. Lymphopenia in 19 (47.5%), raised creatinine in 8(20%) and hyperbilirubinemia in 19(47.5%) of patients were seen. Vasculitis laboratory test results included: RF in 2 patients, ANA in 3 patients and ANCA in one patient. 17(42.5%) of patients had hypocomplementemia in one or more complement tests. Of the four patients who were expired, three had a decrease in complement.Conclusion: In 17 of patients (42.5%) we detected low complement levels. A decrease in complement levels may predict a critical state of the disease. Therefore, measuring its levels may be helpful in making earlier decisions to initiate disease-suppressing treatments, including corticosteroids and IVIG.

The frequency of MetS was not significantly different from that of the control group, but almost half of the patients were found with this syndrome. This calls for further follow up and appropriate treatment of patients with MetS.