Background: Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. Aim: We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Results: Musculoskeletal manifestations included myopathy shoulder disorder immune-negative non-erosive peripheral arthritis axial involvement simulating spondylarthritis and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation seen in patients with hypoparathyroidism may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore hypoparathyroidism can be responsible for an increase in bone mineral density. However the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. Conclusion: Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism including muscular axial peripheral articular and entheseal manifestations.

Background: Guggulipid an oleo-gum resin extracted from the bark of Commiphora wightii of the Burseraceae family holds a significant place in Ayurvedic medicine due to its historical use in treating various disorders including inflammation gout rheumatism obesity and lipid metabolism imbalances. Objective: This comprehensive review aims to elucidate the molecular targets of guggulipids and explore their cellular responses. Furthermore it summarizes the findings from in-vitro in-vivo and clinical investigations related to arthritis and various inflammatory conditions. Methods: A comprehensive survey encompassing in-vitro in-vivo and clinical studies has been conducted to explore the therapeutic capacity of guggulipid in the management of rheumatoid arthritis. Various molecular pathways such as cyclooxygenase-2 (COX-2) vascular endothelial growth factor (VEGF) PI3-kinase/AKT JAK/STAT nitric oxide synthase (iNOS) and NFΚB signaling pathways have been targeted to assess the antiarthritic and anti-inflammatory effects of this compound. Results: The research findings reveal that guggulipid demonstrates notable antiarthritic and anti-inflammatory effects by targeting key molecular pathways involved in inflammatory responses. These pathways include COX-2 VEGF PI3-kinase/AKT JAK/STAT iNOS and NFΚB signaling pathways. in-vitro in-vivo and clinical studies collectively support the therapeutic potential of guggulipid in managing rheumatoid arthritis and related inflammatory conditions. Conclusion: This review provides a deeper understanding of the therapeutic mechanisms and potential of guggulipid in the management of rheumatoid arthritis. The collective evidence strongly supports the promising role of guggulipid as a therapeutic agent encouraging further research and development in guggulipid-based treatments for these conditions.

Background: Primary hyperparathyroidism (PHPT) should be considered in the differential diagnosis of a patient with suspected secondary osteoporosis and severe osteoporosis with multiple fractures is frequently the first clinical manifestation of the disease. Case Presentation: Mutilating arthritis (arthritis mutilans) can be part of the clinical presentation of a number of rheumatic diseases most commonly seen in psoriatic arthritis rheumatoid arthritis and juvenile idiopathic arthritis but also in systemic lupus systemic sclerosis and multicentric reticulohistiocytosis. Evidence exists that subperiosteal and subchondral bone resorption seen in PHPT could induce the so-called ‘osteogenic synovitis’ which could eventually lead to the development of a secondary osteoarthritis with bone deformities. Conclusion: Here we present a case report of a patient initially diagnosed with PHPT who presented with mutilating arthritis of the finger joints and discuss whether the severe acro-osteolysis is a manifestation of the endocrinopathy or whether there is a co-existing undiagnosed inflammatory joint disease.

Background: Ankylosing spondylitis (AS) is an autoimmune disease that has the characteristics of difficult early diagnosis and a high disability rate. Objective: The objective of this study was to further explore the possible mechanism and potential function of lncRNA in AS. Methods: We used lncRNA microarray technology to detect the expression of lncRNA and mRNA in patients with active AS stable patients and healthy controls (HC). Afterward bioinformatics analysis was conducted on differentially expressed genes. Seven differentially expressed lncRNAs were screened out for real-time fluorescent quantitative PCR (RT-qPCR) combined with various clinical indicators for correlation analysis and the receiver operating characteristic (ROC) curve was used to analyze the potential of lncRNA as a diagnostic marker for AS. Results: The results showed that the expression levels of NR-037662 and ENST00000599316 in the AS subgroups were significantly higher than those in the HC group while the expression levels of ENST00000577914 and ENST00000579003 were lower than those in the HC group. The expression levels of NR-003542 and ENST00000512051 in the ASA group were significantly higher than those in the ASS and HC groups while NR-026756 was just the opposite. Spearman’s correlation analysis showed that the expression level of NR-003542 was positively correlated with Bath Ankylosing Spondylitis Functional Index (BASFI) Erythrocyte Sedimentation Rate (ESR) and high sensitivity C-Reactive Protein (hsCRP). The expression level of NR-026756 was negatively correlated with the Bath Ankylosing Spine Inflammatory Disease Activity Index (BASDAI) BASFI ESR hsCRP and globulin (GLOB). In addition it was also found that the ROC curve analysis of the 4 lncRNAs between the AS group (ASA group and ASS group) and the HC group were statistically significant and the area under the curve (AUC) of NR-037662 ENST00000599316 ENST00000577914 and ENST00000579003 was 0.804 0.812 0.706 and 0.698 respectively. Conclusion: It was found that these differentially expressed lncRNAs of AS may be involved in the occurrence and development of the disease. Among them NR-037662 ENST00000599316 ENST00000577914 and ENST00000579003 might have the potential to become AS diagnostic molecular markers. Moreover NR -003542 ENST00000512051 and NR-026756 might have the potential to be indicators of disease activity.

