The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review

Risk relationship between six autoimmune diseases and malignancies: An umbrella review

BACKGROUND

The bidirectional relationship between autoimmune diseases and malignancy has been widely discussed. And the relationship between autoimmune diseases and the risk of malignancy varies. Here, we categorized and re-analyzed the evidence of the association between six autoimmune diseases and malignancy risk, in order to provide ideas for the prevention of malignancy in the long-term individualized management of patients with autoimmune diseases.

METHODS

We systematically searched the relevant literatures in PubMed, Web of Science and Cochrane Library to identify and re-analyze studies methodically on the association between six autoimmune diseases and their malignancy risk. Our results showed that.

RESULTS

We included 34 meta-analyses including systematic lupus erythematosus, rheumatoid arthritis, psoriasis, ankylosing spondylitis, primary Sjogren's syndrome, multiple sclerosis, totalling 742 studies. Our results showed that the remaining five AIDs, with the exception of MS, were positively associated with the risk of overall malignancy. Among them, patients with SLE had the highest risk of developing lymphomas, oropharyngeal cancer and non-Hodgkin's lymphoma, and the lowest risk of developing uterine cancer, melanoma and endometrial cancer. The RA patients had the highest risk of developing lymphomas, Hodgkin's lymphoma and non-Hodgkin's and the lowest risk of colon cancer. pSS patients had the highest risk of lymphoma. MS patients had the highest risk of lung cancer and the lowest risk of testicular cancer. AS patients had the highest risk of lymphoblastic leukemia. PsO patients had the highest risk of keratinocyte cancer.

CONCLUSION

Patients with systematic lupus erythematosus, rheumatoid arthritis, psoriasis, ankylosing spondylitis and primary Sjogren's syndrome lead to an increased risk of overall malignancy, whereas patients with MS lead to a decreased risk of overall malignancy. However, the risk relationship between the same AIDs and different malignancies varied.

T cell dysregulation in rheumatoid arthritis: Recent advances and natural product interventions

Autoimmune diseases result from chronic and dysregulated activation of the immune system, culminating in pathological self-tissue damage. These disorders are primarily driven by adaptive immune responses, particularly those mediated by T and B lymphocytes, which mistakenly target self-antigens expressed in host tissues. In rheumatoid arthritis (RA), the pathogenesis is closely associated with the emergence of tissue-invasive effector T cells and the functional impairment of regulatory T cells (Tregs), both of which play pivotal roles in disease progression. Therapeutic interventions targeting these dysregulated T cell populations have emerged as a promising strategy for RA management. Although synthetic immunosuppressants remain the mainstay of RA treatment, their long-term application is often hampered by adverse effects, diminished therapeutic efficacy, and poor patient adherence. These limitations highlight the critical need for the development of novel therapeutic approaches. Natural compounds derived from medicinal plants have been widely utilized in the clinical management of RA, with growing evidence supporting their immunomodulatory potential, particularly in restoring T cell-mediated immune tolerance. This review aims to provide a comprehensive overview of recent advances in understanding T cell dysregulation in RA and to elucidate the mechanisms through which natural compounds regulate immune responses. By integrating current findings, this work seeks to offer a theoretical foundation for the optimized use of natural compounds in the treatment of RA, while exploring their potential in advancing precision medicine and personalized therapeutic strategies.

Low vaccination rates and awareness status in patients with rheumatoid arthritis: a nationwide cross-sectional survey study

To examine the pneumococcal, haemophilus influenza, hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccine rates and and predictors of vaccination among a Türkiye population of rheumatoid arthritis (RA) patients. In this multicenter, cross-sectional study, vaccination levels and related factors were questioned by face-to-face survey method during routine clinical examination of patients with RA followed in different regions of Türkiye. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software package, version 26. A total of 715 patients (mean age 53.1 ± 13 years), of whom 552 (77.2%) were women, were included in this study. The rate of vaccine awareness education in the whole patient group was 40.1%. The vaccination rates for influenza, pneumococcal, HAV, and HBV were 34.3%, 21.8%, 12.3%, and 28.5%, respectively. It was noteworthy that the level of vaccine awareness education was a positive predictive factor affecting vaccination in all vaccine types (p < 0.001, for all vaccine types). The rates of low income were higher in the vaccinated group for pneumococcal (p < 0.001) and haemophilus influenza (p = 0.011) vaccine than in the unvaccinated group. The participants with living in a rural area were significantly higher in the unvaccinated group for HAV and HBV vaccine than in the vaccinated group (p < 0.001). The frequency of less than two medical visits per year was significantly higher in the unvaccinated group for pneumococcal (p < 0.014) and haemophilus influenza (p < 0.001 ) and HBV vaccine (p = 0.009) than in the vaccinated group. multivariate analysis found that rural area (for Haemophilus influenza and HAV vaccines) and financial income (Pneumococcal vaccine) in specifically were associated with increased vaccination rates (p < 0.001). Additionally, the rate of vaccination education was significantly higher in the vaccinated group for all vaccine types, which is noteworthy as a result of the positive effect of education on vaccination (p < 0.001). Vaccination awareness education and rates are low in primary prevention for RA patients. Vaccination awareness training is important in increasing the level of vaccine rates.

Incidence, prevalence and mortality of rheumatoid arthritis in Canterbury, Aotearoa New Zealand

BACKGROUND

There is relatively little research regarding the frequency of rheumatoid arthritis (RA) in Canterbury and no previous studies comparing the mortality of RA in Aotearoa New Zealand to a general population.

AIMS

To determine the incidence, prevalence and mortality of RA in Canterbury, Aotearoa New Zealand.

METHODS

Clinical records of persons attending the Christchurch Hospital rheumatology service between 1 January 2006 and 31 December 2008 (Period 1) and between 1 January 2011 and 31 December 2013 (Period 2) were reviewed to identify individuals who met the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria. Medical records for persons treated by private sector rheumatologists were also reviewed. The period prevalence and average annual incidence for each time period were calculated. Prevalence and incidence rates for the total population were age- and sex-adjusted based on the usually resident population from the 2013 national Census. Standardised mortality ratios (SMRs) compared to the general population were calculated.

RESULTS

The annual incidence was 24.40 per 100 000 (95% confidence interval (CI): 21.36-27.43) for Period 1 and 22.06 per 100 000 (95% CI: 19.32-24.81) for Period 2. The period prevalence was 442.65 per 100 000 (95% CI: 420.08-465.04) for Period 1 and 448.66 per 100 000 (95% CI: 427.31-470.01) for Period 2. The all-cause SMR for individuals with incident RA was 1.25 (95% CI: 0.95-1.60). The SMR for all prevalent RA during Period 1 was 2.01 (95% CI: 1.85-2.19) and for Period 2 was 1.87 (95% CI: 1.69-2.06).

CONCLUSIONS

The frequency of RA in the Canterbury population is comparable to other regions. Mortality for all individuals with prevalent RA was approximately two times higher than the general population.

Integrating network pharmacology and experimental validation via PPAR signaling to ameliorate rheumatoid arthritis: Insights from Corydalis Decumbentis Rhizoma (Xiatianwu)

Corydalis Decumbentis Rhizoma (Xiatianwu, XTW) exhibits a positive effect in treating rheumatoid arthritis (RA). However, the precise molecular mechanisms underlying its effects remain unclear. In this study, TNF-α was used to induce inflammation and establish and in vitro RA model. Network pharmacology was employed to identify the important active components and targets in the treatment of XTW on RA. CCK-8 was used to investigate the cell viability. GW9662 (a PPARG antagonist) was applied to validate the network pharmacology prediction. ELISA was used to measure pro-inflammatory cytokines (IL-6, IL-1β, and INF-γ) and oxidative stress markers (MMP-2, MDA, and ROS). HPLC-MS was conducted to validate the four important active ingredients (bicuculline, ferulic acid, berberine, and jatrorrhizine) in XTW. Western blotting was carried out to detect the protein levels of PPAR-γ. In vitro experiments demonstrated that XTW exerted dose-dependent anti-RA effects by downregulating pro-inflammatory cytokines and oxidative stress markers. Through Network pharmacology, three targets (RXRA, PPARG, and PPARA) and four active ingredients (bicuculline, ferulic acid, berberine, and jatrorrhizine) were demonstrated important in the treatment of XTW on RA. Besides, PPAR signaling pathway may be a therapeutic target for XTW treating RA. Further experiments confirmed that XTW administration significantly inhibited inflammation and oxidative stress by upregulating the PPAR signaling pathway. In conclusion, XTW modulates RXRA, PPARG, and PPARA through the PPAR signaling pathway, thereby mitigating inflammation and oxidative stress in RA.

Understanding the role of ethosomes in rheumatoid arthritis: innovative solutions to challenges in transdermal delivery of synthetic drugs and phytoconstituents

Rheumatoid Arthritis (RA), an autoimmune disease, is a chronic inflammatory disorder affecting the joints leading to severe damage and cartilage destruction. Current therapies for RA such as DMARDs, NSAIDs, glucocorticoids and phytoconstituents often face challenges related to solubility and transdermal permeability. Considering the barriers posed by the stratum corneum in transdermal drug delivery, ethosomes have shown promising results in overcoming these hurdles. The presence of ethanol in ethosomes imparts flexibility and disrupts the skin's lipid bilayer, allowing for transdermal penetration. Researchers have explored the potential of ethosomal drug delivery systems loaded with various synthetic drugs and phytoconstituents for the management of RA. Despite promising preclinical findings, these systems have yet to transition from the bench to the bedside, and there is a lack of comprehensive review papers highlighting the potential of ethosomes in RA treatment. Considering the commercial challenges in scaling up such nano systems, this review aims to analyse the current state of the art and advancements in ethosomal formulations loaded with synthetic agents and phytoconstituents. Further, it explores the impact of excipients and processing parameters, on the preparation of ethosomes and their efficacy in overcoming skin barriers, to enhance the permeability of therapeutic agents.

