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Xia J, Gao H, Tang J, Jiang R, Xiao L, Sheng H, Lin J. A novel diagnostic model based on lncRNA PTPRE expression, neutrophil count and red blood cell distribution width for diagnosis of seronegative rheumatoid arthritis. Clin Exp Med 2024; 24:86. [PMID: 38662200 PMCID: PMC11045583 DOI: 10.1007/s10238-024-01343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Diagnosis of seronegative rheumatoid arthritis (SNRA) is difficult due to the lack of diagnostic markers. The study aims to construct a novel diagnostic model based on long noncoding RNAs (lncRNAs) expression and laboratory indicators to provide a new idea for diagnostic methods of SNRA. Differentially expressed lncRNAs in peripheral blood cells of RA patients were screened through eukaryotic long noncoding RNA sequencing and validated by quantitative real-time PCR. Meanwhile, the correlation between lncRNAs expression and laboratory indicators was analyzed. The diagnostic value was evaluated by receiver operating characteristic curve analysis. Finally, combined with laboratory indicators, a diagnostic model for SNRA was constructed based on logistic regression and visualized by nomogram. Expression of ADGRE5, FAM157A, PTPN6 and PTPRE in peripheral blood was significantly increased in RA than healthy donors. Meanwhile, we analyzed the relationship between lncRNAs and erythrocyte sedimentation rate, C-reactive protein and CD4 + T cell-related cytokines and transcription factors. Results showed that FAM157A and PTPN6 were positively related to RORγt, and negatively related to GATA3. Moreover, PTPRE has potential discrimination ability between SNRA and healthy donor (AUC = 0.6709). Finally, we constructed a diagnostic model based on PTPRE, neutrophil count and red blood cell distribution width (RDW). The AUC of the model was 0.939 and well-fitted calibration curves. Decision curve analysis indicated the model had better predict performance in SNRA diagnosis. Our study constructed a novel diagnostic model based on PTPRE, neutrophil count and RDW which may serve as a potential tool for the diagnosis of SNRA.
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Affiliation(s)
- Jinfang Xia
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huali Gao
- Department of Orthopedic Surgery, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jifeng Tang
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renquan Jiang
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lianbo Xiao
- Department of Orthopedic Surgery, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
| | - Huiming Sheng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jinpiao Lin
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Fujisaki A, Tsukamoto J, Narimatsu H, Hayashida Y, Todoroki Y, Hirano N, Takeda K, Shin S, Ota S, Anai K, Fukumitsu S, Yoshimatsu Y, Kono Y, Ueno M, Ide S, Murakami Y, Aoki T. Zero Echo Time Magnetic Resonance Imaging; Techniques and Clinical Utility in Musculoskeletal System. J Magn Reson Imaging 2024; 59:32-42. [PMID: 37288953 DOI: 10.1002/jmri.28843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
Zero echo time (ZTE) sequence is recent advanced magnetic resonance technique that utilizes ultrafast readouts to capture signals from short-T2 tissues. This sequence enables T2- and T2* weighted imaging of tissues with short intrinsic relaxation times by using an extremely short TE, and are increasingly used in the musculoskeletal system. We review the imaging physics of these sequences, practical limitations, and image reconstruction, and then discuss the clinical utilities in various disorders of the musculoskeletal system. ZTE can be readily incorporated into the clinical workflow, and is a promising technique to avoid unnecessary radiation exposure, cost, and time-consuming by computed tomography in some cases. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Akitaka Fujisaki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Jun Tsukamoto
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Hidekuni Narimatsu
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yo Todoroki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Natsumi Hirano
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Kazuki Takeda
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Sho Shin
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoru Ota
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenta Anai
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Satoshi Fukumitsu
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yuta Yoshimatsu
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yuichiro Kono
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Midori Ueno
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yu Murakami
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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Geng Y, Gao T, Zhang X, Wang Y, Zhang Z. The association between disease duration and mood disorders in rheumatoid arthritis patients. Clin Rheumatol 2021; 41:661-668. [PMID: 34689245 DOI: 10.1007/s10067-021-05967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
AIMS The mood disorders have been recognized as common comorbidities of rheumatoid arthritis (RA), however unknown in patients with different RA courses. Therefore, we aimed to investigate the status of mood disorders in early RA and non-early RA patients and further identify the associated factors for mood disorders. METHODS Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed in all enrolled RA patients. Besides clinical assessments, power Doppler and greyscale (GS) ultrasound of 28 joints was performed. The frequency of mood disorders was compared between early RA and non-early RA patients. Multivariate regression was used to identify the associated factors for mood disorders. RESULTS Tow hundred one RA patients were enrolled, with 76 early RA (disease duration ≤ 2 years) and 125 non-early RA (disease duration > 2 years). Mood disorders (depression and/or anxiety) were found in 42 (20.9%) patients. Depression was more frequently observed in early RA than non-early RA patients (26.3% vs. 14.4%, P = 0.036). A similar trend for anxiety was also observed in early RA compared to non-early RA patients, although the difference was insignificant (13.2% vs. 5.6%, P = 0.062). Disease duration (OR = 0.991, 95% CI 0.985-0.998, P = 0.009), health assessment questionnaire disability index (HAQ-DI) (OR = 1.045, 95% CI 1.005-1.086, P = 0.029) and GS synovitis score (OR = 1.065, 95% CI 1.017-1.115, P = 0.007) were identified as factors associated with depression. Disease duration (OR = 0.981, 95% CI 0.967-0.995, P = 0.009), HAQ-DI (OR = 1.071, 95% CI 1.013-1.133, P = 0.017) and GS synovitis score (OR = 1.072, 95% CI 1.012-1.136, P = 0.019) were identified to be associated with anxiety. CONCLUSIONS Depression and anxiety were almost doubled in frequency in early RA than in long-standing RA patients. RA patients with short disease duration, high HAQ-DI and GS score were more likely to be in depression and anxiety. Key Points • Mood disorders were more frequent in early RA than non-early RA patients. • More attention to psychological status is needed in RA patients. • RA patients with short disease duration, poor physical function and severe synovitis were more likely to have depression and/or anxiety.
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Affiliation(s)
- Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Tianjing Gao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Xiaohui Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China.
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Li J, Li L, Wang Y, Zhao Y, Hu P, Xu Z, Liu F, Liang Q, Tian X, Huang C. Systematic investigation on the anti-rheumatoid arthritis material basis and mechanism of Juan Bi Tang. Part 1: Integrating metabolic profiles and network pharmacology. J Pharm Biomed Anal 2021; 202:114133. [PMID: 34051482 DOI: 10.1016/j.jpba.2021.114133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
Previously, our cooperative team confirmed the chemical composition and anti-rheumatoid arthritis (RA) efficacy of Juanbi-Tang (JBT), a clinically and historically used traditional Chinese medicine formula, in two model animals. In this study, we developed an in vivo-in silico strategy to elucidate the anti-RA material basis and mechanism of JBT. With the aid of high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (HPLC-Q-TOF), the metabolic profiles were investigated in normal and collagen-induced arthritis RA rats following oral administration of JBT. Based on the absorbed constituents in RA rats, network pharmacology was employed to predict the anti-RA mechanisms, followed by molecular docking validation. Consequently, there were 18 absorbed compounds with 6 chemical structures, which were absolutely identified by matching with standard compounds in plasma, and 17 generated metabolites involved of 7 biotransformation pathways, including glucuronidation, sulfation, hydroxylation, deglycosylation, methylation, taurine, and glycine conjugation. Moreover, RA disease affected the absorption and metabolism of the constituents in JBT, given the undetected 2 absorbed compounds and 4 metabolites in RA rats. The analysis of network pharmacology indicated that those absorbed compounds in JBT may fight against RA through the MAPK, FoxO, and Rap1 pathways. Molecular docking also validated these results. Overall, this is the first study to describe the metabolic profiles of JBT-treated healthy and RA rats, and it provides a possible anti-RA mechanism through multiple absorbed compounds and targets by network pharmacology.
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Affiliation(s)
- Jiajia Li
- Shenyang University of Chemical Technology, Shenyang, 110142, China; Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Lei Li
- Shenyang University of Chemical Technology, Shenyang, 110142, China
| | - Yangyang Wang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Yuxuan Zhao
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Pei Hu
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Zhou Xu
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Fang Liu
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China
| | - Qianqian Liang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoting Tian
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China.
| | - Chenggang Huang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai, 201203, China; College of Life and Environmental Sciences, Shanghai Normal University, Shanghai, 201203, China.
