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Xiong T, Krusche M. [Wearables in rheumatology]. Z Rheumatol 2024; 83:234-241. [PMID: 37289217 PMCID: PMC10973074 DOI: 10.1007/s00393-023-01377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
As a result of digitalization in medicine wearable computing devices (wearables) are becoming increasingly more important. Wearables are small portable electronic devices with which the user can record data relevant to health, such as number of steps, activity profile, electrocardiogram (ECG), heart and breathing frequency or oxygen saturation. Initial studies on the use of wearables in patients with rheumatological diseases show the opening up of new possibilities for prevention, disease monitoring and treatment. This study provides the current data situation and the implementation of wearables in the discipline of rheumatology. Additionally, future potential fields of application as well as challenges and limits of the implementation of wearables are illustrated.
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Affiliation(s)
- Tingting Xiong
- Sektion für Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- Sektion für Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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2
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Peng Y, Wu Y, Chen S, Liu Y, Qian H, He Y, Huang H, Cai M, Liu W, Shi G. Circulating cell-free DNA correlate to disease activity and treatment response of patients with radiographic axial spondyloarthritis. Sci Rep 2024; 14:178. [PMID: 38168507 PMCID: PMC10762258 DOI: 10.1038/s41598-023-50543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
Microdamage and its related inflammation contribute to the development of radiographic axial spondyloarthritis (r-axSpA). Inflammation and cell death in damaged tissues are associated with cell-free DNA (cfDNA) release. Here we investigated whether circulating cfDNA could be a potential biomarker for evaluating disease activity and treatment response in r-axSpA. Circulating cfDNA was detected in the discovery and validation cohort with 79 and 60 newly diagnosed r-axSpA patients respectively and 42 healthy controls using the Quant-iT PicoGreen dsDNA reagent and kit. As a result, cfDNA levels were significantly higher in r-axSpA patients compared with healthy controls in the discovery and validation cohort. Moreover, cfDNA levels were positively correlated with CRP, ASDAS-CRP and neutrophil counts. Additionally, non-steroid anti-inflammatory drugs (NSAIDs) combined with disease-modifying anti-rheumatic drugs or tumor necrosis factor inhibitors but not NSAIDs alone could reduce cfDNA levels. Moreover, a decrease of cfDNA levels after treatment was associated with an effective therapeutic response. Intriguingly, patients with higher levels of cfDNA at diagnosis responded better to combination therapy rather than NSAIDs. However, patients with lower levels of cfDNA displayed similar responses to combination or mono-NSAID treatment. In conclusion, circulating cfDNA levels showed a significant correlation with disease activity as well as treatment efficacy in patients with r-axSpA. Moreover, cfDNA at diagnosis might predict the response to different therapy. Consequently, cfDNA may serve as a useful biomarker of inflammation in r-axSpA.
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Affiliation(s)
- Yun Peng
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yuanhui Wu
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital Affiliated of Nanchang University, Nanchang, Jiangxi, China
| | - Shiju Chen
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yan He
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Heqing Huang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Meimei Cai
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Wen Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China.
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China.
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3
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Iyer P, Hwang M, Ridley L, Weisman MM. Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with. RMD Open 2023; 9:e003372. [PMID: 37949613 PMCID: PMC10649803 DOI: 10.1136/rmdopen-2023-003372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
Increasing evidence suggests that there is a pivotal role for physical force (mechanotransduction) in the initiation and/or the perpetuation of spondyloarthritis; the review contained herein examines that evidence. Furthermore, we know that damage and inflammation can limit spinal mobility, but is there a cycle created by altered spinal mobility leading to additional damage and inflammation?Over the past several years, mechanotransduction, the mechanism by which mechanical perturbation influences gene expression and cellular behaviour, has recently gained popularity because of emerging data from both animal models and human studies of the pathogenesis of ankylosing spondylitis (AS). In this review, we provide evidence towards an appreciation of the unsolved paradigm of how biomechanical forces may play a role in the initiation and propagation of AS.