Determinants of health-related quality of life in adults living with rheumatoid arthritis: a systematic review

OBJECTIVE

To systematically review contemporary studies identifying health-related quality of life (HRQoL) determinants in rheumatoid arthritis (RA) and synthesize the evidence.

METHODS

Three electronic databases were searched for cross-sectional or prospective cohort studies published 2000 or later that identified HRQoL determinants using multivariable prediction models and evaluated HRQoL using the SF-36/12/8/6D or EQ-5D. Two authors conducted screening, data extraction, and quality assessment. Findings were synthesized using a narrative synthesis approach.

RESULTS

Twenty-one studies were included. Seventy determinants were evaluated. Determinants were classified into five domains: (i) sociodemographic, (ii) RA-related, (iii) comorbidities and general health, (iv) health behaviours, and (v) psychosocial. RA-related determinants were the most studied determinants. Forty-four determinants were identified as statistically significant HRQoL determinants. Age and gender were the most evaluated determinants in the sociodemographic domain, but associations between older age and female gender and better HRQoL were inconsistent. Disease duration, disease activity, and physical function were the most evaluated determinants in the RA-related domain. Higher disease activity and worse physical function were associated with lower HRQoL, but association between longer disease duration and HRQoL was inconsistent. All comorbidities identified were associated with lower HRQoL. Exercise and sleep were the only significant determinants in the health behaviours domain and were associated with better HRQoL. Anxiety and depression were the most evaluated psychosocial variables and were associated with lower HRQoL.

CONCLUSION

HRQoL determinants were identified from multiple domains. The existing literature consists mostly of cross-sectional studies. More prospective studies are needed to assess temporal relationship between determinants and HRQoL.

Predicting rheumatoid arthritis in the middle-aged and older population using patient-reported outcomes: insights from the SHARE cohort

BACKGROUND

In light of global population aging and the increasing prevalence of Rheumatoid Arthritis (RA) with age, strategies are needed to address this public health challenge. Machine learning (ML) may play a vital role in early identification of RA, allowing an early start of treatment, thereby reducing costs. This study aims first to identify potential variables related to RA, and second to explore and evaluate the potential of ML to identify RA patients in people over 50 years.

METHOD

We developed ML predictive models (lightGBM, logistic regression, k nearest neighbor, naive Bayes, random forrest, and XGBoost) using patient-reported outcomes collected from the SHARE database (7th and 9th wave).

RESULTS

Difficulties in daily life such as stooping and pulling are risk factors for RA. Lifestyle activities participation is negatively associated with RA. ML models performed differently with the lightGBM model achieving the highest AUC (0.748, 95 % CI: 0.739-0.758), and logistic regression and lightGBM showing the highest accuracy at 0.902. The sensitivity of naive Bayes was highest at 0.442. Significant differences were observed in the Hosmer-Lemeshow test (P < 0.05).

CONCLUSION

The predictive models based on patient-reported outcome measures achieved fair performance with limited potential to early identify RA patients. Lifestyle activities and difficulties in daily life were associated with risk of RA and should be considered in anamnesis.

Beyond rheumatoid arthritis: A meta-analysis of the prevalence of anxiety and depressive disorders in rheumatoid arthritis

BACKGROUND

The prevalence of anxiety and depressive disorders in patients with rheumatoid arthritis (RA) is heterogenous with reports from 2.4 % to 85.2 % and 15 %-73.2 %, respectively. The present study provides meta-analytic current, and lifetime estimates of anxiety and depressive disorders amongst those living with RA.

METHOD

An online search of PubMed, PsycINFO, CINAHL, and WoS was conducted. Of the 3801 articles identified, 13 and 22 studies were coded for anxiety or depressive disorder prevalence in RA, respectively. Studies were included if they prospectively examined individuals (age >16) with RA, used semi-structured diagnostic interviews, and reported lifetime or current anxiety or depressive disorder comorbidity.

RESULTS

Data were analyzed using a Bayesian multilevel modelling approach, revealing current and lifetime prevalence of anxiety disorders to be 13.5 % CI95 % (9.2-17.3) and 22.2 %, CI95 % (15.9-29.1), respectively. Models also demonstrated the current and lifetime prevalence of depressive disorders to be 17.9 % CI95 % (10.1-27.1) and 32.4 %, CI95 % (18.3-47.6), respectively. Moderator analyses revealed numerically greater rates of GAD and MDD than other anxiety or depressive disorders.

LIMITATIONS

There were too few estimates to extensively model several moderators or to conduct exhaustive comparisons of demographic populations requiring greater representation such as males, non-White participants, and people with young adult RA onset.

CONCLUSIONS

The prevalence and risk for comorbid anxiety and depressive disorders in RA is extremely high. Routine screening and ongoing monitoring of individuals with RA for comorbid anxiety and depressive disorders is important to support improved prognosis.

Global, regional and national burden of rheumatoid arthritis from 1990 to 2021, with projections of incidence to 2050: a systematic and comprehensive analysis of the Global Burden of Disease study 2021

BACKGROUND

To provide insights into rheumatoid arthritis (RA) epidemiological trends, including prevalence, incidence, disability-adjusted life years (DALYs), corresponding average annual percentage change (AAPC), gender disparities, regional variations, age-specific rates, socio-economic correlations, risk factors, and future projections.

METHODS

Data were extracted from the Global Burden of Disease Study (GBD) 2021. AAPC was calculated by joinpoint regression and two-sample Mendelian randomization (MR) analysis was performed to verify the causal relationship between the smoking factor and RA. The future incidence trend was predicted by the Bayesian age-period-cohort (BAPC) model.

RESULTS

Global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) increased significantly while age-standardized DALYs rate (ASDR) decreased from 1990 to 2021. Regional variations were pronounced, with Andean Latin America reporting the highest burden. Females consistently exhibited higher age-standardized rate (ASR) across all metrics. Age-specific prevalence, incidence, and DALYs rates peaked at different age groups, highlighting complex demographic dynamics. Socio-demographic index (SDI) analysis demonstrated a positive correlation between RA burden and socio-economic development. The two-sample MR analysis confirmed a causal effect between smoking and RA. From 2022 to 2050, the ASIR will increase moderately.

CONCLUSIONS

The study underscores the escalating burden of RA globally, emphasizing the need for healthcare providers to be aware of the effects of aging populations and other societal factors on the risk of developing RA, and to develop targeted interventions, including smoking cessation programs, age- and gender-appropriate healthcare, and early diagnosis strategies.

Massage therapy in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation, pain, and reduced mobility. Although pharmacological treatments, such as therapies with disease-modifying antirheumatic drugs and biologic agents, have improved disease outcomes, many patients continue to experience residual symptoms that impair their quality of life. This review examines the role of massage therapy as a complementary intervention in RA, focusing on its clinical benefits and underlying mechanisms. A systematic search of Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ) up to February 2025 was conducted using relevant MeSH terms. Evidence from clinical studies suggests that massage modalities-including Swedish massage, aromatherapy massage, and foot reflexology-can reduce pain, improve joint function, and modulate inflammatory markers (e.g., IL-6, TNF-α) and cortisol levels, thereby promoting neuroendocrine balance and lymphatic drainage. Furthermore, massage therapy may offer additional benefits in managing comorbid conditions and enhancing psychological well-being. This review also underscores the pivotal role of nurse-led care in integrating massage therapy into comprehensive treatment plans, despite existing challenges in training and standardization of protocols. Future research with larger sample sizes and longer follow-up periods is essential to establish robust guidelines and optimize the use of massage therapy as an adjunct treatment in RA.

Programmable chronogenetic gene circuits for self-regulated circadian delivery of biologic drugs

Cells of the body rely on the circadian clock to orchestrate daily changes in physiology that impact both homeostatic and pathological conditions, such as the inflammatory autoimmune disease rheumatoid arthritis (RA). In RA, high levels of proinflammatory cytokines peak early in the morning hours, reflected by daily changes in joint stiffness. Chronotherapy (or circadian medicine) seeks to delivery drugs at optimal times to maximize their efficacy. However, chronotherapy remains a largely unexplored approach for disease modifying, antirheumatic treatment, particularly for cell-based therapies. In this study, we developed autonomous chronogenetic gene circuits that produce the biologic drug interleukin-1 receptor antagonist (IL-1Ra) with desired phase and amplitude. We compared expression of IL-1Ra from circuits that contained different circadian promoter elements (E'-boxes, D-boxes, or RREs) and their ability to respond to inflammatory challenges in murine pre-differentiated induced pluripotent stem cells (PDiPSC) or engineered cartilage pellets. We confirmed that each circuit reliably peaked at a distinct circadian time over multiple days. Engineered cells generated significant amounts of IL-1Ra on a circadian basis, which protected them from circadian dysregulation and inflammatory damage. These programmable chronogenetic circuits have the potential to align with an individual's circadian rhythm for optimized, self-regulated daily drug delivery.

Multiomics analysis of human serum and animal experiments reveals the protective mechanism of Qingre Huoxue Decoction against rheumatoid arthritis

Objective

Qingre Huoxue Decoction (QRHXD) is a traditional Chinese herbal prescription widely used in clinical practice with significant therapeutic effects on RA; however, its mechanism of action remains unclear. This study aimed to investigate the efficacy and underlying mechanisms of QRHXD in treating RA through clinical research, multiomics approaches, and animal experiments.

Methods

We conducted a 24-week clinical study in which QRHXD was the primary treatment, collecting serum samples from patients before and after treatment for integrated proteomic and metabolomic analysis to identify potential therapeutic targets. Bioinformatics analysis of differentially expressed proteins (DEPs) and differential metabolites (DMs) was performed using hierarchical clustering, volcano plots, heat maps, Gene Ontology (GO), and Kyoto Encyclopaedia of Genes and Genomes (KEGG) analysis. To validate the identified therapeutic targets, we constructed a collagen-induced arthritis (CIA) mouse model.

