Successful treatment of classic pyoderma gangrenosum with intralesional infliximab injection: A case report

Pyoderma gangrenosum (PG) is a rare dermatological disease characterized by the rapid development of painful skin ulcers. While systemic infliximab is considered a standard treatment for patients with PG, herein, we report our success with the use of intralesional infliximab in a 40-year-old woman with systemic lupus erythematosus (SLE) and PG.

Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old

Osteoporosis is a disease recognized by bone density reduction and is particularly common among older women, which imposes them to fractures. The evidence shows that if do no serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families, and the country. In this study, we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016. This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in the bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, the use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated. The results showed that non-screening is the best strategy, given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non-screening method compared to screening is cost-effective. The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improve the quality of life of the patients.

Experiences of the Patients with Behcet's Syndrom from Adherence to Treatment: A Qualitative Content Analysis

Background

Adherence to treatment plays an important role in the effectiveness of treatment in patients with Behcet's Syndrome (BS). An in-depth understanding of the experiences of patients with BS will help to improve the patients' management. The present qualitative study aimed to explore the experiences of patients with BS from adherence to treatment.

Methods

This qualitative study was conducted during February-September 2019 at Shahid Motahari Behcet's Clinic in Shiraz, Iran. Data were collected through eight unstructured observations and 22 individual in-depth semi-structured interviews with 20 participants (15 patients with BS, three family members, and two rheumatologists). Data analysis was performed simultaneously with data collection, using the conventional content analysis as proposed by Graneheim and Lundman. Data were managed using MAXQDA 10 software.

Results

Data analysis resulted in 21 sub-categories, seven categories, and three themes. The themes included barriers to treatment adherence (inability to cope with treatment and challenges in access to health care), facilitators of treatment adherence (incentives, receiving support, and striving to adapt to illness), and missing aspects of the treatment program (inadequate patient education and the neglect of lifestyle modification).

Conclusion

The barriers to and facilitators of treatment adherence as well as the missing aspects of the treatment program of patients with BS were identified. Adherence to treatment is not only determined by the patients, but also affected by the support system and relies upon the existing context and the nature of the treatment plan. These parameters should be considered during patient management to effectively promote treatment adherence.

Association of Large Vessel Aneurysm/Pseudo-Aneurysm/Aortitis and Deep Vein Thrombosis in Patients with Behçet's Disease: A Case Report

BACKGROUND

Behçet's disease (BD) is a complex vasculitis with some vascular manifestations including venous thrombosis, arterial thrombosis/aneurysm/pseudoaneurysm, and co-associated venous thrombosis and arterial lesions. We present two patients with Behçet's disease came with progressive both arterial and venous involvement.

CASE PRESENTATION

The first patient was a young man with recurrent oral aphthosis and skin folliculitis and referred with complaint of new abdominal pain and 2 months severe headache. He had not referred to a physician due to COVID-19 pandemic until that time. In addition, he gradually developed a lower extremity edema and eventually was diagnosed with BD complicated with brain sagittal sinus vein thrombosis, abdominal aortic aneurysms and aortitis and deep vein thrombosis (DVT) of femoral vein. The second patient was a young woman with previous history of uveitis, DVT and recurrent oral and genital aphthosis presented with a large inguinal mass due to large iliac artery pseudoaneurysm impending to rupture, and after the operation, due to poor follow-up, developed a new femoral DVT.

CONCLUSION

It seems the same inflammatory process is responsible for arterial and venous involvement in patients with BD, so it should be considered that involvement in one side (venous/arterial) can be a risk factor for the other side (venous/arterial) and early immunosuppressive treatment should always be considered to improve the prognosis.

Quality of Life Assessment in Patients with Behçet's Disease using the Persian Version of the Leeds BD-QoL Questionnaire

Background:

Behçet’s disease (BD) can negatively impact the quality of life (QoL) of the affected patients. The present study aimed to assess the QoL of BD patients using the Leeds BD-QoL and compare its results with the WHOQOL-BREF questionnaire.