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Affiliation(s)
- Priyanka Iyer
- Division of Rheumatology, Department of Medicine, UC Irvine Healthcare, Orange, California, USA
| | - Mark Hwang
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Lauren Ridley
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Mauro D, Gandolfo S, Tirri E, Schett G, Maksymowych WP, Ciccia F. The bone marrow side of axial spondyloarthritis. Nat Rev Rheumatol 2023:10.1038/s41584-023-00986-6. [PMID: 37407716 DOI: 10.1038/s41584-023-00986-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Enrico Tirri
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Lefferts AR, Norman E, Claypool DJ, Kantheti U, Kuhn KA. Cytokine competent gut-joint migratory T Cells contribute to inflammation in the joint. Front Immunol 2022; 13:932393. [PMID: 36159826 PMCID: PMC9489919 DOI: 10.3389/fimmu.2022.932393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023] Open
Abstract
Although studies have identified the presence of gut-associated cells in the enthesis of joints affected by spondylarthritis (SpA), a direct link through cellular transit between the gut and joint has yet to be formally demonstrated. Using KikGR transgenic mice to label in situ and track cellular trafficking from the distal colon to the joint under inflammatory conditions of both the gut and joint, we demonstrate bona-fide gut-joint trafficking of T cells from the colon epithelium, also called intraepithelial lymphocytes (IELs), to distal sites including joint enthesis, the pathogenic site of SpA. Similar to patients with SpA, colon IELs from the TNFΔARE/+ mouse model of inflammatory bowel disease and SpA display heightened TNF production upon stimulation. Using ex vivo stimulation of photo-labeled gut-joint trafficked T cells from the popliteal lymph nodes of KikGR and KikGR TNFΔARE/+ we saw that the CD4+ photo-labeled population was highly enriched for IL-17 competence in healthy as well as arthritic mice, however in the TNFΔARE/+ mice these cells were additionally enriched for TNF. Using transfer of magnetically isolated IELs from TNF+/+ and TNFΔARE/+ donors into Rag1 -/- hosts, we confirmed that IELs can exacerbate inflammatory processes in the joint. Finally, we blocked IEL recruitment to the colon epithelium using broad spectrum antibiotics in TNFΔARE/+ mice. Antibiotic-treated mice had reduced gut-joint IEL migration, contained fewer Il-17A and TNF competent CD4+ T cells, and lessened joint pathology compared to untreated littermate controls. Together these results demonstrate that pro-inflammatory colon-derived IELs can exacerbate inflammatory responses in the joint through systemic trafficking, and that interference with this process through gut-targeted approaches has therapeutic potential in SpA.
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Evaluating the Impact of High Intensity Interval Training on Axial Psoriatic Arthritis Based on MR Images. Diagnostics (Basel) 2022; 12:diagnostics12061420. [PMID: 35741229 PMCID: PMC9222014 DOI: 10.3390/diagnostics12061420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
High intensity interval training (HIIT) has been shown to benefit patients with psoriatic arthritis (PsA). However, magnetic resonance (MR) imaging has uncovered bone marrow edema (BME) in healthy volunteers after vigorous exercise. The purpose of this study was to investigate MR images of the spine of PsA patients for changes in BME after HIIT. PsA patients went through 11 weeks of HIIT (N = 19, 4 men, median age 52 years) or no change in physical exercise habits (N = 20, 8 men, median age 45 years). We acquired scores for joint affection and pain and short tau inversion recovery (STIR) and T1-weighted MR images of the spine at baseline and after 11 weeks. MR images were evaluated for BME by a trained radiologist, by SpondyloArthritis Research Consortium of Canada (SPARCC) scoring, and by extraction of textural features. No significant changes of BME were detected in MR images of the spine after HIIT. This was consistent for MR image evaluation by a radiologist, by SPARCC, and by texture analysis. Values of textural features were significantly different in BME compared to healthy bone marrow. In conclusion, BME in spine was not changed after HIIT, supporting that HIIT is safe for PsA patients.