Results

Clinical research has shown that QRHXD can improve clinical symptoms and relevant indicators in RA patients, including the disease activity score-28 (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), tender joint count (TJC), swollen joint count (SJC), visual analogue scale (VAS), patient-reported outcome (PRO), and health assessment questionnaire (HAQ). Proteomics and metabolomics analysis identified 83 DEPs and 54 DMs, including 46 upregulated and 37 downregulated proteins, as well as 11 upregulated and 43 downregulated metabolites. KEGG enrichment analysis revealed that DEPs are primarily associated with fatty acid degradation, ferroptosis, glycerolipid metabolism, and related pathways. The identified DMs are primarily associated with the AMPK signalling pathway, FoxO signalling pathway, glycolysis/gluconeogenesis, MTOR signalling pathway, and so on. GO enrichment analysis indicated that the DEPs were mainly associated with apoptotic mitochondrial changes, protein modification processes, fatty-acyl-CoA binding, and so on. Integrated proteomics and metabolomics analyses revealed a significant increase in fructose-1,6-biphosphatase 1 (FBP1) levels and a reduction in AMP-activated protein kinase (AMPK) levels in patients with RA. QRHXD inhibited FBP1 and activated AMPK signalling. Animal experiments validated the findings from proteomics and metabolomics analyses, demonstrating that QRHXD could also delay bone destruction and reduce inflammatory factor levels in CIA mice.

Conclusion

QRHXD may reduce the disease activity of RA, attenuate the inflammatory response, and delay bone destruction by inhibiting FBP1 and activating the AMPK signalling pathway.

A review on the epidemiology of rheumatoid arthritis: An update and trends from current literature

Rheumatoid arthritis (RA) is a systemic, chronic autoimmune disease affecting mainly the joints, often with extra articular manifestations. This review provides an update on RA epidemiological trends and management. PubMed and EMBASE were searched from 2014 to 2024 using rheumatoid arthritis as keyword, combined with incidence, prevalence, diagnosis, classification, and management. Emphasis was on papers published in the past 5 years. Globally, the age-standardised prevalence and incidence rate (ASPR and ASIR) of RA increased with varying figures. The ASPR increased by 0.37%, 14.1%, and 6.4% from 1990 to 2019, 2020 and 2017 respectively; and 9% from 1980 to 2019. The ASIR increased by 0.3% and 8.2% from 1990 to 2019 and 2017 respectively; the disability-adjusted life years (DALY) figures increased 0.12% and decreased 0.36% in the same period from different authors. Reduction in ASIR were reported while ASPR varies. Disease modifying anti-rheumatic drugs (DMARDs) remain the cornerstone of treatment.

Joint replacement for rheumatoid arthritis: When, why, and how! Insights from an orthopedic surgeon

The past several decades have seen significant advancements in joint replacement surgery for rheumatoid arthritis (RA). Joint replacement procedures have become vital options for patients with severe joint damage and functional impairment. There has been an increased emphasis on personalized surgical strategies that tailor joint replacement decisions based on a patient's unique clinical characteristics and the extent of joint damage. Achieving personalized outcomes requires clearly understanding the patient's baseline joint function and comparative data on different prosthetic designs and techniques. Comprehensive preoperative preparation is fundamental to ensuring surgical success. This includes thoroughly evaluating the patient's medication history, the extent of joint damage, and overall systemic health. Despite careful surgical planning, trade-offs between different replacement options often remain. In this paper, we review the perioperative preparation and surgical techniques in joint replacement surgery for RA. Additionally, we discuss the challenges in optimizing postoperative rehabilitation and preventing complications, which remains a key factor in achieving full recovery and maximizing the benefits of joint replacement surgery for RA patients. The pathological basis of RA is an acute or chronic inflammation of the synovial membrane. As a result, synovial joints throughout the body can be affected, including joints in the upper limbs (shoulders, elbows, wrists, metacarpophalangeal joints, and interphalangeal joints) as well as in the lower limbs (hips, knees, and ankles). If drug treatments fail to control inflammation adequately, recurrent synovitis in the affected joints can lead to swelling, effusion, cartilage erosion, and eventual cartilage loss. Due to decreased weight-bearing, along with the use of various medications-particularly glucocorticoids-widespread subchondral bone osteoporosis, bone marrow edema, and bone destruction may occur, leading to cystic degeneration and even extensive bone defects. In the advanced stages of RA, deformities can develop, such as "boutonniere" and "swan-neck" deformities in the fingers, ulnar deviation of the wrist, "otto pelvic" due to central acetabular erosion and dislocation of the hip, varus or valgus deformities of the knee, flexion contractures, and destruction or fusion of the ankle joint. The foot can also present deformities, such as hallux valgus and overlapping toes. Total joint replacement surgery has become the most effective surgical treatment for severe joint destruction and deformities in late-stage RA. Among all joints, the hip and knee are the most frequently replaced, as their dysfunction severely impacts the patient's ability to walk, leading to disability and loss of mobility. In this review, we provided a comprehensive discussion on the perioperative management of patients with RA, focusing on preoperative preparation, intraoperative planning, and postoperative rehabilitation and assessment. Rheumatology Department Perspective on Preoperative Preparation for RA Joint Replacement Surgery.

Prevalence and characteristics of adults with difficult-to-treat rheumatoid arthritis in a large patient registry

OBJECTIVES

An estimated 5-20% of patients with rheumatoid arthritis (RA) fail multiple treatments and are considered 'difficult-to-treat' (D2T), posing a substantial clinical challenge for rheumatologists. A European League Against Rheumatism (EULAR) task force proposed a definition of D2T-RA in 2021. We applied EULAR's D2T definition in a cohort of patients with established RA to assess prevalence, and we compared clinical characteristics of participants with D2T-RA with matched comparisons.

METHODS

Data from the longitudinal Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS) registry were used. Participants were classified as D2T if they met EULAR's definition. A comparison group of non-D2T-RA patients were matched 2:1 to every D2T patient, and differences in characteristics were evaluated in descriptive analyses. Prevalence rates of D2T were estimated using Poisson regression.

RESULTS

We estimated the prevalence of D2T-RA to be 14.4 (95% CI: 12.8, 16.3) per 100 persons among 1581 participants with RA, and 22.3 (95% CI: 19.9, 25.0) per 100 persons among 1021 who were biologic/targeted synthetic DMARD experienced. We observed several differences in demographics, comorbidities and RA disease activity between D2T-RA and non-D2T-RA comparisons. Varying EULAR sub-criteria among all participants in BRASS resulted in a range of D2T-RA prevalence rates, from 0.6 to 17.5 per 100 persons.

CONCLUSION

EULAR's proposed definition of D2T-RA identifies patients with RA who have not achieved treatment targets. Future research should explore heterogeneity in these patients and evaluate outcomes to inform the design of future studies aimed at developing more effective RA management protocols.

Mediating Effect of IADL and Depression in the Relationship Between Ability to Perform Movements and Death Preparation in Elderly with Osteoarthritis or Rheumatoid Arthritis

Background/Objectives: This study investigated the mediating effects of instrumental activities of daily living (IADL) and depression on the relationship between the ability to perform movements and death preparation among older adults with osteoarthritis (OA) or rheumatoid arthritis (RA). Methods: This study is a secondary analysis of data from the Ministry of Health and Welfare of Korea's 5th (2020) survey of the elderly. It included 1483 elderly individuals with OA or RA. We measured the ability to perform movements, death preparation, IADL, and depression using validated scales. Hayes' PROCESS Macro for SPSS model 6 was used to determine the mediating effects. Results: Death preparation exhibited significant differences based on satisfaction with economic conditions, fall experiences, and suicidal ideation. A significant correlation existed between the ability to perform movements, death preparation, IADL, and depression. IADL demonstrated a significant mediating effect between the ability to perform movements and death preparation. However, depression did not exhibit a significant mediating effect. Conclusions: IADL significantly mediates the relationship between movement ability and death preparation in elderly individuals with OA or RA. Lower movement ability was associated with higher death preparation and greater IADL dependence. However, contrary to expectations, depression did not show a significant mediating effect. These findings offer significant insights for developing interventions to enhance the quality of life and prepare for dignified death in elderly individuals with OA or RA. Future longitudinal studies are required to clarify the causal relationships and evaluate the efficacy of IADL enhancement programs.

Rheumatoid Factor: Diagnostic and Prognostic Performance and Therapeutic Implications in Rheumatoid Arthritis

Rheumatoid factor (RF) is the first autoantibody identified in rheumatoid arthritis (RA) which targets the fragment crystallizable (Fc) region of immunoglobulin (Ig) G. Although IgM isotype is predominant, other Ig isotypes, including IgG and IgA, also exist. While RF is not specific to RA, it remains a valuable serological test for diagnosing the disease, as evidenced by its inclusion in the 2010 classification criteria for RA based on elevated serum RF levels. RF is also associated with RA severity, including joint damage and extra-articular manifestations, serving as a poor prognostic factor and aiding in the identification of difficult-to-treat RA. Recent studies have demonstrated that high serum RF levels are associated with a reduced response to tumor necrosis factor (TNF) inhibitors. In contrast, anti-TNF antibodies lacking the Fc portion have shown stable efficacy in RA patients regardless of baseline RF levels. These findings reaffirm the clinical significance of RF measurement, 80 years after its initial discovery. This review explores the diagnostic and prognostic significance of RF and its impact on treatment selection in RA management.

Retrospective Analysis of 28 Cases of Complex Regional Pain Syndrome

Background

Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by persistent pain and local autonomic dysfunction. Its exact cause remains unclear, making diagnosis and treatment challenging.

Objective

The objective was to investigate the clinical characteristics of CRPS patients and identify risk factors influencing its onset.

Design

Retrospective analysis of medical records from 28 CRPS patients, examining variables such as demographics, comorbidities, triggering events, pain duration and location, previous examinations and treatments, clinical findings, auxiliary tests, initial and follow-up treatment outcomes, symptom relief time, and degree.