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Liu W, Qian X, Ji W, Lu Y, Wei G, Wang Y. Effects and safety of Sinomenine in treatment of rheumatoid arthritis contrast to methotrexate: a systematic review and Meta-analysis. J TRADIT CHIN MED 2018; 36:564-77. [PMID: 29932627 DOI: 10.1016/s0254-6272(16)30075-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically evaluate the curative clinical efficacy and safety of sinomenine (SIN) in
treatment of rheumatoid arthritis (RA) in comparison to methotrexate (MTX). METHODS We searched the China National Knowledge Infrastructure Database, Chinese Biomedical
Literature Database, China Science and Technology Journal Database, Wanfang Database, Pubmed and
Cochrane Library electronically up to August 31, 2015, without language limitation. Only randomized
controlled trials (RCTs) were included. Software Review Manager 5.3 was used for Meta-analysis. RESULTS A total of 16 eligible studies within 1500 RA patients were included. The meta-analysis indicated
that on basis of MTX, SIN was more effective in total effective rate (P < 0.000 01). Besides, SIN
alone versus MTX also showed advantages in RA therapy (P = 0.04) Taken together, adverse events
occurred less frequently in combination of SIN and MTX than MTX alone (P < 0.0001), especially in digestive
system (P < 0.000 01),while occurred more in dermato mucosal system with SIN treatment versus
MTX (P = 0.02), and were similar for both remedies in nervous system (P = 0.12) and hematological
system (P = 0.25). CONCLUTION Compared to MTX, SIN had better clinical efficacy and relatively fewer adverse events
in treatment of RA, especially when it was used together with MTX. Due to the poor methodological
quality, well-designed, multiple-center RCTs are still required to further confirm the findings.
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McWilliams DF, Marshall M, Jayakumar K, Doherty S, Doherty M, Zhang W, Kiely PDW, Young A, Walsh DA. Erosive and osteoarthritic structural progression in early rheumatoid arthritis. Rheumatology (Oxford) 2016; 55:1477-88. [DOI: 10.1093/rheumatology/kew197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 12/14/2022] Open
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7
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Sim YS. Are DMARDs enough to prevent surgery in rheumatoid hands? BMC Proc 2015. [PMCID: PMC4445348 DOI: 10.1186/1753-6561-9-s3-a91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Association between Serum 25-Hydroxyvitamin D Level and Rheumatoid Arthritis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:913804. [PMID: 26064964 PMCID: PMC4434189 DOI: 10.1155/2015/913804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 02/05/2023]
Abstract
The objective of this study is to examine and evaluate whether serum 25(OH)D is associated with disease activity in patients with rheumatoid arthritis (RA). Our results suggested that serum 25(OH)D in RA groups has significant lower level (35.99 ± 12.59 nmol/L) than that in the normal groups (54.35 ± 8.20 nmol/L, P < 0.05). Based on the DAS28, patients with RA were divided into four subgroups, and no differences were found in the four groups (P > 0.05). The 25(OH)D levels in complete remission, low disease activity, middle disease activity, and high disease activity group were 32.86 ± 12.26, 33.97 ± 13.28, 38.41 ± 10.64, and 38.94 ± 13.35 nmol/L, respectively. Based on the serum 25(OH)D levels, patients with RA were divided into inadequate group and normal group, and there were no significant differences in baseline characteristics and disease activity in the two groups. Our results showed that serum 25(OH)D levels in the inadequate group are significantly lower than those in the normal group. However, no correlations were found between 25(OH)D levels and disease activity among 116 patients with RA. The present findings will help to understand the association between 25(OH)D and disease activity of RA.
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Tutoğlu A, Boyaci A, Boyaci N, Kaya Z, Aridici R, Koca I. Is There Any Relationship between Joint Destruction and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis? J Phys Ther Sci 2014; 26:1093-6. [PMID: 25140104 PMCID: PMC4135205 DOI: 10.1589/jpts.26.1093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/30/2014] [Indexed: 12/22/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the possible relationship between joint destruction and carotid intima-media thickness in patients with rheumatoid arthritis. [Subjects and Methods] Thirty-four RA patients and 31 healthy controls were enrolled in this study. The disease activity for 28 joints was recorded for each patient using the erythrocyte sedimentation rate (DAS28ESR), a visual analog scale (VAS0-10 cm), and a disability index, the health assessment questionnaire (HAQ). X-ray imagesof the patients were scored according to the modified Sharp/van der Heijde method, and the common carotid intimal medial thickness (CIMT) was automatically measured with software using high-resolution Doppler ultrasound. [Results] Contrary to our hypothesis, the modified total Sharp score (mTSS) and CIMT were not significantly associated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the RA patients and the right CIMT, left CIMT, and mean CIMT scores were significantly elevated. Positive correlation was detected between the mean CIMT score and age, CRP levels, LDL concentration and triglycerides (TG) level. In the regression model, where the mean CIMT was the independent variable and age, CRP, LDL, and TG were dependent variables, age was found to be an independent predictor of CIMT. [Conclusions] Patients suffering from RA require close monitoring for cardiovascular risks, and the comorbidity of age-related cardiovascular disease should not be overlooked.
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Affiliation(s)
- Ahmet Tutoğlu
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Turkey
| | - Ahmet Boyaci
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Turkey
| | - Nurefsan Boyaci
- Department of Radiology, Harran University Medical School, Turkey
| | - Zekeriya Kaya
- Department of Cardiology, Harran University Medical School, Turkey
| | - Rifat Aridici
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Turkey
| | - Irfan Koca
- Department of Physical Medicine and Rehabilitation, Gaziantep University Medical School, Turkey
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Tomosynthesis of the Wrist and Hand in Patients With Rheumatoid Arthritis: Comparison With Radiography and MRI. AJR Am J Roentgenol 2014; 202:386-90. [DOI: 10.2214/ajr.12.10029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hamad MB, Marzouk S, Kaddour N, Masmoudi H, Fakhfakh F, Rebai A, Bahloul Z, Maalej A. Anticyclic citrullinated peptide antibody and rheumatoid factor in south Tunisian patients with rheumatoid arthritis: association with disease activity and severity. J Clin Lab Anal 2013; 28:21-6. [PMID: 24375820 DOI: 10.1002/jcla.21638] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 05/15/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To explore relationships between immunological status, clinical features, radiographic damage, disease activity, and functional disability in Tunisian patients with rheumatoid arthritis (RA). MATERIALS AND METHODS The study was carried out in 112 patients with RA. Demographic characteristics, disease duration, disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ), and the Sharp/van der Heijde score were collected. Anticyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor (RF) were performed. RESULTS We found that anti-CCP positivity was associated with longer disease duration (P = 0.001), presence of RF (P = 4.89 × 10(-8) ), and night pain positivity (P = 0.025). Patients with positive RF had more night pain and higher anti-CCP positivity (for all P ≤ 0.05). Anti-CCP titer was correlated with disease duration (P = 0.034) and Sharp total score (P = 1.2 × 10(-4) ). Moreover, there was a significant correlation between RF and anti-CCP antibodies titers (P = 0.011). Indeed, DAS28 correlated with HAQ (P = 1.8 × 10(-7) ) and morning stiffness duration (P = 0.045). In multivariate regression analysis, the main factors associated with anti-CCP titers were radiographic damage (P = 1.625 × 10(-4) ) and RF (P = 0.013). For DAS28, only HAQ (P = 2.9 × 10(-4) ) was associated. CONCLUSION These findings suggest that anti-CCP antibodies are associated with RF and more severe joint damage. Moreover, disease activity is associated with functional disability.
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Affiliation(s)
- Mariem Ben Hamad
- Laboratory of Human Molecular Genetics, Faculty of Medicine, University of Sfax, Sfax, Tunisia
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Filková M, Aradi B, Senolt L, Ospelt C, Vettori S, Mann H, Filer A, Raza K, Buckley CD, Snow M, Vencovský J, Pavelka K, Michel BA, Gay RE, Gay S, Jüngel A. Association of circulating miR-223 and miR-16 with disease activity in patients with early rheumatoid arthritis. Ann Rheum Dis 2013; 73:1898-904. [PMID: 23897768 PMCID: PMC4173742 DOI: 10.1136/annrheumdis-2012-202815] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Identification of parameters for early diagnosis and treatment response would be beneficial for patients with early rheumatoid arthritis (ERA) to prevent ongoing joint damage. miRNAs have features of potential biomarkers, and an altered expression of miRNAs was shown in established rheumatoid arthritis (RA). OBJECTIVE To analyse RA associated miRNAs in the sera of patients with ERA to find markers of early disease, clinical activity or predictors of disease outcome. METHODS Total RNA was isolated from whole sera in ERA patients (prior to and after 3 and 12 months of therapy with disease modifying antirheumatic drugs), in patients with established RA and in healthy controls (HC) using phenol-chloroform extraction. Expression of miR-146a, miR-155, miR-223, miR-16, miR-203, miR-132 and miR-124a was analysed by TaqMan Real Time PCR. RESULTS From all analysed miRNAs, levels of miR-146a, miR-155 and miR-16 were decreased in the sera of ERA patients in comparison with established RA. A change in circulating miR-16 in the first 3 months of therapy was associated with a decrease in DAS28 in long term follow-up in ERA (p=0.002). Levels of circulating miR-223 in treatment naïve ERA correlated with C reactive protein (p=0.008), DAS28 (p=0.031) and change in DAS28 after 3 months (p=0.003) and 12 months (p=0.011) of follow-up. However, neither miR-16 nor miR-223 could distinguish ERA from HC. CONCLUSIONS Differential expression of circulating miR-146a, miR-155 and miR-16 in the sera of ERA patients may characterise an early stage of the disease. We suggest miR-223 as a marker of disease activity and miR-16 and miR-223 as possible predictors for disease outcome in ERA.