Background: Inflammatory markers are crucial in diagnosing and monitoring rheumatoid arthritis. Patients with rheumatoid arthritis (RA) live with constant pain that limits their daily activities. Our study highlights the effects of disease activity on the quality of life in patients with rheumatoid arthritis. Methods: Swollen joint count (SJC) tender joint count (TJC) and visual activity scale (VAS) were utilized to acquire patients' subjective feelings of wellness and their performance of routine daily activities to determine the disease activity. The patient's erythrocyte sedimentation rate (ESR) was measured at the clinical hematology laboratory using the Westergren method. The Quality of Life was rated on a scale of 1 to 10. Results: Our study found that disease activity is inversely proportional to the quality of life. Out of 111 patients 3 (2.7%) were in remission 1 (0.9%) had mild disease 51 (45.9%) had moderate disease and 56 (50.5%) had high disease activity. The ESR was normal (<20) in 11 patients (9.9%) moderately elevated (20-50) in 56 (50.5%) patients and very high (>50) in 44 (39.6%) patients. The study revealed that 66% of patients in remission had normal while 33% had moderately elevated ESR. 12.5% of patients with moderate disease activity had normal ESR and none with high disease activity had normal ESR. Of 44 patients with high ESR 7 had moderate disease activity and 37 had high disease activity. In our study 60% of patients had a less than 50% quality of life compared to patients with pre-arthritis. Conclusion: High disease activity affects the productivity and quality of life in patients with rheumatoid arthritis. Assessing the impact of different interventions on the QOL should be an essential task that can help define a holistic and integrative treatment and rehabilitation model for RA patients.

Introduction: Mixed connective tissue disease (MCTD) is defined as a systemic rheumatic disease characterized by the presence of high titer anti-U1 ribonucleoprotein (U1 RNP) antibodies in combination with clinical features commonly seen in systemic lupus erythematosus (SLE) systemic sclerosis (SSc) rheumatoid arthritis (RA) and polymyositis (PM). Case Presentation: The annual incidence of MCTD is 1.9 per 100000 adults. Any organ system can be involved in MCTD however four clinical features that suggest the presence of MCTD rather than another systemic rheumatic disease are Raynaud phenomenon with swollen hands or puffy fingers absence of severe kidney disease and central nervous system (CNS) disease at first presentation generally insidious onset of pulmonary hypertension and presence of autoantibodies anti-U1 ribonucleoprotein (U1 RNP) especially antibodies to the 68 kD protein. MCTD although initially thought to be a disease with a benign course is not considered a valid argument at present. This connective tissue disorder can present with life-threating organ involvement with rapid progression of disease. Conclusion: We report two cases of MCTD one with mild disease and another with life-threatening illness describing the range of severity at presentation of this disorder.

Osteoarthritis in the temporomandibular joint (TMJ) is a chronic disease characterized by irreversible damage to articular surfaces including inflammation loss of articular cartilage and subchondral bone alterations which would be radiographically evident only in later stages. Symptomatic slow-acting so-called nutraceutical drugs have been proposed as a treatment for osteoarthritis in comparison to non-steroidal anti-inflammatory drugs (NSAID) because of their appreciable safety profile even in long-term intake. Glucosamine being one among them proved highly efficient in knee osteoarthritis. However its application in TMJ osteoarthritis dates back only to 2001 and is still inconclusive in its efficiency even with systematic reviews in restoring the structural and functional aspects of damaged TMJ. Glucosamine being a natural compound and also a contributor to building the matrix of articular cartilage can be utilized effectively for TMJ osteoarthritis as an adjunct along with other conventional treatment modalities available till now which also have moderate prognosis in most of the clinical scenarios. This review summarizes data relating to the mechanism of osteoarthritis and its management using glucosamine formulations. The beneficial effects of glucosamine on the pathophysiology of TMJ osteoarthritis are possibly due to its contribution to hyaluronic acid regulation and in establishing a proper balance between anabolism/catabolism in the articular tissues.