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7
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Wang Y, Liu X, Wang W, Shi Y, Ji X, Hu L, Wang L, Yin Y, Xie S, Zhu J, Zhang J, Jiao W, Huang F. Adherence, Efficacy, and Safety of Wearable Technology-Assisted Combined Home-Based Exercise in Chinese Patients With Ankylosing Spondylitis: Randomized Pilot Controlled Clinical Trial. J Med Internet Res 2022; 24:e29703. [PMID: 35040798 PMCID: PMC8808346 DOI: 10.2196/29703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 10/23/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022] Open
Abstract
Background Clinical practice guidelines recommend that exercise is essential in the self-management of ankylosing spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be difficult and patients may decline participation, whereas effective home-based exercise interventions that do not require regular medical center visits are likely to be more accessible for AS patients. Objective The goal of the research was to investigate the adherence, efficacy, and safety of a wearable technology–assisted combined home-based exercise program in AS. Methods This was a 16-week investigator-initiated, assessor-blinded, randomized, pilot controlled trial conducted at Chinese People’s Liberation Army General Hospital. We enrolled patients with AS who had no regular exercise habits and had been stable in drug treatment for the preceding month. Patients were randomly assigned (1:1) using a computer algorithm. An exercise program consisting of moderate-intensity aerobic exercise and functional exercise was given to the patients in the intervention group. The exercise intensity was controlled by a Mio FUSE Heart Rate Monitor wristband, which uses photoplethysmography to measure heart rate. Patients in the control group received usual care. The primary outcome was the difference in the Ankylosing Spondylitis Disease Activity Score (ASDAS). The secondary outcomes were patient global assessment (PGA), physician global assessment (PhGA), total pain, nocturnal pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BAS Functional Index (BASFI), BAS Metrology Index (BASMI), Spondyloarthritis International Society Health Index (ASAS HI), 36-item Short Form Survey (SF-36), maximal oxygen uptake (VO2) max, body composition, range of motion of joints, and muscle endurance tests. Retention rate, adherence rate, barriers to being active, and adverse events were also assessed. Results A total of 77 patients were screened, of whom 55 (71%) patients were enrolled; 2% (1/55) withdrew without treatment after randomization. Patients were assigned to the intervention (n=26) or control group (n=28). The median adherence rate of the prescribed exercise protocol was 84.2% (IQR 48.7%-97.9%). For the primary outcome, between-group difference of ASDAS was significant, favoring the intervention (–0.2, 95% CI –0.4 to 0.02, P=.03). For the secondary outcomes, significant between-group differences at 16 weeks were detected in PGA, PhGA, total pain, BASDAI, BASDAI-fatigue, BASDAI–spinal pain, BASDAI–morning stiffness intensity, BASFI, and BASMI. Moreover, the frequency of difficulty in ASAS HI-motivation at 16 weeks was less in the intervention group (P=.03). Between-group difference for change from baseline were also detected in VO2 max, SF-36, back extensor endurance test, and the range of motion of cervical lateral flexion at 16 weeks. Lack of time, energy, and willpower were the most distinct barriers to being active. Incidences of adverse events were similar between groups (P=.11). Conclusions Our pilot study suggests that this technology-assisted combined home-based exercise program can improve the clinical outcomes of patients with AS who have no exercise habit, with good adherence and safety profile. Trial Registration Chinese Clinical Trial Registry ChiCTR1900024244; http://www.chictr.org.cn/showproj.aspx?proj=40176
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Affiliation(s)
- Yiwen Wang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xingkang Liu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Weimin Wang
- Health Management Institute, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanyun Shi
- Health Management Institute, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaojian Ji
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lidong Hu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lei Wang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yiquan Yin
- Advanced Research Institute of Olympic, Beijing Sport University, Beijing, China
| | - Siyuan Xie
- College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianglin Zhang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wei Jiao
- College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Feng Huang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese People's Liberation Army General Hospital, Beijing, China
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B Cell Involvement in the Pathogenesis of Ankylosing Spondylitis. Int J Mol Sci 2021; 22:ijms222413325. [PMID: 34948121 PMCID: PMC8703482 DOI: 10.3390/ijms222413325] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Abstract
Extensive research into ankylosing spondylitis (AS) has suggested the major role of genetics, immune reactions, and the joint-gut axis in its etiology, although an ultimate consensus does not yet exist. The available evidence indicates that both autoinflammation and T-cell-mediated autoimmune processes are actively involved in the disease process of AS. So far, B cells have received relatively little attention in AS pathogenesis; this is largely due to a lack of conventional disease-defining autoantibodies. However, against prevailing dogma, there is a growing body of evidence suggestive of B cell involvement. This is illustrated by disturbances in circulating B cell populations and the formation of auto-reactive and non-autoreactive antibodies, along with B cell infiltrates within the axial skeleton of AS patients. Furthermore, the depletion of B cells, using rituximab, displayed beneficial results in a subgroup of patients with AS. This review provides an overview of our current knowledge of B cells in AS, and discusses their potential role in its pathogenesis. An overarching picture portrays increased B cell activation in AS, although it is unclear whether B cells directly affect pathogenesis, or are merely bystanders in the disease process.