Methods

Statistical methods were used to analyze the clinical data of 28 CRPS patients, assessing general characteristics and risk factors associated with the disease.

Results

Females accounted for 57.14% of the cases, with an average patient age of 57.89 years. About 82.14% of patients experienced a triggering event prior to the onset of pain. The median time to diagnosis was 4.5 months, with a maximum duration of up to 7 years. Misdiagnosis occurred in 46.43% of patients. Laboratory tests showed that 77.78% (7 of 9) had abnormal bone metabolism; among those who underwent bone density scans, 66.67% (6 of 9) had osteoporosis, whereas 11.11% (1 of 9) had reduced bone mass. X-rays of 25 patients revealed that 44% (11 of 25) had either reduced bone mass or osteoporosis, with 2 showing more severe osteoporosis on the affected side compared with the healthy side. Rheumatoid arthritis was observed in 7.14% of patients. Post-treatment, significant pain relief was noted in 26 patients.

Conclusion

This study helps clinicians more accurately identify and manage CRPS, reducing misdiagnosis and delayed diagnosis. In addition, the data suggest that osteoporosis and rheumatoid arthritis may be potential risk factors for CRPS.

New perspective on the clinical and laboratory characteristics of rheumatoid pleural effusion: A 29-case series

OBJECTIVE

Rheumatoid pleural effusion (RPE) usually occurs in middle-aged men. Pleural fluid analyses have revealed high lactate dehydrogenase (LDH) levels and low pH and glucose levels in RPE. We aimed to investigate the clinical and laboratory features of patients with RPE since the beginning of the 21st century.

METHODS

Medical records of patients with RPE were reviewed between May 2006 and October 2021. The patients were divided into <60 year (younger) and ≥60 year (older) groups.

RESULTS

The younger group comprised 6 patients (median age 53.5 years, female 33%) and older group comprised 23 patients (median age 76 years, female 52.2%). Compared to the younger group, the older group had fewer cases of fever (83.3 versus 18.2%, P = .007) and chest pain (66.7 versus 8.7%, P = .008). In pleural fluid analysis, the older group presented higher pH (P = .004) and lower LDH levels (P = .044). Seven patients died during the follow-up period.

CONCLUSION

Most patients with RPE were over 60 years of age, and approximately half of them were female. The pleural fluid analysis showed milder inflammation in older patients than in middle-aged patients. The mortality rate of patients with RPE was distinctly higher than that previously reported.

PASSing to the patient side: early achieving of an acceptable symptom state in patients with rheumatoid arthritis treated with Janus kinase inhibitors

OBJECTIVE

Patients Acceptable Symptom State (PASS) is a single dichotomized question assessing health satisfaction. We aimed to investigate PASS achievement within 4 weeks of treatment with Janus kinase (JAK) inhibitors (Jakinibs) and its association with treatment response after 4 and 12 weeks in rheumatoid arthritis (RA) patients.

METHODS

We recruited consecutive RA patients starting baricitinib or tofacitinib. At baseline, 4 and 12 weeks, we calculated disease activity [Disease Activity Score on 28 joints (DAS28), Clinical Disease Activity Index, Simplified Disease Activity Index], disease status [remission and low-disease activity (LDA)], percentage of patients achieving PASS, and the time to attain PASS. We assessed the impact of clinically relevant variables on PASS achievement by logistic regression analysis.

RESULTS

We enrolled 113 patients [98 (86.7%) females; median age 59.6 (interquartile range 16.9), median disease duration 144 (132) months]. 90 (79.6%) patients achieved PASS after 10 (8) days. A similar percentage of PASS achievers and non-achievers was in remission/LDA at weeks 4 and 12, but the reduction of disease activity was significantly greater in PASS achievers. All patients achieving Boolean remission at weeks 4 and 12 had achieved PASS within 4 weeks. The impact of Patients Global Assessment (PGA) on DAS28 was significantly greater in PASS non-achievers compared to PASS achievers; inversely, the impact of C-reactive protein was more relevant in PASS achievers. At multivariate analysis, pain and PGA were significantly associated with PASS.

CONCLUSIONS

In our cohort, Jakinibs allowed an early achievement of PASS in a great percentage of RA patients. PASS is strictly dependent on PGA and pain and could suggest, early in the management of RA patients, therapeutic success.

Clinical and Pathophysiological Tangles Between Allergy and Autoimmunity: Deconstructing an Old Dichotomic Paradigm

Allergic and autoimmune disorders are characterised by dysregulation of the immune responses to otherwise inert environmental substances and autoantigens, leading to inflammation and tissue damage. Their incidence has constantly increased in the last decades, and their co-occurrence defies current standards in patient care. For years, allergy and autoimmunity have been considered opposite conditions, with IgE and Th2 lymphocytes cascade driving canonical allergic manifestations and Th1/Th17-related pathways accounting for autoimmunity. Conversely, growing evidence suggests that these conditions not only share some common inciting triggers but also are subtended by overlapping pathogenic pathways. Permissive genetic backgrounds, along with epithelial barrier damage and changes in the microbiome, are now appreciated as common risk factors for both allergy and autoimmunity. Eosinophils and mast cells, along with autoreactive IgE, are emerging players in triggering and sustaining autoimmunity, while pharmacological modulation of B cells and Th17 responses has provided novel clues to the pathophysiology of allergy. By combining clinical and therapeutic evidence with data from mechanistic studies, this review provides a state-of-the-art update on the complex interplay between allergy and autoimmunity, deconstructing old dichotomic paradigms and offering potential clues for future research.

Echinococcus granulosus' laminated layer immunomodulates nitric oxide, cytokines, and MMPs in PBMC from rheumatoid arthritis patients

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that affects the joints. Treatments are symptomatic and can induce side effects in some patients. In this sense and based on previous studies, our aim was to investigate the ex vivo immunoregulatory effect of the laminated layer (LL) during rheumatoid arthritis. LL is the outside layer of parasitic cyst of the helminth Echinococcus granulosus.Our main objective was to study the effect of LL on nitric oxide (NO) and cytokines production, matrix metalloproteinases (MMPs) activities, inducible NO synthase (iNOS) and nuclear factor κappa B (NF-κB) expression. In this context, cultures of peripheral blood mononuclear cells (PBMC) from Algerian RA patients in active (ARA) and inactive (IRA) stage of the disease were stimulated with LL extract (50, 100, 150μg/mL). However, PBMC from ARA patients were stimulated with methotrexate (MTX; 0.5μg/mL) and biological disease modifying anti-rheumatic drugs (bDMARDs): anti-TNFα (10μg/mL), anti-IL6 (10μg/mL), anti-CD20 (10μg/mL), alone or combined with LL (50μg/mL).Our results showed that LL reduced NO, TNF-α, and IL-17A production, MMP9/2 activities, and iNOS/NF-κB expression in PBMC from ARA patients. Concomitantly, LL increases IL-10 and TGF-β1 production in the same cultures. Interestingly, the decrease in NO production induced by bDMARDs was greater in association with LL.Collectively, our findings indicate a strong immunoregulatory effect of LL on NO, MMPs, and cytokines. LL probably acts through the NF-κB pathway. The development of biodrugs derived from LL of E. granulosus could be a potential candidate to modulate inflammation during RA.

Deep-insights: Nanoengineered gel-based localized drug delivery for arthritis management

Arthritis is an inflammatory joint disorder that progressively impairs function and diminishes quality of life. Conventional therapies often prove ineffective, as oral administration lacks specificity, resulting in off-target side effects like hepatotoxicity and GIT-related issues. Intravenous administration causes systemic side effects. The characteristic joint-localized symptoms such as pain, stiffness, and inflammation make the localized drug delivery suitable for managing arthritis. Topical/transdermal/intra-articular routes have become viable options for drug delivery in treating arthritis. However, challenges with those localized drug delivery routes include skin barrier and cartilage impermeability. Additionally, conventional intra-articular drug delivery also leads to rapid clearance of drugs from the synovial joint tissue. To circumvent these limitations, researchers have developed nanocarriers that enhance drug permeability through skin and cartilage, influencing localized action. Gel-based nanoengineered therapy employs a gel matrix to incorporate the drug-encapsulated nanocarriers. This approach combines the benefits of gels and nanocarriers to enhance therapeutic effects and improve patient compliance. This review emphasizes deep insights into drug delivery using diverse gel-based novel nanocarriers, exploring their various applications embedded in hyaluronic acid (biopolymer)-based gels, carbopol-based gels, and others. Furthermore, this review discusses the influence of nanocarrier pharmacokinetics on the localization and therapeutic manipulation of macrophages mediated by nanocarriers. The ELVIS (extravasation through leaky vasculature and inflammatory cell-mediated sequestration) effect associated with arthritis is advantageous in drug delivery. Simply put, the ELVIS effect refers to the extravasation of nanocarriers through leaky vasculatures, which finally results in the accumulation of nanocarriers in the joint cavity.

Current Concepts and Clinical Applications in Cartilage Tissue Engineering

Cartilage injuries are extremely common in the general population, and conventional interventions have failed to produce optimal results. Tissue engineering (TE) technology has been developed to produce neocartilage for use in a variety of cartilage-related conditions. However, progress in the field of cartilage TE has historically been difficult due to the high functional demand and avascular nature of the tissue. Recent advancements in cell sourcing, biostimulation, and scaffold technology have revolutionized the field and made the clinical application of this technology a reality. Cartilage engineering technology will continue to expand its horizons to fully integrate three-dimensional printing, gene editing, and optimal cell sourcing in the future. This review focuses on the recent advancements in the field of cartilage TE and the landscape of clinical treatments for a variety of cartilage-related conditions.