Methods:

In the present cross-sectional study, 179 BD patients and 304 healthy individuals (the control group) were recruited in Shiraz, 2017. The Persian version of the Leeds BD-QoL and WHOQOL-BREF questionnaires were used to assess the QoL of patients with BD. The QoL in the patient and control groups was compared after controlling the effect of some variables (age, sex, marital status, and educational level) using the multiple linear regression analysis. Spearman’s correlation coefficient was calculated for the Leeds BD-QoL and WHOQOL-BREF scores. Disease activity was measured using the Behçet’s Disease Current Activity Form. All the statistical analysis was performed using SPSS software (version 21.0). P<0.05 was considered statistically significant.

Results:

The mean of the Leeds BD-QoL total score in the patient group was 12.3±8.7. The control group had significantly higher scores in the WHOQOL-BREF total score and the physical health and psychological health domains compared with the patient group; mean difference of 10.24, 10.8, and 4.62, respectively (P<0.001). The Spearman’s correlation coefficient for the Leeds BD-QoL score and WHOQOL-BREF total score and its domains (physical health, psychological health, social relationships, and environment) was -0.669, -0.713, -0.714, -0.536, and -0.550, respectively. The disease activity score was correlated with the Leeds BD-QoL score (r=0.361, P<0.001).

Conclusion:

BD patients had a lower QoL than healthy individuals, specifically in the physical health and psychological health domains. An increase in disease activity and severity was associated with a reduced QoL. The Persian version of the Leeds BD-QoL questionnaire had an acceptable correlation with the WHOQOL-BREF questionnaire.

The Patients' Beliefs Regarding the Role of Food, Mucosal Trauma, Menstruation, and Psychological Stress in the Recurrence of Behçet's Disease Symptoms

Behçet’s disease is a systemic vasculitis. Mucocutaneous involvement is the most prominent finding, but triggering factors are not well-known. We decided to assess the beliefs of patients with Behçet’s disease regarding the potential role of food, mucosal injury, menstruation, and stress in the appearance of symptoms. In this cross-sectional study, 60 patients with Behçet’s disease who fulfilled the International Study Group criteria for Behçet’s disease and referred to the outpatient Behçet’s clinic of Motahari, affiliated to Shiraz University of Medical Sciences, were included. A questionnaire was designed by the research team consisting of the rheumatologist involved in the study, two dietitians, and a psychiatrist. The patients were interviewed face-to-face to fill in the questionnaire. The assessed variables were all food categories, menstruation, psychological stress, and oral mucosal injury as the potential triggers of symptoms onset. The most common foods reported as triggers for oral ulcers were eggplant (78.3%), melon (68.3%), walnut (68.2%), and cantaloupe (66.7%). Walnut was reported by three patients (5%) as the most common trigger for genital ulcers. Nervous tension (83%) and annoying arguments (45%) were the two most common psychological stress triggers for oral ulcers. Seven patients (11.7%) reported tooth brushing, as the trigger for oral ulcers. The irregular menstrual cycle was a trigger for oral ulcers in only two patients. Food items such as eggplant, walnut and melon were common self-reported triggers for mucocutaneous lesions in patients with Behçet’s disease. Nervous tension and annoying arguments were also common psychological triggers for oral aphthous ulcers.

Inflammatory and T Helper 17/ Regulatory T Cells Related Cytokines Balance in Cutaneous Lupus Erythematosus (CLE)

The cutaneous lupus erythematosus (CLE) is a common manifestation among systemic lupus erythematosus (SLE) patients. Malar rash and discoid lupus (DLE) are in the category of acute and chronic CLE, respectively. The pathogenesis of CLE is multifactorial, and cytokine imbalances contribute to immune dysfunction and the induction of organ damage. Many aspects of cytokine dysregulation are still unclear in SLE and in particular CLE. Therefore, we concurrently measured the inflammatory [Tumor necrosis factor-alpha (TNF-α) and Interleukin (IL)-6)], T helper (Th)-17 (IL-17 and IL-23) and regulatory T cells [Transforming growth factor-beta (TGFβ) and IL-10)]-related cytokines in patients with CLE (patients with malar rash and/or DLE) and compared them with SLE patients and healthy individuals (n=25 in each group, a total of 75 patients). The serum levels of cytokines were assessed by Enzyme-Linked Immunosorbent Assay (ELISA) method. IL-6 cytokine was significantly higher in SLE, DLE, and malar rash patients compared to those in healthy controls (p=0.025) and in patients with arthralgia (p=0.038), and gastrointestinal involvement (p=0.048). IL-17 was significantly higher in malar rash patients compared to normal individuals (p=0.023), SLE (p=0.008) and DLE patients (p=0.019) and in patients with oropharyngeal ulcer (p=0.05) but, IL-23 was significantly higher only in DLE patients than healthy controls (p=0.019). In conclusion, inflammatory cytokines such as IL-6 involved in inflammation and differentiation of Th17 cells are probably responsible in part for Th17 activity in CLE. IL-17, IL-23, and IL-6/IL-6R (IL-6 receptor) inhibitors may be good treatments for CLE patients. So targeting these cytokines activity pathways can improve the CLE treatment strategy and may open a novel guideline for SLE and CLE treatment.