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Affiliation(s)
- Mária Filková
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Borbala Aradi
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ladislav Senolt
- Department of Clinical and Experimental Rheumatology of the 1st Faculty of Medicine, Institute of Rheumatology, Charles University in Prague, Prague, Czech Republic
| | - Caroline Ospelt
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Serena Vettori
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Heřman Mann
- Department of Clinical and Experimental Rheumatology of the 1st Faculty of Medicine, Institute of Rheumatology, Charles University in Prague, Prague, Czech Republic
| | | | - Karim Raza
- University of Birmingham, Birmingham, UK
| | | | - Martyn Snow
- Royal Orthopaedic Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jiří Vencovský
- Department of Clinical and Experimental Rheumatology of the 1st Faculty of Medicine, Institute of Rheumatology, Charles University in Prague, Prague, Czech Republic
| | - Karel Pavelka
- Department of Clinical and Experimental Rheumatology of the 1st Faculty of Medicine, Institute of Rheumatology, Charles University in Prague, Prague, Czech Republic
| | - Beat A Michel
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Renate E Gay
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen Gay
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Jüngel
- Centre of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Viatte S, Plant D, Lunt M, Fu B, Flynn E, Parker BJ, Galloway J, Solymossy C, Worthington J, Symmons DPM, Dixey JJ, Young A, Barton A. Investigation of rheumatoid arthritis genetic susceptibility markers in the early rheumatoid arthritis study further replicates the TRAF1 association with radiological damage. J Rheumatol 2012; 40:144-56. [PMID: 23242182 DOI: 10.3899/jrheum.121034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The TRAF1 genetic region conferring susceptibility to rheumatoid arthritis (RA) has been reported to associate with radiological damage. We aimed to test RA genetic susceptibility markers for association with a continuous measure of radiological damage over time using longitudinal modeling techniques. METHODS Sixty-seven RA susceptibility variants were genotyped in 474 patients in the Early Rheumatoid Arthritis Study (ERAS) using Sequenom MassArray technology. Correlation between genetic markers and Larsen score was assessed longitudinally using zero-inflated negative binomial regression to include repeat measurements in the same individual at different timepoints. Genetic markers associated with radiological damage in ERAS were tested using the same modeling techniques on previously published data from the Norfolk Arthritis Register (NOAR). RESULTS The single marker associated longitudinally with Larsen score in ERAS (p = 0.02) and in NOAR (p = 0.04) was rs2900180 at the TRAF1 locus. Analysis of individual timepoints in ERAS showed that rs2900180 displays its effect primarily on the extent of Larsen score early in the disease course. Combined longitudinal analysis of the 2 cohorts suggests further association of several loci with Larsen score (KIF5A, PTPN22, AFF3, TAGAP) and therefore a significant accumulation of RA severity markers among RA susceptibility markers (p = 0.016). CONCLUSION The marker rs2900180 is associated with the extent of radiological damage in the ERAS cohort. This represents the second independent study correlating rs2900180 at the TRAF1 locus with radiological severity in RA. Replication in a large dataset is required to establish the role of other RA susceptibility loci in disease severity.
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Affiliation(s)
- Sebastien Viatte
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Aoki T, Yamashita Y, Oki H, Takahashi H, Hayashida Y, Saito K, Tanaka Y, Korogi Y. Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) of the wrist and finger at 3T: comparison with chemical shift selective fat suppression images. J Magn Reson Imaging 2012; 37:733-8. [PMID: 22911970 DOI: 10.1002/jmri.23795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/31/2012] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare fat-suppressed magnetic resonance imaging (MRI) quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using chemical shift selective fat-suppressed T1-weighted spin-echo (CHESS) images for evaluating rheumatoid arthritis (RA) lesions of the hand and finger at 3T. MATERIALS AND METHODS MRI was performed in eight healthy volunteers and eight RA patients with a 3.0T MR system (Signa HDxt GE healthcare) using an eight-channel knee coil. FS-CHESS-T1-SE and IDEAL imaging were acquired in the coronal planes covering the entire structure of the bilateral hands with a slice thickness of 2 mm. In the RA patients both images were obtained after intravenous gadolinium administration. Image quality was evaluated on a five-point scale (1 = excellent to 5 = very poor). Synovitis and bone marrow contrast uptake on MR images were reviewed by two musculoskeletal radiologists using the Rheumatoid Arthritis MRI Scoring System (RAMRIS) of the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) group. RESULTS IDEAL showed uniform FS unaffected by magnetic field inhomogeneity and challenging geometry of hand and fingers, while CHESS-T1-SE often showed FS failure within the first metacarpal joint, tip of the finger, and ulnar aspect of the wrist joint. Overall image quality was significantly better with IDEAL than CHESS-T1-SE images (4.43 vs. 3.43, P < 0.01). Interobserver agreement (κ value) for synovitis and bone marrow contrast uptake was good to excellent with IDEAL (0.74-0.91, 0.62-0.89, respectively). CONCLUSION IDEAL could compensate for the effects of field inhomogeneities, providing uniform FS of the hand and finger than did the CHESS-T1-SE sequence.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Aoki T, Yamashita Y, Saito K, Tanaka Y, Korogi Y. Diagnosis of early-stage rheumatoid arthritis: usefulness of unenhanced and gadolinium-enhanced MR images at 3 T. Clin Imaging 2012; 37:348-53. [PMID: 23465990 DOI: 10.1016/j.clinimag.2012.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/08/2012] [Accepted: 07/15/2012] [Indexed: 12/18/2022]
Abstract
Forty-one consecutive unclassified arthritis patients with polyarthralgia including wrist joint were evaluated with 3-T MRI as possible early-stage rheumatoid arthritis (RA). After prospective follow-up, 21 of 41 patients fulfilled the American College of Rheumatology (ACR) criteria. Synovitis was detected in all 21 RA patients (sensitivity=100%) with postcontrast MRI and in 14 patients (67%) with unenhanced MRI when none of them fulfilled ACR diagnostic criteria. Fat-suppressed intermediate-weighted fast spin-echo (FSE) image showed high detection rate of synovitis and bone erosion, whereas FIESTA image clearly delineated joint fluid and bone trabeculae. MRI at 3 T is a potentially powerful tool for discriminating and managing early-stage RA patients.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental, Health, Kitakyushu, Japan.
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Changes in proliferation kinetics of T cells: a new predictive cellular biomarkers for early rheumatoid arthritis? J Clin Immunol 2012; 32:991-9. [PMID: 22526594 PMCID: PMC3443480 DOI: 10.1007/s10875-012-9692-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/30/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE It has been demonstrated that early treatment of rheumatoid arthritis (RA) patients prevents further joint damage and disability, but biomarkers enabling early RA to be distinguished within the undifferentiated arthritis (UA) cohort are still being sought. PURPOSE The aim of the research was to study the pathomechanism of initiation and progression of UA→RA and to find such new predictive biomarkers on the basis of functional studies of the immune system. METHODS 55 patients with UA were enrolled into the study and followed up for 2 years. The dynamic parameters of proliferation of the peripheral blood CD4+ T cells were recorded at the UA stage. During the follow-up study, standard diagnostic procedures were performed to make the final diagnosis. Comparison of the CD4+ T cell proliferation parameters in the UA-RA and UA-non-RA patients was conducted after the final diagnosis was established. RESULTS Our studies showed that the G0-G1 transition time, the cell cycle duration, the number of cell divisions per dividing CD4+ cells and the percentage of dividing CD4+ T cells differed significantly between UA-RA and UA-non-RA patients. Moreover, these proliferation parameters achieved higher specificity and sensitivity in the detection of early RA within UA patients compared to the routine serological tests available. CONCLUSION The proliferation parameters of CD4+ T cells reflect central pathophysiological changes in RA and can be used as new biomarkers for early RA diagnosis, which would enable the international rheumatology recommendation to be achieved concerning the early diagnosis and treatment of RA patients.