Multitiered Proteome Analysis Displays the Hyperpermeability of the Rheumatoid Synovial Compartment for Plasma Proteins

Rheumatoid arthritis (RA) is characterized by synovial hyperplasia and cartilage/bone destruction. RA affects the synovial joints, the synovial lining, and the permeability of the synovium. As the latter is of central relevance for the distribution of systemically delivered therapeutics into synovial fluid (SF), we here assessed the protein composition of paired plasma and SF of patients diagnosed with RA at three distinct levels of depth using mass spectrometric approaches: the "total" proteome, the "total" immunoglobulin G1 (IgG1) antibody repertoire, and the RA-specific anticitrullinated protein IgG1 autoantibody repertoire. The SF proteome was found to be dominated in numbers and concentration by plasma proteins, although we additionally detected several cartilage- and neutrophil-derived proteins of lower abundance. Strikingly, the plasma proteins were not only qualitatively reflected in SF but also quantitatively, independent of their size and/or other biochemical features. Also, the synovial "total" IgG1 and autoreactive anticitrullinated protein antibody IgG1 repertoire highly resembled the IgG1 repertoires detected in plasma within the same patient. Our comprehensive multilayer data thus reveals that the proteome, including the dominant, most abundant (auto)antibody clones, present in SF of RA patients is a direct reflection of the proteome present in blood, spiked by the local (immune) processes within the RA joint. We thus conclude that proteins directly pass from blood into SF of these joints without substantial bias. These findings thereby not only exemplify the use of in-depth multilayer proteome analyses to revisit basic concepts underlying RA pathology and to monitor the local (immune) processes destructive to cartilage but also provide evidence indicating that (protein-based) therapeutics may equally enter SF of swollen joints and that pharmacokinetic analyses of such therapeutics in blood are directly relevant to the synovial compartment.

Pharmacokinetic and Pharmacodynamic Study of Folic Acid-Modified Chitosan-Stearic Acid Nanomicelles Loaded with Tetrandrine for Rheumatoid Arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease, and it is currently incurable. Tetrandrine (TET) has an obvious curative effect with therapeutic efficacy on RA, but its use is limited due to its poor water-solubility and bioavailability. Therefore, TET-loaded nanomicelles modified with chitosan, stearic acid, and folic acid (FCST) was prepared in the study, and the pharmacokinetics and pharmacodynamics were studied.

METHODS

The plasma concentrations of FCST and TET were measured by the PLC-MS/MS method at different times, and the pharmacokinetic parameters were calculated. A collagen-induced arthritis (CIA) model was established with rats. On the 16th day after the first immunization, 50 rats were randomized into five groups with 10 rats in each group according to the arthritis score. The drugs were administered by intraperitoneal injection for 30 days. The swelling degree and joint score of the rats were tested during each administration. In addition, the pro-inflammatory factors IL-1β, IL-6, IL-17, and TNF-α in the serum of the rats were tested by an ELISA kit, and their joints were examined by histopathology.

RESULTS

Pharmacokinetic studies showed that the AUC0-72h of FCST was 1.93 times that of TET. FCST demonstrated higher bioavailability compared to TET (p < 0.05). Pharmacodynamic studies demonstrated that FCST had significant anti-inflammatory effects, and its anti-inflammatory activity was stronger compared to the same dose of TET, as evidenced by measuring toe thickness and observing toe appearance. It significantly reduced the expression of IL-1, IL-6, IL-17, and TNF-α in rats with rheumatoid arthritis (p < 0.05).

CONCLUSIONS

FCST can significantly improve bioavailability and has a significant therapeutic effect on rheumatoid arthritis.

Prevalence, comorbidities, and disease-related complications of rheumatoid arthritis in Colombia: a national cross-sectional study based on administrative claims data

BACKGROUND

To date, there has been limited exploration, particularly on a national scale, of the prevalence patterns of comorbidities and complications associated with rheumatoid arthritis (RA) in Colombia. We aimed to analyze the prevalence patterns of comorbidities and disease-related complications of RA patients enrolled in Colombia's contributory healthcare regime.

METHODS

We performed a nationwide observational descriptive cross-sectional study using administrative claims data. We used a set of sensitive and specific electronic algorithms (i.e., a set of rules) applied to linked data based on ICD-10 codes and unique medication use codes. We compared all those algorithms with several sources, including governmental agencies and scientific literature, to identify all the known adults treated for RA.

RESULTS

A total of 123,080 RA cases for 2018 were identified, corresponding to a point prevalence of 0.86 (95% CI 0.86-0.87) per 100. Compared to a non-RA reference population, hypertension (68.2 vs. 20.0%), osteoarthritis (43.6 vs. 6.1%), and osteoporosis (18.6 vs. 1.1%) provided larger standardized mean differences. Lupus (30.04; 95%CI 29.3-30.8), multiple sclerosis (7.18; 95%CI 6.6-7.8), and osteoporosis (5.57; 95%CI 5.5-5.6) provided higher age- and sex-adjusted prevalence ratios. Disease-related complications were found in 62.2% of cases.

CONCLUSIONS

We describe the first comprehensive assessment of the prevalence patterns of disease-related complications and comorbidities that define the RA burden of disease within a multimorbidity profile. Also, our study provides a narrower and more reliable point prevalence estimate for RA in Colombia.

Exploring Anticitrullinated Antibodies (ACPAs) and Serum-Derived Exosomes Cargoes

BACKGROUND

Autoantibodies such as rheumatoid factor (RF) and anticitrullinated protein autoantibodies (ACPAs) are useful tools for rheumatoid arthritis (RA). The presence of ACPAs against citrullinated proteins (CPs), especially citrullinated fibrinogen (cFBG), seems to be a useful serological marker for diagnosing RA. RA patients' sera were found to be enriched in exosomes that can transmit many proteins. Exosomes have been found to express citrullinated protein such as cFBG.

OBJECTIVE

We conducted this study in two stages. In the first phase, we aimed to evaluate the association between autoantibodies and risk factors. In the next step, ACPA-positive serum samples from the first phase were subjected to exosomal studies to explore the presence of cFBG, which is a frequent target for ACPAs.

METHODS

We investigated the autoantibodies in one hundred and sixteen Saudi RA patients and correlated with host-related risk factors. Exosomes were extracted from patients' sera and examined for the presence of cFBG using monoclonal antibodies.

RESULTS

The study reported a high female-to-male ratio of 8:1, and seropositive RA (SPRA) was more frequent among included RA patients. The frequency and the levels of ACPAs were similar in both genders. Autoantibodies incidences have a direct correlations with patient age, while the average titers decreased as the age increased. Further, the highest incidence and levels of autoantibodies were reported in patients with RA duration between 5 and 10 years. Smoking and family history have no impact on autoantibody, except for ACPAs titers among smokers' RA. Our analysis of serum exosomes revealed that about 50% of SPRA patients expressed cFBG.

CONCLUSIONS

The female-to-male ratio is 8:1, which is higher than the global ratio. We can conclude that patients' age and disease duration contribute to the autoantibodies, particularly RF and anti-MCV, whereas smoking and family history had no effects on autoantibodies. We detected cFBG in all exosomes from SPRA patients; thus, we suggest that the precise mechanism of exosomes in RA pathogenesis can be investigated to develop effective treatment strategies.

In situ forming gels as subcutaneous delivery systems of curcumin and piperine

In this study an in situ forming gel for curcumin and piperine delivery is investigated as a long-lasting strategy in the local treatment of inflammatory and degenerative joint disease, such as osteoarthritis and rheumatoid arthritis. Particularly glyceryl monooleate, in association with phosphatidylcholine and ethanol, were employed. Different ratios between excipients were tested, with the aim to obtain a liquid form suitable for subcutaneous injection, gaining a semisolid consistency in contact with biological fluids. A formulative study was conducted to assess the composition impact on the structural properties of the formulations, particularly focusing on injectability and phase transition. Curcumin and piperine were loaded, singularly or jointly, in selected in situ forming gels. Structural characterization, performed by X-ray scattering, revealed disordered reverse micellar phases, undergoing transition to hexagonal and cubic Pn3m phase upon hydration. In vitro dialysis release study demonstrated a sustained release of both drugs over 96 h, with a faster release in the case of jointly loaded drugs. Mechanistic analysis and water uptake studies indicated a drug release governed by both diffusion and swelling/erosion of the lipid supramolecular structure. Furthermore, an ex vivo release analysis performed using human skin explants suggested the formulation suitability for subcutaneous injection, indicating that the presence of piperine in the in situ formed gel allowed to double the curcumin release with respect to the simple curcumin loaded gel.

Association between colorectal cancer and arthritis among Americans in 2005-2016

BACKGROUND

Colorectal cancer (CRC) ranks among the most prevalent cancers globally. Some studies have found that arthritis could reduce the risk of CRC through inflammatory immune mediation. However, there have been no reports on whether arthritis is related to CRC. Therefore, the correlation between arthritis and CRC was investigated to provide some theoretical support for understanding the prevention and diagnosis of CRC.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the relationship between arthritis and CRC among Americans. A total of 300,106 adults participated in the study, and through a questionnaire survey, they were categorized into the control group and the CRC group. In this study, arthritis was considered the exposure variable, and 17 covariates were included. The relationship between the variables and CRC was then revealed through baseline characteristic analysis, association analysis, and stratified analysis. The predictive efficiency of arthritis for the CRC was assessed using the receiver operating characteristic curve (ROC) analysis. Finally, nomogram was created to evaluate the predictive capacity.

RESULTS

A total of 297,681 control subjects and 2,425 CRC subjects within this survey. Significant disparities were observed between the two groups for all variables except for drink and poverty income ratio (PIR). Three models demonstrated a clear association between arthritis and CRC (model 1: odds ratio (OR) = 3.57, 95% confidence interval (CI) = 2.5-5.1, P = 0.00000000025; model 2: OR = 1.71, 95% CI = 1.15-2.53, P = 0.008; model 3: OR = 1.56, 95% CI = 1.03-2.38, P = 0.0369), indicating that the effect of arthritis on CRC was not significantly confounded by other covariates across the three models. Stratified analysis showed that arthritis was positively associated with CRC, and the area under the curve (AUC) was 0.818, indicating that arthritis was more effective in the prognosis of CRC. Finally, the decision curve and calibration curve indicated that the nomogram could effectively predict CRC.