Temperament and character in patients with systemic lupus erythematosus

BACKGROUND

In addition to identified neuropsychiatric characteristic of systemic lupus erythematosus (SLE), changes in personality seem to occur in patients with SLE. Even in absence of an axis I psychiatric diagnosis, personality variations play important role in general wellbeing of these patients. This study investigated personality features in patients with SLE using Temperament and Character Inventory (TCI).

METHOD

In this case-control study personality features of 59 patients with confirmed diagnosis of SLE were evaluated using Persian version of TCI-125 questionnaire. Collected data from patients with SLE were statistically compared with normative data for Iranian population.

RESULTS

Among four subscales of temperament, reward dependence (RD) and harm-avoidance (HA) were significantly lower than general population. Self-directedness (SD) character dimension was significantly lower in SLE patients compared to normative data. No significant difference was noted in novelty-seeking (NS) and persistence (PS) temperament scales and cooperativeness (CO) and self-transcendence (ST) character scales.

CONCLUSION

Personality changes in SLE is characterized by higher HA and RD along with low SD. These features are associated with higher anxiety, social withdrawal and lower resourcefulness and purposefulness.

Recalcitrant cases of pyoderma gangrenosum, responding dramatically to systemic tacrolimus

Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous disease, without any well-known specific and effective treatment. Here we report two patients with severe recalcitrant perineal pyoderma gangrenosum, successfully treated with low dose systemic tacrolimus. Tacrolimus can be a safe effective drug in the management of recalcitrant PG.

An elevated pro-inflammatory cytokines profile in Behcet's disease: A multiplex analysis

The serum levels of sixteen cytokines related to innate immunity, Th1, Th2 and Th17 cells in the sera of 44 patients with Behcet's Disease (BD) and 44 healthy controls have been investigated using the cytokine array technique. Among the cytokines related to innate immunity, the levels of IL-1α, IL-1 β, IL-6, IL-12, IL-15 and TNF-α were statistically higher in BD patients than healthy controls. In the case of Th1- and Th17-related cytokines, IL-2, IFN-γ, IL-17 and IL-23 were significantly higher in patients. From Th2-related cytokines, only IL-13 showed statistically higher levels in patients than controls. Among different evaluated cytokines, the differences in IL-1 α, IL-1 β, IL-6 and Ʃinnate-related cytokines were more prominent between cases and controls. In addition, the results showed that Ʃinnate- and ƩTh17-related cytokines are better indicators of cytokines imbalances in BD than each one of the innate- and Th17-related cytokines. Moreover, disease activity score and clinical activity index can also be affected by the levels of pro-inflammatory (IL-6) and anti-inflammatory (IL-4) cytokines. In conclusion, the results revealed that imbalances in the expression of innate immunity- as well as Th1- and Th17-related cytokines may play not only a pivotal role in BD pathogenesis but also can be important in disease severity.

Screening of patients with juvenile idiopathic arthritis and those with rheumatoid arthritis for celiac disease in southwestern Iran

BACKGROUND/AIMS

Celiac disease (CD) is a common enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. It is frequently found in conjunction with other autoimmune diseases. The purpose of this study was to investigate the prevalence of CD in patients with juvenile idiopathic arthritis (JIA) and those with rheumatoid arthritis (RA) in southwestern Iran.