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A comparative study on the diversity of clinical features between the sero-negative and sero-positive rheumatoid arthritis patients. Rheumatol Int 2011; 32:3897-901. [PMID: 22198665 DOI: 10.1007/s00296-011-2329-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Abstract
To investigate the similarities and differences in clinical features between the sero-negative and sero-positive rheumatoid arthritis (RA) patients. Two hundred and sixty-two RA patients who fulfilled the 1987 ACR RA Classification Criteria were enrolled into this study. They were divided into sero-negative and sero-positive group depending on the presence or absence of rheumatoid factor (RF) and anti-cyclic citrullinate peptide (anti-CCP). The clinical features were compared between these two groups. Forty-six (17.6%) RA patients were classified as sero-negative group. The disease onset of sero-negative RA patients was later than that of sero-positive RA patients (52.4 ± 15.9 vs. 47.4 ± 15.5 years, P < 0.05). At the end of the first 2 years after disease onset, bone erosion shown in the hand X-ray occurred in 4 out of 24 (16.7%) patients with sero-negative RA. However, only 5.2% (5/97) patients with sero-positive RA developed bone erosion (P < 0.05). In the sero-positive RA patients, the titer of RF was correlated with swollen joint counts (SJC), tender joint counts (TJC), erythrocyte sedimentation rate (ESR), and disease activity score in 28 joints (DAS28) (P < 0.05), but anti-CCP was not. Sero-negative and sero-positive RA are probably two distinct disease subtypes driven by different mechanisms.
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Liu XD, Chen Y, Liu FY, Ye LH, Cai L. Effect of Wenhua Juanbi recipe on proliferation and apoptosis of synoviocytes in rats with collagen-inducing arthritis. Chin J Integr Med 2011; 19:453-8. [PMID: 21717160 DOI: 10.1007/s11655-011-0753-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effect of Wenhua Juanbi Recipe (WJR) on proliferation and apoptosis of synoviocytes in rats with collagen-inducing arthritis (CIA). METHODS A CIA model was induced by intradermal injection of bovine collagen type II emulsion at the base of rat tails. Thirty modeled healthy Wistar rats were randomly assigned to one of three groups (10 per group): the model group, the methotrexate (MTX)-treated group (0.78 mg/kg) and the WJR-treated group (22.9 g/kg). A group of 10 healthy rats was used as normal control. Treatments or normal saline for the control group were administered by oral gavage once daily. Rats were sacrificed after 30-day treatment and subjected to the following examinations: arthritis index (AI) was estimated, inflammatory cell infiltration and proliferation in synovial membrane were evaluated by microscopy, the synoviocyte apoptosis was determined by TUNEL assay, and the cell apoptosis index was calculated. RESULTS AI was lowered significantly in the WJR group compared to the model group (P<0.01). The pathological findings observed in the model group were reversed in the WJR group, including increase in inflammatory cell infiltration and synoviocyte proliferation in synovial membrane and reduction in cell apoptosis index (all P<0.01). CONCLUSIONS Synoviocyte proliferation and apoptosis reduction were present in CIA rats. WJR was effective in treating the rat model of CIA. The therapeutic effect might be exerted through inducing apoptosis and suppressing proliferation of synoviocytes.
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Affiliation(s)
- Xi-de Liu
- Department of Arthropathy, Zhejiang Provincial Hospital of Integrated Traditional and Western Medicine, Hangzhou, China.
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Clinical features of rheumatoid arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Farragher TM, Lunt M, Plant D, Bunn DK, Barton A, Symmons DPM. Benefit of early treatment in inflammatory polyarthritis patients with anti-cyclic citrullinated peptide antibodies versus those without antibodies. Arthritis Care Res (Hoboken) 2010; 62:664-75. [PMID: 20461787 PMCID: PMC2962800 DOI: 10.1002/acr.20207] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective To compare the clinical utility of anti–cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) testing in predicting both functional outcome and response to treatment in early inflammatory polyarthritis (IP) patients. Methods A total of 916 IP subjects from a primary care incidence registry (1990–1994) had anti-CCP antibody and RF status determined at baseline. Mean change in Health Assessment Questionnaire (HAQ) score between baseline and 5 years was compared by antibody status. The effect of treatment with disease-modifying antirheumatic drugs and/or steroids over 5 years, early (<6 months of symptom onset) versus late initiation, and duration of treatment were also compared by anti-CCP antibody status. The analysis was adjusted for treatment decisions and censoring over the followup, using marginal structural models. Results Anti-CCP antibody–positive patients (n = 268) had more severe disease both at presentation and 5 years of followup, and this was independent of RF. On adjustment, anti-CCP antibody–negative patients treated early experienced a significant improvement in functional disability compared with anti-CCP antibody–negative patients who were never treated (−0.31; 95% confidence interval [95% CI] −0.53, −0.08), and experienced additional benefit for each additional month of early treatment. Anti-CCP antibody–positive patients treated early did not have a significant improvement in HAQ score compared with those not treated (−0.14; 95% CI −0.52, 0.24). Conclusion In this first observational study to examine the influence of anti-CCP antibody status on treatment response, anti-CCP antibody–positive IP patients showed less benefit from treatment, particularly early treatment, than anti-CCP antibody–negative patients. This provides support for the inclusion of anti-CCP antibodies as well as RF in the classification criteria for rheumatoid arthritis and for stratification by anti-CCP antibody status in clinical trials.
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Affiliation(s)
- Tracey M Farragher
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
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Farragher TM, Lunt M, Fu B, Bunn D, Symmons DPM. Early treatment with, and time receiving, first disease-modifying antirheumatic drug predicts long-term function in patients with inflammatory polyarthritis. Ann Rheum Dis 2009; 69:689-95. [PMID: 19858538 PMCID: PMC2927614 DOI: 10.1136/ard.2009.108639] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the influence of early disease-modifying antirheumatic drug (DMARD) treatment on long-term functional outcome in patients with recent-onset inflammatory polyarthritis (IP), and the impact of the duration of first and subsequent DMARD treatment. METHODS 642 subjects from a primary care registry of patients with new-onset IP, recruited 1990-4, were followed up for 10 years. Mean change in Health Assessment Questionnaire (HAQ) scores between baseline and 10 years were compared by time to, and time receiving, first DMARD treatment and total time receiving treatment, using linear regression. Adjustment for time-dependent confounders and censoring was performed using marginal structural weights. RESULTS When adjusted for baseline and subsequent disease severity, those treated early (<6 months from symptom onset) experienced a non-significant improvement in function compared with those never treated (adjusted mean difference in change (adj_MDIC) in HAQ -0.24; 95% CI -0.58 to 0.09); and a significant benefit for each additional month of treatment within 6 months of the onset of symptoms (adj_MDIC -0.10; 95% CI -0.19 to -0.02). Patients who discontinued their first DMARD within 6 months experienced a significant deterioration in long-term function (adj_MDIC in HAQ 0.28; 95% CI 0.04 to 0.52), while those who continued their first treatment for > 3 years experienced an improvement (adj_MDIC in HAQ -0.37; 95% CI -0.77 to 0.04). CONCLUSIONS The importance of time to, and response to, first DMARD treatment and total duration of DMARD treatment in modifying the 10-year function in patients with IP has been demonstrated.
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Affiliation(s)
- Tracey M Farragher
- arc Epidemiology Unit, The University of Manchester, Oxford Road, Manchester, UK
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What can we learn from the presence of anti-cyclic citrullinated peptide antibodies in systemic lupus erythematosus? Joint Bone Spine 2009; 76:501-7. [PMID: 19289297 DOI: 10.1016/j.jbspin.2008.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 11/20/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anti-cyclic citrullinated peptide (anti-CCP) antibodies have proved to be a specific marker for the diagnosis of rheumatoid arthritis (RA). However, the antibodies can also be detected in other rheumatic diseases, especially systemic lupus erythematosus (SLE). Recent studies have shown anti-CCP antibodies are associated with erosive arthritis in SLE patients. Since erosive arthritis is not common in SLE and many patients with non-erosive arthritis also have anti-CCP antibodies, the clinical significance of anti-CCP antibodies in SLE needs to be further studied. OBJECTIVE To investigate the prevalence and clinical significance of anti-CCP antibodies in Chinese SLE patients. METHODS Serum samples from 138 SLE patients were examined for anti-CCP with the second generation anti-CCP detection kit. The associations of anti-CCP with clinical and laboratory features, especially arthritis, in such SLE patients were analyzed. RESULTS The prevalence of anti-CCP was 13.8% (19/138) in Chinese SLE patients. Seventy of 138 SLE patients had experienced arthritis, of whom 14 patients were anti-CCP+. Significantly, anti-CCP antibodies were more frequently found in SLE patients with arthritis than without arthritis (20% vs 7.4%, P<0.05). A statistical correlation between anti-CCP and rheumatoid factor (RF) was found in SLE patients with arthritis (r=0.36, P=0.002). The frequency of arthritis was significantly higher in SLE patients with anti-CCP than without (73.7% vs 47.1%,P<0.05). Eight out of 138 SLE patients showed joint erosions on radiographs. When compared with anti-CCP- patients, erosive arthritis occurred more often in anti-CCP+ patients (35.7% vs 5.4%, P<0.001). Interestingly, two patients without anti-CCP and RF who had erosive arthritis were anti-RA33 antibodies positive. All of 8 SLE patients with erosive arthritis in our study fulfilled 1987 ACR criteria for RA. With regard to other clinical and laboratory features, there were no differences between SLE patients with arthritis and without or between anti-CCP+ patients and anti-CCP- patients. CONCLUSIONS Anti-CCP antibodies have a frequency of 13.8% in Chinese SLE patients and its presence is closely associated with the onset of arthritis and bone erosion.