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Romero-López JP, Elewaut D, Pacheco-Tena C, Burgos-Vargas R. Inflammatory Foot Involvement in Spondyloarthritis: From Tarsitis to Ankylosing Tarsitis. Front Med (Lausanne) 2021; 8:730273. [PMID: 34692724 PMCID: PMC8531414 DOI: 10.3389/fmed.2021.730273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Spondyloarthritis (SpA) is a group that includes a wide spectrum of clinically similar diseases manifested by oligoarticular arthritis and axial or peripheral ankylosis. Although axial SpA is predominant in Caucasians and adult-onset patients, juvenile-onset and Latin American patients are characterized by severe peripheral arthritis and particularly foot involvement. The peripheral involvement of SpA can vary from tarsal arthritis to the most severe form named ankylosing tarsitis (AT). Although the cause and etiopathogenesis of axSpA are often studied, the specific characteristics of pSpA are unknown. Several animal models of SpA develop initial tarsitis and foot ankylosis as the main signs, emphasizing the role of foot inflammation in the overall SpA spectrum. In this review, we attempt to highlight the clinical characteristics of foot involvement in SpA and update the knowledge regarding its pathogenesis, focusing on animal models and the role of mechanical forces in inflammation.
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Affiliation(s)
- José Pablo Romero-López
- Laboratorio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla de Baz, Mexico
- Laboratorio de Inmunología Clínica 1, Posgrado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional de México, Ciudad de México, Mexico
| | - Dirk Elewaut
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - César Pacheco-Tena
- Facultad de Medicina, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Rubén Burgos-Vargas
- Department of Rheumatology, Hospital General de México, “Dr. Eduardo Liceaga”, Ciudad de México, Mexico
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Perrotta FM, Lories R, Lubrano E. To move or not to move: the paradoxical effect of physical exercise in axial spondyloarthritis. RMD Open 2021; 7:rmdopen-2020-001480. [PMID: 33547227 PMCID: PMC7871344 DOI: 10.1136/rmdopen-2020-001480] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 01/05/2023] Open
Abstract
In the last years, new researches focused on the role of biomechanical stress and microdamage in the pathogenesis of inflammatory arthritis and, in particular, in axial spondyloarthritis (axSpA). Animal models showed how entheseal stress and physical exercise could contribute to the development of inflammation and new bone formation at entheseal and articular sites, by activating innate immune system and the release of cytokines. Furthermore, clues of the involvement of biomechanical stress in the development of axSpA are present in clinical experiences. However, rehabilitation and exercise programmes are the cornerstone of treatment for axSpA, reducing disease activity and improving spinal function and quality of life. The concept of mechanical stress as a contributor to disease development and progression represents, potentially, a conceptual challenge for this approach. The aim of this review is to discuss the current evidence on the intriguing contribution of the biomechanical stress to the pathogenesis of inflammation and new bone formation and to evaluate and reflect on the role of exercise in the treatment and in the management of the disease, considering both the beneficial effects and its possible paradoxical action.
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Affiliation(s)
- Fabio Massimo Perrotta
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
| | - Rik Lories
- Skeletal Biology and Engineering Research Centre, Catholic University College Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
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Kaeley GS, Kaler JK. Peripheral Enthesitis in Spondyloarthritis: Lessons from Targeted Treatments. Drugs 2021; 80:1419-1441. [PMID: 32720292 DOI: 10.1007/s40265-020-01352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A significant proportion of patients with spondyloarthritis (SpA) have peripheral enthesitis. Data suggest that psoriatic arthritis (PsA) patients with enthesitis have a higher disease burden than those without enthesitis. Over the past decade, there has been a proliferation of treatment options for spondyloarthropathy. These medications target multiple signaling pathways, including tumor necrosis factor (TNF), interleukin (IL)-17A, IL-12/23, IL-23, thymus (T)-cell co-stimulation, intracellular Janus kinases, and phosphodiesterase enzymes. As a key domain in SpA, enthesitis outcomes are included in pivotal trials of these agents and are reported as secondary outcome measures. One significant limitation is that the clinical evaluation of enthesitis relies on eliciting tenderness on palpation and is insensitive when compared with imaging. Furthermore, direct comparisons between studies are not available due to the use of different outcome measures, lack of consistent and comprehensive reporting outcomes, and subgroup analyses with a lower number of patients with enthesitis. This systematic review describes the epidemiology, pathophysiology, and available targeted therapies against enthesitis, as well as a detailed report of their efficacy. One major trend identified during this review is incomplete reporting of outcome measures, as many studies reported proportions of enthesitis prevalence. Factors that affected responsiveness in clinical trials included the entheseal instrument used, the number of subjects available for comparison, as well as the therapeutic agent. In general, anti-TNF and anti-IL-17 agents, as well as Janus kinase inhibitors, show moderate responsiveness for enthesitis. The data for IL-23 targeting is contradictory.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA.