MATERIALS AND METHODS

A total of 53 children with JIA and 55 adults with RA were enrolled. Anti-tissue transglutaminase (tTG) immunoglobulin (Ig) A serum levels were measured by performing an enzyme-linked immunosorbent assay. Patients with anti-tTG IgA serum levels of >15 U/mL were considered seropositive and subjected to upper gastrointestinal endoscopy. Duodenal biopsies were histopathologically evaluated based on the modified Marsh classification.

RESULTS

One child with JIA (1.8%) and six adults with RA (11.3%) were positive for the anti-tTG IgA antibody, but the histopathological evaluations of the duodenal biopsies in these patients revealed no evidence of CD-related enteropathy.

CONCLUSION

Although the investigation of anti-tTG antibodies is widely used as a noninvasive serologic test for the initial diagnosis of CD, because of the high positive predictive value, the clinical utility of this test alone for making a diagnosis is doubtful. We found no cases of CD among our patients with JIA and RA. The periodic screening of rheumatologic patients with positive anti-tTG IgA for CD can be helpful in making an early diagnosis of CD in these patients.

Randomized clinical trial of peganum oil for knee osteoarthritis

Osteoarthritis affects about 50% of people aged older than 65 years. Pain is the most important symptom in this disease. Today public interest in the use of complementary medicine, especially traditional herbal medicines has increased. The present study was designed to investigate the efficacy of traditional preparation of Peganum harmala L oil on patients with knee osteoarthritis. The product has been analyzed and standardized by high-performance liquid chromatography. A double blind controlled randomized clinical trial consisting of 54 patients were performed. Patients rubbed the drug or control (olive oil) on the knee 4 drops 3 times a day for 4 weeks. The patients were asked to fill out the Western Ontario and McMaster Universities Arthritis Index and Visual Analogue Scale questionnaires at week 0 and 4. The adapted results from the questionnaires showed that pain and difficulty in function were significantly decreased in Peganum oil group after 4 weeks. There was no significant difference in stiffness change between 2 groups.

High prevalence of Helicobacter pylori infection in Behcet's disease

Background

Behcet’s disease (BD) is a multisystem disease of unknown etiology. There are several clues which may indicate an ethiopathogenesis role for Helicobacter pylori infection in this disease.

Methods

In a case control study in an out patient department, 48 patients with BD were compared to age, sex matched controls regarding presence of H. pylori infection by serology and urea breath test (UBT).

Results

Ongoing H. pylori infection was more prevalent among patients with BD using result of UBT with odds ratio of 3.1 (95% CI: 1.34 – 7.26, PV < 0.001).

Conclusion

H. pylori infection may have a role in the pathogenesis of BD.

Absence of autoantibodies against oral and vascular-related cell lines in the sera of patients with Behcet's disease

BACKGROUND

Behcet's disease (BD) is an autoinflammatory disease with unclear pathogenesis. The oral and vascular tissue are the main target organs in BD. The role of humoral immunity in pathogenesis of oral and vascular lesions in BD patients has not been well studied. Therefore, the aim of this study was to investigate the presence of autoantibodies in the sera of BD patients using oral and vascular tissue related cell lines.

METHODS

Proteins from oral (KB, HGF-1) and vascular (HUVEC) related cell lines as well as C2C12 (a muscle myoblast cell line) were extracted as representatives of oral and vascular tissue antigens and the presence of autoantibodies in BD's sera were investigated using high throughput two dimensional electrophoresis (2DE) and immunoblotting techniques. Sera of other autoimmune diseases (RA and SLE) and normal individuals were used as controls.

RESULTS

After silver staining of 2DE gels, 2831, 2195, 1732, and 1839 spots were detectable in the proteome map of HUVEC, KB, HGF-1, and C2C12 cell lines, respectively. The majority of spots were in the pH range of 5 - 8 and the molecular weight range of 14 - 66 Kd. The immunoreactivity of BD, RA, SLE, and normal sera were not different with separated proteins of the cell lines.

CONCLUSIONS

According to our results, it seems that humoral immunity is not significantly involved in BD pathogenesis. Therefore, investigation of the role of cellular immunity, especially TH1 and TH17 cells and their cytokine profiles, in the pathogenesis of BD is recommended for future studies.