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Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D. Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. ACTA ACUST UNITED AC 2007; 56:2143-9. [PMID: 17599737 DOI: 10.1002/art.22722] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous in vitro and animal studies have suggested that vitamin D, in particular, its metabolite 25-hydroxyvitamin D (25[OH]D), may have immunomodulatory effects. To study further the potential immunomodulatory effects of vitamin D in humans, we explored the hypothesis that serum vitamin D metabolites may be inversely associated with current disease activity, severity, and functional disability in patients with early inflammatory polyarthritis (IP). METHODS We studied 206 consecutive patients with IP who were enrolled in the Norfolk Arthritis Register between January 2000 and November 2003 inclusive. Patients were studied within 6 months of symptom onset. None of the patients was taking steroids, and all had received <6 weeks of disease-modifying therapy. Associations between serum levels of 25(OH)D and 1,25-dihydroxyvitamin D (1,25[OH](2)D) at baseline and the swollen and tender joint counts, Health Assessment Questionnaire (HAQ) scores, C-reactive protein (CRP) levels, and the Disease Activity Score 28-joint assessment (DAS28) scores at baseline and 1 year were assessed. RESULTS The median age at symptom onset was 59 years (range 20-88 years), with a median disease duration of 4 months. At baseline, there was an inverse relationship between 25(OH)D levels and the tender joint count, DAS28 score, and HAQ score. The only inverse relationship with 1,25(OH)(2)D was with the HAQ score. Each 10-ng/ml increase in the level of 25(OH)D was associated with a decrease in the DAS28 score of 0.3 and in the CRP level of approximately 25%. At 1 year, the only significant result was an inverse association between baseline vitamin D metabolite levels and the HAQ score; that is, those with higher metabolite levels had lower HAQ scores. CONCLUSION These data provide further support that vitamin D plays an immunomodulatory role in inflammatory arthritis. This association needs to be examined in other cohorts of patients with early IP, as well as in longitudinal studies. If confirmed, the clinical response to vitamin D supplementation should be examined in early IP.
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Affiliation(s)
- Sanjeev Patel
- St. Helier University Hospital, Carshalton, London, UK.
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Naseem H, Thomson W, Silman A, Worthington J, Symmons D, Barton A. The PTPN22*C1858T functional polymorphism is associated with susceptibility to inflammatory polyarthritis but neither this nor other variants spanning the gene is associated with disease outcome. Ann Rheum Dis 2007; 67:251-5. [PMID: 17666450 PMCID: PMC3055597 DOI: 10.1136/ard.2007.071894] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The PTPN22 gene has been widely confirmed as a susceptibility gene for rheumatoid arthritis (RA) in populations of Northern European descent. The aim of the current study was to explore the role of variants spanning the PTPN22 gene in determining susceptibility to and outcome of inflammatory polyarthritis (IP). PATIENTS AND METHODS Single nucleotide polymorphism (SNP) variants spanning the gene were genotyped using the Sequenom MassArray platform and tested, firstly for their association with susceptibility to IP. Genotype frequencies were compared between new onset IP cases (n = 843) and population controls (n = 471). Secondly, a within-cohort analysis was performed testing each variant for association with a number of clinical outcome measures reflecting disease severity including radiological erosions, physical function, measured using the Health Assessment Questionnaire (HAQ) score, and disease activity at defined time-points following disease presentation. RESULTS A significant association between carriage of the PTPN22*1858T allele and IP (odds ratio (OR) = 1.4 (95% CI 1.1-1.9), p = 0.02) was observed. The strength of the effect was similar in the RA subgroup (OR = 1.4 (95% CI 1.0-1.9), p = 0.05). No association between IP susceptibility and any of the other SNPs was detected. No association was detected for any of the SNPs tested, including the PTPN22*C1858T polymorphism, for either erosive status, Larsen score by 5 years or other markers of clinical outcome. CONCLUSION The PTPN22*C1858T polymorphism is associated with susceptibility to IP, but we have found no evidence for association of this or other variants spanning the gene with clinical outcome measures.
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Affiliation(s)
- H Naseem
- ARC Epidemiology Unit, University of Manchester, UK
| | - W Thomson
- ARC Epidemiology Unit, University of Manchester, UK
| | - A Silman
- ARC Epidemiology Unit, University of Manchester, UK
| | | | - D Symmons
- ARC Epidemiology Unit, University of Manchester, UK
| | - A Barton
- ARC Epidemiology Unit, University of Manchester, UK
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Sanmartí R, Gómez-Centeno A, Ercilla G, Larrosa M, Viñas O, Vazquez I, Gómez-Puerta JA, Gratacós J, Salvador G, Cañete JD. Prognostic factors of radiographic progression in early rheumatoid arthritis: a two year prospective study after a structured therapeutic strategy using DMARDs and very low doses of glucocorticoids. Clin Rheumatol 2007; 26:1111-8. [PMID: 17109060 PMCID: PMC9110530 DOI: 10.1007/s10067-006-0462-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 09/29/2006] [Accepted: 09/30/2006] [Indexed: 11/30/2022]
Abstract
The objective of the study was to analyze the prognostic factors of radiographic progression in a series of patients with early rheumatoid arthritis (RA) after 2 years of therapy with a structured algorithm using disease-modifying antirheumatic drugs (DMARDs) and very low doses of oral glucocorticoids. One hundred and five patients (81% female) with early RA (disease duration <2 years) treated with the same therapeutic protocol using gold salts and methotrexate in a step-up strategy, together with methylprednisolone (4 mg/day), were followed up for 2 years. The outcome variable was radiographic progression after 2 years of DMARD therapy using the modified Larsen method. Clinical, biological, immunogenetic, and radiographic data were analyzed at study entry and after 1 and 2 years of follow-up. Radiographic progression (increase of four or more units in the Larsen score) was observed in 32% of patients after 2 years of follow-up. The percentage of erosive disease increased from 18.3% at baseline to 28.9% at 12 months and 44.6% at 24 months, in spite of a significant improvement in disease activity. New erosions appeared in 33% of patients after 2 years. Several baseline parameters were associated with radiographic progression in the univariate analysis: shared epitope (SE) homozygozity, HLA-DRB*04 alleles, female gender, hemoglobin, erythrocyte sedimentation rate, and anticyclic citrullinated peptide antibodies (anti-CCP). In the multivariate analysis, female gender [odds ratio (OR) 5.5, 95% confidence interval (CI): 1.1-28.2, p = 0.04], DRB1*04 alleles (OR 3.1, 95% CI 1.1-9, p = 0.03) and, marginally, anti-CCP antibodies (OR 3.6, 95% CI 0.9-14.5, p = 0.06), were associated with progression. Female patients with both DRB1*04 alleles and anti-CCP antibodies showed the highest scores in radiographic progression. The presence, but not the titer, of anti-CCP antibodies predicted progression. The positive predictive value of the multivariate model for progression was only 53.9% whereas the negative predictive value was 80.3%. In a series of early RA patients treated with a structured algorithm using DMARDs and very low doses of glucocorticoids, radiographic progression was observed in one third of patients after 2 years. Female gender, DRB1*04 alleles (rather than the SE), and the presence of anti-CCP antibodies at baseline (independently of the titer) were the most important predictors of progression. The utility of these parameters in clinical practice is limited by their relatively low positive predictive value.