CONCLUSION

This study found that arthritis had a strong association with the occurrence of CRC, providing ideas and strategies for its early detection.

The global prevalence of interstitial lung disease in patients with rheumatoid arthritis: a systematic review and meta-analysis

This study aims to review the literature and estimate the global pooled prevalence of interstitial lung disease among patients with rheumatoid arthritis (RA-ILD). The influence of risk factors like geography, socioeconomic status, smoking and DMARD use will be explored. A systematic review was performed according to the PRISMA and JBI guidelines. Studies published between January 1980 and February 2024 were sourced from 7 electronic databases and screened for eligibility. A random-effects meta-analysis model was used to produce pooled prevalences and the potential between-study heterogeneity was identified using sensitivity, subgroup, meta-regression and correlation analyses. 33 studies were included in this meta-analysis containing 14,281 RA patients. The global pooled prevalence of RA-ILD was 21.38% (CI: 0.1542-0.2886), with a high heterogeneity (I2) of 98%. The prevalence of usual interstitial pneumonia and non-specific interstitial pneumonia among RA patients were 11.01% and 6.86% respectively. Africa had the highest RA-ILD prevalence with an imprecise estimate of 38.15% (95% Confidence Interval [CI]: 2.29-94.2) and Europe had the lowest prevalence of 10.15% (CI: 2.86-30.23). Other risk factors associated with a higher prevalence of RA-ILD included living in low-income countries, smoking and DMARD use. The biggest limitation of this study is the high heterogeneity of results and underrepresentation of Oceania and low-income countries. This study has clarified the global prevalence of RA-ILD. The risk factors identified in this study can aid clinicians in identifying high-risk populations and highlight the need for screening these populations. Smoking cessation should also be encouraged.

The Role of Long Non-Coding RNA in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to joint damage and physical dysfunction. The pathogenesis of RA is highly complex, involving genetic, epigenetic, immune, and metabolic factors, among others. Over the years, research has highlighted the importance of non-coding RNAs (ncRNAs) in regulating gene expression. Given their dysregulation in numerous conditions, ncRNAs are thought to play a role in pathological processes. In RA, aberrant levels of circulating long ncRNAs (lncRNAs) are commonly observed in peripheral blood, along with their dysregulated expression in peripheral blood mononuclear cells and synovial tissue. This review discusses the involvement of lncRNAs in inflammation and the aggressive characteristics of fibroblast-like synoviocytes, a key cellular population driving RA progression.

DNA and RNA Methylation in Rheumatoid Arthritis-A Narrative Review

Rheumatoid arthritis (RA) is a progressive autoimmune disease leading to structural and functional joint damage and, eventually, to physical disability. The pathogenesis of the disease is highly complex and involves interactions between fibroblast-like synoviocytes (FLSs) and immune cells, which stimulate the secretion of pro-inflammatory factors, leading to chronic inflammation. In recent years, studies have demonstrated the importance of epigenetics in RA. Specifically, epigenetic alterations have been suggested to serve as diagnostic and treatment biomarkers, while epigenetic mechanisms are thought to be involved in the pathogenesis of RA. Epigenetic regulators coordinate gene expression, and in the case of inflammatory diseases, they regulate the expression of a broad range of inflammatory molecules. In this review, we discuss current evidence on the involvement of DNA and RNA methylation in RA.

Prevalence and Associated Factors of Sarcopenia in Thai Rheumatoid Arthritis Patients: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Sarcopenia associates with poor health-related quality of life (HRQoL). This study aimed to determine prevalence and factors associated with sarcopenia in rheumatoid arthritis (RA) patients. The HRQoL between RA patients with and without sarcopenia also was compared.

METHODS

This cross-sectional study recruited RA patients, aged ≥20 years, at Chiang Mai University Hospital between May and November 2023. Their skeletal muscle mass (bioelectrical impedance analysis), grip strength (hand dynamometer), and physical performance (gait speed test) were evaluated. Sarcopenia was defined according to the Asian Working Group for Sarcopenia. Patient characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), nutrition (mini nutrition assessment), and medications were recorded.

RESULTS

Of 299 patients (89.0% female; age 61.3 ± 11.6 years; disease duration 13.9 ± 8.6 years), 37.5% had sarcopenia (27.4% severe sarcopenia). In multivariable analysis, body mass index (odds ratio [95% confidence interval] 1.46/1 unit decrease [1.27, 1.68], p < 0.001), disease duration (1.89/10 years increase [1.27, 2.83], p = 0.002), deformity of hands/feet (3.80 [1.50, 9.61], p = 0.005), mini nutritional assessment score (1.21/1 score decrease [1.04, 1.40], p = 0.012), and high C-reactive protein (CRP) (1.94 [1.02, 3.69], p = 0.044) were independent factors associated with sarcopenia. There was no relationship between sarcopenia and disease activity (DAS-28-ESR or CRP) or medication use. RA patients with sarcopenia had higher HAQ score than those without, but potentially lower scores in physical function domain of SF-36 with adjusted mean difference of 0.2 (95% confidence interval 0.03, 0.32, p = 0.022) and -5.9 (-12.24, 0.38, p = 0.066), respectively.

CONCLUSIONS

About one third of the Thai RA patients in this center had sarcopenia. Low body mass index, long disease duration, joint deformity, malnutrition, and high CRP were independent factors associated with sarcopenia. Sarcopenia affects physical capabilities and the physical function domain of the HRQoL.

Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis

OBJECTIVES

This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).

METHODS

We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant literature published prior to May 2023. Two independent reviewers assessed the studies using population/intervention/comparison/outcome/study criteria, and quantitative tools were used to gauge the methodological quality of the included studies. Independent quality assessments were carried out using the Cochrane Collaboration's risk-of-bias tool. Effect sizes were determined using mean difference (MD) or standardised mean difference (SMD) with corresponding 95% CIs.

RESULTS

Ultimately, 14 articles were included, encompassing a total of 3369 RA patients. NLC exhibited significant advantages in the primary outcome, disease activity (MD =-0.09, 95% CI (-0.17 to -0.01)), and the secondary outcome, self-efficacy (MD=0.40, 95% CI (0.03, 0.77)). In subgroup analysis, NLC was more effective in reducing disease activity compared with usual care (MD=-0.15, 95% CI (-0.26 to -0.04)), and there was no significant difference in disease activity reduction between NLC and rheumatologist-led care (MD=-0.02, 95% CI (-0.14, 0.10)). In terms of self-efficacy, no significant difference was observed between NLC and usual care (SMD=0.56, 95% CI (-0.09, 1.21)) or between NLC and rheumatologist-led care (SMD=0.20, 95% CI (-0.19, 0.59). When comparing other secondary outcomes (pain, satisfaction, quality of life, fatigue, stiffness, physical function and psychological status), the effectiveness of NLC for RA patients was similar to that of the control group, with no statistically significant differences.

CONCLUSIONS

NLC proves highly effective in managing RA patients, surpassing usual care and equating to rheumatologist-led care in primary and some secondary outcomes. It may be feasible to allow nurses to participate in the disease management of some RA patients instead of doctors.

PROSPERO REGISTRATION NUMBER

CRD42022362071.

Improving dexamethasone drug loading and efficacy in treating rheumatoid arthritis via liposome: Focusing on inflammation and molecular mechanisms

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects approximately 0.46% of the global population. Conventional therapeutics for RA, including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids, frequently result in unintended adverse effects. Dexamethasone (DEX) is a potent glucocorticoid used to treat RA due to its anti-inflammatory and immunosuppressive properties. Liposomal delivery of DEX, particularly when liposomes are surface-modified with targeting ligands like peptides or sialic acid, can improve drug efficacy by enhancing its distribution to inflamed joints and minimizing toxicity. This study investigates the potential of liposomal drug delivery systems to enhance the efficacy and targeting of DEX in the treatment of RA. Results from various studies demonstrate that liposomal DEX significantly inhibits arthritis progression in animal models, reduces joint inflammation and damage, and alleviates cartilage destruction compared to free DEX. The liposomal formulation also shows better hemocompatibility, fewer adverse effects on body weight and immune organ index, and a longer circulation time with higher bioavailability. The anti-inflammatory mechanism is associated with the downregulation of pro-inflammatory cytokines like tumor necrosis factor-α (TNF-α) and B-cell-activating factor (BAFF), which are key players in the pathogenesis of RA. Additionally, liposomal DEX can induce the expression of anti-inflammatory cytokines like interleukin-10 (IL-10), which has significant anti-inflammatory and immunoregulatory properties. The findings suggest that liposomal DEX represents a promising candidate for effective and safe RA therapy, with the potential to improve the management of this debilitating disease by providing targeted delivery and sustained release of the drug.