Anti-cardiolipin and anti-Neutrophil Cytoplasmic Antibodies in Iranian patients with Behcet's disease

BACKGROUND

The prevalence of anti-Neutrophil Cytoplasmic Antibodies (ANCAs) and anti-Cardiolipin Antibodies (anti-CL Ab) in Behcet's Disease (BD) and also their roles in vascular involvement is controversial.

OBJECTIVE

To assess the prevalence of ANCAs and anti-CL Ab as well as their correlations with clinical manifestations in Iranian patients with BD.

METHODS

In this case/control study, the sera from 88 patients with BD and 88 healthy controls were evaluated. The levels of ANCAs and anti-CL Ab were measured using indirect ELISA method.

RESULTS

The levels of anti-CL, anti-PR3 and anti-MPO (Myeloperoxidase) IgG autoantibodies between BD patients and healthy controls were not statistically different (p=0.21, p=0.28 and p=0.74, respectively). In addition, there were no significant deferences between BD patients with and without vascular involvement in the levels of anti-CL (1.42 ± 1.24 GPLU/ml and 1.58 ± 1.18 GPLU/ml, respectively; p=0.71), anti-PR3 (0.0 ± 0.0 U/ml and 0.08 ± 0.27 U/ml, respectively; p=0.10) and anti MPO (0.48 ± 0.23 U/ml and 0.52 ± 0.22 U/ml, respectively; p=0.41) IgG autoantibodies. Nevertheless, mean titer of anti-CL IgG was higher in male patients with skin rash than those without skin rash (2.2 ± 0.88 GPLU/ml and 1.11 ± 1.22 GPLU/ml, respectively; p=0.017).

CONCLUSION

While anti-CL, anti-PR3 and anti-MPO IgG autoantibodies do not play a major role in susceptibility to BD or pathogenesis of vascular involvement in our patients, anti-CL Ab might be involved in skin lesion development in Iranian male BD patients. However, the results should be confirmed in other studies.

C16 ceramide is crucial for triacylglycerol-induced apoptosis in macrophages

Triacylglycerol (TG) accumulation caused by adipose triglyceride lipase (ATGL) deficiency or very low-density lipoprotein (VLDL) loading of wild-type (Wt) macrophages results in mitochondrial-mediated apoptosis. This phenotype is correlated to depletion of Ca(2+) from the endoplasmic reticulum (ER), an event known to induce the unfolded protein response (UPR). Here, we show that ER stress in TG-rich macrophages activates the UPR, resulting in increased abundance of the chaperone GRP78/BiP, the induction of pancreatic ER kinase-like ER kinase, phosphorylation and activation of eukaryotic translation initiation factor 2A, the translocation of activating transcription factor (ATF)4 and ATF6 to the nucleus and the induction of the cell death executor CCAAT/enhancer-binding protein homologous protein. C16:0 ceramide concentrations were increased in Atgl-/- and VLDL-loaded Wt macrophages. Overexpression of ceramide synthases was sufficient to induce mitochondrial apoptosis in Wt macrophages. In accordance, inhibition of ceramide synthases in Atgl-/- macrophages by fumonisin B1 (FB1) resulted in specific inhibition of C16:0 ceramide, whereas intracellular TG concentrations remained high. Although the UPR was still activated in Atgl-/- macrophages, FB1 treatment rescued Atgl-/- macrophages from mitochondrial dysfunction and programmed cell death. We conclude that C16:0 ceramide elicits apoptosis in Atgl-/- macrophages by activation of the mitochondrial apoptosis pathway.

Comparing the Effect of Phenytoin Syrup and Triamcinolone Acetonide Ointment on Aphthous Ulcers in Patients with Behcet's Syndrome

BACKGROUND

Recurrent aphthous stomatitis (RAS) appears to be the most common type of oral ulcers. The lesion is usually self limited but its painful presentation results in some difficulties. Therefore, an efficient therapeutic strategy is required and currently existing therapies seem to be inadequate because of its unclear etiology. Here the therapeutic effect of triamcinolone acetonide ointment as a relatively expensive medication has been compared with phenytoin syrup on aphthous ulcers in patients with Behcet's syndrome.