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Affiliation(s)
- R Sanmartí
- Arthritis Unit, Rheumatology Service, IDIBAPS, Hospital Clinic of Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Symmons DPM, Silman AJ. Aspects of early arthritis. What determines the evolution of early undifferentiated arthritis and rheumatoid arthritis? An update from the Norfolk Arthritis Register. Arthritis Res Ther 2007; 8:214. [PMID: 16817941 PMCID: PMC1779379 DOI: 10.1186/ar1979] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Over 3500 patients with recent onset inflammatory polyarthritis (IP) have been recruited by the Norfolk Arthritis Register (NOAR) since 1990. Longitudinal data from this cohort have been used to examine the prevalence and predictors of remission, functional disability, radiological outcome, cardiovascular mortality and co-morbidity and the development of non-Hodgkin's lymphoma. Rheumatoid factor titre, high baseline C-reactive protein and high baseline HAQ score are all predictors of a poor outcome. There is a strong association between possession of the shared epitope and the development of erosions. Patients who satisfy the American College of Rheumatology criteria for rheumatoid arthritis (RA) have a worse prognosis than those who do not. However, it appears that these patients are a poorly defined subset of all those with IP rather than having an entirely separate disease entity. New statistical techniques offer exciting possibilities for using longitudinal datasets such as NOAR to explore the long-term effects of treatment in IP and RA.
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Kudo-Tanaka E, Ohshima S, Ishii M, Mima T, Matsushita M, Azuma N, Harada Y, Katada Y, Ikeue H, Umeshita-Sasai M, Miyatake K, Saeki Y. Autoantibodies to cyclic citrullinated peptide 2 (CCP2) are superior to other potential diagnostic biomarkers for predicting rheumatoid arthritis in early undifferentiated arthritis. Clin Rheumatol 2007; 26:1627-33. [PMID: 17286215 DOI: 10.1007/s10067-007-0558-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 01/15/2007] [Accepted: 01/16/2007] [Indexed: 12/01/2022]
Abstract
We evaluated the diagnostic value of anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies and other potential diagnostic biomarkers (IgM rheumatoid factor, anti-agalactosyl IgG antibodies, matrix metalloproteinase 3, C-reactive protein) for predicting early development of rheumatoid arthritis (RA). Patients were defined as having recent-onset undifferentiated arthritis (UA) if they had developed arthritis in two or more joints within the previous 2 years and could not be classified with a well-defined arthropathy. Baseline levels of biomarkers were measured in blood samples collected at the entry of the study and the patients were followed for 1 year to monitor development of RA. Diagnoses of RA and non-RA arthropathies were made according to individual standard diagnostic criteria. A total of 146 patients were enrolled in the study. In the follow-up year, 18 patients developed RA, 54 developed non-RA arthropathies, and 60 remained in the UA category. The sensitivity and specificity of the presence of anti-CCP2 antibodies for the diagnosis of RA were 83.3 and 93.0%, respectively. The positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of anti-CCP2 antibodies for RA (65.2, 97.2, and 91.7%, respectively) were higher than for any other biomarker. Combination of anti-CCP2 with any other biomarker only slightly improved each diagnostic value compared to the presence of anti-CCP2 alone. Among the anti-CCP2-positive patients, the average titer was significantly higher in those with RA than in non-RA or UA patients (163.7 +/- 138.4 vs 55.2 +/- 72.0 U/ml, p = 0.017). Anti-CCP2 antibodies are superior to any other single biomarker for predicting early development of RA in patients with recent-onset UA and the diagnostic value of anti-CCP2 alone is similar to that for biomarker combinations. Moreover, the anti-CCP2 antibody titer is useful to discriminate between patients at high risk for early developing RA from those at risk of developing non-RA arthropathies.
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Affiliation(s)
- Eriko Kudo-Tanaka
- Department of Clinical Research, NHO Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka 586-8521, Japan
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Abstract
Rheumatoid arthritis (RA) is common and leads to joint damage due to persistent synovitis. The persistence of inflammation is maintained by hyperplastic stromal tissue, which drives the accumulation of leukocytes in the synovium. Aggressive treatment after the first 3-4 months of symptoms, with either disease modifying anti-rheumatic drugs or anti-tumor necrosis factor (TNF)-alpha therapy, reduces the rate of disease progression. However, it rarely switches off disease such that remission can be maintained without the continued need for immunosuppressive therapy. There is increasing evidence that the first few months after symptom onset represent a pathologically distinct phase of disease. This very early phase may translate into a therapeutic window of opportunity during which it may be possible to permanently switch off the disease process. The rationale for, and approaches to, treatment within this very early window are discussed.
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Affiliation(s)
- Karim Raza
- Rheumatology Research Group, Division of Immunity and Infection, Institute of Biomedical Research, MRC Centre for Immune Regulation, University of Birmingham, Birmingham B15 2TT, UK.
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Bukhari M, Lunt M, Barton A, Bunn D, Silman A, Symmons D. Increasing age at symptom onset is associated with worse radiological damage at presentation in patients with early inflammatory polyarthritis. Ann Rheum Dis 2006; 66:389-93. [PMID: 16950810 PMCID: PMC1855997 DOI: 10.1136/ard.2006.055657] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increasing age at onset has been associated with worse outcome in rheumatoid arthritis, although there are few data from unselected inception cohorts. HYPOTHESIS Increasing age is associated with a higher risk of erosions at presentation, and this increase is not explained by age-related disease confounders. SUBJECTS AND METHODS 222 subjects (median onset age 59 years) were studied from a primary-care-based register of new-onset inflammatory polyarthritis. Patients had hand and feet radiographs taken within 12 months from symptom onset. Films were scored by two readers using the Larsen score. The risk of erosions in those aged 50-69 and >or=70 years at onset was compared with the risk in those aged <50 years both before and after adjustment for possible age-related disease confounders. RESULT The prevalences of erosions were 22%, 52% and 71% in those aged <50, 50-69 and >or=70 years at onset equivalent to odds ratios (ORs) (95% confidence intervals (CIs)) of 3.5 (2.2 to 5.7) and 7.4 (4.5 to 12.1), respectively, in the two older age groups. Excluding those with proximal interphalangeal (PIP) erosions alone (due to possible osteoarthritis) did not alter these findings. Adjustments for disease characteristics using logistic regression did not attenuate these findings: adjusted ORs (95% CIs) 3.6 (2.1 to 6.1) and 6.9 (3.8 to 12.2) for age groups 50-69 and >or=70 years, respectively. The influence of age was stronger than most of the disease-related variables in predicting erosions in this cohort. CONCLUSION Increasing age at symptom onset is strongly associated with higher occurrence of erosions within the first year unexplained by greater disease severity.
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Affiliation(s)
- Marwan Bukhari
- ARC Epidemiology Unit, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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30
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Mierau R, Genth E. Diagnosis and prognosis of early rheumatoid arthritis, with special emphasis on laboratory analysis. Clin Chem Lab Med 2006; 44:138-43. [PMID: 16475897 DOI: 10.1515/cclm.2006.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnosis of rheumatoid arthritis (RA) is mainly based on clinical criteria of symmetric polyarthritis of the hands and feet, with morning stiffness lasting usually more than 1 h. Autoantibodies typical for RA, i.e., rheumatoid factors and anti-cyclic citrullinated peptide, and measurements of inflammation add more specific information, especially for early diagnosis, where clinical presentation may be oligosymptomatic involving only a few joints. These laboratory parameters are also relevant for prognosis of disease persistence, functional impairment and radiological progression.
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31
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Hider SL, Silman A, Bunn D, Manning S, Symmons D, Lunt M. Comparing the long-term clinical outcome of treatment with methotrexate or sulfasalazine prescribed as the first disease-modifying antirheumatic drug in patients with inflammatory polyarthritis. Ann Rheum Dis 2006; 65:1449-55. [PMID: 16540547 PMCID: PMC1798363 DOI: 10.1136/ard.2005.049775] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the clinical and functional outcome at 2 and 5 years in patients with inflammatory polyarthritis treated with either methotrexate (MTX) or sulfasalazine (SSZ) as the first disease-modifying antirheumatic drug (DMARD). METHODS Patients recruited to a primary-care-based inception cohort of patients with inflammatory polyarthritis were eligible for this analysis if they were started on either SSZ (n = 331) or MTX (n = 108) as their first DMARD within 3 months. Outcomes assessed included the Disease Activity Score (DAS)28, Health Assessment Questionnaire, radiological erosions (Larsen Score) and cumulative mortality with the proportions still on the original treatment. To overcome potential bias in allocation to these two treatments, a propensity score was calculated based on baseline disease status variables. RESULTS are expressed as the mean difference between MTX and SSZ, both unadjusted and adjusted for propensity score. RESULTS The baseline differences between the two groups disappeared after adjusting for propensity score. At 2 and 5 years there were few differences in the clinical outcomes, either unadjusted or after adjustment for propensity. By contrast, at 5 years the proportion that was erosive was lower in the MTX group: odds ratio 0.3 (95% confidence interval 0.1 to 0.8), with a 31% lower Larsen Score after adjustment. At both time points, those treated with MTX were at least twice as likely to remain on that drug as those treated with SSZ. CONCLUSION Long-term clinical outcome is similar in patients prescribed MTX and SSZ, although it would seem that MTX has greater potential to suppress erosions, which supports it being the first DMARD of choice.