In Silico and In Vivo Evaluation of Anti-Arthritic Effects of Bakuchiol from Psoralea corylifolia Seeds in Experimental Rat Model

Rheumatoid arthritis is an autoimmune disease mainly affecting the joints categorized by inflammation, swelling of the synovium and decrease in the joint movement. Bakuchiol, a meroterpene class of natural product present in Psoralea corylifolia known to possess anti-inflammatory effects by a variety of mechanisms. However, its effects in rheumatoid arthritis still remain unclear. In the present investigation, we studied the anti-arthritic effects of bakuchiol via in silico and in vivo experiments. It also showed antioxidant effects measured using DPPH assay where it showed free radical scavenging activity with IC50 value 468.26 μg/ml. Molecular Docking studies carried out on COX-1 (PDB ID: 3 N8Z), COX-2 (PDB ID: 4PH9) and TNF-α (PDB ID: 7JRA), proteins involved in inflammation in arthritis. Bakuchiol showed the maximum binding affinity for TNF-α with binding affinity score is -7.29 kcal/moland less affinity was observed for COX-1 and 2. In vivo antiarthritic effects were studied in arthritic female wistar rats model prepared by intradermal injection of freund's complete adjuvant. Bakuchiol was administered orally at dose of 10,20 and 40 mg/kg for 21 days. Our treatment showed that bakuchiol at 20 and 40 mg/kg exhibited significant anti-inflammatory effects (p<0.001) showed by significant decrease in paw volume, paw diameter, spleen and thymus weight and increase in pain threshold and body weight in arthritic rat model. A significant decrease in hematological parameters such as total leukocyte count (TLC), platelet count, CRP and rheumatoid arthritis factor (RF) and increase in red blood cells count, ESR and hemoglobin further demonstrated that bakuchiol treatment suppresses the progression of adjuvant induced arthritis (AIA) in arthritic rat model. Histological analysis further revealed that bakuchiol ameliorates the pathological manifestations of AIA and reverse the abnormality induced by AIA in rats shown by protection against bone necrosis involved with low influx of inflammatory cells. Therefore, in silico and in vivo results revealed that bakuchiol has the potential to be developed as potent antiarthritic agent.

Translation Research in Therapeutic Approaches from Conventional to Novel Nano-therapeutics for Rheumatoid Arthritis Treatment

Rheumatoid arthritis is a systemic autoimmune disorder related to joint inflammation, bone erosion, and deformity. Numerous studies indicate that the causes and consequences of RA are still being debated, and therapeutic strategies are in the translation stage. Non-steroidal anti-inflammatory drugs continue to be often used to relieve pain. Still, due to their poor efficacy, failure to halt the spread of the disease, and undesirable adverse effects, they are no longer regarded as first-line treatments. The development of biologic DMRDs designed to reduce the inflammatory response led to substantial changes to the strategy for managing this disease. Although biologic DMRDs have made significant strides in the management of Rheumatoid arthritis, certain patients' lack of response to biological approaches and therapy cessation due to systemic toxicity are unresolved problems. Therefore, to improve the in vivo effect and reduce systemic adverse effects, new approaches are needed to proactively target and transport therapeutic molecules to target sites. The intriguing method of nanotechnology enables the encapsulation of drugs to prevent their deterioration and systemic adverse effects. The next generation of Rheumatoid arthritis therapies might be based on advances in nanomaterial-based drug delivery, Trojan horse, and antibody targeting approaches. This article presents an overview of the advancements in Rheumatoid arthritis therapy, ranging from traditional methods to recent cutting-edge, ongoing pre-clinical and clinical approaches.

Nano-based Therapeutics for Rheumatoid Arthritis: Recent Patents and Development

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease marked by inflammation of synovium and generation of autoantibodies. Bone and cartilage are frequently damaged along with weakening of tendons and ligaments resulting in disability. An effective RA treatment needs a multi-disciplinary approach which relies upon pathophysiology that is still partially understood. In RA patients, inflammation was induced by pro-inflammatory cytokines including IL-1, IL-6 & IL-10. The conventional dosage regimens for treating RA have drawbacks such as ineffectiveness, greater doses, frequent dosing, relatively expensive and serious adverse effects. To formulate an effective treatment plan for RA, research teams have recently focused on producing several nanoformulations containing anti-inflammatory APIs with an aim to target the inflamed area. Nanomedicines have recently gained popularity in the treatment of RA. Interestingly, unbelievable improvements have been observed in current years in diagnosis and management of RA utilizing nanotechnology. Various patents and clinical trial data have been reported in relevance to RA treatment.

Relationship of Interleukin 6 with Hepatic Steatosis and Liver Fibrosis in Rheumatoid Arthritis at a Rheumatology Care Center in Cartagena, Colombia

BACKGROUND/OBJECTIVES

This study aimed to investigate the association of IL-6 with steatotic liver disease (SLD) and liver fibrosis (LF) in rheumatoid arthritis (RA) patients at a rheumatology center in Cartagena de Indias, Colombia.

METHODS

This was a cross-sectional study that included RA and non-RA cases. The level of cellular expression of interleukin 6 (IL-6) was evaluated by flow cytometry in peripheral blood leukocytes, and the presence of SLD and LF was detected by elastosonography. The main outcome was to establish the association between the levels of cellular expression of IL-6 and the development of SLD and LF.

RESULTS

This study included 47 cases of RA and 34 cases on-RA, with a mean age of 54 and 55 years, respectively. The frequency of SLD was 55.3% in RA and 38.2% in non-RA. The frequency of LF was 12.8% in RA and 14.7% in non-RA, with no statistical difference. The levels of cellular expression of IL-6 were significantly higher in RA compared to non-RA. Cellular expression of IL-6 was associated with the presence of SLD (54% vs. 30.3%; p = 0.002). This association was not maintained in RA cases (49.5% vs. 47.6%; p = 0.571). No association was found between cellular expression of IL-6 and LF in the total population (43.8% vs. 42.7%; p = 0.813) nor in RA cases (59.41% vs. 48.3%; p = 0.526).

CONCLUSIONS

IL-6 levels were related to SLD in the evaluated sample, and RA was not a risk factor for SLD or LF. The prognostic role of IL-6 for SLD in patients with RA requires further studies.

Deciphering the genetic impact of signal peptide missense CTLA-4 polymorphism with rheumatoid arthritis in the Indian population: A case-control and in silico studies

Cytoplasmic T Lymphocyte Antigen-4 (CTLA-4) gene encodes for a glycoprotein, expressed on activated T-cells to transfer an inhibitory signal to control T-cell activation and proliferation. Techniques coupled with Real-time Polymerase Chain Reaction (PCR) and High-Resolution Melting Analysis (HRMA) were used to screen a missense signal peptide polymorphism (CTLA-4 + 49 A/G rs231775) in the Indian population to detect its association with Rheumatoid Arthritis (RA). Further, the resulting outcome was confirmed by Sanger's sequencing technique, and genotype frequencies were calculated. In eukaryotic cells, the M domain of the Signal Recognition Particle (SRP-54) recognizes the N-terminal region of the Signal Peptide (SP) sequence. SP directs the polypeptide chain into the Sec-61 translocon of the Endoplasmic Reticulum (ER) for further protein modification. As the Single Nucleotide Polymorphism (SNP) rs231775 lies in the signal peptide region of CTLA-4, an in-silico study was also performed to predict the mRNA stability and SP-SRP protein interaction. From the study, it was observed that the genotype frequency of rs231775 SNP G/G homozygous dominant was significantly higher in RA patients than G/A heterozygous dominant and A/A homozygous recessive conditions (Odd Ratio (OR) = 2.0862; 95 % Confidence Interval (C.I) = 1.2584 to 3.4584; Relative Risk (RR) = 1.8507; p = 0.0044). Moreover, the rs231775 SNP G allele frequency was higher in RA than the control group G = 0.407 (40.7 %) vs 0.32 (32 %). In silico approaches of Protein-Protein docking and Molecular Dynamics (MD) simulation reveal CTLA-4 rs231775 SNP (G allele) has destabilized the SP-SRP protein complex, which may affect the translocation of CTLA-4 nascent polypeptide chains into the ER via activating Regulation of Aberrant Protein Production (RAPP) pathway.

Association between life's simple 7 (LS7) and arthritis: the mediating role of body fat percentage (BFP)

BACKGROUND

Life's Simple 7 (LS7), developed by the American Heart Association, addresses seven key health behaviors and relationship factors. Although LS7 has been studied in relation to various chronic diseases, its association with arthritis remains unclear. This study seeks to investigate the association between LS7 and arthritis, with particular emphasis on the mediating role of body fat percentage (BFP).

METHODS

Data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES), including 16,332 adult participants, were analyzed. The connection between LS7 and arthritis was evaluated using multivariable logistic regression, smooth curve fitting, and subgroup analysis. Mediation analysis assessed the role of BFP in this relationship. Additionally, ROC curve analysis was used to assess the predictive performance of the model, and the Boruta algorithm identified the influential factors associated with arthritis.

RESULTS

After adjusting for relevant covariables, each standard deviation increase in LS7 was linked to a 13% lower likelihood of arthritis [OR = 0.87, 95% CI: 0.84, 0.89]. Participants in the highest LS7 tertile (T3) exhibited a 50% reduced likelihood of developing arthritis compared to those in the lowest tertile (T1) [OR = 0.50, 95% CI: 0.43, 0.60]. Mediation analysis confirmed that BFP significantly mediated the LS7-arthritis relationship. Furthermore, the Boruta algorithm identified LS7 and BFP as key variables associated with arthritis.

CONCLUSION

Elevated LS7 scores were associated with a lower likelihood of arthritis, with BFP serving as a mediating factor. Improving LS7 scores and managing body fat may help prevent arthritis. Due to the study's cross-sectional design, causality cannot be confirmed. Future research should use longitudinal studies to verify these findings and target high-risk groups.