| | - Jaspreet K Kaler
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA
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12
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Van Mechelen M, Martens T, Vanden Berghe P, Lories R, Gulino GR. Impact of barrier tissue inflammation and physical activity on joint homeostasis in mice. Rheumatology (Oxford) 2021; 61:1690-1698. [PMID: 34175921 DOI: 10.1093/rheumatology/keab517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate whether physical activity interferes with joint homeostasis in the presence of distant inflammation originating at barrier tissues such as skin or gut. METHODS Eight-week-old male C57/Bl6 mice were treated with imiquimod cream on a shaved area of the back skin or with dextran sodium sulphate dissolved in the drinking water to induce psoriasis-like skin or inflammatory bowel disease-like gut inflammation. Afterwards, part of the mice was subjected to a 4-week forced running routine (n = 10 per group). Severity of cutaneous or intestinal inflammation was assessed clinically, by histology and by quantitative PCR. Knees and paws were analyzed by micro-computed tomography, histology, immunohistochemistry, second-harmonic generation microscopy and quantitative PCR. RESULTS Local induction of inflammation triggered a systemic response with splenomegaly, loss of bone mass and bone marrow changes. Psoriasis- but not inflammatory bowel disease-like inflammation led to synovial lining layer hyperplasia, an increase in infiltrating CD45+ synovial cells, and suppressed entheseal extracellular matrix gene expression levels. Mechanical loading decreased the amount of F4/80+ synovial macrophages in untreated mice only and led to morphological alterations in the collagen fibers of the enthesis. CONCLUSION Systemic inflammation and mechanical loading act independently of each other. The former, originating from distant sites, can trigger mild synovial inflammation in mice, a propensity that may also impact the development of arthritis in patients; the latter has no impact on the severity of systemic inflammation, but independently affects joint homeostasis.
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Affiliation(s)
- Margot Van Mechelen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Tobie Martens
- Department of Chronic Diseases Metabolism and Ageing, TARGID, Laboratory for Enteric NeuroScience (LENS) and Cell & tissue Imaging Cluster (CIC), KU Leuven, Leuven, Belgium
| | - Pieter Vanden Berghe
- Department of Chronic Diseases Metabolism and Ageing, TARGID, Laboratory for Enteric NeuroScience (LENS) and Cell & tissue Imaging Cluster (CIC), KU Leuven, Leuven, Belgium
| | - Rik Lories
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Giulia R Gulino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium
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Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol 2021; 17:387-404. [PMID: 34113018 DOI: 10.1038/s41584-021-00625-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 12/20/2022]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disorder of unknown aetiology. Unlike other systemic autoimmune diseases, in AS, the innate immune system has a dominant role characterized by aberrant activity of innate and innate-like immune cells, including γδ T cells, group 3 innate lymphoid cells, neutrophils, mucosal-associated invariant T cells and mast cells, at sites predisposed to the disease. The intestine is involved in disease manifestations, as it is at the forefront of the interaction between the mucosal-associated immune cells and the intestinal microbiota. Similarly, biomechanical factors, such as entheseal micro-trauma, might also be involved in the pathogenesis of the articular manifestation of AS, and sentinel immune cells located in the entheses could provide links between local damage, genetic predisposition and the development of chronic inflammation. Although these elements might support the autoinflammatory nature of AS, studies demonstrating the presence of autoantibodies (such as anti-CD74, anti-sclerostin and anti-noggin antibodies) and evidence of activation and clonal expansion of T cell populations support an autoimmune component to the disease. This Review presents the evidence for autoinflammation and the evidence for autoimmunity in AS and, by discussing the pathophysiological factors associated with each, aims to reconcile the two hypotheses.