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Affiliation(s)
- S L Hider
- Arc Epidemiology Unit, Manchester University, Manchester, UK
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32
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Hunter DJ, Conaghan PG. Imaging outcomes and their role in determining outcomes in osteoarthritis and rheumatoid arthritis. Curr Opin Rheumatol 2006; 18:157-62. [PMID: 16462521 DOI: 10.1097/01.bor.0000209427.61904.66] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the advances in knowledge of outcomes that have occurred recently as a result of imaging research in both osteoarthritis and rheumatoid arthritis. RECENT FINDINGS Recent imaging advances in osteoarthritis have offered insights into fundamental questions including the cause of pain and reasons for disease progression. Although ongoing disease modification clinical drug trials in osteoarthritis mostly use standardized plain radiographs to monitor structural changes in the joint, magnetic resonance imaging is rapidly evolving as a method of monitoring joint structure and with time may become the preferred method of monitoring this feature in osteoarthritis clinical trials. The past decade has seen major advances in the treatment of rheumatoid arthritis in which imaging determines whether individual agents or therapeutic regimens are structure modifying. Although conventional radiography remains the gold standard for assessing structural progression in rheumatoid arthritis, growing work on the performance metrics of magnetic resonance imaging has resulted in its increasing use in trials. Ultrasonography shows preliminary promise as a useful outcome measure. SUMMARY Recent advances in imaging are improving our understanding of the etiopathogenesis and treatment of persons with osteoarthritis and rheumatoid arthritis. Complex challenges face us over the coming years as clinicians and researchers grapple with the use of these new techniques, the insights they may provide, and their clinical application.
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Affiliation(s)
- David J Hunter
- Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, Massachussetts 02118, USA.
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33
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Abstract
This article reviews radiographic data from six cohorts of patients with early inflammatory arthritis. Of the patients, 8% to 15% had erosive disease at the first encounter with the rheumatologist. Classic scoring methods were applied to quantify damage, but baseline damage was low in early inflammatory arthritis. Yearly progression in damage score was assessed only in patients with high suspicion of rheumatoid arthritis at baseline or who had a final diagnosis of rheumatoid arthritis at follow-up and varied between 0.5% and 1.7% of the maximal damage of the scoring method per year. The large number of patients with zero values for erosions and lower progression rates will influence sample sizes in clinical trials in early inflammatory arthritis when including radiographic change as an outcome.
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Affiliation(s)
- Annelies Boonen
- Division of Rheumatology, Department of Internal Medicine, University Hospital Maastricht Care and Public Health Research Institute, University Maastricht, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Welsing PMJ, Landewé RBM, van Riel PLCM, Boers M, van Gestel AM, van der Linden S, Swinkels HL, van der Heijde DMFM. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: A longitudinal analysis. ACTA ACUST UNITED AC 2004; 50:2082-93. [PMID: 15248205 DOI: 10.1002/art.20350] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Radiologic progression in rheumatoid arthritis (RA) is considered the consequence of persistent inflammatory activity. To determine whether a change in disease activity is related to a change in radiologic progression in individual patients, we investigated the longitudinal relationship between inflammatory disease activity and subsequent radiologic progression. METHODS The databases of the University Medical Center Nijmegen (UMCN) cohort and the Maastricht Combination Therapy in RA (COBRA) followup study cohort were analyzed. The UMCN cohort included 185 patients with early RA who were followed up for up to 9 years. Patients were assessed every 3 months for disease activity and every 3 years for radiologic damage. The COBRA cohort included 152 patients with early RA who were followed up for up to 6 years. Patients were assessed at least every year for disease activity and every 12 months for radiologic damage. Disease activity was assessed with the Disease Activity Score (DAS) (original DAS in the UMCN cohort, DAS28 in the COBRA cohort). Radiologic damage was measured by the Sharp/van der Heijde score in both cohorts. Data were analyzed with longitudinal regression analysis (generalized estimating equations [GEE]), using autoregression for longitudinal associations and radiologic damage as the dependent variable. Time, time(2) baseline predictors for radiologic progression and their interactions with time, as well as DAS/DAS28 (actual values or interval means and interval SDs of the means) were subsequently modeled as explanatory variables. RESULTS Data analyzed by GEE showed a decrease in radiologic progression over time (regression coefficient for time(2) -1.0 [95% confidence interval -1.4, -0.6] in the UMCN cohort and -0.4 [95% confidence interval -0.8, 0.0] in the COBRA cohort). After adjustment for time effects and baseline predictors of radiologic progression and their interactions with time, a positive longitudinal relationship was indicated by autoregressive GEE between the mean interval DAS and radiologic progression in the UMCN cohort (regression coefficient 5.4 [95% confidence interval 2.1, 8.6]), and between the DAS28 and radiologic progression in the COBRA cohort (regression coefficient 1.4 [95% confidence interval 0.8, 2.0]). In the UMCN cohort, the SD of the mean interval DAS was independently longitudinally related to the radiologic progression over the same periods (regression coefficient 20.2 [95% confidence interval 7.2, 33.3]). In both cohorts, the longitudinal relationships between (fluctuations in) disease activity and radiologic progression were found selectively in rheumatoid factor (RF)-positive patients. CONCLUSION Radiologic progression is not linear in individual patients. Fluctuations in disease activity are directly related to changes in radiologic progression, which supports the hypothesis that disease activity causes radiologic damage. This relationship might only exist in RF-positive patients.
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Barton A, Lamb R, Symmons D, Silman A, Thomson W, Worthington J, Donn R. Macrophage migration inhibitory factor (MIF) gene polymorphism is associated with susceptibility to but not severity of inflammatory polyarthritis. Genes Immun 2004; 4:487-91. [PMID: 14551601 DOI: 10.1038/sj.gene.6364014] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the study was to investigate whether polymorphisms of macrophage migration inhibitory factor (MIF) determine susceptibility to or severity of inflammatory polyarthritis (IP). Genotypes for a single-nucleotide polymorphism (MIF-173*G/C) and a tetranucleotide (CATT)(n) repeat mapping to the promoter region of the MIF gene were compared between UK Caucasian IP cases (n=438) and controls (n=343). Both polymorphisms were also investigated for association with features of disease activity and severity at baseline and by 5 years. The MIF-173*C allele (OR 1.7, 95% CI 1.3-2.4, P=1.8 x 10(-4)) and the CATT(7) allele (OR 1.5, 95% CI 1.0-2.1, P=0.02) were found to be associated with increased susceptibility to IP. Furthermore, presence of the haplotype containing both associated polymorphisms was associated with a three-fold increase risk of developing IP. No association with disease severity or activity either at baseline or by 5 years was detected for either of the promoter polymorphisms studied. In conclusion, MIF is a susceptibility gene for the development of IP. The same alleles previously reported to be associated with susceptibility to juvenile idiopathic arthritis account for the increased risk. The promoter polymorphisms of MIF, investigated in this study, do not influence the severity of disease outcome by 5 years.
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Affiliation(s)
- A Barton
- Arthritis Rheumatism Campaign Epidemiology Research Unit, University of Manchester, Manchester, UK.
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36
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Barton A, Platt H, Salway F, Symmons D, Barrett E, Bukhari M, Lunt M, Zeggini E, Eyre S, Hinks A, Tellam D, Brintnell B, Ollier W, Worthington J, Silman A. Polymorphisms in the tumour necrosis factor gene are not associated with severity of inflammatory polyarthritis. Ann Rheum Dis 2004; 63:280-4. [PMID: 14962963 PMCID: PMC1754913 DOI: 10.1136/ard.2003.008680] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tumour necrosis factor alpha (TNFalpha) is a powerful inflammatory mediator in rheumatoid and other types of inflammatory arthritis. Polymorphisms within the TNFalpha gene have previously been investigated to determine their role in the aetiopathogenesis of rheumatoid arthritis (RA), but it is unclear whether reported associations are with susceptibility to, or severity of, disease. OBJECTIVE To examine the association between both individual TNFalpha single nucleotide polymorphisms (SNPs) and haplotypes with the development and severity of erosions by 5 years in patients with inflammatory polyarthritis (IP). METHODS 438 patients from the Norfolk Arthritis Register observational inception cohort of patients with IP were x rayed 5 years after disease onset. They were genotyped for nine SNPs mapping to the TNFalpha gene, using a SNaPshot primer extension assay. Haplotypes were constructed in patients with IP, who were compared for the presence and extent of erosions at 5 years. RESULTS No association between individual TNFalpha SNPs or haplotypes in the patients who developed erosions at 5 years compared with those who remained non-erosive was found. Restricting analysis to patients who satisfied ACR criteria for RA by 5 years did not affect the conclusions. CONCLUSION The TNFalpha gene does not seem to be associated with severity as assessed by erosive outcome at 5 years in patients with IP.