Fibromyalgia (FM) is a complex widespread pain disorder characterized by symptoms such as fatigue sleep deprivation mental fog mood swings and headaches. Currently there are only three FDA-approved medications for FM patients: duloxetine milnacipran and pregabalin with outcomes frequently being inadequate. This research team aims to investigate the effects of diet and lifestyle modifications on FM with emphasis on anti-inflammatory diet antioxidants and gluten-free diets as well as supplementation with Magnesium CQ10 and Vitamin D microbiome sleep exercise and cognitive behavioral therapy. We reviewed the pathophysiology of certain foods that can be proinflammatory with the release of cytokines leading to activation of pain fatigue and aggravation of the majority of Fibromyalgia symptoms. A literature review was performed by identifying FM articles published between 1994 and 2022 via PubMed and EMBASE databases with particular emphasis on randomized controlled trials meta-analysis and evidence-based treatment guidelines. This review article was completed by a comprehensive narrative review process in which our team systematically examined relevant scientific literature to provide a comprehensive overview of the significant role that diet and other lifestyle modifications play in mediating symptoms of Fibromyalgia. We propose that diet modifications and lifestyle changes such as sleep exercise and weight loss can be important steps in managing FM.

Background: Tumor necrosis factor alpha (TNFα) is a pivotal cytokine involved in the pathogenesis of certain inflammatory diseases such as rheumatoid arthritis (RA) spondyloarthropathies and inflammatory bowel diseases. In the last two decades TNFα inhibitors (TNFi) have revolutionized the treatment and outcome of the above disorders. However the use of TNFi has been associated with the development of many autoimmune phenomena and paradoxical skin manifestations that may present as the same type of clinical indications for which the TNFi effectively used. Thus they may display as arthritis uveitis colitis psoriasis and several other cutaneous clinical manifestations among them the development of morphea a localized scleroderma skin lesion. Case Presentation: We describe a 58-year-old woman with seronegative RA refractory to methotrexate who was treated with ABP-501 (Hefiya) an adalimumab (ADA) biosimilar and developed an oval-shaped deep skin lesion of approximately 3.5cm in size affecting the left part of her back compatible with morphea 3 months after the initiation of therapy. ADA biosimilar was discontinued and two months later she had substantial skin improvement. Conclusion: This is the first report of morphea manifestation during TNFi biosimilar since the patient had no other trigger factors for morphea development like trauma and infections. Physicians dealing with patients treated with TNFi biosimilars should be aware of paradoxical skin reactions among them morphea; thus close monitoring a minute and careful clinical examination and a follow- up check are required.</P>

Background and Aim: A tenosynovial giant cell tumor (TGCT) is a proliferative lesion of the synovial membrane of the joints tendon sheaths and/or bursae. There are two described subtypes including the localized and diffuse forms. A TGCT can also be intraarticular or extraarticular. An intraarticular localized tenosynovial giant cell tumor (L-TGCT) of the knee is characterized by nodular hyperplasic synovial tissue that can remain asymptomatic for a long time but as the mass grows it may cause mechanical symptoms that may require surgical treatment. The aim of our study is to present a rare case of an L-TGCT of the knee joint treated with an arthroscopic excision. Case Report: We describe the case of a 17-year-old female with pain swelling and knee locking in the absence of trauma. The magnetic resonance imaging (MRI) displayed a well-circumscribed small mass in the anterior medial compartment adherent to the infrapatellar fat pad. The lesion presented the typical MRI characteristics of an intraarticular localized TGCT. The patient was treated with an arthroscopic mass removal and partial synovectomy. The gross pathology showed an ovoid nodule that was covered by a fibrous capsule; a histopathology examination confirmed the diagnosis. The patient was able to return to normal daily activities one month after surgery; at the three-year follow-up she was free of symptoms with no evidence of disease on the MRI. Conclusion: In patients with a small-dimension L-TGCT in the anterior compartment of the knee that presents an MRI pattern and causes mechanical symptoms an arthroscopic en-bloc excision can be performed that results in good outcomes and a rapid return to preinjury levels.