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Mease PJ, Liu M, Rebello S, Hua W, McLean RR, Hur P, Ogdie A. Disease Characteristics, Quality of Life, and Work Productivity by Enthesitis Site: Real-world Data From the US Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2020; 48:367-375. [PMID: 32482647 DOI: 10.3899/jrheum.191117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of clinical enthesitis by body site in patients with psoriatic arthritis (PsA). METHODS Adults with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013-March 2018) were included. Enthesitis at enrollment was assessed by the Spondyloarthritis Research Consortium of Canada Enthesitis Index and classified by affected sites (upper, lower, or both). Disease activity (e.g., Clinical Disease Activity Index, Clinical Disease Activity Index for PsA), patient-reported outcomes (PRO; e.g., patient-reported pain and fatigue), and work productivity were compared between those with and without enthesitis using t- or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. The association of enthesitis with disease activity and PRO measures versus no enthesitis was modeled using multivariable-adjusted linear or logistic regression. RESULTS Of 2003 patients with PsA, 391 (19.5%) had enthesitis: 80 (20.5%) in upper sites only; 137 (35.0%) in lower sites only; and 174 (44.5%) in both. Regardless of location, disease activity and PRO were worse in patients with versus without enthesitis. In adjusted models, the presence of enthesitis at any site was significantly associated with worse disease activity versus no enthesitis. Enthesitis in lower or both upper and lower sites was associated with higher pain and fatigue scores and greater work impairment versus no enthesitis. CONCLUSION Patients with clinical enthesitis had worse disease activity regardless of enthesitis location versus those without enthesitis, and patients with enthesitis in lower or both upper and lower sites had worse pain, fatigue, and work impairment.
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Affiliation(s)
- Philip J Mease
- P.J. Mease, MD, MACR, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington;
| | - Mei Liu
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Sabrina Rebello
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Winnie Hua
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Robert R McLean
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Peter Hur
- P. Hur, PharmD, MBA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Alexis Ogdie
- A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cambré I, Gaublomme D, Schryvers N, Lambrecht S, Lories R, Venken K, Elewaut D. Running promotes chronicity of arthritis by local modulation of complement activators and impairing T regulatory feedback loops. Ann Rheum Dis 2019; 78:787-795. [PMID: 30928902 DOI: 10.1136/annrheumdis-2018-214627] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The mechanisms driving onset of joint inflammation in arthritides such as rheumatoid arthritis and spondyloarthritis and the conversion to disease chronicity are poorly understood. We hypothesised mechanostrain could play an instrumental role herein by engaging local and/or systemic pathways, thereby attenuating disease course and outcome. METHODS The development of collagen antibody-induced arthritis (CAIA) in C57BL/6 mice was evaluated both clinically and histologically under different loading regimens: control, voluntary running or hindpaw unloading. Bone surface porosity was quantified by high-resolution µ-CT. Gene expression analyses were conducted by microarrays and qPCR on microdissected entheses, murine and human synovial tissues (both normal and inflamed). Serum cytokines and chemokines were measured by ELISA. The influence of complement activation and T regulatory (Treg) cell function on the induction and resolution phase of disease was studied by respectively pharmacological modulation and conditional Treg depletion. RESULTS Voluntary running strongly impacts the course of arthritis by impairing the resolution phase of CAIA, leading to more persistent inflammation and bone surface porosity. Mechanical strain induced local complement activation, increased danger-associated molecular pattern expression, activating Fcγ receptors as well as changes in fibroblast phenotype. Interestingly, complement C5a receptor blockade inhibited the enhanced joint pathology caused by voluntary running. Moreover, Treg depletion led to a loss of disease resolution in CAIA mice, which was not observed under voluntary running conditions. CONCLUSIONS Running promotes onset and chronicity of arthritis by local upregulation of complement activators and hampering regulatory T cell feedback loops.
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Affiliation(s)
- Isabelle Cambré
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Ghent, Belgium.,Molecular Immunology and Inflammation Unit, VIB Center of Inflammatory Research, Ghent, Belgium
| | - Djoere Gaublomme
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Ghent, Belgium.,Molecular Immunology and Inflammation Unit, VIB Center of Inflammatory Research, Ghent, Belgium
| | - Nadia Schryvers
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Ghent, Belgium.,Molecular Immunology and Inflammation Unit, VIB Center of Inflammatory Research, Ghent, Belgium
| | - Stijn Lambrecht
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Ghent, Belgium
| | - Rik Lories
- Division of Rheumatology, Katholieke Universiteit Leuven Hospital, Leuven, Belgium.,Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Koen Venken
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Ghent, Belgium.,Molecular Immunology and Inflammation Unit, VIB Center of Inflammatory Research, Ghent, Belgium
| | - Dirk Elewaut
- Molecular Immunology and Inflammation Unit, VIB Center of Inflammatory Research, Ghent, Belgium
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