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38
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van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, de Jong BA, Breedveld FC, Verweij CL, Toes REM, Huizinga TWJ. Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study. ACTA ACUST UNITED AC 2004; 50:709-15. [PMID: 15022309 DOI: 10.1002/art.20044] [Citation(s) in RCA: 403] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a common, severe, chronic inflammatory joint disease. Since the disease may initially be indistinguishable from other forms of arthritis, early diagnosis can be difficult. Autoantibodies seen in RA can be detected years before clinical symptoms develop. In an inception cohort of patients with recent-onset arthritis, we undertook this study to assess the predictive value of RA-specific autoantibodies to cyclic citrullinated peptides (CCPs) in patients with undifferentiated arthritis (UA). METHODS Anti-CCP2 antibody tests were performed at baseline in 936 consecutive, newly referred patients with recent-onset arthritis. Patients who could not be properly classified 2 weeks after inclusion were categorized as having UA. Patients with UA were followed up for 3 years and evaluated for progression of their disease to RA as defined by the American College of Rheumatology (ACR) 1987 revised criteria. RESULTS Three hundred eighteen of 936 patients with recent-onset arthritis were classified as having UA and were available for analysis. After 3 years of followup, 127 of 318 UA patients (40%) had been classified as having RA. RA had developed in 63 of 249 patients (25%) with a negative anti-CCP test and in 64 of 69 patients (93%) with a positive anti-CCP test (odds ratio 37.8 [95% confidence interval 13.8-111.9]). Multivariate analysis of the presence of anti-CCP antibodies and parameters from the ACR criteria identified polyarthritis, symmetric arthritis, erosions on radiographs, and anti-CCP antibodies as significant predictors of RA. CONCLUSION Testing for anti-CCP antibodies in UA allows accurate prediction of a substantial number of patients who will fulfill the ACR criteria for RA.
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Affiliation(s)
- F A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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39
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Nielen MMJ, van Schaardenburg D, Reesink HW, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MHMT, Habibuw MR, Vandenbroucke JP, Dijkmans BAC. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. ACTA ACUST UNITED AC 2004; 50:380-6. [PMID: 14872479 DOI: 10.1002/art.20018] [Citation(s) in RCA: 1223] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Autoantibodies have been demonstrated in single serum samples from healthy subjects up to 10 years before they developed rheumatoid arthritis (RA). However, the time course for the development of antibodies before onset of clinical RA is unknown, nor is it known which antibody, or combinations of antibodies, might be most sensitive or specific for predicting future development of the disease. The present study was undertaken to investigate this. METHODS Patients with RA who had been blood donors before the onset of disease symptoms were enrolled. Frozen serum samples from each donor were retrieved, together with 2 serum samples from controls matched for age, sex, and date of donation. All samples were tested for IgM rheumatoid factor (IgM-RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. RESULTS Seventy-nine patients with RA (62% female; mean age at onset of symptoms 51 years) were included. A median of 13 samples (range 1-51) per patient were available; the earliest samples had been collected a median of 7.5 years (range 0.1-14.5) before the onset of symptoms. Thirty-nine patients (49%) were positive for IgM-RF and/or anti-CCP on at least one occasion before the development of RA symptoms, a median of 4.5 years (range 0.1-13.8) before symptom onset. Of the 2,138 control samples, 1.1% were positive for IgM-RF, and 0.6% were positive for anti-CCP. CONCLUSION Approximately half of patients with RA have specific serologic abnormalities several years before the onset of symptoms. A finding of an elevated serum level of IgM-RF or anti-CCP in a healthy individual implies a high risk for the development of RA. We conclude that IgM-RF and anti-CCP testing with appropriately high specificity may assist in the early detection of RA in high-risk populations.
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Smolen JS, Aletaha D. The challenge of following process, damage, and function in patients with rheumatoid arthritis in clinical care. Curr Rheumatol Rep 2003; 5:336-40. [PMID: 12967513 DOI: 10.1007/s11926-003-0014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Josef S Smolen
- Department of Rheumatology, Internal Medicine III, Vienna General Hospital, University of Vienna, Wolkersbergenstrasse 1, Vienna A-1130, Austria.
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Abstract
Therapeutic possibilities for the treatment of early rheumatoid arthritis (RA) have expanded largely. New treatment modalities appear very effective with respect to relevant outcomes, such as radiographic progression. At the same time, the costs of disease-modifying antirheumatic drugs (DMARDs) have exponentially increased so that--given the rather high prevalence of RA--cost may become a limiting factor in the treatment of patients with RA. Therefore, there is a need to define the profile of those patients that should be treated with the most effective, and, unfortunately, the most costly, DMARDs. The authors describe herewith the heterogeneity of RA with respect to its most important outcomes, as well as the inability to predict those outcomes appropriately at the individual patient level. This heterogeneity of RA is not acknowledged in the modern landmark clinical trials that the authors base therapeutic decisions on, and the external validity of those trials is at stake. In this article, the authors discuss the consequences of the heterogeneity of RA in light of the perceived lack of external validity of evidence-generating landmark trials. The authors propose the following solutions to overcome this discrepancy: 1) earlier recognition of RA, and 2) appropriate prediction of treatment efficacy, because the most challenging scientific efforts may be taken in the near future in order to arrive at a tailor-made therapy for every individual presenting with RA.
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Affiliation(s)
- Robert B M Landewé
- Department of Internal Medicine and Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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42
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Epstein WV. The case against haste in the treatment of rheumatoid arthritis: comment on the editorial by Pincus et al. ARTHRITIS AND RHEUMATISM 2003; 48:573-5; author reply 576-9. [PMID: 12571870 DOI: 10.1002/art.10742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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43
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Huizinga TWJ, Machold KP, Breedveld FC, Lipsky PE, Smolen JS. Criteria for early rheumatoid arthritis: from Bayes' law revisited to new thoughts on pathogenesis. ARTHRITIS AND RHEUMATISM 2002; 46:1155-9. [PMID: 12115216 DOI: 10.1002/art.10195] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bukhari M, Lunt M, Harrison BJ, Scott DGI, Symmons DPM, Silman AJ. Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis: results from the Norfolk Arthritis Register Study, a large inception cohort. ARTHRITIS AND RHEUMATISM 2002; 46:906-12. [PMID: 11953966 DOI: 10.1002/art.10167] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify the relative contributions of clinical and laboratory variables, determined at baseline, in predicting the deterioration of radiographic damage 5 years after presentation in patients with inflammatory polyarthritis. METHODS Data from 439 subjects who sought primary care for inflammatory polyarthritis were analyzed. All subjects had paired radiographs, of which the first was obtained within 24 months of presentation and the second at 5 years after presentation. The contribution of baseline clinical and laboratory variables in predicting the degree of radiologic severity as judged by the Larsen score was assessed at both time points. Additionally, the role of these factors in predicting change after adjustment for baseline severity was also measured. RESULTS By 5 years, 49% of subjects had evidence of erosions. The median Larsen score on the first film was 2 (interquartile range [IQR] 0-10) and the median score on the followup film was 7 (IQR 1-25). These corresponded to a median deterioration of 3 (IQR 0-14) in all subjects, whereas those subjects with evidence of erosions at first film showed a median deterioration of 15 (IQR 6-29) on followup. The rheumatoid factor (RF) status, C-reactive protein levels, the presence of nodules, and number of swollen joints at baseline were all predictive of radiographic severity at first film. Not surprisingly, the baseline radiographic score was a predictor of severity of deterioration. However, after adjusting for baseline severity, a high titer of RF (>1:160) was also an independent predictor of deterioration over 5 years: individuals with an initial RF at that level had a progression in their Larsen score that was 2.3 times (95% confidence interval 1.7-3.2) higher than that in the RF-negative individuals. Apart from this, only age had an independent effect, after adjusting for baseline severity, in predicting increasing radiographic joint damage. CONCLUSION High-titer RF is an important variable in predicting continuing severity of radiographic damage during the first 5 years after presentation with inflammatory polyarthritis.
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Affiliation(s)
- M Bukhari
- University of Manchester Medical School, Manchester, UK
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45
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St Clair EW. Radiographic joint damage in rheumatoid arthritis: a community-based perspective. ARTHRITIS AND RHEUMATISM 2001; 44:1231-3. [PMID: 11409416 DOI: 10.1002/1529-0131(200106)44:6<1231::aid-art212>3.0.co;2-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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