Therapeutic potential of antibody-drug conjugates possessing bifunctional anti-inflammatory action in the pathogenies of rheumatoid arthritis

In an age where there is a remarkable upsurge in developing precision medicines, antibody-drug conjugates (ADCs) have emerged as a progressive therapeutic strategy. ADCs typically consist of monoclonal antibodies (mAb) conjugated to the cytotoxic payloads by utilizing a linker, combining the benefits of definitive target specificity of mAbs and potent killing impact of payload to achieve precise and efficient elimination of target cells. In addition to their well-established role in oncology, ADCs are currently demonstrating encouraging potential in addressing the unmet requirements in the treatment of autoimmune conditions such as rheumatoid arthritis (RA). Prevalent long-term autoimmune disease RA costs billions of dollars annually but still, there is a lack of precision-targeted therapeutics with minimal side effects. This review provides an overview of the RA pathogenesis, pre-existing therapies, and their limitations, the introduction of ADCs in RA treatment, the mechanism of ADCs, and a summary of ADCs in preclinical and clinical trials. Based on the literature we also propose a strategy in ADC synthesis, which may increase the efficiency in targeting multifactorial diseases like RA. We propose to utilize DMARDs (Disease-modifying anti-rheumatic drugs), the first-line treatment for RA, as a payload for ADC synthesis. DMARDs are the only class of medication that limits the disease progression, but their efficacy is limited due to off-target toxicities. Hence, utilizing them as payload will help to deliver them directly at the targeted site, reducing their off-target toxicity, which in turn will increase their efficiency in targeting disease. Also, as mAbs are not sufficient to achieve remission, they are given in combinations with DMARDs. Hence, synthesizing ADCs may reduce the multiple and higher dosages given to patients, which in turn may enhance patient compliance.

Audiological Features in Patients with Rheumatoid Arthritis: A Systematic Review

Hearing impairment in patients with rheumatoid arthritis has been underestimated for decades. Rheumatoid arthritis can affect both the middle ear (specifically, the incudomalleolar and incudostapedial joints) and inner ear (including the cochlea and acoustic nerve) simultaneously. Despite ongoing research, consensus on effective treatments for hearing impairment in these patients remains elusive. This systematic review aims to consolidate clinically relevant information for healthcare providers by summarizing current evidence on hearing impairment in rheumatoid arthritis patients. We conducted the current systematic review by searching platforms of PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect to retrieve eligible articles regarding hearing impairment related to rheumatoid arthritis. We extract any data on characteristics, pathophysiology, examination, and treatment related to rheumatoid arthritis. Based on the currently available evidence, we advocate for the use of specific audiometric tests to facilitate early detection of hearing impairment in these patients. Regular audiological assessments are recommended to monitor hearing ability and potentially prevent further deterioration. Finally, we propose a modified treatment protocol that integrates steroids, hydroxychloroquine, and non-invasive brain stimulation as a novel therapeutic approach for managing these symptoms. This protocol aims to offer clinicians new strategies to address hearing impairment in patients with rheumatoid arthritis effectively.

Deep learning based predictive modeling to screen natural compounds against TNF-alpha for the potential management of rheumatoid arthritis: Virtual screening to comprehensive in silico investigation

Rheumatoid arthritis (RA) affects an estimated 0.1% to 2.0% of the world's population, leading to a substantial impact on global health. The adverse effects and toxicity associated with conventional RA treatment pathways underscore the critical need to seek potential new therapeutic candidates, particularly those of natural sources that can treat the condition with minimal side effects. To address this challenge, this study employed a deep-learning (DL) based approach to conduct a virtual assessment of natural compounds against the Tumor Necrosis Factor-alpha (TNF-α) protein. TNF-α stands out as the primary pro-inflammatory cytokine, crucial in the development of RA. Our predictive model demonstrated appreciable performance, achieving MSE of 0.6, MAPE of 10%, and MAE of 0.5. The model was then deployed to screen a comprehensive set of 2563 natural compounds obtained from the Selleckchem database. Utilizing their predicted bioactivity (pIC50), the top 128 compounds were identified. Among them, 68 compounds were taken for further analysis based on drug-likeness analysis. Subsequently, selected compounds underwent additional evaluation using molecular docking (< - 8.7 kcal/mol) and ADMET resulting in four compounds posing nominal toxicity, which were finally subjected to MD simulation for 200 ns. Later on, the stability of complexes was assessed via analysis encompassing RMSD, RMSF, Rg, H-Bonds, SASA, and Essential Dynamics. Ultimately, based on the total binding free energy estimated using the MM/GBSA method, Imperialine, Veratramine, and Gelsemine are proven to be potential natural inhibitors of TNF-α.

Analysis of data from the NHANES 1999-2018 and Mendelian randomization studies reveals the relationship between alcohol use and rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a complex multifactorial autoimmune disease affected by genetics and environmental factors. The relationship between alcohol consumption and RA remains controversial. This study aimed to assess the association between alcohol consumption and RA risk using cross-sectional analysis and Mendelian randomization (MR).

METHODS

We investigated the association between alcohol consumption and RA risk through multivariate linear regression and subgroup analyses. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 which involved 32,308 participants. Subsequently, a two-sample MR study was conducted to assess the causal effect of spirits intake on RA. Instrumental variables (IVs) for spirits intake were screened from genome-wide association study (GWAS) datasets, including 69,949 individuals from the UK Biobank study, while summary statistics relating to RA were obtained from a GWAS meta-analysis of 417,256 participants. The primary inverse variance weighted (IVW) method and other supplementary MR methods were used to estimate the causal association between spirits intake and RA. Sensitivity analyses were performed to confirm the robustness and reliability of the results.

RESULTS

In the cross-sectional analysis, we observed that alcohol consumption was significantly positively linked with RA risk (odds ratio [OR] = 1.030; 95% confidence interval [CI], 1.025-1.034). According to subgroup analyses stratified by age, sex, race, smoking status, marital status, education attainment, and body mass index (BMI), consistently showed a positive relationship between alcohol consumption and RA risk in each subgroup (all OR > 1, P < 0.05). Furthermore, MR analysis indicated a causal association between spirits intake and RA (OR = 1.043, P < 0.05). Sensitivity analyses supported the robustness and reliability of these findings (all P > 0.05).

CONCLUSION

This study indicated that alcohol consumption is correlated with an increased risk of RA, but further studies are necessary to clarify the exact association.

Pitfalls and pearls in diagnosing inflammatory arthritis in older patients

Given current demographic shifts, the number of older adults continues to grow, with almost half of patients over 65 being diagnosed with some form of arthritis. Rheumatic diseases pose unique diagnostic challenges in older patients due to the convergence of physiologic changes of aging, confounding difficulties to care, and atypical disease manifestations. This review summarizes the current published evidence to guide clinicians in evaluating geriatric patients with rheumatologic concerns, focusing on inflammatory arthritis. Using the background of epidemiologic data on various musculoskeletal diseases, clinical presentations, current diagnostic tests, and known physiologic changes of aging, this review highlights five diagnostic pitfalls in inflammatory polyarthritis among older patients. The pitfalls include: 1) broader differential diagnosis; 2) atypical presentations; 3) communication, cognitive, and social impairments; 4) the role of chronological vs. biological age; and 5) anchoring bias by assuming older adults are simply "older young adults". These pitfalls are discussed in the context of geriatric principles such as the "hallmarks of aging" and the expected pathophysiologic changes of organ systems. Furthermore, the review discusses the strengths and weaknesses of diagnostic tests used in arthritis and introduces some of the geriatric assessment tools that systematically evaluate multimorbidity and geriatric syndromes. With familiarity of the potential diagnostic pitfalls, knowledge of both normal and pathologic aging processes, awareness of the difference between biological and chronological age, and the ability to use geriatric assessment tools to better characterize older patients, clinicians will be better able to diagnose and manage rheumatic conditions in this population.

Towards understanding the role of nanomedicine in targeting TNFR2 in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovium and progressive joint destruction which significantly affects both quality of life and socioeconomic status. Admittedly, various treatments are available, but they are usually accompanied by various side effects, from mild to severe, and potentially with adverse events. Tumour necrosis factor-alpha (TNF-α) plays a crucial role in the pathophysiology of RA. It promotes inflammatory, apoptosis and necroptosis via TNF receptor-1 (TNFR1) but elicit anti-inflammatory effects via TNFR2. Herein, targeting TNFR2 has gained attention in RA studies. Understanding the role of nanomedicine in modulating TNFR2 signalling may be the instrument in development of RA therapies. Nanotechnology has made a significant progress in treating various conditions of diseases since its inception. Due to this, nanomedicine has emerged as a promising therapeutics approach for RA. Recent studies have demonstrated the potential of nanomedicine in RA theranostics, combining therapy and diagnostics for improved treatment outcomes. Owing to the challenges and advancements in the field of nanotechnology, nanoparticles are seen as an applicable candidate in the treatment of RA. In this review, we provide an overview of the role of nanomedicine in targeting TNFR2 for the treatment of RA and highlight the limitations of current therapies as well as the potential of nanocarriers with controlled drug release and active targeting abilities.

The mediating role of kinesiophobia in pain intensity, physical function, and physical activity level in inflammatory arthritis

Pain is the main symptom of inflammatory arthritis and it can impair physical functional performance and physical activity level. Some individuals can develop kinesiophobia and experience a vicious circle of worsening health. This study aimed to investigate the association between pain and physical functional performance/physical activity and determine whether kinesiophobia mediates this association. This was a cross-sectional study with individuals diagnosed with inflammatory arthritis (rheumatoid arthritis or spondyloarthritis) treated at a Rheumatology Outpatient Clinic. We assessed pain (Visual Analogue Scale), physical activity (International Physical Activity Questionnaire - long form), kinesiophobia (Tampa Scale for Kinesiophobia), and physical functional performance (Handgrip Strength Dynamometry, 30-second Sit-to-Stand test, Static Muscular Endurance test, and Timed Up and Go test). The mediating effect of kinesiophobia on the relationship between pain intensity and physical functional performance/physical activity was analyzed, and the significance of the mediating effect (kinesiophobia) was tested through a bootstrap approach. Thirty-three individuals with inflammatory arthritis (mean age: 48 ± 12 years) participated in the study. Kinesiophobia mediates the relationship between pain intensity and physical functional performance analyzed by the 30-second Sit-to-Stand test [indirect effect (IE)overall = -0.343, bootstrap 95% confidence interval (CI): -0.698 to -0.002] and by knee flexion at 90º of the dominant limb (IEoverall = -1.55, bootstrap 95% CI: -3.43 to -0.237). In conclusion, pain intensity can affect physical functional performance through kinesiophobia in individuals with inflammatory arthritis.