METHODS

Thirty out of 60 our patients with Behcet's syndrome were randomly treated by phenytoin syrup and the remaining were advised to use 0.1% triamcinolone acetonide ointment. After a week, they were visited again to determine the status of aphthous ulcers.

RESULT

Positive response in the triamcinolone acetonide group and phenytoin group was 86.7% and 53.3%, respectively.

CONCLUSION

The effectiveness of triamcinolone acetonide ointment was more than phenytoin on aphthous ulcers in patients with Behcet's syndrome.

The relation between serum homocysteine level and eye involvement in Behçet's disease

BACKGROUND

Behçet's disease is a chronic, multisystemic disease of unknown etiology in which eye involvement is the most common cause of morbidity. In this study, we investigated the possible relation between serum homocysteine level and ocular involvement in patients with Behçet's disease.

METHODS

One hundred and fifty patients who fulfilled the criteria of the International Study Group for Behçet's disease (96 females and 54 males) were enrolled. All the patients were evaluated carefully by an experienced ophthalmologist for the diagnosis of ocular involvement. Serum homocysteine, vitamin B12, and folate levels were determined. The patients were categorized according to the presence or absence of uveitis. The data were statistically analyzed by using Student's t-test and P values less than 0.05 were considered statistically significant.

RESULTS

Fifty- nine patients (39.3%) had eye involvement, which included anterior uveitis, vitritis, macular damage, optic atrophy, panuveitis, posterior uveitis, retinal vasculitis, and retinal hemorrhage. Serum levels of folate and vitamin B12 were comparable in patients with Behçet's disease. There was no significant correlation between serum homocysteine level in patients with and without eye involvement.

CONCLUSION

Our findings suggest that homocysteine level does not have significant effect on eye involvement in patients with Behçet's disease.

Anticardiolipin and antibeta2glycoproteinI antibodies in patients with hepatitis B and C infections

BACKGROUND

The clinical significance of antiphospholipid antibodies in patients with chronic hepatitis C virus (HCV) and some other viral infections is controversial.

OBJECTIVE

To study the prevalence of anticardiolipin antibody (ACLA) and antibeta2glycoproteinI antibody (antibeta2GPI antibody) in HCV and hepatitis B virus (HBV) infected patients and its association with liver clinical parameters.

METHODS

Serum levels of ACLA, antibeta2GPI antibody as well as platelet count, ALT (alanine transaminase), PT (prothrombine time), disease duration and liver histologic findings of 38 patients with HBV and 15 patients with HCV infections were compared with those of 58 healthy controls.

RESULTS

Serum titres of ACLA in HCV and HBV patients (13.4 +/-7.1 GPL units/ml), and in each of the HCV (15.18+/-9.91 GPL units/ml) and HBV (12.7 +/- 5.7 GPL units/ml) patients were significantly higher than that of the control group (3.4+/-2.3GPL units/ml). However, there was no significant difference in serum levels of antibeta2GPI antibody from patients with HCV and HBV (3.3 +/- 1.3 GPL units/ml) or HCV alone (2.79 +/- 1.01 GPL units/ml) or HBV alone (3.4+/-1.3GPL units/ml) and that of the control group (3.3+/-1.1GPL units/ml).

CONCLUSION

The findings suggest that the presence of ACLA has no pathologic significance in patients with HBV and HCV infections.

TNF-alpha, TNF-beta and IL-4 gene polymorphisms in Iranian patients with multiple sclerosis

OBJECTIVES

To investigate the association between tumor necrosis factor-alpha (TNF-alpha) G-308A, tumor necrosis factor-beta (TNF-beta) G+252A and interleukin-4 (IL-4) C-590T polymorphisms and susceptibility to multiple sclerosis (MS) development and clinical course of the disease.

MATERIALS AND METHODS

Two hundred and seventy patients with MS and 542 sex and ethnic matched controls were enrolled in the present study. An allele-specific oligonucleotide polymerase chain reaction was used to detect the polymorphism at position -308 of the TNF-alpha gene. The genotypes of TNF-beta and IL-4 were determined by polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

Allelic and genotypic frequencies for these polymorphisms were similar in patients with MS and population controls or among different types of the disease.

CONCLUSION

The results of the present study suggest that the three mentioned functional polymorphisms are not likely to cause susceptibility to MS in the Iranian population.